Acute-on-chronic Liver Failure: MELD Score 30-day Mortality Predictability and Etiology in a Pakistani Population

Background: Cirrhosis is a pathological condition that ultimately leads to liver failure. Acute on chronic liver failure (ACLF) has a high short term mortality rate. Viral hepatitis is the most common cause of liver failure in our local population. We carried out this study to identity the 30-day mortality and etiology of patients presenting with ACLF using Model for End-Stage Liver Disease (MELD) score predictability. Methodology: This was a descriptive case series, conducted at Sheikh Zayed Hospital, Lahore, Pakistan from January 31, 2018 to July 30, 2018. One hundred and eighty five patients who met the inclusion criteria were enrolled using 95% confidence level and 4% margin of error. Data was entered and analyzed with SPSS version 23.0. Numerical variables including age was presented by Mean ± S.D. Categorical variables i.e. gender, etiology of acute-on-chronic liver failure and 30-day mortality were presented by frequency and percentage. Data was stratified for age, gender, duration of chronic liver disease and MELD grade to address the effect modifiers. Post-stratification chi-square test was calculated using 95% significance (p≤0.05). Results: Majority of the enrolled patients were male (74.6%) while only 25.4% of the patients were female. One hundred and thirty patients (70.3%) had underlying viral hepatitis while twelve patients (6.5%) and forty three patients (23.2%) presented with alcoholic liver disease and drug-induced ACLF, respectively. Eighty patients (43.2%) died within 30 days of admission.The 30-day mortality with respect to MELD grade was statistically significant (p<0.001) with the highest mortality noted in grade-IV and thirty five patients (43.8%) dying within 30 days of admission (p<0.001). Grade-II and III MELD scores also contributed to the 30-day mortality with twenty three patients (28.8%) and nineteen patients (23.8%) dying within 30 days of admission (p<0.001). Conclusion: MELD scores are able to accurately predict the short-term mortality in patients with ACLF and viral hepatitis was the most common etiology in our population. Early detection and use of appropriate prognostic models may alleviate mortality and morbidity in paitents with ACLF

OPERATIONAL COSTS OF CANAL COMPANIES AND IRRIGATION DISTRICTS IN THE INTERMOUNTAIN REGION

This study reports on the trends of operational costs of farmer owned and operated irrigation enterprises (irrigation districts and canal companies) in five intermountain states. Administrative costs have risen faster then operation and maintenance costs. While salaries of employees have not risen significantly over time, legal costs have greatly escalated.Agribusiness,

Investigation of electric discharge machining parameters to minimize surface roughness

: Surface roughness during electrical discharge machining (EDM) was determined, in which material is removed by thermo-electric process due to the occurrence of successive discharge between workpiece and electrode. Box-Behnken design (BBD) involving four parameters discharge current (I), Pulse ON time (PON), Pulse OFF time (POFF) and Gap voltage, with three levels was employed to minimize the surface roughness. Other parameters such as Servo speed, Polarity and Die-electric pressure were kept constant throughout the machining. A copper electrode tool was used to machine the holes in AISI 1045 steel work piece. Mathematical models were developed using Response Surface Methodology (RSM), while Analysis of variance (ANOVA) was used to observe individual effect, interaction between parameters, and to check validity of models. Results revealed that pulse on time and discharge current were two main significant parameters that statistically affected surface roughness

Multi-objective optimisation for minimum quantity lubrication assisted milling process based on hybrid response surface methodology and multi-objective genetic algorithm

© 2019 by SAGE Publications Ltd.Parametric modelling and optimisation play an important role in choosing the best or optimal cutting conditions and parameters during machining to achieve the desirable results. However, analysis of optimisation of minimum quantity lubrication–assisted milling process has not been addressed in detail. Minimum quantity lubrication method is very effective for cost reduction and promotes green machining. Hence, this article focuses on minimum quantity lubrication–assisted milling machining parameters on AISI 1045 material surface roughness and power consumption. A novel low-cost power measurement system is developed to measure the power consumption. A predictive mathematical model is developed for surface roughness and power consumption. The effects of minimum quantity lubrication and machining parameters are examined to determine the optimum conditions with minimum surface roughness and minimum power consumption. Empirical models are developed to predict surface roughness and power of machine tool effectively and accurately using response surface methodology and multi-objective optimisation genetic algorithm. Comparison of results obtained from response surface methodology and multi-objective optimisation genetic algorithm depict that both measured and predicted values have a close agreement. This model could be helpful to select the best combination of end-milling machining parameters to save power consumption and time, consequently, increasing both productivity and profitability.Peer reviewedFinal Published versio

Extremely Preterm (23 Weeks) Vaginal Cephalic Delivery En Caul and Subsequent Postpartum Intraventricular Hemorrhage and Respiratory Distress: A Teaching Case.

En caul deliveries are defined as a fetus that is delivered completely contained within an amniotic sac and are considered to be less common than 1 in 80,000 live births. Vaginal en caul births compared to abdominal or cesarean are the rarest subtype. Most en caul births are associated with prematurity and low gravida. The combination of prematurity, high gravida, vaginal en caul birth, and severe postpartum complications has not previously been described. We report a woman with gravida of 12 delivering vaginally a neonate female en caul at the extremely preterm gestational age of 23 weeks. The neonate subsequently decompensated, underwent respiratory distress, and was diagnosed with a bilateral intraventricular hemorrhage. Owing to deteriorating status, supportive care was removed and the infant was pronounced dead 5 days after delivery

Mutational analysis of fructose-1,6-bisphosphate aldolase of Neisseria meningitidis serogroup B

Fructose-1,6-bisphosphate aldolase (FBA) is a classical cytoplasmic glycolytic enzyme which, despite lacking a predicted signal peptide, has been demonstrated to be expressed and transported to the surface of numerous Gram-positive bacteria and shown to interact with host molecules and perform non-glycolytic biological functions. Genome-based studies have also demonstrated that the glycolytic pathway appears to be non-functional in the meningococcus due to absence of phosphofructokinase, one of the important enzymes in this pathway. This study aimed to investigate whether the FBA, a so-called housekeeping enzyme, is required for maximal in vitro growth of N. meningitidis. An FBA knock-out mutant was created in N. meningitidis using an inverse polymerase chain reaction (PCR) and allelic exchange methodology. Phenotypic analysis of FBA-deficient mutant strains such as growth profiling experiments showed that the FBA-deficient mutant grew at the same rate (in broth culture and on solid media) as the wild-type strain, suggesting that FBA is not required for optimal growth of N. meningitidis under the in vitro conditions tested. No differences in either colony or bacterial cell morphology (using light microscopy) were observed. In summary, despite being a central enzyme in the glycolytic cycle, FBA is not required for in vitro growth of N. meningitidis.Key words: Neisseria meningitidis, aldolase, mutagenesis, growth kinetics, glycolytic cycle

Multiobjective Local Search Techniques for Evolutionary Polygonal Approximation

Proceedings of: 10th International Symposium on Distributed Computing and Artificial Intelligence . University of Salamanca (DCAI 2013). Salamanca, Spain, Spain, May 22-24, 2013.Polygonal approximation is based on the division of a closed curve into a set of segments. This problem has been traditionally approached as a single-objective optimization issue where the representation error was minimized according to a set of restrictions and parameters. When these approaches try to be subsumed into more recent multi-objective ones, a number of issues arise. Current work successfully adapts two of these traditional approaches and introduces them as initialization procedures for a MOEA approach to polygonal approximation, being the results, both for initial and final fronts, analyzed according to their statistical significance over a set of traditional curves from the domain.This work was supported in part by Projects MEyC TEC2012-37832-C02-01, MEyC TEC2011-28626-C02-02 and CAM CONTEXTS (S2009/TIC-1485).Publicad

The role of glyceraldehyde 3-phosphate dehydrogenase (GapA-1) in Neisseria meningitidis adherence to human cells

BackgroundGlyceraldehyde 3-phosphate dehydrogenases (GAPDHs) are cytoplasmic glycolytic enzymes, which although lacking identifiable secretion signals, have also been found localized to the surface of several bacteria (and some eukaryotic organisms); where in some cases they have been shown to contribute to the colonization and invasion of host tissues. Neisseria meningitidis is an obligate human nasopharyngeal commensal which can cause life-threatening infections including septicaemia and meningitis. N. meningitidis has two genes, gapA-1 and gapA-2, encoding GAPDH enzymes. GapA-1 has previously been shown to be up-regulated on bacterial contact with host epithelial cells and is accessible to antibodies on the surface of capsule-permeabilized meningococcal cells. The aims of this study were: 1) to determine whether GapA-1 was expressed across different strains of N. meningitidis; 2) to determine whether GapA-1 surface accessibility to antibodies was dependant on the presence of capsule; 3) to determine whether GapA-1 can influence the interaction of meningococci and host cells, particularly in the key stages of adhesion and invasion.ResultsIn this study, expression of GapA-1 was shown to be well conserved across diverse isolates of Neisseria species. Flow cytometry confirmed that GapA-1 could be detected on the cell surface, but only in a siaD-knockout (capsule-deficient) background, suggesting that GapA-1 is inaccessible to antibody in in vitro-grown encapsulated meningococci. The role of GapA-1 in meningococcal pathogenesis was addressed by mutational analysis and functional complementation. Loss of GapA-1 did not affect the growth of the bacterium in vitro. However, a GapA-1 deficient mutant showed a significant reduction in adhesion to human epithelial and endothelial cells compared to the wild-type and complemented mutant. A similar reduction in adhesion levels was also apparent between a siaD-deficient meningococcal strain and an isogenic siaD gapA-1 double mutant.ConclusionsOur data demonstrates that meningococcal GapA-1 is a constitutively-expressed, highly-conserved surface-exposed protein which is antibody-accessible only in the absence of capsule. Mutation of GapA-1 does not affect the in vitro growth rate of N. meningitidis, but significantly affects the ability of the organism to adhere to human epithelial and endothelial cells in a capsule-independent process suggesting a role in the pathogenesis of meningococcal infection

Fructose-1,6-bisphosphate aldolase of Neisseria meningitidis binds human plasminogen via its C-terminal lysine residue

Neisseria meningitidis is a leading cause of fatal sepsis and meningitis worldwide. As for commensal species of human neisseriae, N. meningitidis inhabits the human nasopharynx and asymptomatic colonization is ubiquitous. Only rarely does the organism invade and survive in the bloodstream leading to disease. Moonlighting proteins perform two or more autonomous, often dissimilar, functions using a single polypeptide chain. They have been increasingly reported on the surface of both prokaryotic and eukaryotic organisms and shown to interact with a variety of host ligands. In some organisms moonlighting proteins perform virulence-related functions, and they may play a role in the pathogenesis of N. meningitidis. Fructose-1,6- bisphosphate aldolase (FBA) was previously shown to be surface-exposed in meningococci and involved in adhesion to host cells. In this study, FBA was shown to be present on the surface of both pathogenic and commensal neisseriae, and surface localization and anchoring was demonstrated to be independent of aldolase activity. Importantly, meningococcal FBA was found to bind to human glu- plasminogen in a dose-dependent manner. Site-directed mutagenesis demonstrated that the C-terminal lysine residue of FBA was required for this interaction, whereas # subterminal lysine residues were not involved