Frequency and characteristic features of portal hypertensive gastropathy in patients with viral cirrhosis.

To determine the frequency and specific characteristic features of portal hypertensive gastropathy (PHG) in cirrhosis due to viral etiology. Cross-sectional descriptive study. The Aga Khan University Hospital, Karachi, from June 2006 till June 2008. Patients with hepatitis B and C cirrhosis were included who underwent screening esophago-gastroduodenoscopy (EGD) for varices. Baveno III consensus statement was used for diagnosing PHG on endoscopy and divided them into two subgroups i.e. mild and severe. Data related to platelet/spleen ratio, MELD score and Child Turcotte Pugh (CTP) score indicating severity of cirrhosis were recorded in all patients. Findings were compared by using independent sample t-test. Out of 360 patients who underwent screening EGD, 226 (62.8%) were males. Two hundred and eighty one (78%) had hepatitis C while 79 (22%) suffered from hepatitis B related cirrhosis. Three hundred patients (83.3%) had PHG while 71 (24%) had severe PHG. Higher proportion of esophageal varices (89.7%) was present among those who had PHG (p \u3c 0.001). On univariate analysis lower platelet counts (11755 vs. 16790; p \u3c 0.001), increased spleen size (14.12.9 cm vs. 122.4cm; p \u3c 0.001) were found in PHG patients as compared to those without it. Similarly, lower platelet/spleen ratio was noted in patients with severe PHG (916400 vs. 1477899; p \u3c 0.001). Furthermore, on multivariate analysis CTP score \u3e 8 MELD score \u3e 12 and platelets/spleen ratio \u3c 900 were significantly associated factors with severe PHG. Frequency of PHG was 83% while severe PHG was seen in 24% cases of viral hepatic cirrhosis. MELD score \u3e 12, CTP score 8 and platelets/spleen ratio \u3c 900 were significant factors of severe PHG

Precipitating Factors and The Outcome of Hepatic Encephalopathy in Liver Cirrhosis

Objective: To determine precipitants of hepatic encephalopathy (HE) and their impact on hospital stay and mortality. Study Design: Cross-sectional, analytical study. Place and Duration of Study: The Aga Khan University Hospital, from January 2005 to December 2007. Methodology: Consecutive patients admitted with different grades of HE were evaluated between January 2005 and December 2007. The precipitants of HE were correlated with the different grades of HE, and length of hospital stay and mortality. Chi-square test was used to compare the proportion of precipitating factors versus hospital stay and grade with significance at p \u3c 0.05. Results: Of the 404 patients 252 (62%) were males. Hepatitis C virus was the cause of cirrhosis in 283 (70%); Child Turcotte Pugh (CTP) class C was present in 317 (78%) patients. On presentation, 17% patients had grade 1 HE while 44%, 29% and 10% had grades 2, 3 and 4 respectively. The most common precipitant of HE was spontaneous bacterial peritonitis in 83 (20.5%), constipation in 74 (18.3%) and urinary tract infection in 62 (15.3%). One hundred and forty (35%) patients had ³ 2 precipitating factors while no precipitant was noted in 50 (12%) patients. Mean hospital stay was 4±3 days. The lesser the number of precipitants, shorter was the length of stay (p \u3c 0.01) and lesser was the grade of HE (p=0.025). Complete reversal of HE was noted in 366 patients (91%) while the remaining had grade 1 HE on discharge. Nine (2.2%) patients died during the hospital stay. No mortality was noted in patients without precipitants. Conclusion: Patients presenting with ³ 2 precipitating factors and advanced grade of HE had a prolonged hospital stay. Moreover, patients without precipitants had better outcomes

The significance of ternary hybrid cross bio-nanofluid model in expanding/contracting cylinder with inclined magnetic field

Significance: Bio-nanofluids have achieved rapid attention due to their potential and vital role in various fields like biotechnology and energy, as well as in medicine such as in drug delivery, imaging, providing scaffolds for tissue engineering, and providing suitable environments for cell growth, as well as being used as coolants in various energy systems, wastewater treatment, and delivery of nutrients to plants.Objective: The present study proposes a novel mathematical model for the ternary hybrid cross bio-nanofluid model to analyse the behaviour of blood that passes through a stenosed artery under the influence of an inclined magnetic field. The model considers the effect of expanding/contracting cylinder, infinite shear rate viscosity, and bio-nanofluids.Methodology: The considered model of the problem is bounded in the form of governing equations such as PDEs. These PDEs are transformed into ODEs with the help of similarity transformations and then solved numerically with the help of the bvp4c method.Findings: The results show that the flow rate and velocity decrease as the inclination angle of the magnetic field increases. Additionally, research has found that the presence of nanoparticles in the bio-nanofluid has a significant impact on the velocity and flow rate. Therefore, the flow rate decreases, in general, as the stenosis becomes more severe.Advantages of the study: The results obtained from this study may provide insights into the behaviour of blood flow in stenosed arteries and may be useful in the design of medical devices and therapies for the treatment of cardiovascular diseases

Uni-Planar MIMO Antenna for Sub-6 GHz 5G Mobile Phone Applications

This article presents the design of a uni-planar MIMO antenna system for sub-6 GHz 5G-enabled smartphones. The MIMO antenna designed comprises four loop-shaped radiators placed at each corner of the mobile phone board, which follows the principle of pattern diversity. The single-antenna element resonates at 3.5 GHz, its impedance bandwidth is noted to be 1.28 GHz (3-4.28 GHz) for S11 90%. The isolation of >10 dB between antenna elements is achieved for the MIMO configuration. Furthermore, the MIMO antenna designed provides enough radiation coverage to support different sides of the mobile phone board, which is an important feature for future 5G-enabled handsets. In addition, the impacts of human hands and heads on MIMO antenna performance are investigated, and acceptable performance in the data and conversation modes is observed.The authors sincerely appreciate the support from Universidad Carlos III de Madrid and the European Union's Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie Grant 80153

Protein Engineering of Endoglucanase CelR of Clostridium thermocellum for Enhanced Expression

Background: Enhanced production and improved properties of cellulases for a greater activity on plant biomass would rank amongst the top priorities for second-generation ethanol production. Based on the emergence of protein engineering as a cutting-edge technology for enhancing enzyme activity and expression level, the present study is aimed at the application of this technique to the major cellulosomal processing endoglucanase of C. thermocellum, CelR for refining enzyme characteristics. Methods: The full-length native enzyme gene (CelR) and a truncated version without the docking domains at C-terminus (CelR-CB) were PCR amplified using gene specific primers. The amplified PCR products were T/A cloned in the vector pTZ57 R/T and transformed in E. coli DH5α. The cellulase genes from the confirmed transformed plasmids were sub-cloned in T7 promoter-based expression vector pET-28a and expression analysis was done in E. coli (DE3) BL21 codon Plus. Results: An SDS PAGE analysis of both the CelR derivatives revealed that the truncated version i.e. CelR-CB showed a two-fold increase in expression level as compared to the full-length enzyme. Conclusion: The increased expression level of CelR in E. coli coupled with its increased production therefore makes it a promising method for augmenting the recombinant enzyme production for potential applications.

FREQUENCY AND SOURCE OF INFECTION IN PATIENTS WITH SEPSIS

Objective: To determine the frequency and source of infection in patients with sepsis. Patients and Methods: This one year cross sectional study was carried at tertiary care teaching hospital. The criteria for selection is any patient of ≥12 years of age, either gender admitted in ward who came under the criteria for sepsis accordingly as systemic inflammatory response syndrome due to infection as existent etiology or at least with clinical evidence of infection while the necessary specific and relevant investigations were also advised and sort accordingly whereas the blood and urine sample for bacterial culture / sensitivity was collected and sent soon to confirm the diagnosis. The frequency and percentages was calculated while the numerical statistics were used to compute mean ±SD. Results: During one year study period total fifty patients diagnosed with sepsis with the mean age ±SD for whole population was 40.84±6.85 years, of fifty individuals 28 (56%) were males and 22 (44%) were females and majority belonged to rural population (60%). The organ system dysfunction identified were coagulopathy (50%), central nervous system (40%), hepatic (38%) and renal (42%). The common source of infection detected were Respiratory tract infection (16%), urinary tract infections (16%), intravenous catheters (16%) and urethral catheterization (18%) respectively. Conclusion: The study detected higher incidence of infection with gram negative pathogen was common microorganism while the common source of infections identified urethral catheterization (18%), intravenous catheters (16%), urinary tract infections (16%) and respiratory tract infections (16%). Keywords: Sepsis, Blood culture, Source of infection & Systemic inflammatory response syndrome

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks