PREVALENCE OF ASYMPTOMATIC PERIPHERAL ARTERIAL DISEASE AND ITS ASSSOCIATION WITH AGE AND GENDER IN TYPE 2 DIABETES MELLITUS IN A TERTIARY CARE TEACHING HOSPITAL: A CROSS-SECTIONAL STUDY

Objective: The true prevalence of peripheral arterial disease (PAD) in individuals with diabetes has been difficult to determine because of the lack of symptoms and insensitive diagnosis. We estimated the prevalence of PAD and its association with age and gender in Type 2 diabetes mellitus (DM) who were asymptomatic for PAD. Methods: Total 150 Type 2 DM patients were screened and examined for PAD using Ankle Brachial Index and Color Doppler. Prevalence of PAD was further studied and statistically analyzed to find its association with age and gender. Results: Prevalence of PAD in our study was 16%. Out of total 150 Type 2 DM patients, 24 patients were diagnosed to have PAD by Color Doppler. The prevalence was 12.0% in the fifth and sixth decade followed by 3.3% in seventh and eighth decade and 0.7% in <40 years age group. Out of total 150 cases, there were 83 males and among them 15 (18.1%) had PAD and out of 67 females, 9 (13.4%) had PAD. After application of Chi-square test to the above observations, there was no statistically significant association of age and gender with PAD in our study population. Conclusion: In the present study, the prevalence of PAD was 16%; 10% and 6% in males and in females, respectively. There was no statistically significant correlation of PAD with age and gender

De-Risking Pretreatment of Microalgae To Produce Fuels and Chemical Co-Products

Conversion of microalgae to renewable fuels and chemical co-products by pretreating and fractionation holds promise as an algal biorefinery concept, but a better understanding of the pretreatment performance as a function of algae strain and composition is necessary to de-risk algae conversion operations. Similarly, there are few examples of algae pretreatment at scales larger than the bench scale. This work aims to de-risk algal biorefinery operations by evaluating the pretreatment performance across nine different microalgae samples and five different pretreatment methods at small (5 mL) scale and further de-risk the operation by scaling pretreatment for one species to the 80 L scale. The pretreatment performance was evaluated by solubilization of feedstock carbon and nitrogen [as total organic carbon (TOC) and total nitrogen (TN)] into the aqueous hydrolysate and extractability of lipids [as fatty acid methyl esters (FAMEs)] from the pretreated solids. A range of responses was noted among the algae samples across pretreatments, with the current dilute Brønsted acid pretreatment using H₂SO₄ being the most consistent and robust. This pretreatment produced TOC yields to the hydrolysate ranging from 27.7 to 51.1%, TN yields ranging from 12.3 to 76.2%, and FAME yields ranging from 57.9 to 89.9%. In contrast, the other explored pretreatments (other dilute acid pretreatments, dilute alkali pretreatment with NaOH, enzymatic pretreatment, and flash hydrolysis) produced lower or more variable yields across the three metrics. In light of the greater consistency across samples for dilute acid pretreatment, this method was scaled to 80 L to demonstrate scalability with microalgae feedstocks

Chlorhexidine versus povidone–iodine skin antisepsis before upper limb surgery (CIPHUR) : an international multicentre prospective cohort study

Introduction Surgical site infection (SSI) is the most common and costly complication of surgery. International guidelines recommend topical alcoholic chlorhexidine (CHX) before surgery. However, upper limb surgeons continue to use other antiseptics, citing a lack of applicable evidence, and concerns related to open wounds and tourniquets. This study aimed to evaluate the safety and effectiveness of different topical antiseptics before upper limb surgery. Methods This international multicentre prospective cohort study recruited consecutive adults and children who underwent surgery distal to the shoulder joint. The intervention was use of CHX or povidone–iodine (PVI) antiseptics in either aqueous or alcoholic form. The primary outcome was SSI within 90 days. Mixed-effects time-to-event models were used to estimate the risk (hazard ratio (HR)) of SSI for patients undergoing elective and emergency upper limb surgery. Results A total of 2454 patients were included. The overall risk of SSI was 3.5 per cent. For elective upper limb surgery (1018 patients), alcoholic CHX appeared to be the most effective antiseptic, reducing the risk of SSI by 70 per cent (adjusted HR 0.30, 95 per cent c.i. 0.11 to 0.84), when compared with aqueous PVI. Concerning emergency upper limb surgery (1436 patients), aqueous PVI appeared to be the least effective antiseptic for preventing SSI; however, there was uncertainty in the estimates. No adverse events were reported. Conclusion The findings align with the global evidence base and international guidance, suggesting that alcoholic CHX should be used for skin antisepsis before clean (elective upper limb) surgery. For emergency (contaminated or dirty) upper limb surgery, the findings of this study were unclear and contradict the available evidence, concluding that further research is necessary

Detection of paroxysmal atrial fibrillation or flutter in patients with acute ischemic stroke or transient ischemic attack by Holter monitoring

Background and purpose: Paroxysmal atrial fibrillation and flutter are strong risk factors for stroke. Due to high recurrence rate of ischemic events and given the benefit of oral anticoagulation over antiplatelet drugs, it is important to identify this arrhythmia. Unfortunately, paroxysmal AF or flutter is asymptomatic in majority and therefore, difficult to detect. Methods: Consecutive patients presenting with symptoms of acute ischemic stroke or transient ischemic attack were included. All patients free of AF or flutter on presentation underwent 24 h Holter monitoring within 7 days of admission. Results: Overall, fifty two (52) patients (mean age 59.51 ± 13.45 years) with acute stroke (80.8%) and TIA (19.8%) underwent 24 h Holter monitoring. Paroxysmal AF was detected in 3 cases (5.8%), all 3 patients had acute stroke and were older than age 60 years. Type of stroke was the only factor which was associated with greater risk of having paroxysmal AF or flutter, AF accounted for 50% cases (2 out of 4) of clinically suspected cardio embolic stroke. Conclusion: Screening consecutive patients with ischemic stroke with routine Holter monitoring will identify new atrial fibrillation/flutter in approximately one in 17 patients. Older age and type of stroke are strongly associated with increased risk. By carefully selecting the patients, the detection rates could be further increased

Clinical evaluation of the retention of four different pit and fissure sealants on the first permanent molars – An original research

Objective: In this study, the retention rates of four different pit and fissure sealant materials on the first permanent molars were clinically assessed and compared. Materials and Methods: A total of 120 kids aged 7 to 10 participated in a randomized controlled experiment. On their first permanent teeth, the subjects each got one of the four sealant materials (A, B, C, or D). Over the course of 24 months, the retention rates were evaluated every 6 months. The Chi-square test and Kaplan–Meier survival analysis were used for statistical analysis. Results: At 6, 12, 18, and 24 months, the following retention rates were observed overall: A (85%, 78%, 65%, 52%), B (90%, 82%, 70%, 60%), C (78%, 70%, 55%, 42%), and D (95%, 88%, 75%, 62%). At each time point, the sealant materials showed significant variations in retention rates (P 0.05). While sealants A and C showed lower retention rates, sealant D showed the best retention rates, followed by sealant B. Conclusion: This study shows that different materials have different retention rates for pit and fissure sealants on first permanent molars. Higher retention rates for sealants D and B suggest that they may be superior than sealants A and C. These results highlight how crucial it is to choose the right sealant materials to guarantee long-term retention and effectiveness in avoiding dental cavities

Correction to: Improvements in cholesterol efux capacity of HDL and adiponectin contribute to mitigation in cardiovascular disease risk after bariatric surgery in a cohort with morbid obesity

An amendment to this paper has been published and can be accessed via the original article

Evaluation of bond strength and adhesive remnant index of different lingual retainers in human incisor teeth

Objective: This study aimed to evaluate and compare the bond strengths of four different lingual retainers and assess the adhesive remnant index (ARI) to determine their effectiveness in orthodontic retention. Methodology: Eighty human incisor teeth were divided into four groups, with each group bonded using a different retainer: Group 1 (E-Glass retainer), Group 2 (0.017” Co-axial stainless steel wire), Group 3 (Splint C.T. fiber mesh), and Group 4 (0.010” stainless steel ligature wire). Bond strength was measured using a universal testing machine, and ARI scores were recorded to assess bond failure types. Results: Group 1 (E-Glass retainer) demonstrated the highest bond strength, followed by Group 3 (Splint C.T. fiber mesh), Group 2 (Co-axial stainless steel wire), and Group 4 (stainless steel ligature wire). Cohesive bond failures were observed in most groups, except for the co-axial stainless steel wire group, which exhibited adhesive failures. Conclusion: E-Glass fiber-reinforced retainers showed the highest bond strength, making them a promising alternative to conventional stainless steel wires for orthodontic retention, especially in patients with esthetic concerns or nickel hypersensitivity. Stainless steel retainer groups exhibited lower bond strengths, and cohesive bond failures were prevalent. Further research is needed to validate these findings in clinical settings and evaluate the long-term effectiveness of different lingual retainers

24-Hour Levodopa-Carbidopa Intestinal Gel: Clinical Experience and Practical Recommendations.

Infusion of levodopa-carbidopa intestinal gel (LCIG; also designated carbidopa-levodopa enteral suspension) for 16 hours is a standard treatment for patients with advanced Parkinson\u27s disease, and clinical observations suggest that 24-hour LCIG infusion may further reduce symptoms. This review provides practical advice on the management of patients transitioning to 24-hour LCIG infusion. We review available clinical data for 24-hour infusion and discuss adjustments to dosing, recommendations for monitoring, and management of patient concerns, based on our clinical experience. Data from multiple studies suggest that LCIG may improve non-motor symptoms. Although few studies have examined 24-hour LCIG infusion, available data indicate that certain patients may benefit from around-the-clock treatment. Studies of 24-hour LCIG infusion are limited by small sample sizes and open-label study designs, which may hamper translation to clinical practice. In our experience, we have found that patients may benefit from 24-hour infusion when reductions in nocturnal symptoms and improvements to quality of sleep are needed. Levodopa-unresponsive freezing of gait or poorly controlled troublesome dyskinesias may also indicate a patient may benefit from 24-hour infusion. Dose adjustments, especially of the nocturnal rate, are typically necessary and, as with 16-hour infusion, patients should be monitored for autonomic dysfunction; overnight wearing off symptoms; weight changes; fluctuations in plasma levels of vitamins B6/B12, folate, and homocysteine; changes in sleep patterns; or worsening of hallucinations, delusions, and/or nightmares. Available data and our clinical experience suggest that 24-hour LCIG may be warranted among selected patients who have poorly controlled nocturnal fluctuations or early morning off symptoms