Efficacy of chemical and electrical cautery (Comparison) in management of Anterior Epistaxis

Objective: To compare the efficacy of chemical versus electrical cautery in the management of patients presenting with anterior epistaxis in terms of frequency of bleeding. Materials and Methods: Study Design = Randomized Control Trial (RCT) Study Setting = ENT Department Benazir Bhutto Hospital, Rawalpindi Duration = 6 months Sampling Technique = Consecutive (Non Probability) A Randomized Control Trial (RCT) of six months was done after the approval of the Ethical Committee. A total of 90 cases of anterior epistaxis were randomly divided into two groups: A (electrical cautery) and B (chemical cautery) using a random number trial with 45 in each group respectively. Informed consent was taken from all patients. Patients were explained about the procedure and its risk-benefit ratio. A detailed history was taken about epistaxis from patients presenting in an emergency. The site of bleeding was assessed. Pulse and blood pressure of patients were monitored. Patients were treated on an emergency basis. The nasal cavity was inspected with the help of a nasal speculum and suction of any blood clots was done. Bleeding points were identified and sprayed with lidocaine. The bleeding area was cauterized with a silver nitrate stick or electrical cautery for a few seconds. Antibiotic ointment was applied at the site of cautery to both groups. The patient was discharged on cessation of bleeding. A Performa was given to patients to fill 48 hours, 1 week, and 2 weeks after the procedure containing questions regarding relief of symptoms. Recurrent bleed was diagnosed on a history of separate bleed from nose post-procedure that was sudden in onset, with an identifiable bleeding point on inspection by speculum, total duration of all episodes in previous 24 hours less than 30 minutes. Results: A total of 90 cases (45 in each group) were taken. The mean age was calculated and found 34.42±8.70 in Group-A and 34.29+8.94 years for group B., The male patients were 32 (71.11%) in Group-A and 30 (66.67%) in Group-B while females were 13 (28.89%) in Group-A and 15 (33.33%) in Group-B, efficacy between chemical and electrical cautery in patients with reference to frequency of bleeding was 42 (93.33%) in Group-A and 35 (77.78%) in Group-B, the p value was calculated as 0.03 which shows a significant difference. <br>Conclusion: This study concluded that the efficacy of electrical cautery is significantly higher than chemical cautery in the management of epistaxis. However, some other trials on larger sample size are required to validate the findings of this study. &nbsp

Experimental Investigations of a Solar Water Treatment System for Remote Desert Areas of Pakistan

Pakistan is among the countries that have already crossed the water scarcity line, and the situation is worsened due to the recent pandemic. This is because the major budget of the country is shifted to primary healthcare activities from other development projects that included water treatment and transportation infrastructure. Consequently, water-borne diseases have increased drastically in the past few months. Therefore, there is a dire need to address this issue on a priority basis to ameliorate the worsening situation. One possible solution is to shift the focus/load from mega-projects that require a plethora of resources, money, and time to small domestic-scale systems for water treatment. For this purpose, domestic-scale solar stills are designed, fabricated, and tested in one of the harshest climatic condition areas of Pakistan, Rahim Yar Khan. A comprehensive overview of the regional climatology, including wind speed, solar potential, and ambient temperature is presented for the whole year. The analysis shows that the proposed system can adequately resolve the drinking water problems of deprived areas of Pakistan. The average water productivity of 1.5 L/d/m2 is achieved with a total investment of PKR 3000 (<20). This real site testing data will serve as a guideline for similar system design in other arid areas globally

Optimization of Clostridium tyrobutyricum encapsulation by extrusion method and characterization of the formulation

Purpose: To optimize the process parameters for the encapsulation of Clostridium tyrobutyricum (Ct) and to determine its in vitro characteristics.Methods: The process parameters, including the concentration of the wall and hardening material, Ct to gelatin ratio and hardening time, were studied by single factor analysis, while optimization was performed by orthogonal experimental design for the encapsulation rate of Ct.Results: Optimal conditions exhibited by orthogonal experimental design at a 92.17 % encapsulation rate with a viable count of 9.61 ± 0.06 lgCFU/g were: 6 % modified starch, 3 % sodium alginate, and 2 % CaCl2 at a Ct to gelatin ratio of 1:1 with a hardening time of 30 min. The survival rates of encapsulated Ct were higher than free Ct in simulated gastric (6.22 %) and intestinal juices (15.55 %). Reduction in viable counts of Ct at 90 °C were higher for free cells (44.76 %) than encapsulated cells (28.09 %) after 30 min of heat treatment. Correspondingly, encapsulation boosted the capacity of Ct to withstand the strong acidic conditions of the stomach and improved the storage properties of Ct.Conclusion: The results suggested that extrusion is a good technique for the encapsulation of Ct, as it enhances the viability of Ct during their transit through the gastrointestinal tract. Furthermore, encapsulation is favorable for Ct if planned for use in formulations where high temperature treatment is required

Coated cysteamine, a potential feed additive for ruminants — An updated review

For sustainable development, better performance, and less gas pollution during rumen fermentation, there is a need to find a green and safe feed additive for ruminants. Cysteamine (CS) is a biological compound naturally produced in mammalian cells. It is widely used as a growth promoter in ruminants because of its ability to control hormone secretions. It mainly controls the circulating concentration of somatostatin and enhances growth hormone production, leading to improved growth performance. CS modulates the rumen fermentation process in a way beneficial for the animals and environment, leading to less methane production and nutrients loss. Another beneficial effect of using CS is that it improves the availability of nutrients to the animals and enhances their absorption. CS also works as an antioxidant and protects the cells from oxidative damage. In addition, CS has no adverse effects on bacterial and fungal alpha diversity in ruminants. Dietary supplementation of CS enhances the population of beneficial microorganisms. Still, no data is available on the use of CS on reproductive performance in ruminants, so there is a need to evaluate the effects of using CS in breeding animals for an extended period. In this review, the action mode of CS was updated according to recently published data to highlight the beneficial effects of using CS in ruminants

Chitosan/poly vinyl alcohol/graphene oxide based ph-responsive composite hydrogel films: drug release, anti-microbial and cell viability studies

The composite hydrogels were produced using the solution casting method due to the non-toxic and biocompatible nature of chitosan (CS)/polyvinyl alcohol (PVA). The best composition was chosen and crosslinked with tetraethyl orthosilicate (TEOS), after which different amounts of graphene oxide (GO) were added to develop composite hydrogels. Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), atomic force microscopy (AFM) and contact angle was used to analyze the hydrogels. The samples were also evaluated for swelling abilities in various mediums. The drug release profile was studied in phosphate-buffered saline (PBS) at a pH of 7.4. To predict the mechanism of drug release, the data were fitted into kinetic models. Finally, antibacterial activity and cell viability data were obtained. FTIR studies revealed the successful synthesis of CS/PVA hydrogels and GO/CS/PVA in hydrogel composite. SEM showed no phase separation of the polymers, whereas AFM showed a decrease in surface roughness with an increase in GO content. 100 µL of crosslinker was the critical concentration at which the sample displayed excellent swelling and preserved its structure. Both the crosslinked and composite hydrogel showed good swelling. The most acceptable mechanism of drug release is diffusion-controlled, and it obeys Fick’s law of diffusion for drug released. The best fitting of the zero-order, Hixson-Crowell and Higuchi models supported our assumption. The GO/CS/PVA hydrogel composite showed better antibacterial and cell viability behaviors. They can be better biomaterials in biomedical applications

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

The effect of bark extract on growth performance, carcass characteristics, immune response, and intestinal morphology in broilers as an alternative to antibiotic growth promoter

Objective Present study was designed to evaluate the efficacy of Acacia nilotica bark extract as an alternative to antibiotic growth promoters in broilers. Methods Six hundred, day-old broiler chicks were randomly divided into six groups (NC, without any supplementation; AB, NC+Zinc Bacitracin; PB, NC+Safmannan; ANBE1, NC+A. nilotica bark extract 0.1%; ANBE3, NC+A. nilotica bark extract 0.3%; ANBE5, NC+A. nilotica bark extract 0.5%), with ten replicates per group (10 chicks/replicate) and feeding trial was lasted for 35 days. Results Results showed that weight gain (1,296.63 g) and feed conversion ratio (FCR, 1.59) of AB was better than NC, during the finisher phase. Overall FCR of AB (1.53), PB (1.54), and ANBE5 (1.54) was significantly (p<0.05) better than NC. From carcass parameters relative weight of wing and heart were highest in ANBE3 (2.5% and 1.51%, respectively). Significantly (p<0.05) highest blood glucose level was observed in NC (264.5 mg/dL) and highest albumin concentration was found in AB (1.46 mg/dL). In addition, antibody titer levels against ND and IBD were higher in ANBE5 than NC, while higher relative weight of bursa was observed in ANBE3 than NC. The villus height to crypt depth ratio in all experimental groups was better than NC. Conclusion Acacia nilotica bark extract could be a suitable alternative to antibiotic growth promoters to support the growth in broilers

Bronchial carcinoid presenting with abdominal pain

Bronchial carcinoid tumors are very rare pulmonary neoplasms. They usually present with pulmonary symptoms or paraneoplastic syndromes. Typical (well-differentiated) tumors are usually indolent with survival exceeding 90% after resection. Atypical carcinoids have a worse prognosis. They are much more likely to recur locally or to have distant metastases. This case report describes a patient who presented with abdominal pain and hepatic lesions who was subsequently diagnosed to have bronchial carcinoid

A Low-Cost Sustainable Energy Solution for Pristine Mountain Areas of Developing Countries

The rise in energy requirements and its shortfall in developing countries have affected socioeconomic life. Communities in remote mountainous regions in Asia are among the most affected by energy deprivation. This study presents the feasibility of an alternate strategy of supplying clean energy to the areas consisting of pristine mountains and forest terrain. Southeast Asia has a much-diversified landscape and varied natural resources, including abundant water resources. The current study is motivated by this abundant supply of streams which provides an excellent environment for run-of-river micro vertical axis water turbines. However, to limit the scope of the study, the rivers and streams flowing in northern areas of Pakistan are taken as the reference. The study proposes a comprehensive answer for supplying low-cost sustainable energy solutions for such remote communities. The suggested solution consists of a preliminary hydrodynamic design using Qblade, further analysis using numerical simulations, and finally, experimental testing in a real-world environment. The results of this study show that the use of microturbines is a very feasible option considering that the power generation density of the microturbine comes out to be approximately 2100 kWh/year/m2, with minimal adverse effects on the environment