Microbial profiling and risk factors assessment for Otitis Media and Otitis Externa

Background: Otitis media and otitis externa are common otological manifestations in all generations especially in children. There is lack of accurate identification of the causative agent and thus poor diagnosis for such infections. Therefore, it leads to permanent anatomical disabilities including poor speech and defects in balancing and hearing. The study was conducted to isolate, characterize and identify the microbes causing otitis media and otitis externa. Methods: A total of 250 patients having otitis media and otitis externa were enrolled in the study from March 2011 to October 2011. All patients were examined through clinical examination and detailed history was collected. Pus samples from the discharging ears were plated on MacConkey’s, Chocolate and Blood agar for 24 to 48 hours. Isolates were identified on the basis of morphology, staining reactions and various biochemical tests. Results: In this study, only 6% cases yielded no growth, 14% yielded mixed cultures while 80% cases yielded pure cultures. The presumptive diagnosis for ear swabbing was otitis media (76%) and otitis externa (24%). The most common bacterial isolates obtained were Staphylococcus aureus (43.3%) followed byPseudomonas aeruginosa (25%) in the diagnosed cases of otitis media. While for the cases of otitis externa,Pseudomonas aeruginosa was the predominant organism with 52.2%. Infection of otitis media was most common among children and the persons having low socioeconomic conditions. Conclusion: Pseudomonas aeruginosa was identified as the principal pathogen followed by Staphylococcus aureus. To circumvent the painful effects of acute and chronic ear infections, an accurate microbial profiling may play pivotal role

Long-term glycemic variability and risk of adverse outcomes: a systematic review and meta-analysis

OBJECTIVE: Glycemic variability is emerging as a measure of glycemic control, which may be a reliable predictor of complications. This systematic review and meta-analysis evaluates the association between HbA1c variability and micro- and macrovascular complications and mortality in type 1 and type 2 diabetes. RESEARCH DESIGN AND METHODS: Medline and Embase were searched (2004–2015) for studies describing associations between HbA1c variability and adverse outcomes in patients with type 1 and type 2 diabetes. Data extraction was performed independently by two reviewers. Random-effects meta-analysis was performed with stratification according to the measure of HbA1c variability, method of analysis, and diabetes type. RESULTS: Seven studies evaluated HbA1c variability among patients with type 1 diabetes and showed an association of HbA1c variability with renal disease (risk ratio 1.56 [95% CI 1.08–2.25], two studies), cardiovascular events (1.98 [1.39–2.82]), and retinopathy (2.11 [1.54–2.89]). Thirteen studies evaluated HbA1c variability among patients with type 2 diabetes. Higher HbA1c variability was associated with higher risk of renal disease (1.34 [1.15–1.57], two studies), macrovascular events (1.21 [1.06–1.38]), ulceration/gangrene (1.50 [1.06–2.12]), cardiovascular disease (1.27 [1.15–1.40]), and mortality (1.34 [1.18–1.53]). Most studies were retrospective with lack of adjustment for potential confounders, and inconsistency existed in the definition of HbA1c variability. CONCLUSIONS: HbA1c variability was positively associated with micro- and macrovascular complications and mortality independently of the HbA1c level and might play a future role in clinical risk assessment

Experimental validation of bulk-graphene as a thermoelectric generator

Quest for alternate energy sources is the core of most of the research activities these days. No matter how small or large amount of energy can be produced by utilizing the non-conventional techniques and sources, every bit of innovation can reshape the future of energy. In this work, experimental analysis of the thermoelectric (TE) properties of bulk-graphene in the temperature range of (303 to 363) K is presented. Graphene powder was pressed to form a pellet which was used to fabricate the TE device. The effects of temperature on the Seebeck coefficient, electrical and thermal conductivities, and the dimensionless figure of merit (FOM) were measured. The increasing value of the Seebeck coefficient (thermopower) with temperature is indicant of the metallic behavior. Additionally, the observed thermopower (TEP) is positive, which shows that the majority charge carriers are holes and peaked to a value of 56 μV K-1 at 363 K. The thermopower of the pellet is four times larger than the previously reported values for single layer graphene (SLG) and few layer graphene (FLG). In addition to this, low values of the thermal conductivity were observed for the pellet which is one of the requirements of a good TE material. Besides this, an upward trend is observed with increasing temperature for FOM, which attains a peak value of 0.0016 at 363 K, which is almost ten times that of the previously reported values

Graphene Based Functional Hybrids: Design and Technological Applications

Because of the versatile chemical, physical, and electrical properties, graphene as well as its nanocomposites are regarded as the backbone of engineering and scientific innovation. Different physical and chemical methods are used to create sustainable carbon materials. Furthermore, fabrication methods are employed in order to produce the composites, which are of constituents with desirable properties. Because of their biocompatibility, graphene nanomaterials have enormous potential for improving biology and drug delivery. The proposed chapter provides a variety of fabrication methods for sustainable graphene composites and highlights various applications of graphene. Furthermore, graphene nanocomposites are promising multifunctional materials with improved tensile strength and elastic modulus. Despite some challenges and the fact that carbon nanotube/polymer composites are sometimes better in some specific performance, graphene nanocomposites may have a wide range of potential applications due to their outstanding properties and the low cost of graphene. Because these graphene composites have a controllable porous structure, a large surface area, high conductivity, high temperature stability, excellent anti-corrosion properties, and composite compatibility, they can be used in energy storage as electrocatalysts, electro-conductive additives, intercalation hosts, and an ideal substrate for active materials. Meanwhile, the chapter summaries the graphene nanocomposites requirements for technological innovation and scientific applied research

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

ENHANCEMENT OF GERMINATION AND EMERGENCE OF CANOLA SEEDS BY DIFFERENT PRIMING TECHNIQUES

The present study was conducted to enhance the germination and emergence of canola (Brassica napus   ) CV. Zafar-2000 seeds using different priming treatments. For comparison with non-soaked control, different priming techniques i.e. osmopriming with PEG-6000, hydropriming and matriconditioning with compost,jute mat and press mud of sugar mill for 24 hours were used. All priming treatments were effective in improving germination percentage as compared to control except SMP with press mud. The osmopriming and matriconditioning (jute mat) proved to be the best in reducing the time to 50% germination and mean germination time among all priming treatments. During emergence test, both priming treatments i.e; osmopriming and matriconditioning (jute mat for 24 hours reduced the time to 50% emergence and mean emergence time. Maximum root and shoot lengths were recorded in hydroprimed seeds. Highest electrical conductivity was recorded for control while lowest electrical conductivity was recorded in osmoprimed seeds. It is concluded that priming of seeds with PEG6000 and matriconditioning (jute mat) are most effective in improving germination and seedling emergence of canola seeds

Outcomes of patients with elevated pulmonary artery systolic pressure on echocardiography due to chronic lung diseases

Background: Pulmonary hypertension is associated with increased mortality, and lung diseases are the second most common cause of pulmonary hypertension. We aimed to evaluate the prognostic value of echocardiography in low-middle income countries where right heart catheterization is difficult to performMethods: This retrospective chart review study included adult patients hospitalized from June 2012 to May 2021, with a pulmonary artery systolic pressure (PASP) of ≥35 mmHg on echocardiography. The control arm consisted of patients with similar lung diseases who did not have an elevated PASPResults: The study and control arm consisted of 128 patients each, with both groups having similar lung diseases. Obesity hypoventilation syndrome was the most common etiology of elevated PASP (28.1 %), followed by pulmonary embolism (20.3 %). The overall 1-year mortality of the study cohort, after diagnosis of elevated PASP, was 20.3 %. The control cohort with normal PASP had a 1-year mortality of 4.7 %. In the study cohort, patients with bronchiectasis had the highest cause-specific 1-year mortality (45.5 %). In the normal PASP cohort, the highest cause-specific 1-year mortality was observed in patients with interstitial lung disease (13.0 %). One-year hospital readmission was observed in 46.9 % and 33.6 % of patients in the study and control arms, respectively. On multivariate analysis, increased odds of 1-year mortality were observed in patients with elevated PASP, patients with 1-year hospital readmission, and in patients with interstitial lung disease or bronchiectasis.Conclusion: Elevated PASP on echocardiography may be a prognostic factor for mortality in patients with chronic lung diseases

Aortic valve intervention rates in patients of different ethnicity with severe aortic stenosis in Leicestershire, UK

Objectives To explore the ethnic differences in patients undergoing aortic valve (AV) intervention for severe aortic stenosis (AS) in Leicestershire, UK.Methods Retrospective cohort study of all surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) at a single tertiary centre between April 2017 and March 2022, using local registry data.Results Of the 1231 SAVR and 815 TAVI performed, 6.5% and 3.7% were in ethnic minority patients, respectively. Based on the 2011 Census data for those with a Leicestershire postcode, crude cumulative rate of SAVR (n=489) was 0.64 per 1000 population overall and 0.69, 0.46 and 0.36 in White, Asian and Black populations, respectively; and 0.50 per 1000 population overall for TAVI (n=383), with 0.59, 0.16 and 0.06 for White, Asian and Black populations, respectively. Asians undergoing SAVR and TAVI were 5 and 3 years younger, respectively, than white patients with more comorbidities and a worse functional status.The age-adjusted cumulative rates for SAVR were 0.62 vs 0.72 per 1000 population for White and Asian patients and 0.51 vs 0.39 for TAVI. Asians were less likely to undergo SAVR and TAVI than White patients, with a risk ratio (RR) of 0.66 (0.50–0.87) and 0.27 (0.18–0.43), respectively, but the age-adjusted RR was not statistically significant.Conclusion The crude rates of AV interventions are lower in Asian patients compared with the White population in Leicestershire, although age-adjusted rates were not statistically different. Further research to determine the sociodemographic differences in prevalence, incidence, mechanisms and treatment of AS across the UK is required

Impact of diabetes on remodelling, microvascular function and exercise capacity in aortic stenosis

Objective To characterise cardiac remodelling, exercise capacity and fibroinflammatory biomarkers in patients with aortic stenosis (AS) with and without diabetes, and assess the impact of diabetes on outcomes.Methods Patients with moderate or severe AS with and without diabetes underwent echocardiography, stress cardiovascular magnetic resonance (CMR), cardiopulmonary exercise testing and plasma biomarker analysis. Primary endpoint for survival analysis was a composite of cardiovascular mortality, myocardial infarction, hospitalisation with heart failure, syncope or arrhythmia. Secondary endpoint was all-cause death.Results Diabetes (n=56) and non-diabetes groups (n=198) were well matched for age, sex, ethnicity, blood pressure and severity of AS. The diabetes group had higher body mass index, lower estimated glomerular filtration rate and higher rates of hypertension, hyperlipidaemia and symptoms of AS. Biventricular volumes and systolic function were similar, but the diabetes group had higher extracellular volume fraction (25.9%±3.1% vs 24.8%±2.4%, p=0.020), lower myocardial perfusion reserve (2.02±0.75 vs 2.34±0.68, p=0.046) and lower percentage predicted peak oxygen consumption (68%±21% vs 77%±17%, p=0.002) compared with the non-diabetes group. Higher levels of renin (log10renin: 3.27±0.59 vs 2.82±0.69 pg/mL, p<0.001) were found in diabetes. Multivariable Cox regression analysis showed diabetes was not associated with cardiovascular outcomes, but was independently associated with all-cause mortality (HR 2.04, 95% CI 1.05 to 4.00; p=0.037).Conclusions In patients with moderate-to-severe AS, diabetes is associated with reduced exercise capacity, increased diffuse myocardial fibrosis and microvascular dysfunction, but not cardiovascular events despite a small increase in mortality