Role of early contrast enhanced CT scan in severity prediction of acute pancreatitis

Abstract Severe pancreatitis occurs in approximately 15-25% of patients with acute pancreatitis. The objective of our study was to compare the CTSeverity Index (CTSI) with a clinical score (BISAP score) to predict severity of acute pancreatitis. Forty-eight consecutive patients with acutepancreatitis who underwent contrast enhanced CT scan within 72 hours of presentation were included. Results of our study showed that both CTSI and BISAP score were reliable predictors of mortality (p value = 0.019 and \u3c0.001 respectively) and need for mechanical ventilation (p value = .002 and .006 respectively). Positive predictive value of CTSI to predict recovery without intervention was 91.4% as compared to 78% for that of BISAP score. Receiver Operating Characteristics (ROC) Curves showed CT scan was superior to BISAP Score in predicting need of percutaneous or surgical intervention. Early CT scan may be utilized for prediction of clinical course of patients with acute pancreatitis

Low-velocity impact characterization of fiber-reinforced composites with hygrothermal effect

In this article, low-velocity impact characteristics of UHN125C carbon fiber/epoxy composite, including unidirectional (0°), cross-directional (0°/90°), and quasi-isotropic layups, were experimentally measured. The effect of the fiber orientation angle and stacking sequences on impact force and induced strain were measured via an instrumented drop-weight apparatus with special concern for the moisture absorption effect. Dried specimens were immersed in distilled water for a certain period of time to absorb water for intermediate and saturated moisture content. It was observed that the impulse was reduced with the increase in moisture content; on the other hand, strain increased with moisture, as measured by DBU-120A strain-indicating software (MADSER Corp., El Paso, TX). Impact damage is widely recognized as one of the most detrimental damage forms in composite laminates because it dissipates the incident energy by a combination of matrix damage, fiber fracture, and fiber-matrix debonding. Therefore, it is extremely important to know the impact strength of a structure, especially for applications in industries such as aerospace, ship design, and some other commercial applications. The use of composite materials in engineering applications is increasing rapidly because they have higher strength-to-weight ratios than metals. The strength, stiffness, and, eventually, the life of composite materials are affected more than conventional materials by the presence of moisture and temperature. Thus, it is necessary to analyze the response of composites in a hydrothermal environment

Gafor : Genetic algorithm based fuzzy optimized re-clustering in wireless sensor networks

Acknowledgments: The authors are grateful to the Deanship of Scientific Research at King Saud University for funding this work through Vice Deanship of Scientific Research Chairs: Chair of Pervasive and Mobile Computing. Funding: This research was funded by King Saud University in 2020.Peer reviewedPublisher PD

MANUFACTURING OF LIGHT-WEIGHT REFRACTORY BRICKS USING LOCAL RAW MATERIAL

Refractories with low thermal conductivity, high porosity and good mechanical strength are desirable to control the heat losses during high temperature processing. Locally produced insulating firebricks cannot be used at high temperatures due to poor refractoriness and low hot strength. In the present experimental work, locally available cheap raw materials, namely, clay, rice husk and saw dust were used to manufacture light-weight refractory bricks using different ratios of raw materials. Various process parameters were investigated and the bricks with optimized properties were produced which can be used upto 1200 °C. Moreover, the bricks produced will be lower in price and also beneficial from energy conservation point of view due to low heat losses

Association between perioperative hypothermia and surgical site infection after elective abdominal surgery: A prospective cohort study

Introduction: Surgical site infections (SSIs) account for 14-16% of nosocomial infections and are one of the major causes of increased morbidity, hospital stay, cost of care, and even mortality. Hypothermia as a risk factor for SSI is debated but there is lack of conclusive evidence. The present study explores the association of hypothermia with SSI.Methodology: This is a prospective cohort study conducted on adult patients who underwent elective laparotomy. Patients were divided into two cohorts, the Hypothermia Cohort and the Normothermia Cohort, based upon episodes of hypothermia of \u3c360C in the perioperative period. SSI was diagnosed based upon criteria defined by the Center for Disease Control and Prevention (CDC). Postoperative follow-up to detect SSI was done until 30 days after the operation.Results: A total of 183 patients met the selection criteria and were included in the study. Ninety patients (49%) had perioperative hypothermia and were followed in the Hypothermia Cohort, while 93 patients (51%) who remained normothermic in the perioperative period were followed in the Normothermia Cohort. Mean age of the patients was 49.77 +/- 14.82 years. Almost two-thirds of the participants were females (63.9%). Patients who developed hypothermia were significantly older and had lower BMI. Also the proportion of female patients was significantly higher in the Normothermic Cohort.Rate of SSI was similar in both groups (10% versus 10.8%) with p-value of 0.867. Multivariable regression analysis also failed to show any significant association between hypothermia and SSI.Conclusion: Our study failed to show any statistically significant association between hypothermia and surgical site infection

Impact of natural killer cells on outcomes after allogeneic hematopoietic stem cell transplantation: A systematic review and meta-analysis.

Background: Natural killer (NK) cells play a vital role in early immune reconstitution following allogeneic hematopoietic stem cell transplantation (HSCT). Methods: A literature search was performed on PubMed, Cochrane, and Clinical trials.gov through April 20, 2022. We included 21 studies reporting data on the impact of NK cells on outcomes after HSCT. Data was extracted following the PRISMA guidelines. Pooled analysis was done using the meta-package (Schwarzer et al.). Proportions with 95% confidence intervals (CI) were computed. Results: We included 1785 patients from 21 studies investigating the impact of NK cell reconstitution post-HSCT (8 studies/1455 patients), stem cell graft NK cell content (4 studies/185 patients), therapeutic NK cell infusions post-HSCT (5 studies/74 patients), and pre-emptive/prophylactic NK cell infusions post-HSCT (4 studies/77 patients). Higher NK cell reconstitution was associated with a better 2-year overall survival (OS) (high: 77%, 95%CI 0.73-0.82 vs low: 55%, 95%CI 0.37-0.72; n=899), however, pooled analysis for relapse rate (RR) or graft versus host disease (GVHD) could not be performed due to insufficient data. Higher graft NK cell content demonstrated a trend towards a better pooled OS (high: 65.2%, 95%CI 0.47-0.81 vs low: 46.5%, 95%CI 0.24-0.70; n=157), lower RR (high: 16.9%, 95%CI 0.10-0.25 vs low: 33%, 95%CI 0.04-0.72; n=157), and lower acute GVHD incidence (high: 27.6%, 95%CI 0.20-0.36 vs low: 49.7%, 95%CI 0.26-0.74; n=157). Therapeutic NK or cytokine-induced killer (CIK) cell infusions for hematologic relapse post-HSCT reported an overall response rate (ORR) and complete response (CR) of 48.9% and 11% with CIK cell infusions and 82.8% and 44.8% with NK cell infusions, respectively. RR, acute GVHD, and chronic GVHD were observed in 55.6% and 51.7%, 34.5% and 20%, and 20.7% and 11.1% of patients with CIK and NK cell infusions, respectively. Pre-emptive donor-derived NK cell infusions to prevent relapse post-HSCT had promising outcomes with 1-year OS of 69%, CR rate of 42%, ORR of 77%, RR of 28%, and acute and chronic GVHD rates of 24.9% and 3.7%, respectively. Conclusion: NK cells have a favorable impact on outcomes after HSCT. The optimal use of NK cell infusions post-HSCT may be in a pre-emptive fashion to prevent disease relapse

Low apoplastic Na+ and intracellular ionic homeostasis confer salinity tolerance upon Ca2SiO4 chemigation in Zea mays L. under salt stress

Salinity is known to have a greater impact on shoot growth than root growth. Na+ buildup in plant tissue under salt stress has been proposed as one of the main issues that causes growth inhibition in crops via ionic imbalances, osmotic stress and pH disturbances. However, the evidence for apoplastic Na+ buildup and the role of silicon in Na+ accumulation at the subcellular level is still enigmatic. The current study focuses on the accumulation of Na+ in the apoplast and symplast of younger and older leaves of two maize varieties (Iqbal as salt-tolerant and Jalal as salt-sensitive) using hydroponic culture along with silicon supplementation under short-term salinity stress. Subcellular ion analysis indicated that silicon nutrition decreased Na+ concentration in both apoplastic washing fluid and symplastic fluid of maize under salt stress. The addition of silicon under NaCl treatment resulted in considerable improvement in fresh biomass, relative water content, chlorophyll content, and concentration of important subcellular ions (i.e., Ca2+, Mg2+, and K+). Knowledge of subcellular ion analysis is essential for solving the mechanisms underlying vital cellular functions e.g. in the current study, the soluble Na+ concentration in the apoplast of older leaves was found to be significantly greater (36.1 mM) in the salt-sensitive variety under NaCl treatment, which was 42.4% higher when compared to the Na+ concentration in the salt-tolerant variety under the same treatment which can influence permeability of cell membrane, signal transduction pathways and provides insights into how ion compartmentalization can contributes to salt tolerance. Calcium silicate enrichment can contribute to increased growth and improved ionic homeostasis by minimizing leaf electrolyte leakage, improving mechanical functions of cell wall and reducing water loss, and improved photosynthetic function. In current investigation, increased water content and intracellular ionic homeostasis along with reduced concentration of Na+ in the maize leaf apoplast suggest that calcium silicate can be used to ameliorate the adverse effects of salt stress and obtain yield using marginal saline lands

Outcomes with chimeric antigen receptor t-cell therapy in relapsed or refractory acute myeloid leukemia: a systematic review and meta-analysis

BackgroundWe conducted a systematic review and meta-analysis to evaluate outcomes following chimeric antigen receptor T cell (CAR-T) therapy in relapsed/refractory acute myeloid leukemia (RR-AML).MethodsWe performed a literature search on PubMed, Cochrane Library, and Clinicaltrials.gov. After screening 677 manuscripts, 13 studies were included. Data was extracted following PRISMA guidelines. Pooled analysis was done using the meta-package by Schwarzer et al. Proportions with 95% confidence intervals (CI) were computed.ResultsWe analyzed 57 patients from 10 clinical trials and 3 case reports. The pooled complete and overall response rates were 49.5% (95% CI 0.18-0.81, I2 =65%) and 65.2% (95% CI 0.36-0.91, I2 =57%). The pooled incidence of cytokine release syndrome, immune-effector cell associated neurotoxicity syndrome, and graft-versus-host disease was estimated as 54.4% (95% CI 0.17-0.90, I2 =77%), 3.9% (95% CI 0.00-0.19, I2 =22%), and 1.6% (95%CI 0.00-0.21, I2 =33%), respectively.ConclusionCAR-T therapy has demonstrated modest efficacy in RR-AML. Major challenges include heterogeneous disease biology, lack of a unique targetable antigen, and immune exhaustion

Analyses of structural and electrical properties of aluminium doped ZnO-NPs by experimental and mathematical approaches

Pure and aluminium doped ZnO-NPs were played the central role in every field of life due to extraordi-nary physical, chemical and electrical properties. The main objective of the present research was used to enhance the electrical conductivity and reduce the electrical resistivity of aluminium doped zinc oxide-NPs. Synthesis of pure and aluminium doped zinc oxide-NPs (Zn1-xAlxO) at x = 0, 2.5, 5, 7.5 and 10 wt% was carried out by co-precipitation method. The XRD results depicted that hexagonal wurtzite crystal structure and crystallite size in the range of 13-25 nm were calculated by using Debye-Scherrer's equa-tion. Likewise, the non-uniform, irregular and pore like surface morphology of the prepared NPs was evi-dent from SEM micrographs. Various functional groups (CH, CO, OH and ZnO) attached to the surface of aluminium doped zinc oxide-NPs were identified by FTIR analysis. The UV-VIS spectra also depicted a shift towards the blue region of the visible spectrum. In terms of electrical properties with the help of experimental and mathematical analyses of aluminum doped zinc oxide-NPs exhibited higher conductiv-ity (1.34 x 10(-6) to 1.43 x 10(-3) S/cm) and lower resistivity (5.46 x 10(5) to 6.99 x 10(2) Omega-cm). The present results suggest that the aluminum doped zinc oxide-NPs have been improved the structural and electrical properties which make it a good candidate for optoelectronic devices. (c) 2021 The Authors. Published by Elsevier B.V. on behalf of King Saud University. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).</p

A multidisciplinary approach to triage patients with breast disease during the COVID-19 pandemic: Experience from a tertiary care center in the developing world

Background: The COVID-19 pandemic has created a need to prioritize care because of limitation of resources. Owing to the heterogeneity and high prevalence of breast cancers, the need to prioritize care in this vulnerable population is essential. While various medical societies have published recommendations to manage breast disease during the COVID-19 pandemic, most are focused on the Western world and do not necessarily address the challenges of a resource-limited setting.Aim: In this article, we describe our institutional approach for prioritizing care for patients presenting with breast disease.Methods and results: The breast disease management guidelines were developed and approved with the expertise of the Multidisciplinary Breast Program Leadership Committee (BPLC) of the Aga Khan University, Karachi, Pakistan. These guidelines were inspired, adapted, and modified keeping in view the needs of our resource-limited healthcare system. These recommendations are also congruent with the ethical guidelines developed by the Center of Biomedical Ethics and Culture (CBEC) at the Sindh Institute of Urology and Transplantation (SIUT), Karachi. Our institutional recommendations outline a framework to triage patients based on the urgency of care, scheduling conflicts, and tumor board recommendations, optimizing healthcare workers\u27 schedules, operating room reallocation, and protocols. We also describe the Virtual Blended Clinics , a resource-friendly means of conducting virtual clinics and a comprehensive plan for transitioning back into the post-COVID routine.Conclusion: Our institutional experience may be considered as a guide during the COVID-19 pandemic, particularly for triaging care in a resource-limited setting; however, these are not meant to be universally applicable, and individual cases must be tailored based on physicians\u27 clinical judgment to provide the best quality care