Drug induced liver injury is associated with high mortality- A study from a tertiary care hospital in Pakistan

Background and aim: In light of few established drug induced liver injury (DILI) registries, this study aims to evaluate the clinical spectrum and predictors of mortality and morbidity of hospitalized patients with suspected DILI.Patients and methods: DILI cases were identified and categorized on basis of COIMS/RUCAM score and the exclusion of other liver diseases. Clinical and laboratory parameters were analyzed to identify the predictors of morbidity (prolonged hospital stay \u3e 5 days) and mortality.Results: Out of 462 patients, there were 264 (57.6%) males and the mean age of the cohort was 50.83 years (range: 20-94 years). DILI was classified as definite or highly probable in 31.1%, probable in 62.5%, and possible in 7.4% of cases. Pattern of liver injury was hepatocellular in 25.1%, cholestatic in 56.17%, and mixed in 18.72% of patients. Anti-tuberculosis drugs (ATDs) were found to be the most common category of drugs causing DILI, in 295 (63.9%) patients. Clinically, encephalopathy was present in 21.6% patients; other presenting symptoms included abdominal pain (57.1%), vomiting (57.1%), jaundice (54.1%) and pruritus (42.3%). In-hospital mortality was 26.5% and prolonged hospital stay (\u3e 5 days) was observed in 35.93% of patients. Mortality was significantly greater in patients with encephalopathy, male gender, hepatocellular pattern of DILI, increased INR and use of ventilator support.Conclusion: In our study, the most frequent cause of DILI in hospitalized patients was ATDs. More than a quarter of patients died during hospital stay. A close control of clinical and biochemical parameters are required to prevent and monitor DILI, especially in patients taking ATDs in our region

Minimal hepatic encephalopathy: Effect of H. pylori infection and small intestinal bacterial overgrowth treatment on clinical outcomes

The effect Helicobacter pylori (Hp) infection and small intestinal bacterial over growth (SIBO) in minimal hepatic encephalopathy (MHE) is not well understood. The aim of the study was to determine the effect of eradication of Hp infection and SIBO treatment on MHE in patients with cirrhosis. Patients with cirrhosis were enrolled and MHE was determined by psychometric tests and critical flicker frequency analysis. Hp infection and SIBO were assessed by urea breath and Hydrogen breath tests respectively in patients with cirrhosis and in healthy volunteers. Patients with Hp infection and SIBO were given appropriate treatment. At six weeks follow-up, presence of Hp infection, SIBO and MHE status was reassessed. Ninety patients with cirrhosis and equal number of healthy controls were included. 55 (61.1%) patients in the cirrhotic group were diagnosed to have underlying MHE. Among cirrhotic group, Hp infection was present in 28 with MHE (50.9%) vs. in 15 without MHE (42.8%) (p = 0.45). Similarly, SIBO was present in 17 (30.9%) vs. 11 (31.4%) (p = 0.95) in patients with and without MHE respectively. In comparison with healthy controls, patients with cirrhosis were more frequently harboring Hp and SIBO (47.7% vs. 17.7% (p \u3c 0.001) and 31.1% vs. 4.4% (p \u3c 0.001) respectively. On follow-up, all patients showed evidence of eradication of Hp and SIBO infection. Treatment of SIBO significantly improved the state of MHE in cirrhotics, however eradication of Hp infection did not improve MHE significantly. Additionally, patients with low Model for End-Stage Liver Disease (MELD) score and belonging to Child class B had significantly better improvement in MHE. A large number of patients with cirrhosis had either active Hp infection or SIBO with or without MHE, compared to healthy controls. Treatment of SIBO significantly improved MHE in patients with cirrhosis, whereas eradication of Hp did not affect the outcome of MHE in these patients

Passive cooling analysis of an electronic chipset using nanoparticles and metal-foam composite PCM: An experimental study

Thermal management of electronic components is critical for long-term reliability and continuous operation, as the over-heating of electronic equipment leads to decrement in performance. The novelty of the current experimental study is to investigate the passive cooling of electronic equipment, by using nano-enriched phase change material (NEPCM) with copper foam having porosity of 97 %. The phase change material of PT-58 was used with graphene nanoplatelets (GNPs) and magnesium oxide (MgO) nanoparticles (NPs), having concentrations of 0.01 wt. % and 0.02 wt. %. Three power levels of 8 W, 16 W, and 24 W, with corresponding heating inputs of 0.77 kW/ m2, 1.54 kW/ m2 and 2.3 kW/ m2, respectively, were used to simulate the heating input to heat sink for thermal characterization. According to results, at 0.77 kW/ m2 heating input the maximum base temperature declined by 13.03 % in 0.02 wt. % GNPs-NEPCM/copper foam case. At heating input of 1.54 kW/ m2, the maximum base temperature reduction of 16 % was observed in case of 0.02 wt. % GNPs-NEPCM/copper foam and 13.1 % in case of 0.02 wt. % MgO-NEPCM/copper foam. Similarly, at heating input of 2.3 kW/ m2, the maximum temperature of base lessened by 12.58 % in case of 0.02 wt. % GNPs-NEPCM/copper foam. The highest time to reach the set point temperature of 50 ⁰ C, 60 ⁰ C, and 70 ⁰ C was in case of GNPs-NEPCM/copper foam composites, while at all power levels MgO-NEPCM/copper foam gave comparable performance to GNPs based composite. Similar trend was observed in the study of enhancement ratio in operation time. From the results, it is concluded that the copper foam incorporation in NEPCM is an effective measure to mitigate the heat sink base temperature and can provide best cooling efficiency at low and higher heating loads

VisTAS:Blockchain-based Visible and Trusted Remote Authentication System

The information security domain focuses on security needs at all levels in a computing environment in either the Internet of Things, Cloud Computing, Cloud of Things, or any other implementation. Data, devices, services, or applications and communication are required to be protected and provided by information security shields at all levels and in all working states. Remote authentication is required to perform different administrative operations in an information system, and Administrators have full access to the system and may pose insider threats. Superusers and administrators are the most trusted persons in an organisation. “Trust but verify” is an approach to have an eye on the superusers and administrators. Distributed ledger technology (Blockchain-based data storage) is an immutable data storage scheme and provides a built-in facility to share statistics among peers. Distributed ledgers are proposed to provide visible security and non-repudiation, which securely records administrators’ authentications requests. The presence of security, privacy, and accountability measures establish trust among its stakeholders. Securing information in an electronic data processing system is challenging, i.e., providing services and access control for the resources to only legitimate users. Authentication plays a vital role in systems’ security; therefore, authentication and identity management are the key subjects to provide information security services. The leading cause of information security breaches is the failure of identity management/authentication systems and insider threats. In this regard, visible security measures have more deterrence than other schemes. In this paper, an authentication scheme, “VisTAS,” has been introduced, which provides visible security and trusted authentication services to the tenants and keeps the records in the blockchain

A semantic rule based digital fraud detection

Digital fraud has immensely affected ordinary consumers and the finance industry. Our dependence on internet banking has made digital fraud a substantial problem. Financial institutions across the globe are trying to improve their digital fraud detection and deterrence capabilities. Fraud detection is a reactive process, and it usually incurs a cost to save the system from an ongoing malicious activity. Fraud deterrence is the capability of a system to withstand any fraudulent attempts. Fraud deterrence is a challenging task and researchers across the globe are proposing new solutions to improve deterrence capabilities. In this work, we focus on the very important problem of fraud deterrence. Our proposed work uses an Intimation Rule Based (IRB) alert generation algorithm. These IRB alerts are classified based on severity levels. Our proposed solution uses a richer domain knowledge base and rule-based reasoning. In this work, we propose an ontology-based financial fraud detection and deterrence model

MobChain:Three-Way Collusion Resistance in Witness-Oriented Location Proof Systems Using Distributed Consensus

Smart devices have accentuated the importance of geolocation information. Geolocation identification using smart devices has paved the path for incentive-based location-based services (LBS). However, a user’s full control over a smart device can allow tampering of the location proof. Witness-oriented location proof systems (LPS) have emerged to resist the generation of false proofs and mitigate collusion attacks. However, witness-oriented LPS are still susceptible to three-way collusion attacks (involving the user, location authority, and the witness). To overcome the threat of three-way collusion in existing schemes, we introduce a decentralized consensus protocol called MobChain in this paper. In this scheme the selection of a witness and location authority is achieved through a distributed consensus of nodes in an underlying P2P network that establishes a private blockchain. The persistent provenance data over the blockchain provides strong security guarantees; as a result, the forging and manipulation of location becomes impractical. MobChain provides secure location provenance architecture, relying on decentralized decision making for the selection of participants of the protocol thereby addressing the three-way collusion problem. Our prototype implementation and comparison with the state-of-the-art solutions show that MobChain is computationally efficient and highly available while improving the security of LPS