39 research outputs found

    Study of Portal vein Doppler indices and other noninvasive markers as predictors of esophageal varices in cirrhotic patients

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    INTRODUCTION: Portal hypertension commonly accompanies liver cirrhosis. The development of esophageal varices (EV) is one of the major complications of portal hypertension. The prevalence of EV in patients with liver cirrhosis ranges from 60% to 80%. The risk of bleeding from these varices is associated with the severity of the liver disease and the size of varices, which are the most important predictors of bleeding. Large EVs (LEVs) are more likely to bleed than small EVs (SEVs) due to high variceal wall tension. Guildlines recommend that all cirrhotic patients should be screened for the presence of EV when liver cirrhosis is diagnosed. Upper gastrointestinal endoscopy, which is the most common and accurate procedure for evaluation of varices, is at times inconvenient for patients and not cost effective. Investigators have attempted to identify characteristics that ‘noninvasively’ predict the presence of varices. These studies have shown that biochemical, clinical, and ultrasonographic parameters alone or together have good predictive value for noninvasively assessing the presence of EV. AIM OF THE STUDY: 1.To evaluate portal hypertension parameters in liver cirrhosis by using Doppler ultrasound. 2.To evaluate other non-invasive parameters in predicting esophageal varices. 3. To correlate portal hypertension parameters in predicting Esophageal varices and upper GI bleed from esophageal varices. MATERIALS AND METHODS: 99 Cirrhotic patients registered in liver clinic (both old and new patients), Dept. of medical gastroenterolgy, Govt. Stanley medical college were enrolled in this study. The study period from April 2010 to February 2010. Their clinical presentation, Child-Pugh status, co-morbid conditions, baseline blood parameters, liver function test, etiology and endoscopic grading of varices will be noted. All patients will be subjected to Doppler evaluation of portal system including portal venous velocity, portal vein diameter, portal vein cross sectional area, the pulsatility and resistive index of hepatic, splenic arteries, spleen size were determined. Other indices like Liver vascular index, congestion index, portal hypertensive index and presence of porto-systemic collaterals also noted. Platelet/spleen ratio, AST/platelet ratio were calculated. The results were analysed and compared between patients without varices and with small and large varices. RESULTS: The most common etiology of cirrhosis in this part of country is Alcohol related liver disease (29%), followed by cryptogenic and Hepatitis B related liver disease (28% & 21% respectively). Non-invasive parameters like Platelet count (114578 in patients without varices vs. 78113 in patients with large varices, P=0.049), Prothrombin time (16.53±4.3 vs. 18.18±4.5, P=0.030), Platelet count/spleen diameter ratio (957 vs. 627, P=0.011) predicted the presence of large esophageal varices. Among the Colour Doppler Ultrasound study parameters, the Portal vein mean velocity (15.44±4.63 vs. 11.91±3.97, P=0.019), Liver vascular index (14.38±5.56 vs. 9.38±4.01, P=0.001), Spleen size>16.2 cm (13.34±4.20 vs.16.29±3.42, P=0.05) predicted the presence of large esophageal varices, increasing the risk for upper gastrointestinal bleeding. Other non-invasive parameters like CTP score, MELD, AST/Platelet ratio, Bilirubin, and Doppler parameters like portal vein diameter, hepatic artery resistive & pulsatility index, splenic artery resistive index, congestive index, portal hypertensive index did not predict the presence of either small or large varices. CONCLUSION: Results of our study indicate that non-invasive tools like platelet count, prothrombin time, platelet/spleen diameter ratio, spleen size >16.2 cm, and Doppler parameters like portal vein velocity, liver vascular index are predictors of presence of large esophageal varices

    Effects of Hot Isostatic Pressing on the Properties of Laser-Powder Bed Fusion Fabricated Water Atomized 25Cr7Ni Stainless Steel

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    25Cr7Ni stainless steel (super duplex stainless steels) exhibits a duplex microstructure of ferrite and austenite, resulting in an excellent combination of high strength and corrosion resistance. However, Laser-Powder Bed Fusion fabrication of a water-atomized 25Cr7Ni stainless steel of novel chemical composition resulted in a purely ferritic microstructure and over 5% porosity. The current study investigated the effects of two hot isostatic pressing parameters on the physical, mechanical, and corrosion properties as well as microstructures of water-atomized 25Cr7Ni stainless steel of novel composition fabricated by L-PBF for the first time in the literature. The corrosion behaviour was studied using linear sweep voltammetry in a 3.5% NaCl solution. The Hot Isostatic Pressing-treated sample achieved over 98% densification with a corresponding reduction in porosity to less than 0.1% and about 3 similar to 4% in annihilation of dislocation density. A duplex microstructure of ferrite 60% and austenite 40%was observed in the X-Ray Diffraction and etched metallography of the HIP-treated samples from a purely ferritic microstructure prior to the HIP treatment. With the evolution of austenite phase, the HIP-treated samples recorded a decrease in Ultimate Tensile Strength, yield strength, and hardness in comparison with as-printed samples. The variation in the morphology of the evolved austenite grains in the HIP-treated samples was observed to have a significant effect on the elongation. With a reduction in porosity and the evolution of the austenite phase, the HIP-treated samples showed a higher corrosion resistance in comparison with the as-printed samples

    Sustained release formulation of an anti-tuberculosis drug based on para-amino salicylic acid-zinc layered hydroxide nanocomposite

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    Background: Tuberculosis (TB), is caused by the bacteria, Mycobacterium tuberculosis and its a threat to humans since centuries. Depending on the type of TB, its treatment can last for 6-24 months which is a major cause for patients non-compliance and treatment failure. Many adverse effects are associated with the currently available TB medicines, and there has been no new anti-tuberculosis drug on the market for more than 50 year, as the drug development is very lengthy and budget consuming process.Development of the biocompatible nano drug delivery systems with the ability to minimize the side effects of the drugs, protection of the drug from enzymatic degradation. And most importantly the drug delivery systems which can deliver the drug at target site would increase the therapeutic efficacy. Nanovehicles with their tendency to release the drug in a sustained manner would result in the bioavalibilty of the drugs in the body for a longer period of time and this would reduce the dosing frequency in drug administration. The biocompatible nanovehicles with the properties like sustained release of drug of the target site, protection of the drug from physio-chemical degradation, reduction in dosing frequency, and prolong bioavailability of drug in the body would result in the shortening of the treatment duration. All of these factors would improve the patient compliance with chemotherapy of TB.Result: An anti-tuberculosis drug, 4-amino salicylic acid (4-ASA) was successfully intercalated into the interlamellae of zinc layered hydroxide (ZLH) via direct reaction with zinc oxide suspension. The X-ray diffraction patterns and FTIR analyses indicate that the molecule was successfully intercalated into the ZLH interlayer space with an average basal spacing of 24 Å. Furthermore, TGA and DTG results show that the drug 4-ASA is stabilized in the interlayers by electrostatic interaction. The release of 4-ASA from the nanocomposite was found to be in a sustained manner. The nanocomposite treated with normal 3T3 cells shows it reduces cell viability in a dose- and time-dependent manner.Conclusions: Sustained release formulation of the nanocomposite, 4-ASA intercalated into zinc layered hydroxides, with its ease of preparation, sustained release of the active and less-toxic to the cell is a step forward for a more patient-friendly chemotherapy of Tuberculosis

    Hypoxic-mediated oxidative stress condition and hydroxyapatite-inducing osteogenic differentiation of human mesenchymal stem cells: a mathematical modelling study

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    Avascular necrosis (AVN) of the bones remains a major clinical challenge. Fractures in the talus, the scaphoid, and the neck of the femur are especially challenging to heal due to the low blood vessel network and the lack of collateral blood supply. These fractures are associated with high rates of nonunion and increased infections that require repeated operations. Conventional treatments by autografting or allografting bone replacement and synthetic bone implants have limitations, including the invasiveness of operative procedures, tissue supply insufficiency, and the risk of host rejection. The advancement in tissue engineering has revealed the potential of stem cells as restorative agents for bone injuries. The administration of mesenchymal stem cells (MSCs) into the talus, the scaphoid, and the neck of the femur could produce enhanced osteogenesis via the manipulation of MSC culture conditions. In this study, we used hydroxyapatite as the nanomaterial, and hypoxic milieu to enhance MSC differentiation capacity into the osteogenic lineage, allowing for more rapid and efficient bone cell replacement treatment. Our results demonstrate 1% oxygen and 12.5 μg/mL of hydroxyapatite (HAP) as the optimal conditions to incorporate the osteogenic medium for the osteogenic induction of MSCs. We also established a proof of concept that the addition of HAP and hypoxic conditions could augment the osteoinductive capacity of MSCs. We also developed an accurate mathematical model to support future bone cell replacement therapy

    Diagnosis of typhoid fever by ELISA

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    A rare case of anti-jo1 syndrome presenting as a interstitial lung disease

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    Antisynthetase syndrome is a rare entity and can be missed if not specifically looked in patients whose initial presentation is with Interstitial Lung Disease. Prognosis is altered when patients presenting with Interstitial Lung Disease. A 45 years old lady with no known comorbidities came with complaints of fever, breathlessness and cough for 4 months. She also had history of muscle weakness. She was treated as COVID pneumonia with oral steroids as her CT chest showed bilateral GGO's. When she came to our hospital she was afebrile, hemodynamically stable, SPo2-88% on room air. She was negative for COVID and COVID antibodies were also negative. On Investigations her CPK, Aldolase, CKMB were elevated. Her ENA profile showed positive anti-Jo1 and anti Ro 52 antibodies. Electromyography and Muscle biopsy suggestive of Inflammatory Myopathy. PFT showed restrictive pattern with reduced Diffusing Capacity of Lung for Carbon Monoxide(DLCO). She was treated with high dose oral steroids and cyclophosphamide. She responded well to the treatment and discharged. Though antisynthetase syndrome is a rare disease, we should keep in mind when patients presenting with interstitial Lung disease. Patients presenting with ILD have guarded prognosis

    Laser powder bed fusion of in-situ composites using dry-mixed Ti6Al4V and Si3N4 powder

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    Herein, we report laser powder bed fusion (L-PBF) of dry-mixed Ti6Al4V + Si3N4 powder to create in-situ titanium matrix composites. The dry-mixed Ti6Al4V powder with 5 wt.% Si3N4 was processed using L-PBF at varying laser energy densities, between 44 and 133 J/mm(3), by changing the laser scan speed (400-1200 mm/s) at constant laser power of 96 W, layer thickness of 20 mu m and scan spacing of 90 mu m. The selected samples were examined for microstructural evolution, in-situ reaction products and hardness. The results showed that the in situ reaction between liquid titanium and Si3N4 forms fine TiN and Ti5Si3 reinforcements in these L-PBF processed samples. However, the irregular shape and fine size of Si3N4 reduced the feedstock flowability, and the composites could not be processed with laser energy density (E) < 89 J/mm(3). The amount, distribution and size of the reinforcements were found to depend on the laser energy density. These in-situ composites exhibited high hardness of 860 +/- 49 KHN, which is 110 % higher than that of Ti6Al4V and ex-situ processed Ti-TiN and Ti-TiC composites. Our results show that the dry-mixed Ti6Al4V-Si3N4 feedstock can be processed using L-PBF but further improvement is required through adjusting Si3N4 powder attributes (size, shape) and concentration
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