Ultraviolet Radiation Effects On Rotifers

The purpose of this investigation was to study ultraviolet radiation effects on rotifers. The rotifer studied was Philodina acuticornis odiosa Milne. Isolation cultures were used to grow the rotifers individually in separate U-plate depressions. The source of ultraviolet radiation consisted of four mercury germicidal lamps used in combination to deliver a uniform flux of 315 uW/cm2 over the sample. Five groups of rotifers, one control and four experimental groups of 96 each, were used. The rotifers used were 2-10 hours of age at the beginning of the experiment. The experimental groups were exposed to uv radiation for 3 minutes, 5 minutes, 7 minutes, 9 minutes. The mean lifetime of each of the control, 3 minutes, 5 minutes, 7 minutes, and 9 minutes irradiated groups was 20.4 days, 19.1 days, 17.1 days, 11.5 days, and 6.3 days respectively. No specific theory, nor the mechanism involved is given to explain these uv radiation effects on rotifers. From the data, it is concluded that some radiation shortens the mean lifetimes of rotifers and that there is a threshold exposure after which the survival of the rotifer changes drastically

Management Strategy in Non-Limb-Threatening Acute Ischaemia of Limbs: Should We Rethink?

The Society of Vascular Surgery and the International Society of Cardiovascular Surgery identify three types of acute limb ischaemia to inform prognosis and management. Type 1 limb ischaemia is non-limb-threatening and is currently managed conservatively. We describe three cases of Type 1 limb ischaemia with femoropopliteal occlusion that were managed differently. The first case was initially managed conservatively but resulted in an adverse outcome following worsening of ischaemia. Overall, the cases managed with earlier intervention had good outcomes suggesting that conservative management alone may not be sufficient despite resolution of symptoms. The trend in other vessel diseases such as NSTEMI and TIA is towards earlier intervention, for example, PCI and CEA. It is likely that acute limb ischaemia has a similar natural history to these conditions. It is time to consider earlier revascularisation in selected patients with non-limb-threatening ischaemia

Technical and Quality Standards and Practices in Healthcare Facilities

This paper presents the highlights of many technical standards, as established by International Organization for Standardization (ISO) through International Classification for Standards (ICS) and British Standards (BS), and quality standards and practices as governed by some international, regional or national institutes in promoting patients rights and safety control in medical sciences and healthcare facilities. The paper draws attention to adopt these standards in Pakistan

Antioxidant, antimicrobial and antiproliferative activities of peel and pulp extracts of red and white varieties of Ipomoea batatas (L) Lam

Purpose: To investigate the antioxidant, antibacterial and anticancer potentials of methanol and ethanol extracts of the peel and pulp of red and white species of Ipomoea batatas (L.) fruit.Methods: Total phenolic contents and flavonoids were determined using chemical assays. Antioxidant studies were carried out using 2,2-diphenyl-1-picrylhydrazyl (DPPH) free radical scavenging assay, inhibition of linoleic acid peroxidation assay and reducing power assay. Antibacterial and antiproliferative activities of extracts were determined using disc diffusion and MDBK cancer cell line inhibition methods, respectively.Results: The extract of peels of red specie (PERS) showed total phenolic contents (TPC) 8.9 mg gallic acid equivalent (GAE)/g dry extract and flavonoids 6.5 mg catechin equivalent (CE)/g dry extract. The extract of PERS also showed promising DPPH free radical scavenging activity, inhibition of linoleic acid peroxidation and reducing power activity. However, mild antibacterial and anti-proliferative activities were noted except that the extract showed significant inhibition of Bacillus subtilis growth.Conclusion: The results indicate that the peel and the pulp of red sweet potato (SP) specie are rich in antioxidants and can potentually be processed as antioxidant food supplements.Keywords: Ipomoea batatas (L.) Lam, Sweet potato, Phenolic content, Antioxidants, Antibacterial activity, Antiproliferative activit

Management of Fournier’s Gangrene; A Randomized Controlled Trial at High Volume Center Comparing the Efficacy of Honey and Eusol Dressing in Wound Healing

OBJECTIVE: To assess the effectiveness of honey dressing in Fournier’s Gangrene against conventional Edinburgh University solution of lime (EUSOL) dressing. METHODOLOGY: This was a prospective experimental study conducted in Liaquat National Medical College and Hospital Karachi for duration of 5 and half years. Total 44 patients having gangrene and no co morbid conditions were included in this study. Patients who had co-morbid conditions like deranged coagulation profile and CVA, who were not willing to participate or loss to follow up were excluded from the study. After getting baseline blood workup (i.e. CBC, S. Creatinine, S. Electrolytes, Urine D/R, C/S and Diabetic workup) done and taking consent, the patients were immediately shifted to operation theatre, the incision and drainage was performed, and the necrotic tissues were debrided. Pus cultures were sent, and patients were started on routine intravenous antibiotics (3rd generation Cephalosporin and metronidazole). A Dressing of wound was done randomly by honey in Group A and by Eusol in Group B. Patients were discharged after wound was completely healed. The data were obtained and analyzed by using SPSS version 20. Mann-Whitney U-test and chi-square test was applied to find out the significance. RESUTS: The patients in Group A got slough cleared in4.82±0.96 days, on average requiring 3.22±0.75 number of debridement’s, complete wound healing and duration of hospital stay being 9.54±0.74 days. The patients in Group B got slough cleared in 8±0.87 days, requiring 5.32±0.72 number of debridement’s, complete wound healing and duration of hospital stay 13.68±1.09 days.There was a significant difference in slough clearance, number of debridement’s required, time taken for complete wound healing and hospital stay between Group A and Group B (P-value <0.001). CONCLUSION: This study predicted that honey is very valuable in the management of Fournier’s gangrene as it ensured early clearance of slough, required lesser number of debridement’s, had early wound healing and had relatively shorter duration of stay in hospital than those treated with conventional EUSOL as dressing material

Virtual reality as a non-conventional rehabilitation for stroke: : A comprehensive review

The authors thank Michael Irvine, PhD, from Liwen Bianji (Edanz) (www.liwenbianji.cn) for editing the English text of a draft of this manuscript.Peer reviewe

Thermo-economic and environmental analysis of integrating renewable energy sources in a district heating and cooling network

This paper presents the technical, environmental, and economic evaluation of integrating various combinations of renewable energy sources-based systems in the expansion of a district heating and cooling network of a Technology Park near Barcelona in Spain. At present, a combined heat and power plant running on fossil fuels serves the heating, cooling, and electricity demand of the Park. However, this energy demand is expected to increase substantially in the coming years. EnergyPRO software was used to model the energy demand growth till 2030. Validation of the software application was done by making a base model using real plant data from the year 2014. The software was then used to project the energy supply based on three 15-year scenarios, having different combinations of renewable energy technologies, from 2016 until 2030. Primary energy consumption, CO2 emissions, and the net present value obtained in each scenario were used to decide the best combinations of renewable energy sources. The results of the study showed that presently, biomass boilers combined with absorption chillers and supported with solar thermal cooling are the most competitive technologies in comparison to ground source heat pumps for large DHC networks. This is mainly because of the lower primary energy consumption (624,380 MWh/year in 2030 vs. 665,367 MWh/year), higher net present value (NPV) (222 million € vs. 178 million €), and lower CO2 emissions (107,753 tons/year in 2030 vs. 111,166 tons/year) obtained as a result of the simulations

Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

Background: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. Methods: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]). Interpretation: Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions

Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes