Antibiotics in acute necrotizing pancreatitis: Perspective of a developing country

Prophylactic antibiotics in acute necrotizing pancreatitis is controversial. The mortality of acute necrotizing pancreatitis is 8-25% in the western world. In view of the limited resources available for managing the complications of infected pancreatitis in developing countries, the use of prophylactic antibiotics may be recommended in selected cases. Various antibiotics show good penetration into the pancreatic tissue; imipenem and quinolones have better penetration. Clinical trials on the use of prophylactic antibiotics in necrotizing pancreatitis have been reviewed. Prophylactic antibiotics have been considered if greater than 30% pancreatic necrosis as documented by CT scan. Imipenem can be given for a duration of 10 to 14 days if no systemic complications are present. In a developing country where the cost of managing complications of pancreatitis can be a limiting factor for patients, the use of prophylactic antibiotics early on in the disease in selected cases can be beneficial

Estrogen receptor alpha-negative and progesterone receptor-positive breast cancer: lab error or real entity?

Aretrospective study comparing the estrogen receptor (ER) alpha subtype and progesterone receptor (PR) profile of breast carcinomas amongst 1625 cases over 2.5 years was carried out. Strictly speaking it is generally believed that breast carcinomas can biochemically express PR only if they are ER-positive. However, a few ERalpha-PR+ cases do exist paradoxically. This class of tumors was the focus of our study in which we looked at the possible reasons for such an immunophenotype and compared it with a group of ERalpha+PR+ breast carcinomas. An internationally recognized immunohistochemical method employing monoclonal antibodies against estrogen and progesterone receptors was used. Correlations with established risk factors i.e. menopausal status, grade, tumor size and lymph node status were analyzed for our study group (ERalpha-PR+) and compared with a control (ERalpha+PR+). Out of the total 1625 cases, 29.91% (486) were ERalpha+PR+, 5.11% (83) were ERalpha+PR-, 56.86% (924) were ERalpha-PR- and 8.12% (132) were ERalpha-PR+. Patients\u27 age was significantly lower in the ERalpha-PR+ group (P=0.002). Statistical analysis of the grading between the two study groups revealed no significant difference (P=0.091), although the ERalpha-PR+ group contained significantly more poorly differentiated tumors than the ERalpha+PR+ one (P=0.032). Tumor size was also significantly larger in the ERalpha-PR+ than in the ERalpha+PR+ group (P=0.046). The frequency of lymph node metastases was independent of receptor profile. In conclusion, our study group does exhibit characteristics which are suggestive of a distinct breast cancer phenotype (ERalpha-PR+) with a different etiology and prognosis

Tuberculous and cryptococcal meningitis in a setting with high TB and low HIV prevalence

OBJECTIVE: To compare the differences in presentation and outcome of patients with tuberculous meningitis (TBM) and cryptococcal meningitis (CCM). STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, from December 1995 to December 2005. METHODOLOGY: Patients with a confirmed diagnosis of TBM or CCM were included in this study. The signs and symptoms, laboratory findings and other variables of patients were entered and analyzed by Statistical Package for Social Sciences (SPSS) Software version 14. RESULTS: We compared 16 patients of TBM with 11 of CCM. None of the patients with TBM were Human Immunodeficiency Virus (HIV) positive while 4 patients with CCM had HIV. The common initial signs and symptoms in patients with TBM were fever, altered mental status and headache; and in patients with CCM were fever, headache and cough. The mean CSF glucose level decreased according to the Medical Research Council (MRC) stage in TBM. The mean CSF RBCs, WBCs, glucose and protein in TBM were 2010/mm3, 228/mm3, 52.32 mg/dL and 289.48 mg/dl respectively and in CCM were 178.54/mm3, 529.54/mm3, 32.63 mg/dL and 432.18 mg/dL respectively. CONCLUSION: TBM and CCM should be suspected in all cases that present with symptoms of chronic meningitis. Patients with TBM are more likely to have altered mental status and higher CSF RBCs; those with CCM are more likely to have headache, cough and higher CSF WBCs

Determining potential of subcooling to attenuate hydrodynamic instabilies for steam-water two phase flow

Hydrodynamic instabilities are regarded as important but are undesirable occurrences for the systems used in process industries, which involve steam. These instabilities affect to a great extent the life line of the safe operation of their systems by inducing thermal stresses and steam induced water hammers. On the basis of system operational analysis, it was found that condensation induced hydrodynamic instabilities were responsible for one third of the destructive events in steam driven systems and their attributes in power and process industry. Thus it becomes vital to investigate the influence of critical parameter such as sub-cooling to curb the destructive effects due to hydrodynamic instabilities on to the process equipment. Here for steam water two phase flows, the attenuation of hydrodynamic instabilities due to sub-cooling and inlet pressure has been investigated. It was found that sub-cooling has more pronounced and notable effect on the attenuation of these instabilities

Correlation of red cell distribution width with inflammatory markers and its prognostic value in patients with diabetes and coronary artery disease

Background. Recent studies have shown red blood cell distribution width (RDW) as a marker for severity and prognosis in coronary artery disease patients. Other studies have also correlated RDW with diabetes mellitus and inflammation. However, such correlation and prognosis in patients with concomitant coronary artery disease and diabetes after percutaneous intervention remains unclear. Material and methods. Our study group comprised of 730 subjects including 700 patients (cases) and 30 normal subjects (control group). Patients who presented with coronary artery disease were divided into diabetic and non-diabetic groups. All patients had RDW measured at admission and percutaneous intervention was done. Follow-up for adverse events was carried out between 6 to 12 months. Results. RDW was elevated in patients as compared to control group (p < 0.05). RDW correlated well with inflammatory markers including erythrocyte sedimen­tation rate, C-reactive protein, HbA1c, white blood cells and troponin. RDW was higher with more severe atherosclerosis based on SYNTAX and Gensini scores (p < 0.05). Prognosis was found to be worse in patients with high RDW as well as in diabetics. Conclusions. RDW has positive correlation with other inflammatory marker. It may be used as a marker in determining the severity and prognosis in diabetic patients with coronary artery disease

Morphology of the proximal femur in a Pakistani population

Purpose: To measure the morphology of the proximal femur in a Pakistani population. Methods: Standardised anteroposterior pelvic radiographs of 116 male and 20 female healthy volunteers aged 20 to 50 (mean, 33) years were taken. Morphologic dimensions of the proximal femur were measured, including canal flare index (CFI), morphological cortical index (MCI), femoral head offset, femoral head diameter, and femoral head position. Results: Based on the CFI, 67% of the subjects had normal canal shapes (CFI, 3.0-4.7), whereas 1% and 33% of the subjects had stovepipe shapes (CFI,2.7). Conclusions: Morphology of the proximal femur in our study population differed significantly from those in western populations, indicating regional variation. It could also be due to the younger age of our population

Knowledge attitude and practices of undergraduate students regarding first aid measures

OBJECTIVES: To assess knowledge, attitude and practices of first aid measures in undergraduate students of Karachi. METHODS: A cross-sectional study was carried out at six colleges of Karachi, three of which were medical colleges and three non-medical colleges. Knowledge was assessed regarding various emergency situations with the help of a questionnaire. The target population size was 460, based on 50% prevalence and 95% confidence interval. The eventual sample size achieved was 446. RESULTS: A total of 446 students were interviewed. Seventy eight students (17.5%) had formal First Aid (FA) training. The mean number of correct answers of students with FA training was 10.3 (+/- 3.5) as opposed to 8.58 (+/- 4.0) in those without FA training (p \u3c 0.001, 95% CI) with a mean difference of 7.84%. The mean number of correct answers by medical students with FA training was 11.2 (+/- 2.9) as opposed to 7.2 (+/- 3.43) by non-medical students (p \u3c 0.001, 95% CI) with a mean difference of 18.14%. Students having received formal first aid training scored better than those who had not (p \u3c 0.001). CONCLUSION: First aid training programmes should be introduced at school and college level in developing countries to decrease the early mortality and morbidity of accidents and emergencies

Forced vibration characteristics of embedded graphene oxide powder reinforced metal foam nanocomposite plate in thermal environment

Abstract Dynamic behavior of a new class of nanocomposites consisted of metal foam as matrix and graphene oxide powders as reinforcement is presented in this study in the framework of forced vibration. Graphene oxide powders are dispersed through the thickness of a plate made from metal foam material according to four various functionally graded patterns on the basis of the Halpin-Tsai micromechanical homogenization method. Also, three kinds of porosity distributions including two symmetric and one uniform patterns are considered for the metal foam matrix. As external effects, the plate is rested on the Winkler-Pasternak substrate and under uniform thermal and transverse dynamic loadings. By an incorporation of the refined higher order plate theory and Hamilton's principle, the governing equations of the dynamically loaded graphene oxide powder reinforced metal foam nanocomposite plate are derived and then solved with Galerkin exact solution method to achieve the resonance frequencies and dynamic deflections of the structure. Moreover, the influence of different boundary conditions is taken into account. The results indicate that the forced vibrational response of the graphene oxide powder strengthened metal foam nanocomposite plate is dramatically dependent on various parameters such as graphene oxide powders' weight fraction, different boundary conditions, various porosity distributions, foundation parameters and temperature change of uniform thermal loading

Forced vibration characteristics of embedded graphene oxide powder reinforced metal foam nanocomposite plate in thermal environment

Dynamic behavior of a new class of nanocomposites consisted of metal foam as matrix and graphene oxide powders as reinforcement is presented in this study in the framework of forced vibration. Graphene oxide powders are dispersed through the thickness of a plate made from metal foam material according to four various functionally graded patterns on the basis of the Halpin-Tsai micromechanical homogenization method. Also, three kinds of porosity distributions including two symmetric and one uniform patterns are considered for the metal foam matrix. As external effects, the plate is rested on the Winkler-Pasternak substrate and under uniform thermal and transverse dynamic loadings. By an incorporation of the refined higher order plate theory and Hamilton's principle, the governing equations of the dynamically loaded graphene oxide powder reinforced metal foam nanocomposite plate are derived and then solved with Galerkin exact solution method to achieve the resonance frequencies and dynamic deflections of the structure. Moreover, the influence of different boundary conditions is taken into account. The results indicate that the forced vibrational response of the graphene oxide powder strengthened metal foam nanocomposite plate is dramatically dependent on various parameters such as graphene oxide powders' weight fraction, different boundary conditions, various porosity distributions, foundation parameters and temperature change of uniform thermal loading.This research is financially supported by the Ministry of Science and Technology of China (Grant No. 2019YFE0112400), National Science Foundation of China (Grant No. 52078310), the Taishan Scholar Priority Discipline Talent Group program funded by the Shan Dong Province, and the first-class discipline project funded by the Education Department of Shandong Province. The publication of this article was funded by Qatar National Library.Scopu

Computational Studies of Confined Submerge Fan to Circulate and Oxygenate Hypolimnetic Layer in Hydro Power Reservoirs

The oxygen level is deficient at the depth of the lakes or reservoirs due to thermal stratification. Due to deficient oxygen level at the bottom of thermal stratified lakes, the reduction reactions occur that form hydrogen sulphide, iron, phosphorous and other compounds which are harmful to the water quality, fish life as well as dam or reservoir structures and other species. Hypolimnetic aeration and oxygenation systems can be used for this purpose to prevent the formation of harmful substances. A prototype design of submerged fan will be used to penetrate at maximum depth of the lakes or reservoirs and find the velocity of the submerged fan through CFD simulations