International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

Development of chitosan based optical fiber chemical sensors

In recent years there has been a tremendous progress in the development of polymer based fiber optic sensors. Particular emphasis on research has been focused on in-line fiber optic interferometric sensors owing to their many advantages like compact size, high sensitivity, immunity to electromagnetic interference etc. Among the polymers used in sensing applications, chitosan a natural biopolymer, has attracted a significant amount of interest. This thesis explores the possibilities of integrating chitosan with inline interferometric sensors for the sensing of chemical and biological species. The first work presented in the thesis involves an interferometric sensor with a no-core fiber (NCF) spliced between single mode fibers (SMF) and functionalized with chitosan (CS)/poly acrylic acid (PAA) self-assembled polyelectrolyte layers for the detection of heavy metal ion Nickel (II) (Ni2+). The sensing scheme is based on multi mode interference (MMI) i.e. interference of fundamental modes and excited higher order modes in the NCF, to detect changes in refractive index induced by Ni2+adsorption on the functionalized sensor. Wavelength shifts were measured real-time for the continuous monitoring of adsorption of Ni2+at different concentrations. The proposed sensor exhibits a linear response in the concentration range upto 500μM, with a Ni2+detection sensitivity of 0.0554 nm/ μM and concentration detection limit of 0.1671 μM. The second work presents an interferometric fiber sensor for detection of hexa-histidine tagged microcin (His-MccS). This intermodal fiber sensor is implemented by a no-core fiber (NCF) functionalized with chitosan (CS)-nickel (Ni) film for direct detection of small peptide: microcin. The fiber intermodal sensor relies on the refractive index modulations due to selective adsorption event at the chitosan (CS)-nickel (Ni) film. Owing to the strong affinity between Ni2+ ions and histidine, the immobilized Ni2+ ions in the chitosan film were utilized as binding agents for the direct detection of hexa-histidine tagged microcin. A comparative study in relation to different target size was conducted: full proteins trypsin, bovine serum albumin (BSA) and human serum albumin (HSA), with high histidine content on their surface and His-MccS (peptide, 11.6 KDa), have been employed for sensor evaluation. Results have shown selectivity for His-MccS relative to trypsin, BSA and HSA. The most telling contribution of this study is the fast detection of small biomolecule His-MccS compared to standard detection procedures like SDS-PAGE and western blot. The proposed sensor exhibits His-MccS detection sensitivity of 0.0308 nm/(ng/ml) in the range of (0-78) ng/ml with concentration detection limit of 0.8368 ng/ml. The third work involves an inline reflection mode intermodal sensor based on direct ligand immobilization for detection of nickel ions (Ni2+). Covalently immobilized nickel specific ligand, Meso-Tetra(4-carboxyphenyl)porphine, on the NCF surface serves as adsorption site for Ni2+ and can induce ambient refractive index (RI) change around the NCF on occurrence of binding events. The change in RI results in spectrum wavelength shifts, which was measured for continuous monitoring of Ni2+ concentration. The proposed sensor was observed to exhibit a sensitivity of 0.1210 nm/M towards Ni2+ ions. The final work demonstrates the use of molecularly imprinted chitosan functionalized PCF based MZI interferometric sensor for the detection of Ni2+ ions. The chitosan was crosslinked with epichlorohydrin (ECH) to increase its mechanical strength and thereby to improve the sensor stability. The sensor exhibits a Ni2+ detection sensitivity of 0.0604 nm/μM in the linear range and a limit of detection of 0.2008 μM. The sensor also shows a good specificity to Ni2+ ions compared to Cu2+, Ca2+, and Na+ ions. Investigation was carried out to examine the effect of crosslinking on the sensor performance by varying the ECH to chitosan molar ratio (5:1, 10:1, and 15:1). It is observed that the sensor achieved its best performance when the molar ratio was 10:1.Doctor of Philosophy (SCBE

Immunization practice in patients with chronic kidney disease on haemodialysis

Background: Immunization is an important component of maintaining health and wellness in patients with chronic kidney disease. The aim of the study is to describe the awareness about the vaccination in patients with chronic kidney disease on haemodialysis and to estimate the vaccination status received in these patients on dialysis. Methods: It is a cross sectional study conducted in 83 patients diagnosed to have chronic kidney disease undergoing dialysis for at least 1 month. Demographic characteristics and comorbidity data (as self-reported) were collected and questionnaire assessment was filled about the vaccination and counselling received. Results:  The prevalence of CKD were 73.5% in males and 26.5% in females with a mean age of 48.9 years. Among the different occupations of the patient with no job/housewife was 56.6% while professional jobs were 18.1% business and non-professional source were 13.3% and agriculture related was 12.0%. Evaluation of education stated that patients educated with higher schooling had 15.6% of prevalence of CKD compared to degree holders and Masters. The different comorbidities among the studied patients were Hypertension- 84.3%, Diabetes- 47%, Stroke- 12%, Connective tissue disorder- 18.1% and COPD- 44.6%

Fiber optic nickel ion sensor based on direct ligand immobilization

An inline intermodal no core fiber (NCF) sensor based on direct ligand immobilization for detection of nickel ions (Ni2+) is proposed. Covalently immobilized nickel specific ligand, Meso-Tetra(4-carboxyphenyl)porphine, on the NCF surface serves as adsorption site for Ni2+ and can induce ambient refractive index (RI) change around the NCF on occurrence of binding events. The change in RI results in spectrum wavelength shifts, which was measured for continuous monitoring of Ni2+ concentration. The proposed sensor was observed to exhibit a sensitivity of 121.03 nm/mM towards Ni2+ ions.Published versio

Heavy metal cation probe with signal to noise ratio measurement of fiber Bragg grating

An intensity-modulated Nickel ions (Ni2+) probe is experimentally demonstrated by using optical fiber Bragg grating (FBG) cascaded by a cleaved fiber end which is functionalized by multilayers of chitosan/poly acrylic acid (PAA). The multilayer film can effectively adsorbed Ni2+ that modulate signal to noise ratio (SNR) of the FBG. The proposed probe exhibits an enhanced sensitivity with detection limitation of 0.01 mM. This kind of relative measurement method contributes to eliminate power fluctuation of the optical source. Temperature can be monitored simultaneously by wavelength shift, which is benefit to minimize temperature cross effect on Ni2+ detection in the future.Published versio