The MELD Score Is Superior to the Maddrey Discriminant Function Score to Predict Short-Term Mortality in Alcohol-Associated Hepatitis: A Global Study.

INTRODUCTION: Several scoring systems predict mortality in alcohol-associated hepatitis (AH), including the Maddrey discriminant function (mDF) and model for end-stage liver disease (MELD) score developed in the United States, Glasgow alcoholic hepatitis score in the United Kingdom, and age, bilirubin, international normalized ratio, and creatinine score in Spain. To date, no global studies have examined the utility of these scores, nor has the MELD-sodium been evaluated for outcome prediction in AH. In this study, we assessed the accuracy of different scores to predict short-term mortality in AH and investigated additional factors to improve mortality prediction. METHODS: Patients admitted to hospital with a definite or probable AH were recruited by 85 tertiary centers in 11 countries and across 3 continents. Baseline demographic and laboratory variables were obtained. The primary outcome was all-cause mortality at 28 and 90 days. RESULTS: In total, 3,101 patients were eligible for inclusion. After exclusions (n = 520), 2,581 patients were enrolled (74.4% male, median age 48 years, interquartile range 40.9-55.0 years). The median MELD score was 23.5 (interquartile range 20.5-27.8). Mortality at 28 and 90 days was 20% and 30.9%, respectively. The area under the receiver operating characteristic curve for 28-day mortality ranged from 0.776 for MELD-sodium to 0.701 for mDF, and for 90-day mortality, it ranged from 0.773 for MELD to 0.709 for mDF. The area under the receiver operating characteristic curve for mDF to predict death was significantly lower than all other scores. Age added to MELD obtained only a small improvement of AUC. DISCUSSION: These results suggest that the mDF score should no longer be used to assess AH's prognosis. The MELD score has the best performance in predicting short-term mortality.

Decision-to-delivery interval and neonatal outcomes for category-1 caesarean sections during the COVID-19 pandemic.

General anaesthesia is known to achieve the shortest decision-to-delivery interval for category-1 caesarean section. We investigated whether the COVID-19 pandemic affected the decision-to delivery interval and influenced neonatal outcomes in patients who underwent category-1 caesarean section. Records of 562 patients who underwent emergency caesarean section between 1 April 2019 and 1 July 2019 in seven UK hospitals (pre-COVID-19 group) were compared with 577 emergency caesarean sections performed during the same period during the COVID-19 pandemic (1 April 2020-1 July 2020) (post-COVID-19 group). Primary outcome measures were: decision-to-delivery interval; number of caesarean sections achieving decision-to-delivery interval < 30 min; and a composite of adverse neonatal outcomes (Apgar 5-min score < 7, umbilical arterial pH < 7.10, neonatal intensive care unit admission and stillbirth). The use of general anaesthesia decreased significantly between the pre- and post-COVID-19 groups (risk ratio 0.48 (95%CI 0.37-0.62); p < 0.0001). Compared with the pre-COVID-19 group, the post-COVID-19 group had an increase in median (IQR [range]) decision-to-delivery interval (26 (18-32 [4-124]) min vs. 27 (20-33 [3-102]) min; p = 0.043) and a decrease in the number of caesarean sections meeting the decision-to-delivery interval target of < 30 min (374/562 (66.5%) vs. 349/577 (60.5%); p = 0.02). The incidence of adverse neonatal outcomes was similar in the pre- and post-COVID-19 groups (140/568 (24.6%) vs. 140/583 (24.0%), respectively; p = 0.85). The small increase in decision-to-delivery interval observed during the COVID-19 pandemic did not adversely affect neonatal outcomes.

Spectroscopic and theoretical investigation on the origin of color in jarosites.

This work aims to understand the origin of the electronic spectra of Fe3+ (d5), Cr3+ (d3), and V3+ (d2) containing jarosites. The electronic spectrum of the Fe-jarosite is currently assigned to spin forbidden transitions. This work shows that the spectra essentially arise due to the tetragonal distortion of the coordination symmetry of the Fe3+ ion in the jarosite crystal, and thereby obviates the need for invoking spin forbidden transitions. The absorption spectra of Cr- and V-jarosite are also assigned to transitions predicted for the tetragonal distortion of the metal ion coordination. The electronic term symbols are worked out using the correlation diagram and Tanabe-Sugano diagram for orbital splitting for all three systems employing ab initio and DFT methods. The bandgaps were computed and corroborated with the experimentally measured values to support the low symmetry at the metal center.

Electronic transitions in layered hydroxides: Consequences of trigonal distortion of octahedral symmetry.

This work describes the assignment of the electronic spectra of metal ions in D3d coordination symmetry. Layered hydroxides are a class of materials that host transition metal ions such as Ni2+, Co2+, and Cr3+ in D3d coordination symmetry. The electronic spectra of these ions in the layered hydroxides exhibit significant fine structure which is assigned to transitions arising from D3d coordination symmetry. Towards this end, the correlation diagrams- complete or partial, and the resultant Tanabe-Sugano like diagrams for D3d symmetry are obtained from first principles and supported by DFT based computations. The approach engendered here helps in better understanding of the electronic transitions arising due to lower symmetry.

Interaction of Pristine Hydrocalumite-Like Layered Double Hydroxides with Carbon Dioxide.

The layered double hydroxides (LDHs) of Ca2+ and trivalent cations, Al3+ and Fe3+, are single-source precursors to generate supported CaO, which picks up CO2 from the gas phase in the temperature range 350-550 °C. The supports are ternary oxides, mayenite, and Ca2Fe2O5. The uptake capacity of the Fe3+-containing LDH at 1.9 mmol g-1 is two times the capacity of the Al3+-containing LDH. The product of CO2 uptake is calcite CaCO3. It is observed that the intercalated chloride ions reduce the thermal penalty by inducing the early decomposition of CaCO3. In the case of the chloride-intercalated LDHs of Ca2+ and Fe3+, the CaCO3 formed is completely decomposed at 900 °C. This is in contrast with the CaCO3 formed from bare CaO, which shows no sign of decomposition at 900 °C under similar conditions. This work shows that the hydrocalumite-like LDHs are candidate materials for CO2 mineralization.

Systematic review with meta-analysis: the association between hepatitis E seroprevalence and haemodialysis.

BACKGROUND: Hepatitis E virus (HEV) infection appears to be more common than previously thought. HEV seroprevalence in patients on maintenance haemodialysis (HD) is unclear with a range from 0% to 44%. In addition, risk factors of transmission of HEV in patients on haemodialysis are unknown. AIM: To perform a systematic review and meta-analysis of HEV seroprevalence in HD patients compared with controls. METHODS: A systematic search of several databases identified all observational studies with comparative arms. Two reviewers extracted data and assessed the methodological quality. A random-effects model was used for pooled odds ratio (OR) and 95% confidence interval (CI) of positive anti-HEV IgG in both groups. Heterogeneity and publication bias were assessed with appropriate tests. RESULTS: We identified 31 studies from 17 countries between 1994 and 2016. Sixteen studies were judged to have adequate quality and 15 to have moderate limitations. HEV infection was more prevalent in patients on haemodialysis compared with controls (OR 2.47, 95% CI 1.79-3.40, I2 = 75.2%, P < .01). We conducted several subgroup analyses without difference in results. Egger regression test did not suggest publication bias (P = .83). Specific risk factors of HEV transmission in patients on haemodialysis were not clearly identified. CONCLUSIONS: Hepatitis E virus infection is more prevalent in patients on haemodialysis compared with non-haemodialysis control groups. Further studies are needed to determine risk factors of acquisition, impact on health, and risk for chronic HEV especially among those patients going to receive organ transplantation.

Comparison of efficacy of three chemotherapeutic agents on Streptococcus mutans count in plaque and saliva: A randomized controlled triple blind study.

BACKGROUND: There is a need for exploration of the role of chemotherapeutic agents and its role in the prevention of early childhood caries (ECC) and its recurrence. AIM: The aim of this study was two-fold: (1) To compare the antimicrobial efficacy of three commonly used chemotherapeutic agents in the prevention of ECC in comparison with a control and (2) To ascertain the role of chemotherapeutic agents in the prevention of ECC. MATERIALS AND METHODS: Sixty children with ECC in the age group 3-6 years were randomly allocated into four groups. To each group of children after full oral rehabilitation either 10% povidone-iodine (PI), or chlorhexidine (CHX) varnish (Cervitec Plus), or fluoride varnish (Fluor Protector) were applied twice at an interval of 1 week, Group 4 served as control. Streptococcus mutans count in saliva and plaque were collected at baseline, 30, 60, and 90 days and the presence of S. mutans was evaluated using the Dentocult SM strip mutans kit. The efficacy of 10% PI, CHX varnish (Cervitec Plus), and fluoride varnish (Fluor Protector) was compared with the control group at 30, 60, and 90 days. An intergroup comparison was also done during the same time intervals. RESULTS: The reduction of S. mutans count in the plaque and saliva was greatest in the fluoride varnish treated groups at all time intervals (30, 60, and 90 days). Fluoride varnish, CHX varnish, and 10% PI showed significant improved efficacy when compared to the control group (P < 0.001). Fluoride varnish showed significantly lower counts of S. mutans compared to CHX varnish at all time intervals (30, 60, and 90 days) and also significantly lower counts compared to 10% PI at 60 and 90 days interval (P < 0.001).

Acute Kidney Injury in Cirrhosis: Baseline Serum Creatinine Predicts Patient Outcomes.

OBJECTIVES: The International Ascites Club (IAC) recently defined Stage 1 acute kidney injury (AKI) for cirrhosis as an acute increase in serum creatinine (SCr) by ≥0.3 mg/dl or by ≥50% in <48 h from a stable value within 3 months. The baseline SCr may influence AKI risk and patient outcomes. The objective of this study is to determine in cirrhosis whether the baseline SCr has any effect on the in-hospital AKI course and patient survival. METHODS: North American Consortium for the Study of End-Stage Liver Disease is a consortium of tertiary-care hepatology centers prospectively enroling non-elective cirrhotic inpatients. Patients with different baseline SCr levels (≤0.5, 0.51-1.0, 1.01-1.5, >1.5 mg/dl) were evaluated for the development of AKI, and compared for AKI outcomes and 30-day survival. RESULTS: 653 hospitalized cirrhotics (56.7±10years, 64% men, 30% with infection) were included. The incidence of AKI was 47% of enrolled patients. Patients with higher baseline SCr were more likely to develop AKI, with significantly higher delta and peak SCr (P<0.001) than the other groups, more likely to have a progressive AKI course (P<0.0001), associated with a significantly reduced 30-day survival (P<0.0001). Multivariate logistic regression showed that the delta SCr during an AKI episode to be the strongest factor impacting AKI outcomes and survival (P<0.001), with a delta SCr of 0.70 mg/dl having a 68% sensitivity and 80% specificity for predicting 30-day mortality. CONCLUSIONS: Admitted cirrhotic patients with higher baseline SCr are at higher risk for in-hospital development of AKI, and more likely to have AKI progression with reduced survival. Therefore, such patients should be closely monitored and treated promptly for their AKI.

Synthon Approach to Structure Models for the Bayerite-Derived Layered Double Hydroxides of Li and Al.

The Br- ion intercalated layered double hydroxide (LDH) of Li and Al obtained from the bayerite-Al(OH)3 precursor crystallizes in a structure different from that of the gibbsite-Al(OH)3 derived counterpart. Additionally, it undergoes temperature- and humidity-induced reversible interpolytype transformations. The dehydrated LDH (T ≈ 120 °C) adopts a structure of hexagonal symmetry (space group P3̅1m) and comprises a stacking of the metal hydroxide layers arranged one above another. On cooling and rehydration, the LDH adopts a structure of monoclinic symmetry with a stepwise increase in the stacking angle, ß. Using the structural synthon approach, based on the systematic elimination of the principal symmetry elements of the hexagonal crystal, structure models were generated for each of the two hydration steps (relative humidity ∼50%, >70%) and the structures refined (space group C2/m). The refined structures show that the interpolytype transitions are a result of rigid translations of successive metal hydroxide layers relative to one another by translation vectors (1/6, 0, 1) and (1/3, 0, 1), respectively.

Structure models for the hydrated and dehydrated nitrate-intercalated layered double hydroxide of Li and Al.

Imbibition of LiNO3 into gibbsite results in the formation of a single phase layered double hydroxide of the composition LiAl2(OH)6(NO3)·1.2H2O. This phase undergoes reversible dehydration along with the compression of the basal spacing accompanied by the reorientation of the nitrate in the interlayer gallery. The hydrated phase is a solid solution of two lattices: (i) a hexagonal lattice defining the ordering of atoms within the metal hydroxide layer, and (ii) a lattice of orthorhombic symmetry defining the ordering of atoms within the interlayer. DFT calculations of the hydration behaviour show that there is no registry between the two sublattices. In the dehydrated phase, the nitrate ion is intercalated with its molecular plane parallel to the metal hydroxide layer and the crystal adopts a structure of hexagonal symmetry.

Whistle Abrasion: A Case Report.

Abrasion is the physical wearing of a tooth surface which can involve the presence of a foreign object repeatedly being in contact with the tooth. A 40-year-old male patient reported to our dental clinic with a 2-3 mm uneven gap between his upper and lower front teeth on occlusion. A detailed history revealed that he was a physical education teacher, and the habitual placement of the whistle for the last 15 years caused an indentation on the whistle which coincided with the abraded teeth. Conditions such as abrasion may need active restorations. A general dental practitioner should accurately identify the cause and treat the esthetic and functional impairment as required.

In silico exploratory study using structure-activity relationship models and metabolic information for prediction of mutagenicity based on the Ames test and rodent micronucleus assay.

The mutagenic potential of chemicals is a cause of growing concern, due to the possible impact on human health. In this paper we have developed a knowledge-based approach, combining information from structure-activity relationship (SAR) and metabolic triggers generated from the metabolic fate of chemicals in biological systems for prediction of mutagenicity in vitro based on the Ames test and in vivo based on the rodent micronucleus assay. In the first part of the work, a model was developed, which comprises newly generated SAR rules and a set of metabolic triggers. These SAR rules and metabolic triggers were further externally validated to predict mutagenicity in vitro, with metabolic triggers being used only to predict mutagenicity of chemicals, which were predicted unknown, by SARpy. Hence, this model has a higher accuracy than the SAR model, with an accuracy of 89% for the training set and 75% for the external validation set. Subsequently, the results of the second part of this work enlist a set of metabolic triggers for prediction of mutagenicity in vivo, based on the rodent micronucleus assay. Finally, the results of the third part enlist a list of metabolic triggers to find similarities and differences in the mutagenic response of chemicals in vitro and in vivo.

Layered Double Hydroxides: Proposal of a One-Layer Cation-Ordered Structure Model of Monoclinic Symmetry.

Layered double hydroxides are obtained by partial isomorphous substitution of divalent metal ions by trivalent metal ions in the structure of mineral brucite, Mg(OH)2. The widely reported three-layer polytype of rhombohedral symmetry, designated as polytype 3R1, is actually a one-layer polytype of monoclinic symmetry (space group C2/m, a = 5.401 Å, b = 9.355 Å, c = 11.02 Å, ß = 98.89°). This structure has a cation-ordered metal hydroxide layer defined by a supercell a = √3 × a0; b = 3 × a0 (a0 = cell parameter of the cation-disordered rhombohedral cell). Successive layers are translated by (1/3, 0, 1) relative to one another. When successive metal hydroxide layers are translated by (2/3, 0, 1) relative to one another, the resultant crystal, also of monoclinic symmetry, generates a powder pattern corresponding to the polytype hitherto designated as 3R2. This structure model not only removes all the anomalies intrinsic to the widely accepted cation-disordered structure but also abides by Pauling's rule that forbids trivalent cations from occupying neighboring sites and suggests that it is unnecessary to invoke rhombohedral symmetry when the metal hydroxide layer is cation ordered. These results have profound implications for the correct description of polytypism in this family of layered compounds.

Malignant Otitis Externa - A Retrospective Study of 15 Patients Treated in a Tertiary Healthcare Center.

OBJECTIVE: Malignant otitis externa (MOE) is an uncommon but potentially fatal disease of the external auditory canal. The study aimed at evaluating the demographic profile, coexisting disabilities, clinical presentations, and management of MOE. MATERIALS AND METHODS: This is a retrospective study of patients with MOE who were treated at the Otorhinolaryngology Department of our institution. The case records of patients treated between 2006 and 2013 for MOE were reviewed from the Medical Records Department of the hospital. The details were tabulated in a master chart, and the data were analyzed. RESULTS: Fifteen patients with MOE were treated as inpatients at the Otorhinolaryngology Department of our hospital during the study period. Of these, 12 were males and three were females. Among the 15 patients, 14 were diabetic and one was non-diabetic. Earache was the most common symptom observed in all patients; edema and granulations in the ear canal was the most common sign observed in 12 patients. Pseudomonas aeruginosa was isolated in 11 patients. All patients were managed medically with intravenous antibiotics. CONCLUSION: MOE is a rare but aggressive condition affecting the external ear, which is commonly observed in elderly diabetic individuals. Immune senescence may be the cause of MOE in elderly people. Pseudomonas is the most common causative organism isolated in this condition. Most of these patients can be managed with medical treatment; reserving surgery only for the removal of granulation tissue and for histopathological examination.