Eco-Innovative UHPC-Enhancing Sustainability, Workability, and Ductility with Recycled Glass Cullet Powder and Plastic Bottle Hybrid Fibers.

Utilizing waste materials in producing ultra-high-performance concrete (UHPC) represents a highly effective approach to creating environmentally sustainable concrete using renewable resources. This study focused on incorporating ground glass cullet (GP) at various replacement levels in UHPC production. Additionally, plastic bottle fibers (PBFs) were derived from discarded plastic bottles and employed in the mix. The replacement levels for GP spanned from 0% to 40%. Single-use plastic bottles were transformed into strip fibers, both with and without the inclusion of microsteel fibers, at varying contents of 1.1% and 2.2% (volume-based). A single-fiber test was conducted on PBFs under different strain rates. The introduction of optimal GP content had a profound positive iMPact on compressive strength. Incorporating 2.2% plastic strips induced strain hardening behavior, while further inclusion of microsteel fibers resulted in substantial enhancements in mechanical properties. Two types of microsteel fibers were employed, characterized by different aspect ratios of 65 and 100. The optimum GP content was identified as 10%. Moreover, the UHPC mix achieved superior compressive strength, exceeding 140 MPa when composed of 1.3% (volume-based) microsteel fibers with an aspect ratio of 65 and 2.2% PBF (volume-based). Notably, mixtures featuring microsteel fibers with a higher aspect ratio demonstrated the highest flexural strength, exceeding 8000 N in the presence of 2.2% PBF. Longer microsteel fibers exhibited adequate slip properties, facilitating strain transfer and achieving a strain-hardening response in conjunction with plastic bottle fibers. These findings illuminate the potential for harnessing hazardous waste materials to improve the performance and sustainability of UHPC formulations.

Long COVID in Pakistan: a cross-sectional analysis of health and psychosocial outcomes.

According to the World Health Organization-led Delphi consensus, long COVID corresponds to the occurrence of symptoms beyond twelve weeks after the onset of acute COVID-19 illness that cannot be explained by alternate diagnosis. This cross-sectional study aimed to analyse the impacts of long COVID on general health and psychosocial well-being. For this study, the participants were interviewed either face to face or via telephone, and their responses were recorded on a questionnaire capturing information on demographics, COVID-19 status, duration of symptoms and long COVID symptoms. The psychosocial impacts of the pandemic were assessed using scales like Short Mood and feeling questionnaire (sMFQ), Warwick-Edinburgh Mental Well-being Scale (WEMWBS), Generalized Anxiety Disorder Assessment (GAD-7) and Perceived Stress Scale (PSS). Regression analysis was conducted to analyse the predictors of long COVID. A total of 300 participants were interviewed, of which 155 (52%) had COVID-19 illness. Of these 54 (35%) had persistent symptoms for a period of more than 12 weeks classified as long COVID. Muscle problems and fatigue were the most frequent (14.7%) symptoms encountered, followed by breathing problems (12.6%) and cognitive issues (12.6%). The symptoms of decrease in appetite and confusion or disorientation during the initial phase of the infection were associated with long COVID. The majority of the participants (83.3%) had moderate level of perceived stress, while moderate to severe levels of stress were observed in 17.3% of the individuals. Moreover, a high level of positive mental well-being was also observed. This study highlights the need for further research into the clinical aspects and implications of long COVID in Pakistan and emphasizes the importance of ongoing support for affected individuals.

Robust Machine Learning Framework for Modeling the Compressive Strength of SFRC: Database Compilation, Predictive Analysis, and Empirical Verification.

In recent years, the field of construction engineering has experienced a significant paradigm shift, embracing the integration of machine learning (ML) methodologies, with a particular emphasis on forecasting the characteristics of steel-fiber-reinforced concrete (SFRC). Despite the theoretical sophistication of existing models, persistent challenges remain-their opacity, lack of transparency, and real-world relevance for practitioners. To address this gap and advance our current understanding, this study employs the extra gradient (XG) boosting algorithm, crafting a comprehensive approach. Grounded in a meticulously curated database drawn from 43 seminal publications, encompassing 420 distinct records, this research focuses predominantly on three primary fiber types: crimped, hooked, and mil-cut. Complemented by hands-on experimentation involving 20 diverse SFRC mixtures, this empirical campaign is further illuminated through the strategic use of partial dependence plots (PDPs), revealing intricate relationships between input parameters and consequent compressive strength. A pivotal revelation of this research lies in the identification of optimal SFRC formulations, offering tangible insights for real-world applications. The developed ML model stands out not only for its sophistication but also its tangible accuracy, evidenced by exemplary performance against independent datasets, boasting a commendable mean target-prediction ratio of 99%. To bridge the theory-practice gap, we introduce a user-friendly digital interface, thoroughly designed to guide professionals in optimizing and accurately predicting the compressive strength of SFRC. This research thus contributes to the construction and civil engineering sectors by enhancing predictive capabilities and refining mix designs, fostering innovation, and addressing the evolving needs of the industry.

Multi-Criteria Optimization of Cost-Effective and Environmentally Friendly Reactive Powder Concrete Incorporating Waste Glass and Micro Calcium Carbonate.

In pursuit of developing an eco-friendly and cost-effective reactive powder concrete (RPC), we utilized a multi-objective optimization technique. This approach pivoted on the incorporation of byproducts, with a spotlight on ground glass powder (GP) as a pivotal supplementary cementitious material (SCM). Our goal was twofold: engineering cost-efficient concrete while maintaining environmental integrity. The derived RPC showcased robust mechanical strength and impressive workability. Rigorous evaluations, containing attributes like compressive strength, resistance to chloride ion penetration, ultrasonic pulse speed, and drying shrinkage, highlighted its merits. Notably, the optimized RPC, despite an insignificant decrease in compressive strength at 90 days compared to its traditional counterpart, maintained steady strength augmentation over time. The refinement process culminated in a notable 29% reduction in ordinary Portland cement (OPC) usage and a significant 64% decrease in silica fume (SF), with the optimized mix composition being 590 for cement, 100 for SF, 335 for GP, and 257 kg/m3 for calcium carbonate. Additionally, the optimized RPC stood out due to the enhanced rheological behavior, influenced by the lubricative properties of calcium carbonate and the water conservation features of the glass powder. The reactive properties of SF, combined with GP, brought distinct performance variations, most evident at 28 days. Yet, both mixtures exhibited superior resistance to chloride, deeming them ideal for rigorous settings like coastal regions. Significantly, the RPC iteration, enriched with selective mineral admixtures, displayed a reduced tendency for drying-induced shrinkage, mitigating potential crack emergence.

Flowability and Strength Characteristics of Binary Cementitious Systems Containing Silica Fume, Fly Ash, Metakaolin, and Glass Cullet Powder.

The present study examines the effects of supplementary cementitious materials (SCMs) on the flowability and strength development of binary mixes. This study was primarily motivated by the need to bridge the knowledge gap regarding paste and mortar mixes containing binary cement from a variety of performance perspectives. This study examined the flowability and strength development of binary mixes in their pastes and mortars when they contain various doses of silica fume (SF), fly ash (FA), metakaolin (MK), and glass cullet powder (GP) compared with the control mix. While the presence of SF and MK reduced workability because of the nature of their particles, the addition of FA and GP improved it to a certain extent because of the spherical and glassy nature of their particles, respectively. In addition, GP was used to compare its performance against SF, MK, and FA as an alternative cementitious material. In this study, the GP performed comparably to the other SCMs investigated and was found to be satisfactory. An investigation of the rheological properties, heat of hydration, thermal analysis, and pore systems of these mixes was conducted. Compared to the control mix, the presence of 5% GP improved the rheological properties and reduced the heat of hydration by 10%. The reduced workability in SF and MK mixes resulted in a lower content of pore water, while GP and FA incorporation enhanced it, owing to improved workability. The pore area is related to the pore water, which is directly related to improved workability. According to the following order, SF > MK > GP > FA, the strength was highest for mixes containing SF and MK, whereas, with GP and FA, there was a gradual reduction in the strength proportional to replacement level and improved workability. SF, GP, and FA can be identified as performance enhancers when formulating ternary and quaternary cementitious systems for low-carbon cement.

Evaluation of the Performance of Low-Cement Strain-Hardening Cementitious Composites Containing Desert Sand and Ground Scoria Rocks.

Fine aggregates are the main ingredients that control the success of the preparation and performance of strain-hardening cementitious composites (SHCCs). Worldwide deserts can be used as eternal sources of fine aggregates for the preparation of SHCCs. Arabian Peninsula desert sand spreads over the largest desert area in the world, covering an area of 2,300,000 km2 among the Arabian Gulf countries. White and dune desert sands were procured for use in this study. The morphological structure is important in selecting the appropriate sand for use in the preparation of SHCCs. The utilization of microfibers such as polyvinyl alcohol (PVA) has become common practice for the preparation of SHCCs. The presence of desert sand is proven to enhance the dispersibility of PVA due to its spherical structure, which alleviates the friction among the ingredients forming SHCCs. Two mechanisms are defined under the tensile force at the interface of microfibers and natural sand, namely, a strong frictional force leading to rupture or a weaker force causing pullout. The synergy between fibers and fine aggregate grains depends on their surface characteristics, which can be modified using different types of mineral admixtures. In this research, the alignment of microfibers as an indication of the quality of dispersion could be evaluated using a proposed approach based on an advanced technique of microstructural analysis. PVA dispersion and its relation to strain-hardening properties are visually correlated to the surface interaction of the mineral admixture and dune sand. The microdurability and cost effectiveness of SHCCs could be assessed using the proposed approach, as depicted by the results obtained in this research work.

Behavioral Evaluation of Strengthened Reinforced Concrete Beams with Ultra-Ductile Fiber-Reinforced Cementitious Composite Layers.

In the literature, there is little information available regarding the behavior of composite beams made up of reinforced concrete (RC) and ultra-ductile fiber-reinforced concrete (UDFRC). In this study, UDFRC was examined for its effectiveness in enhancing the strength of RC beams. With a tensile strength of 4.35 MPa and a strain capacity of 2.5%, PVA-based UDFRC was prepared. The performance of 12 medium-sized reinforced concrete (RC) beams was measured under four-point flexural loading. The beams measured 1800 mm long, 150 mm wide, and 200-260 mm deep. The experimental program on beam specimens was divided into two phases. In the first, four 150 × 200 × 1800 mm RC beams with UDFRC layer thicknesses of 0, 30, 60, and 90 mm were tested. Additionally, four concrete and four concrete-UDFRC beams were investigated, measuring 150 × 230 × 1800 mm and 150 × 260 × 1800 mm, respectively. The study focused on medium-sized, slender RC beams under quasi-static loads and room temperature with additional or substituted UDFRC layers. As a result of replacing concrete with UDFRC, the load-carrying capacity at first crack and steel yield significantly increased between 18.4 and 43.1%, but the ultimate load-carrying capacity increased only in the range of 6.3-10.8%. Furthermore, beams with additional UDFRC layers could carry 30-50% more load than their concrete counterparts. An RC-UDFRC beam had a load-carrying capacity 10-15% greater than that of a comparable RC beam. Generally, there is a lower deflection response in UDFRC-concrete composite RC beams than in control concrete beams. The UDFRC layering can potentially improve the load-carrying capacity of RC beams, at least when ductility provisions are considered.

Mapping of familial hypercholesterolemia and dyslipidemias basic management infrastructure in Pakistan: a cross-sectional study.

Background: Familial hypercholesterolemia (FH) is an autosomal inherited disorder characterised by elevated low-density lipoprotein cholesterol and premature cardiovascular events. Despite being declared as a public health priority, FH remains highly underdiagnosed, generally due to the lack of awareness and shortcomings in the available infrastructure, particularly in lower income countries. Methods: To map the existing infrastructure for the management of FH, a survey was conducted among 128 physicians (cardiologists, paediatricians, endocrinologists, and internal medicine specialists) from different regions of Pakistan. Findings: The respondents encountered a limited number of adults or children with diagnosed FH. A very small proportion of the population had access to free cholesterol and genetic testing even when indicated by a physician. In general, cascade screening of the relatives was not performed. Uniform diagnostic criteria for FH had not been established even within the same institution or province. The use of statins and ezetimibe in addition to lifestyle changes were the most common recommended treatment option for FH patients. The respondents considered lack of financial resources as a major barrier for the management of FH and stressed on taking relevant measures for a uniform FH screening programs around the country. Interpretation: National FH screening programmes are not in place worldwide hence FH is commonly undiagnosed, and many individuals are at a high risk for cardiovascular diseases. Timely screening of population for FH requires knowledge about FH among the clinicians and the availability of fundamental infrastructure coupled with sufficient financial resources. Funding: The authors confirm independence from the sponsor. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results. FS received funding from Higher Education Commission, Pakistan (Grant 20-15760) and UG received grants from Slovenian Research Agency (J3-2536, P3-0343).

Patency and Complications of Arterio-venous Fistula Created in Pre- and Post-dialysis Settings.

OBJECTIVES: To determine the difference in patency and complication rates of arterio-venous fistula (AVF) constructed in pre-dialysis versus post-dialysis settings. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: The Department of Vascular Surgery, Shifa International Hospital, Islamabad from January 2014 to August 2020. METHODOLOGY: Computerised record of 726 patients, who had undergone vascular access surgery for haemodialysis, was collected. Patients were divided into two groups according to those who had undergone AVF surgery: a) prior to the commencement; or b) after the commencement of haemodialysis. Primary and secondary patency rates were determined clinically by using duplex scans. Complications and suitability of AV fistula were assessed in both the groups. Data was collected and analysed using SPSS version 25, considering p-value of less than 0.05 as statistically significant. RESULTS: Early fistula failure was significantly higher in post-dialysis group compared with pre-dialysis group, while primary patency was higher in pre-dialysis (78.2%) group comparing with post-dialysis (66.1%) group. Secondary patency was 88.9% and 75.8% in pre- and post-dialysis groups, respectively. Early dialysis suitability failure rates were 12.2% and 15.1%; and late suitability failure rates were 7.9% and 16.1% in the pre- and post-dialysis groups, respectively. Higher rates of complications like maturation failure, low flow AVF, stenosis, thrombosis, venous hypertension, AV aneurysm, and infections were encountered in post-dialysis group compared to pre-dialysis group. CONCLUSION: Surgical creation of AVF three months prior to commencement of haemodialysis is advantageous in terms of patient outcomes and healthcare resources. However, a multidisciplinary approach and timely referral of patients to a vascular clinic further enhances the outcome with respect to the suitability of vascular access for dialysis. KEY WORDS: Arterio-venous fistula, Dialysis, Patency, Complications, Suitability.

Investigation of the Impact of Graphene Nanoplatelets (GnP) on the Bond Stress of High-Performance Concrete Using Pullout Testing.

Efficient load transmission between concrete and steel reinforcement by bonding action is a key factor in the process of the design procedure of bar-reinforced concrete structures. To enhance the bond strength of steel/concrete composites, the impact of graphene nanoplatelets (GnP) on the bond stress and bond stress-slip response of deformed reinforcement bars, embedded in high-performance concrete (HPC), was investigated using bar pullout tests. In the current study, 36 samples were produced and examined. The main variables were the percentages of GnP, the steel reinforcement bar diameter, and embedded length. Bond behavior, failure mode, and bond stress-slip response were studied. Based on the experimental findings, the inclusion of GnP had a significant favorable influence on the bar-matrix interactions due to the bridging action of GnP as a nano reinforcement. For 0.02 wt.% of GnP, the bond strength was enhanced by more than 41.28% and 53.90% for steel bar diameters of 10 and 16 mm, respectively. The HPC-GnP mixture displayed a reduction in the initial slippage in comparison to the control sample. The test findings were compared to the prediction models created by other researchers and the ACI 408R-12 code.

Strength and Acid Resistance of Ceramic-Based Self-Compacting Alkali-Activated Concrete: Optimizing and Predicting Assessment.

The development of self-compacting alkali-activated concrete (SCAAC) has become a hot topic in the scientific community; however, most of the existing literature focuses on the utilization of fly ash (FA), ground blast furnace slag (GBFS), silica fume (SF), and rice husk ash (RHA) as the binder. In this study, both the experimental and theoretical assessments using response surface methodology (RSM) were taken into account to optimize and predict the optimal content of ceramic waste powder (CWP) in GBFS-based self-compacting alkali-activated concrete, thus promoting the utilization of ceramic waste in construction engineering. Based on the suggested design array from the RSM model, experimental tests were first carried out to determine the optimum CWP content to achieve reasonable compressive, tensile, and flexural strengths in the SCAAC when exposed to ambient conditions, as well as to minimize its strength loss, weight loss, and UPVL upon exposure to acid attack. Based on the results, the optimum content of CWP that satisfied both the strength and durability aspects was 31%. In particular, a reasonable reduction in the compressive strength of 16% was recorded compared to that of the control specimen (without ceramic). Meanwhile, the compressive strength loss of SCAAC when exposed to acid attack minimized to 59.17%, which was lower than that of the control specimen (74.2%). Furthermore, the developed RSM models were found to be reliable and accurate, with minimum errors (RMSE < 1.337). In addition, a strong correlation (R > 0.99, R2 < 0.99, adj. R2 < 0.98) was observed between the predicted and actual data. Moreover, the significance of the models was also proven via ANOVA, in which p-values of less than 0.001 and high F-values were recorded for all equations.

Case report: A rare cause of chest pain: Kommerell's diverticulum.

INTRODUCTION AND IMPORTANCE: Kommerell diverticulum is a very rare congenital defect of the aortic arch associated with the aberrant subclavian artery. It can present with signs of dysphagia, chest pain, or distal embolization in the upper limb. CASE PRESENTATION: We present a case of Kommerell diverticulum with associated large subclavian artery aneurysm in a male patient with chest pain of unknown origin and hypertension. There was an incidental finding of the wide mediastinum on chest X-ray and the patient had a difference in systolic blood pressure in both arms. A right thoracotomy incision was used to successfully excise the aneurysm and reconstruct the subclavian artery. Patient recovery was uneventful. CLINICAL DISCUSSION: Endovascular approaches are also an alternative to conventional open surgeries in the treatment of Kommerell diverticulum. CONCLUSION: Kommerell diverticulum with subclavian artery aneurysm should be considered in the differential diagnosis of non-cardiac chest pain. A simple investigation such as a chest X-ray can make a difference in these patients. Coarctation related to the right ASA might not always be a true coarctation. Endovascular treatment is an alternative to open repair in selected cases, but it needs further investigation in large randomized control trials.

Simplex-Lattice Hydration Prediction and Microstructure Verification of Cementitious Systems.

In this investigation, the age-dependent hydration development of blended pastes containing Portland cement (PC), pulverized fuel ash (PFA) and silica fume (SF) was assessed by quantifying the amount of CH and non-evaporable water using thermo-gravimetric analysis (TGA). Microstructure was investigated using scanning electron microscope (SEM). It was observed that the amount of liberated CH increases up to three-days in PC-PFA binary blended pastes, after which it progressively decreases and this reduction was proportional to the PFA dosage. The introduction of SF to PC-PFA binary mixtures to form ternary blended pastes has caused an early reduction of CH at one day where the majority of SF has been consumed during the first seven-days. The incorporation of 10% SF to PC-PFA pastes altered the low rate of hydration at early age. In addition, the presence of PFA showed insignificant influence on the non-evaporable water content until three-days then its effect became significant after seven-days. On the other hand, SF increased the non-evaporable water content from early ages up to seven-days. However, beyond 28 days, the presence of SF did not exhibit further pozzolanic activity. Furthermore, the ternary blended systems significantly increased the non-evaporable water content within three to seven days compared to the reference paste. Moreover, prediction nonlinear models of these hydration parameters were developed using the simplex-lattice design and validated against the experimental results. The latter have been further supported with SEM microstructural analysis showing good agreement between the predicted and realistic hydration.

Experimentation and Predictive Models for Properties of Concrete Added with Active and Inactive SiO2 Fillers.

Cement is one of the main constituents of concrete material and it is one of the main sources of carbon dioxide emissions in the environment. Fillers within a range of 5⁻7% from different sources can be used as a replacement of cement without compromising the properties of concrete or even tailoring for required property. This paper investigates the influence of inactive silica filler and silica fume on the mechanical- and durability-related properties of concrete with different strengths. The investigated mechanical properties focused on compressive strength at different ages up to 400 days, while the durability-related properties focused on porosity and rapid chloride ion penetrability (RCPT). Two types of ultrafines, namely quartz ultrafine and silica fume, were used. Concrete mixtures with four different water/binder ratios (0.25, 0.30, 0.35, 0.40) were prepared for various dosages of quartz ultrafine (0%, 5%, 8%, 10%, 15%, 25%, and 35%) and different dosages of silica fume (0%, 8%, 10%, and 12%). The results revealed that the compressive strength and durability related properties of concrete with different dosages of ultrafines and silica fume were significantly affected; however, there was a negative impact of ultrafine filler on the compressive strength after replacement of more than 8% of ultrafines. The strength relationships for the concrete with different water-to-cement ratio were assessed and certain modifications were proposed for ultrafines and silica fume. Predictive models were proposed for predicting the compressive strength of concrete in terms of RCPT and porosity for different levels of replacements of ultrafines and silica fume.

Diagnostic, Surgical, and Postoperative Challenges of Neuroendocrine Tumors of the Neck: Clinical Experience and Literature Review.

BACKGROUND: Neuroendocrine tumors of the neck are rare swellings, which constitute about 0.03% of all tumors. Most are sporadically arising paragangliomas. Over 50% arise from the carotid bodies and pose difficulties in diagnosis and surgical management, which may result in disabling complications. OBJECTIVE: To determine the diagnostic, surgical, and postoperative challenges, and how to overcome them, in the management of neuroendocrine tumors of the neck. STUDY DESIGN: Descriptive case series. METHODS: A retrospective analysis of 19 patients who presented to our surgery clinics between 2010 and 2015 with neck swelling and suspicion of neurogenic tumors were included in the study. All patients received preoperative evaluation with Doppler studies and neck computed tomography scan, with the finding of suspicion of neurogenic tumor. Preoperative tissue diagnosis was not attempted as this usually required excisional biopsy. All tumors were surgically excised. Data regarding mean tumor size, neurovascular invasion, postoperative complications, and histopathological findings were recorded and statistically analyzed. RESULTS: Nineteen patients (7 male) with median age of 45 years were included. Mean size of the tumor was 7.5 cm (range: 4.0-11.8 cm). Six of the tumors were right sided and 13 left sided. Clinical findings often were nonspecific and mimicked other conditions. Operative challenges were encountered in 11 (57.9%) patients, who had tumors of more than 5 cm. Vascular invasion was found in 2 (10.5%) patients, but bleeding requiring preoperative transfusion was not required in any patient. Neurological complications occurred in 11 (57.8%) patients; 3 had transit hypoglossal nerve palsy, with full recovery; 2 had complete nerve palsy, with reasonable rehabilitation without further surgical intervention; and 5 developed neurological deficits (hoarseness, dysphagia, or Horner's syndrome) but recovered and compensated well without further operation. Two patients who had vascular invasion required vascular reconstruction. Histopathology in 14 (73.7%) cases was carotid body tumor and 5 were Schwannomas (1 vagal and 4 sympathetic chain). All 4 patients with Schwannomas of cervical sympathetic chain developed Horner's syndrome; 2 of them have compensated well with reasonable recovery; 2 have had tarsorrhaphy for cosmetic reasons. The patient with vagal Schwannoma developed hoarseness and swallowing difficulties, which resolved without intervention. No malignancy was encountered in this series, and there was no mortality. CONCLUSIONS: Neuroendocrine tumors of the neck present diagnostic challenges because of nonspecific clinical findings mimicking other conditions. Preoperative tissue diagnosis is mostly unsuccessful, and exact diagnosis requires excisional biopsy. Surgical excision, which is the main treatment, often has associated technical difficulties and unavoidable complications requiring further intervention.

Liraglutide in diabetes mellitus: More facts and findings.

Liraglutide exert favorable effects on most of the diabetes associated cardiovascular (CV) risk factors and this study was designed to further explore the benefits of liraglutide by observing its effect on plasma sialic acid (PSA) in diabetic rats. A total of 30 streptozotocin induced (50 mg/Kg; i.p.) diabetic rats were randomized into vehicle treated (1 ml/Kg s.c, twice daily) group I, liraglutide treated groups II and III (30 µg/Kg and 150 µg/Kg, twice daily respectively) and studied for 6 weeks. Liraglutide treated groups showed significant reductions in fructosamine levels (p≤0.05) from baseline. Between groups comparison revealed significant difference (p≤.05) at the end point. Similarly, at week 6, liraglutide treated groups showed significantly low levels of PSA compared to baseline (p<0.03 and p<0.005 for group II and III respectively) and control group I (p<0.002 and p<0.001 for group II and III respectively). However, the difference was non-significant between groups II and III (p<0.09). Other parameters including glucose tolerance, fasting plasma glucose (FPG), blood lipids, systolic blood pressure (SBP) and body weight also improved by liraglutide with the group III showing greater improvement. The study concludes that liraglutide produce favourable effects on PSA and may bea useful choice in protecting against diabetes associated CV complications.

Revascularization Of Late-Presenting Acute Limb Ischaemia And Limb Salvage.

BACKGROUND: Late-presenting acute limb ischaemia represents a challenging vascular emergency. The purpose of this study was to evaluate the outcome in patients following revascularization and management of existing or impending reperfusion injury of ischaemic limbs over a 12-year period (2002-2014). METHODS: Routine procedural codes were used to label consecutive patients admitted 72 hours following onset of symptoms for surgical revascularization of an acutely ischaemic limb. Data collected included demography, clinical presentation, synchronous morbidities, procedural specifics and outcomes of surgical management of all patients. RESULTS: The study sample included 206 patients, (117 male and 89 female, average age =49.4±14.6 years) presenting with a diagnosis of acute limb ischemia. The most frequent cause of acute thromboembolic limbs was cardiac disease (n=148). Femoral artery exploration with embolectomy was the most common procedure and was used for aortic, iliac, infrainguinal and distal occlusion. Thirty-four patients required additional vascular surgery due to failure of revascularization by embolectomy. Fasciotomy was performed in 45.6% of cases for existing or impending compartment syndrome when the patient presented very late. Surgical site infection occurred in 8.25% of cases, repeat embolectomy was required in 10.68% of cases; amputation in 13.1% and mortality was 5.8%. Predictors of morbidity and mortality included age of the patient, time of presentation and specific comorbidities. The 5-year amputation-free and survival estimate was 80%. CONCLUSIONS: Our study suggests that late revascularization of acute leg ischaemia improves blood supply to the limb, thereby reducing the number of amputations. The results suggest that revascularization is clinically warranted, even one week following the onset of acute ischaemia. Additional surgical procedures including fasciotomy further reduce the morbidity and mortality.

In vitro biological activity of decoction of Joshanda.

Joshanda is a polyherbal product, commonly practicing in inflammation of upper respiratory tract as tea. The present study was conducted to find out its antimicrobial, phytotoxic, leishmanicidal and cytotoxic activities. The decoction of the product showed profound activity against Gram positive tested pathogens especially S. aureus 36.5 mm zone of inhibition at 8.0 µg/ml. However, it was inactive against C. albicans. Closed correlation was observed between two methods in terms of results. It had potent phytotoxic activity (75%). However, it was devoid of any activity leishmanicidal and cytotoxic activity. Phytochemical studies of Joshanda showed the presence of various pharmacologically active groups.

Cellular and genomic toxicity produced by UV light in Chinese hamster ovary cells.

UVB and UVC toxicity was detected in Chinese Hamster Ovary (CHO) cell lines AA8, UV5 and XEM2 (a V79-derived cell line expressing rat P450 1A1). Unlike FICZ-HPLC assay that showed induction of CYP1A1 enzyme activity after 20 minutes and 2 hour UVC exposure, the EROD assay showed no difference in cytochrome P450 1A1 (CYP1A1) activity after exposure to different doses of UVB and UVC light. Different cytotoxic and mutagenic effect of photo lesions induced by UVC and UVB light was investigated with the DRAG and HPRT assays, comparing the wild type cell line AA8 and the Nucleotide Excision Repair (NER) deficient cell line UV5. DRAG assay showed a significant difference in UV induced cytotoxicity between UVC and UVB reflecting the larger energy and toxic effect of UVC along with significant difference in UV induced toxicity between AA8 and UV5 cell lines. This was further validated through the HPRT assay, which also showed a significant difference in UVC (5 J/m(2)) induced mutagenic effect between these cell lines. In addition, HPRT assay showed the mutagenic effect of photosensitizer, acetophenone. These results show that UVB and UVC generate serious damage through photo products on DNA, and might induce the metabolic activity of CYP1A1.

Huge mesenteric liposarcoma.

Primary mesenteric liposarcoma is extremely rare and is treated by aggressive surgical management i.e. wide excision with adequate margins (in the absence of distant metastases). We report a case of huge slow-growing primary mesenteric liposarcoma in a 52-year-old man, who presented with gross abdominal distension. He was anaemic with pre-operative imaging demonstrating a well-encapsulated huge solid tumour filling the whole abdomen, abutting the anterior abdominal wall without any evidence of distance metastasis or ascites. The patient underwent successful resection of the tumour which weighed 22 kilograms. Histopathology confirmed a well-differentiated liposarcoma with rare mitoses. The patient received full eight cycles of adjuvant chemotherapy. After five years of clinical and imaging follow-up, there was no evidence of metastasis or recurrence of the disease.