Multi-center prospective survey of hepatocellular carcinoma in Kerala: More than 1,200 cases.

BACKGROUND: Hepatocellular carcinoma (HCC) is considered uncommon in India. The aim of this study was to document the demographic characteristics and clinical aspects of HCC in Kerala, India. METHODS: A survey of HCC in Kerala was performed. All gastroenterologists in the region were invited. From May 2018 to April 2020, data was collected in a standardized questionnaire. RESULTS: Forty-three doctors from 15 centers contributed the data. Total 1217 patients were analyzed. This is the largest state-wide survey of HCC in India. HCC was more common in men (90%) than in women (p < 0.01). The etiology of liver disease was hepatitis B virus (7%), hepatitis C virus (4%) and alcohol (40%). Diabetes mellitus was present in 64%, hypercholesterolemia in 17% and hypertension in 38%. Obesity was present in 33% and 15% were overweight. Non-alcoholic fatty liver disease (NAFLD) with or without metabolic syndrome was present in 44%. Serum alpha-fetoprotein was > 400 ng/mL in 24%, total tumor diameter was > 5 cm in 59%, portal vein invasion was seen in 35% and distant metastasis was seen in 15%. Specific therapy was given to 52%. Treatments given included liver transplantation (n = 24), liver resection (n = 39) and transarterial chemoembolization (TACE, n = 184). Although the study was not designed to compare survival, patients who had liver transplantation had longer survival (median 69 months) compared to matched patients given only TACE (median 18 months) (p = 0.03). CONCLUSION: HCC is common in Kerala, India. NAFLD has a predominant association with HCC in Kerala. Most of the patients report late when curative treatment is not possible.

Photovoltaic performance of MOF-derived transition metal doped titania-based photoanodes for DSSCs.

The enduring effort toward stabilizing and improving the efficiency of dye-sensitized solar cells (DSSCs) has stirred the solar research community to follow innovative approaches. Current research centered on electrode materials design, which improves photoanodes' light-harvesting efficiency (LHE). Metal-Organic Frameworks (MOFs) are a new family of materials that can be used as competent materials due to their desirable qualities, including high porosity, flexible synthesis methodology, high thermal and chemical stability, and good light-harvesting capabilities. MOF-derived porous photoanodes can effectively adsorb dye molecules and improve LHE, resulting in high power conversion efficiency (PCE). Doping is a prospective methodology to tune the bandgap and broaden spectral absorption. Hence, a novel and cost-effective synthesis of high surface area transition metal (TM) doped TiO2 nanocrystals (NCs) via the metal-organic framework route for DSSCs is reported here. Among the TM dopants (i.e., Mn, Fe, Ni), a remarkable PCE of 7.03% was obtained for nickel-doped samples with increased Jsc (14.66 mA/cm2) due to the bandgap narrowing and porous morphology of TiO2. The findings were further confirmed using electrochemical impedance spectroscopy (EIS) and dye-desorption experiments. The present study expedites a promising way to enhance the LHE for many innovative optoelectronic devices.

Paper based micro/nanofluidics devices for biomedical applications.

This chapter details the significance, fabrication and biomedical applications of paper-based microfluidic devices. The first part of the chapter describes the importance of paper diagnostic devices, highlighting pretreatment, dipsticks, lateral flow assays, and microPADs. Various methods followed for the fabrication of the paper analytical devices are discussed in the second part. The last part is about some of the important biomedical applications of paper analytical devices. Finally, the challenges and research gaps in the paper microfluidics for biomedical applications are presented.

Development of a paper-based analytical device for the colourimetric detection of alanine transaminase and the application of deep learning for image analysis.

A paper-based colourimetric assay for the detection of alanine transaminase has been developed. In the presence of alanine transaminase, 2,4-dinitrophenyl hydrazine changes to pyruvate hydrazone leading to a colour change from pale yellow to dark yellow. Reaction conditions were optimized using absorption spectroscopic studies. Hydrophobic patterns on the Whatman chromatographic paper were created by wax printing, and the reagents were drop cast at the reagent zone. On the paper device, the intensity of the yellow colour increases with ALT concentration in the range of 20-140 U/L in human serum. For the quantification of ALT, coloured images were captured using a digital camera and were processed with Image J software. The machine learning approach was also explored for the ALT analysis by training with colour images of the paper device and testing using a cross-validation procedure. The results obtained with real clinical samples on the paper device showed good accuracy of less than 5% relative error with the clinical lab results. Furthermore, the paper device shows high selectivity to ALT in the presence of various interfering species in blood serum with a sensitivity of 0.261 a.u/(U/L), a detection limit of 4.12 U/L, and precise results with an RSD of less than 7%. For the testing of whole blood, a plasma separation membrane was integrated with the patterned paper.

Fabrication of Highly Sensitive Nonenzymatic Electrochemical H2O2 Sensor Based on Pt Nanoparticles Anchored Reduced Graphene Oxide.

A highly sensitive nonenzymatic hydrogen peroxide (H2O2) sensor was fabricated using platinum nanoparticles decorated reduced graphene oxide (Pt/rGO) nanocomposite. The Pt/rGO nanocomposite was prepared by single-step chemical reduction method. Nanocomposite was characterized by various analytical techniques including Raman spectroscopy, X-ray diffraction, field emission scanning electron microscope and high-resolution transmission electron microscopy. Screen printed electrodes (SPEs) were fabricated and the nanocomposite was cast on the working area of the SPE. Cyclic voltammetry and amperometry demonstrated that the Pt/rGO/SPE displayed much higher electrocatalytic activity towards the reduction of H2O2 than the other modified electrodes. The sensor exhibited wide linear detection range (from 10 µM to 8 mM), very high sensitivity of 1848 µA mM-1 cm-2 and a lower limit of detection of 0.06 µM. The excellent performance of Pt/rGO/SPE sensor were attributed to the reduced graphene oxide being used as an effective matrix to load a number of Pt nanoparticles and the synergistic amplification effect of the two kinds of nanomaterials. Moreover, the sensor showed remarkable features such as good reproducibility, repeatability, long-term stability, and selectivity.

Transversus Abdominis Plane Block versus Ilioinguinal/Iliohypogastric Nerve Block with Wound Infiltration for Postoperative Analgesia in Inguinal Hernia Surgery: A Randomized Clinical Trial.

BACKGROUND: Various analgesic modalities have been used for postoperative analgesia in patients undergoing inguinal hernia surgery. In this randomized clinical trial, we have compared the analgesic efficacy of transversus abdominis plane (TAP) block with that of ilioinguinal/iliohypogastric (IIIH) nerve block with wound infiltration in patients undergoing unilateral open inguinal hernia repair. AIM: The primary objective of this study was to compare the efficacy of postoperative analgesia of ultrasound-guided TAP block and IIIH block with wound infiltration (WI) in patients undergoing open inguinal hernia surgery. SETTINGS AND DESIGN: This was a randomized clinical trial performed in a tertiary care hospital. MATERIALS AND METHODS: Sixty patients scheduled for hernia repair were randomized into two groups, Group T and Group I. Postoperatively, under ultrasound guidance, Group T received 20 ml of 0.25% ropivacaine - TAP block and Group I received 10 ml of 0.25% ropivacaine - IIIH block + WI with 10 ml of 0.25% ropivacaine. The primary outcome measure was the time to rescue analgesia in the first 24 h postoperatively. Fentanyl along with diclofenac was given as first rescue analgesic when the patient complained of pain. STATISTICAL ANALYSIS: Statistical comparisons were performed using Student's t-test and Chi-square test. RESULTS: Mean time to rescue analgesia was 5.900 ± 1.881 h and 3.766 ± 1.754 h (P < 0.001) and the mean pain scores were 5.73 ± 0.784 and 6.03 ± 0.850 for Group TAP and IIIH + WI, respectively. Hemodynamics were stable in both the groups. One-third of the patients received one dose of paracetamol in addition to the rescue analgesic in the first 24 h. There were no complications attributed to the block. CONCLUSION: As a multimodal analgesic regimen, definitely both TAP block and IIIH block with wound infiltration have a supporting role in providing analgesia in the postoperative period for adult inguinal hernia repair. In this study, ultrasound-guided TAP block provided longer pain control postoperatively than IIIH block with WI after inguinal hernia repair. There were no complications attributed to the blocks in either of the group.

Analgesic Efficacy of Transverse Abdominal Plane Block after Elective Cesarean Delivery - Bupivacaine with Fentanyl versus Bupivacaine Alone: A Randomized, Double-blind Controlled Clinical Trial.

BACKGROUND: The analgesic benefit of transversus abdominis plane (TAP) blocks for cesarean delivery remains controversial. In our study, we compared the analgesic efficacy of TAP block using local anesthetic bupivacaine and adjunct fentanyl with bupivacaine alone in patients undergoing elective cesarean section. METHODS: Our study was a randomized, double-blind, controlled clinical trial where sixty patients undergoing elective cesarean delivery under subarachanoid block (2 ml of 0.5% bupivacaine) were randomized into two groups, A and B. At the end of the surgical procedure, bilateral TAP block was performed guided by the ultrasound. Group A received 38 ml of 0.25% bupivacaine and 2 ml of 50 µg of fentanyl, whereas Group B received 38 ml of 0.25% bupivacaine + 2 ml of normal saline. The total volume was divided equally and administered bilaterally. Each patient was assessed for 24 h after TAP block, for time to rescue analgesia, pain using visual analog scale (VAS) score at rest and on movement, hemodynamic parameters (heart rate and blood pressure), nausea, vomiting, and sedation. Diclofenac 75 mg was given as rescue analgesia when the patient complained of pain or when VAS score >4. RESULTS: Prolonged postoperative analgesia was noticed with both the groups, with a mean time to rescue analgesia of approximately 6.5 h. There was no significant difference in time to rescue analgesia (6.49 ± 0.477 vs. 6.5 ± 0.480) when both the groups were compared among themselves. The pain scores among the two groups when compared did not show any added benefit. Incidence of nausea, vomiting, and sedation when compared between both the groups showed no difference. CONCLUSION: The TAP block as a part of a multimodal analgesic regimen definitely has a role in providing superior analgesia in the postoperative period. However, adjunct fentanyl to local anesthetic bupivacaine was found to have no added advantage when quality and duration of analgesia was compared.

Vertically Aligned TiO2 Nanotube Arrays Decorated with CuO Mesoclusters for the Nonenzymatic Sensing of Glucose.

Highly ordered titanium dioxide (TiO2) nanotubes were modified with CuO mesoclusters through electrodeposition followed by electrooxidation. Field Emission Scanning Electron Microscopy (FESEM) revealed the presence of vertically aligned TiO2 nanotubes with a diameter of 60 nm and CuO mesoclusters of ~500 nm in diameter. Glucose oxidation on the CuO modified TiO2 electrode occurred at +0.55 V. The electrode exhibited a sensitivity of 1836 and 1416 µA mmol⁻¹ L cm−2 for glucose concentrations ranging from 0.625 to 6.25 mmol L⁻¹ and 6.87 to 12.5 mmol L⁻¹ respectively, a limit of detection of 3.4 µmol L⁻¹ (S/N = 3) and a rapid response time of ≤2 s. Physiological concentrations of ascorbic acid, uric acid and dopamine had no effect on the glucose oxidation. Interference from other sugars (lactose and galactose) was negligible. Result obtained from the estimation of blood glucose was found to be in good agreement with those obtained from commercially available glucose sensor strips.

Multi-center prospective survey of inflammatory bowel diseases in Kerala: More than 2000 cases.

BACKGROUND: Inflammatory bowel disease (IBD) is considered uncommon in Asia. The aim of this study was to document the demographic characteristics and clinical aspects of ulcerative colitis (UC) and Crohn's disease (CD) in Kerala, India. METHODS: A survey of IBD in Kerala was performed. All gastroenterologists in the region were invited. From May 2013 to October 2015, data were collected in a standardized pro-forma. RESULTS: Forty-seven doctors in 34 centers contributed data. A total of 2142 patients were analyzed. This is the largest state-wide survey of IBD in India. Ulcerative colitis was diagnosed in 1112 (38 new), Crohn's disease in 980 (53 new), and 50 were unclassified (5 new). The district-wise distribution of IBD cases correlated with the District-wise Gross State Domestic Product (r = 0.69, p < 0.01). Three percent was below the age of 18. Patients with UC had more diarrhea (73% vs. 51%), bleeding PR (79% vs. 34%), and intermittent flares (35% vs. 13%) (all p < 0.01). Patients with CD had more abdominal pain (62% vs. 46%), weight loss (53% vs. 40%), fever (28% vs. 18%), and history of antituberculosis treatment (21% vs. 5%) (all p < 0.01). Compared to adults, children (below 18 years) were more likely to have extensive UC (58% vs. 34%, p < 0.01) and unclassified IBD (15% vs. 2%, p < 0.01). CONCLUSION: Inflammatory bowel disease is common in Kerala, India. The disease characteristics of patients with IBD are almost similar to those from other parts of the country. Both UC and CD were seen in equal proportion in Kerala.

Perioperative management of poly-trauma in a postmitral valve replacement patient with severe left ventricular systolic dysfunction.

The anesthetic management of a patient with severe left ventricular (LV) dysfunction undergoing noncardiac surgery poses a challenge to the anesthesiologist as LV dysfunction is commonly complicated by progressive congestive heart failure and malignant arrhythmias. When the cause for LV dysfunction is postvalve replacement, additional complications such as intraoperative thrombosis, bleeding, and infective endocarditis need to be addressed perioperatively. In such situations, the anesthesiologist must have the knowledge hemodynamics, diagnostic evaluations, and treatment modalities, more so regarding various drugs used during anesthesia. We report a case of postmitral valve replaced patient with severe LV dysfunction posted for surgery of fracture of the femur and facial fractures managed successfully during anesthesia.

Limb-girdle muscular dystrophy with obesity for elective cesarean section: Anesthetic management and brief review of the literature.

Limb-girdle muscular dystrophy (LGMD) is an autosomal recessive disorder in which the pelvic or shoulder girdle musculature is predominantly or primarily involved. We report the management of a 27-year-old primigravida with LGMD associated with obesity posted for elective cesarean section. She was successfully managed with epidural anesthesia assisted with noninvasive positive pressure ventilation. She had an uncomplicated intra- and post-operative course.

Tantalum oxide honeycomb architectures for the development of a non-enzymatic glucose sensor with wide detection range.

Tantalum oxide honeycomb nanostructures (THNS) were fabricated by electrochemical anodisation of tantalum in H2SO4-HF medium. XRD analysis showed that annealing of THNS at 400 °C improves the crystallinity. HRSEM and AFM results illustrated that nanopores with an average diameter of 30 nm were uniformly distributed and the pore size reduced to 24 nm and 18 nm during subsequent electrodeposition of Pt and CuO. Electrodeposited Pt and CuO exhibited face centered cubic (fcc) and monoclinic crystal structure respectively. Cyclic voltammetric studies revealed that, on the hybrid material electrooxidation of glucose occurs at a lower potential (0.45 V). The sensor exhibited linear response to glucose up to 31 mM, fast response time (<3 s) and a low detection limit of 1 µM (S/N=3). The sensor is free of interference from ascorbic acid, uric acid, dopamine and acetaminophen. Sensor was used to analyze glucose in blood serum samples.

Perioperative management of a patient with Gilberts syndrome and rheumatic heart disease.

Anaesthetic management of patients with hepatic dysfunction can be quite challenging, as many anaesthetic agents are metabolized by liver. Heart disease on anti coagulation can pose additional challenge. Here we report a case of Gilbert's syndrome with rheumatic heart disease on anti coagulation posted for elective hernia repair.

Anesthetic management of congenital broncho-esophageal fistula in an adult.

Broncho-esophageal fistula (BEF) are quite rare in adults, more so the congenital variety. The common causes of BEF in adults include infections, trauma, and malignancies. We report a rare case of congenital BEF manifesting in adulthood with repeated pulmonary infections. We emphasize mainly on the preoperative preparation and perioperative management of this patient. It is essential to have a high index of suspicion to diagnose congenital BEF in adults. Anesthesiologists play an important role in successful management of these cases.

Indoor (222)Rn and (220)Rn concentrations and doses in Bangalore, India.

(222)Rn and (220)Rn levels have been measured using passive detector technique by employing time integrated solid-state nuclear track detector-based dosemeters in various types of houses at 10 different locations in and around Bangalore Metropolitan, India. The measured geometric mean concentration values of (222)Rn and (220)Rn levels in 200 dwellings of different types of construction were found to be 32.2±1.6 and 21.4±1.0 Bq m(-3), respectively. The dose rate received by the population of Bangalore ranged between 0.2 and 3.5 mSv y(-1) with an average and the geometric mean of 1.14±0.05 and 1.06 mSv y(-1), respectively. Overall, the result does not show much significant radiological risk for the inhabitants and the (222)Rn levels are well within the limits of global average concentration of 40 Bq m(-3). However, the (220)Rn levels observed were found to be higher than the global average of 10 Bq m(-3).

Earthing defect: a cause for unstable hemodynamics.

Interference of monitored electrocardiogram (ECG) is a common event in intensive care units and operation theaters. Artifacts in the ECG tracing can resemble serious arrhythmia, thus leading to unnecessary usage of antiarrhythmics or electrical defibrillation. In addition, ECG artifacts may lead to serious hemodynamic consequences secondary to intra-aortic balloon pump (IABP) trigger failure. We report a rare event of IABP failure due to ECG artifact, which appeared on placement of the transthoracic echocardiography probe over the chest. Subsequent evaluation revealed potential current leakage from echocardiography machine secondary to earthing defect in the machine.

Investigation of the extraction process and phytochemical composition of preparations of Dodonaea viscosa (L.) Jacq.

ETHNOPHARMACOLOGICAL RELEVANCE: Oily substances extracted by a crude process from the stem including its bark (hereafter referred to as the stem) of Dodonaea viscosa (L.) Jacq. has been used by practitioners of traditional Indian medicine to treat inflammation, pain and other musculoskeletal disorders. AIM OF THE STUDY: The aim of this study is to understand the scientific phenomena behind the process adopted by traditional practitioners for extraction and to establish the principle of extraction process by a simulated scientific method. The study also investigates the phyto-chemical composition of the extracts and compares the simulated extract with the traditional extract. MATERIALS AND METHODS: The traditional method was subjected to a detailed analysis, and it was identified as a crude equivalent of pyrolysis. The process was simulated under controlled conditions in a self-fabricated prototype pyrolyser. The extracts from both methods were compared for their compositional identity and phytochemistry using FT-IR and GC-MS. RESULTS: The results show that in both the cases, the presence of dihydroxy, dimethyl and other substituted catechols, which are postulated as pyrolysate derivatives of the anti-spasmodic flavonoids quercetin, rutin, kaempferol and sakuranetin. CONCLUSION: The applied principle of extraction is identified as slow pyrolysis, which is supported by the visual and chemical similarities of the extracts from both methods. The phyto-chemical analysis indicates the presence of anti-spasmodic chemicals in the extract from the stem of Dodonaea viscosa (L.) Jacq.; these chemicals are likely the active substances in the treatment of inflammation, pain and other musculoskeletal disorders, and the research substantiates the stem's historical use by traditional practitioners.

(226)Ra, (232)Th and (40)K contents in soil samples from Garhwal Himalaya, India, and its radiological implications.

The exposure of human beings to ionising radiation from natural sources is a continuing and inescapable feature of life on earth. Natural radionuclides are widely distributed in various geological formations and ecosystems such as rocks, soil groundwater and foodstuffs. In the present study, the distribution of (226)Ra, (232)Th and (40)K was measured in soil samples collected from different lithological units of the Thauldhar and Budhakedar regions of Garhwal Himalaya, India. The collected soil samples were analysed using gamma ray spectrometry. The activity concentrations of the naturally occurring radionuclides (226)Ra, (232)Th and (40)K in these soil samples were found to vary from below detection level (BDL) to 131 +/- 18 Bq kg(-1), 9 +/- 6 to 384 +/- 53 Bq kg(-1) and 471 +/- 96 to 1406 +/- 175 Bq kg(-1), respectively. The distribution of radionuclides depends upon the rock formation and chemical properties within the earth. The activity concentrations vary widely depending on the sample origin. The external absorbed gamma dose rates due to (226)Ra, (232)Th and (40)K were found to vary from 49 to 306 nGy h(-1). The average radium equivalent activity from these soil samples was 300 Bq kg(-1).