In situ fabrication of lanthanum-doped nickel oxide nanostructures using sol-gel for the degradation of rhodamine B.

Nanoscale science represents a thriving field of research for environmental applications within materials science. This study focuses on the fabrication of pure and La-doped nickel oxide (NiO) nanostructures with varying concentrations (1.0, 2.0, 3.0, and 4.0 wt%) of lanthanum using a facile sol-gel technique. This study explores the structural, morphological, chemical composition, and optical characteristics of the resulting pure and La-doped NiO nanostructures. Techniques such as X-ray diffraction (XRD), scanning electron microscopy (SEM), energy-dispersive X-ray (EDX) spectroscopy, UV-visible spectroscopy, and photoluminescence (PL) spectroscopy were used for material analysis. The observed trend in the energy band gap (Eg) values demonstrates a continuous decrease up to a La-doping concentration of 3 wt% in NiO. However, after this concentration (at 4.0 wt%), there is a noticeable increase in the energy band gap. At lower La-doping concentrations (up to 3 wt%), the incorporation of La ions into the NiO lattice may result in the formation of defects and oxygen vacancies. The presence of these imperfections may lead to new energy levels into the band gap, resulting in partial filling and a subsequent reduction in the band gap. Beyond a specific doping concentration (e.g., 3 wt%), excess La atoms may aggregate or cluster inside the NiO lattice. This agglomeration may cause structural distortions, strain, and disturbances in the crystal lattice, resulting in an increase in the band gap. The 3 wt% La-doped NiO sample demonstrated a notable 84% degradation efficiency of the synthesized nanomaterials coupled with its inherent stability, highlighting its dual attributes of effective pollutant removal and sustained performance. Furthermore, the cyclic stability of the optimized nanostructure is anticipated to be ∼77.42% after six cycles, suggesting promising future applications in photocatalysis.

Tuning the Magnetic Behavior of Zinc Ferrite via Cobalt Substitution: A Structural Analysis.

Cobalt-doped zinc ferrite is a contemporary material with significant structural and magnetic characteristics. Our study explores the magnetic properties of cobalt-substituted zinc ferrite (ZnxCo1-xFe2O4), synthesized via a simple sol-gel method. By varying the cobalt ratio from 0 to 0.5, we found that zinc substitution impacts both the magnetization and lattice parameters. FTIR analysis suggested the presence of functional groups, particularly depicting an M-O stretching band, within octahedral and tetrahedral clusters. X-ray diffraction analysis confirmed the phase purity and cubic structure. The synthesized materials exhibited an average particle size of 24-75 nm. Scanning electron microscopy revealed the morphological properties, confirming the formation of truncated octahedral particles. In order to determine the stability, mass loss (%), and thermal behavior, a thermal analysis (thermogravimetric analysis (TGA)/differential thermal analysis (DTA)) was performed. The magnetic properties of the synthesized ferrites were confirmed via a vibrating sample magnetometer (VSM). Finally, the highest saturated magnetization and lowest coercivity values were observed with higher concentrations of the cobalt dopant substituting zinc. The synthesized nanomaterials have good stability as compared to other such materials and can be used for magnetization in the near future.

COVID-19 spread control policies based early dynamics forecasting using deep learning algorithm.

Many severe epidemics and pandemics have hit human civilizations throughout history. The recent Sever Actuate Respiratory disease SARS-CoV-2 known as COVID-19 became a global disease and is still growing around the globe. It has severely affected the world's economy and ways of life. It necessitates predicting the spread in advance and considering various control policies to avoid the country's complete closure. In this paper, we propose deep learning-based stacked Bi-directional long short-term memory (Stacked Bi-LSTM) network that forecasts COVID-19 more accurately for the country of South Korea. The paper's main objectives are to present a lightweight, accurate, and optimized model to predict the spread considering restriction policies such as school closure, workspace closing, and the canceling of public events. Based on the fourteen parameters (including control policies), we predict and forecast the future value of the number of positive, dead, recovered, and quarantined cases. In this paper, we use the dataset of South Korea comprised of several control policies implemented for minimizing the spread of COVID-19. We compare the performance of the stacked Bi-LSTM with the traditional time-series models and LSTM model using the performance metrics mean absolute error (MAE), mean absolute percentage error (MAPE), and root mean square error (RMSE). Moreover, we study the impact of control policies on forecasting accuracy. We further study the impact of changing the Bi-LSTM default activation functions Tanh with ReLU on forecasting accuracy. The research provides insight to policymakers to optimize the pooling of resources more optimally on the correct date and time prior to the event and to control the spread by employing various strategies in the meantime.

Mobile sensors based platform of Human Physical Activities Recognition for COVID-19 spread minimization.

The development of smartphones technologies has determined the abundant and prevalent computation. An activity recognition system using mobile sensors enables continuous monitoring of human behavior and assisted living. This paper proposes the mobile sensors-based Epidemic Watch System (EWS) leveraging the AI models to recognize a new set of activities for effective social distance monitoring, probability of infection estimation, and COVID-19 spread prevention. The research focuses on user activities recognition and behavior concerning risks and effectiveness in the COVID-19 pandemic. The proposed EWS consists of a smartphone application for COVID-19 related activities sensors data collection, features extraction, classifying the activities, and providing alerts for spread presentation. We collect the novel dataset of COVID-19 associated activities such as hand washing, hand sanitizing, nose-eyes touching, and handshaking using the proposed EWS smartphone application. We evaluate several classifiers such as random forests, decision trees, support vector machine, and Long Short-Term Memory for the collected dataset and attain the highest overall classification accuracy of 97.33%. We provide the Contact Tracing of the COVID-19 infected person using GPS sensor data. The EWS activities monitoring, identification, and classification system examine the infection risk of another person from COVID-19 infected person. It determines some everyday activities between COVID-19 infected person and normal person, such as sitting together, standing together, or walking together to minimize the spread of pandemic diseases.

Frequency of Acquired Renal Cystic Disease in Patients on Long-Term Hemodialysis and Associated Renal Cell Carcinoma.

Background Acquired cystic renal disease is one of the complications of end-stage renal disease (ESRD) patients on dialysis. We aimed to define the prevalence of acquired cystic renal disease in a dialysis center in a tertiary care setup in Pakistan. Materials and methods We conducted a cross-sectional study of 246 patients with ESRD from October 1, 2017, to March 30, 2018. We collected patient demographic data, comorbidities, duration (years), frequency (sessions/week), length of each dialysis session (hours), ultrasound findings, cystic renal disease occurrence, and associated complications for analysis. Results Our patient population consisted of 115 women (46.7%) and 131 men (53.3%) and had a mean age of 55.9 ± 15.1 years. Thirty-seven patients were on dialysis for one year, 78 (31.7%) for two years, and 131 (53.3%) for three or more years, as its more common with increasing duration. The mean dialysis duration was 2.3 ± 0.7 years. Of 246 patients, 49 (19.9%) had acquired cystic renal disease. Conclusions Given improved health care facilities, an increasing number of patients have a good survival on dialysis and develop long-term complications associated with end-stage renal disease, such as acquired cystic renal disease. Because the acquired renal cystic disease is associated with renal cell carcinoma, physicians should evaluate dialysis patients for renal cell carcinoma, especially after three to five years of dialysis.

The Effectiveness of Alternate-day Cinacalcet Therapy for Secondary Hyperparathyroidism in Noncompliant Hemodialysis Patients.

Chronic kidney disease (CKD) is defined as an abnormality of the kidney's structure or function that is present for more than 3 months. Secondary hyperparathyroidism is a consequence of CKD, which eventuates with a decrease in the glomerular filtration rate. This study aimed to evaluate the effectiveness of alternate-day cinacalcet in noncompliant dialysis patients compared with a daily dose. The effects on the levels of intact parathyroid hormone (iPTH), calcium, and phosphorus were measured, and the compliance of patients with our protocol was observed. We followed the patients' (n = 134) iPTH levels every 3 months and their serum calcium and phosphorous monthly for 6 months and compared the results with 6 months of data from patients receiving daily doses of cinacalcet. The patients' mean age was 49.54 ± 16.17 years, the mean duration of dialysis was 6.44 ± 5.10 years, and 37.3% had diabetic nephropathy. The mean dose of alternate-day cinacalcet was 61.92 ± 26.59 mg. The level of iPTH before and after the change was 924.63 ± 474.132 pg/mL and 787.87 ± 496.49 pg/mL, respectively (P = 0.001), and the mean serum calcium level before and after was 8.56 ± 1.91 mg/dL and 8.85 ± 1.25 mg/dL, respectively (P = 0.035). The level of serum phosphorous before and after the change was 4.81 ± 1.32 mg/dL and 5.08 ± 2.3 mg/dL, respectively (P = 0.204). Cinacalcet produced significant reductions in iPTH with intermittent (three times per week) doses and thus was more cost-effective and had better compliance.

Comparative evaluation for thermostability and gastrointestinal survival of probiotic Bacillus coagulans MTCC 5856.

Thermal stability (D-value and pasteurization) and gastric acid resistance of spore forming and nonspore forming probiotic strains were evaluated in this study. Bacillus coagulans MTCC 5856 spores showed highest thermal resistance (D-value 35.71 at 90 °C) when compared with other Bacillus strains and Lactobacillus species. B. coagulans strains exhibited significantly higher resistance to simulated gastric juice (pH 1.3, 1.5, and 2.0) compared to Lactobacillus strains. It also showed high resistance to cooking conditions of chapati (whole wheat flour-based flatbread) (88.94% viability) and wheat noodles (and 94.56% viability), suggesting remarkable thermal resistance during food processing. Furthermore, B. coagulans MTCC 5856 retained 73% viability after microwave cooking conditions (300 s, at 260 °C) and 98.52% in milk and juice at pasteurization temperature (420 min, at 72 °C). Thus, B. coagulans MTCC 5856 clearly demonstrated excellent resistance to gastric acid and high temperature (90 °C), thereby suggesting its extended application in functional foods (milk, fruit juices, chapati, and wheat noodles) wherein high temperature processing is involved.

Standardized Emblica officinalis fruit extract inhibited the activities of α-amylase, α-glucosidase, and dipeptidyl peptidase-4 and displayed antioxidant potential.

BACKGROUND: Emblica officinalis, known as amla in Ayurveda, has been used as a folk medicine to treat numerous pathological conditions, including diabetes. However, the novel extract of E. officinalis fruit extract (amla fruit extract, AFE, Saberry®) containing 100 g kg-1 ß-glucogallin along with hydrolyzable tannins has not yet been extensively studied for its antidiabetic potential. OBJECTIVE: The aim of this study was to investigate the antidiabetic and antioxidant activities of AFE and its stability during gastric stress as well as its thermostability. METHODS: The effect of AFE on the inhibition of pancreatic α-amylase and salivary α-amylase enzymes was studied using starch and yeast α-glucosidase enzyme using 4-nitrophenyl α-d-glucopyranoside as substrate. Further, 2,2-diphenyl-1-picrylhydrazyl radical scavenging and reactive oxygen species inhibition assay was performed against AFE. RESULTS: AFE potently inhibited the activities of α-amylase and α-glucosidase in a concentration-dependent manner with half maximal inhibitory concentration (IC50 ) values of 135.70 µg mL-1 and 106.70 µg mL-1 respectively. Furthermore, it also showed inhibition of α-glucosidase (IC50 562.9 µg mL-1 ) and dipeptidyl peptidase-4 (DPP-4; IC50 3770 µg mL-1 ) enzyme activities. AFE is a potent antioxidant showing a free radical scavenging activity (IC50 2.37 µg mL-1 ) and protecting against cellular reactive oxygen species (IC50 1.77 µg mL-1 ), and the effects elicited could be attributed to its phytoconstituents. CONCLUSION: AFE showed significant gastric acid resistance and was also found to be thermostable against wet heat. Excellent α-amylase, α-glucosidase, and DPP-4 inhibitory activities of AFE, as well as antioxidant activities, strongly recommend its use for the management of type 2 diabetes mellitus. © 2019 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Bioconversion of curcumin into calebin-A by the endophytic fungus Ovatospora brasiliensis EPE-10 MTCC 25236 associated with Curcuma caesia.

Calebin-A is a curcuminoid compound reported to be present in Curcuma longa rhizome. The current study was aimed to isolate and characterize calebin-A from Curcuma caesia rhizome and its production through biotransformation approach using endophytic fungus. C. caesia rhizomes of different ages were subjected to analysis in order to investigate the age at which maximum calebin-A content is present. HP-TLC profiles, HPLC retention times and mass spectrometry detector confirmed the occurrence of calebin-A in C. caesia rhizomes of 12 to 14 months of age but not in rhizomes younger to 12 months. Furthermore, an endophytic fungus strain, EPE-10 that was isolated from the medicinal plant C. caesia was identified as Ovatospora brasiliensis based on morphological and molecular characteristics. This strain O. brasiliensis was deposited to the culture collected centre, MTCC Chandigarh, India under the Budapest treaty and was designated with the Accession Number MTCC 25236. Biotransformation process was carried out at 37 ± 0.5 °C with shaking for 7 days after addition of 0.01% w/v curcumin. Extraction of biotransformed products was done by following partition method and the extracts obtained were analyzed using HPTLC, HPLC and LCMS. The data of the study suggested that O. brasiliensis MTCC 25236 was found to convert curcumin to calebin-A in a time dependant manner with optimum conversion at 48 h. Furthermore, O. brasiliensis MTCC 25236 was found to be positive for the Baeyer-Villiger monooxygenase (BVMOs) enzyme activity which could possibly be the mechanism of this bioconversion. The results of this study for the first time indicated that the endophytic fungus identified as O. brasiliensis MTCC 25236 isolated from the C. caesia rhizome could be a possible source for naturally producing calebin-A.

Evaluation of probiotic Bacillus coagulans MTCC 5856 viability after tea and coffee brewing and its growth in GIT hostile environment.

In recent years, probiotic functional foods have gained quite a popularity and become a preferred choice among consumers, due to their positive effects on the gut microbiota and overall health. However, it is imperative for a probiotic strain to remain live and active at the time of consumption in high enough population density, in order to provide such health benefits. Thus, this study aimed to investigate the Bacillus coagulans MTCC 5856 spore stability after tea and coffee brewing and its subsequent growth in gastrointestinal tract (GIT) hostile environment. B. coagulans MTCC 5856 showed remarkable survival (94.94% and 99.76% in unroasted green coffee and tea, respectively) after brewing conditions and was able to grow in GIT hostile conditions using tea and coffee as a sole nutritional source. B. coagulans MTCC 5856 inclusion in tea and coffee after brewing did not significantly (P > .05) alter the sensory profile when compared to that without the probiotic inclusion. Moreover, B. coagulans MTCC 5856 growth was significantly (P < .05) higher when water soluble fibers were added during brewing, suggesting a synergistic property. It showed over 99% viability (P > .05) in tea and coffee powder at room temperature up to 24 months of storage. This study demonstrated the stability of the tested probiotic strain B. coagulans MTCC 5856 after tea and coffee brewing and its growth in GIT hostile environment, thereby suggesting functional probiotic use in tea and coffee.

Contrast-induced Acute Kidney Injury in Patients with Liver Cirrhosis: A Retrospective Analysis.

Contrast-induced acute kidney injury (CI-AKI) has been studied less extensively in patients with liver cirrhosis (LC). It is unclear whether the presence of severe liver disease is actually a predisposing factor for CI-AKI. Liver cirrhosis is extremely common in Pakistan and is attributed to the high prevalence of chronic viral hepatitis. Patients with LC often undergo contrast-enhanced computed tomograms (CECT) for various diagnostic and therapeutic purposes, and there have been concerns regarding them being at risk for CI-AKI. The available literature on this topic is scanty, and no study has been conducted in Pakistan. The purpose of this study, therefore, was to determine the frequency of CI-AKI in patients with LC undergoing CECT and to determine any significant predispositions. We retrospectively analyzed the records of 470 LC patients at our center. The frequency of CI-AKI in our study was 5.1%. A higher mean model for end-stage liver disease (MELD), MELD including sodium (MELD-Na), and Child-Pugh (CP) scores was significantly associated with developing CI-AKI (p<0.05). Patients with CI-AKI also had a significantly higher mean international normalized ratio (INR) and serum bilirubin levels, with lower mean venous bicarbonate and serum sodium levels (p<0.05). Our results show that patients with a more advanced liver disease and poorer synthetic function are increasingly susceptible to developing CI-AKI. Further studies can investigate the role of bicarbonate therapy in preventing CI-AKI in LC.

Evaluation of the Safety and Efficacy of a Multienzyme Complex in Patients with Functional Dyspepsia: A Randomized, Double-Blind, Placebo-Controlled Study.

Functional dyspepsia (FD) is a highly prevalent disorder having nonspecific symptoms and varied pathophysiology. Its treatment remains a challenge as therapeutic options are limited, unsatisfactory, and elusive. Thus, safety and efficacy of DigeZyme®, a proprietary multienzyme complex (MEC), was evaluated as a dietary supplement in FD patients. In this randomized, double-blind, placebo-controlled, parallel-group study, 40 patients were randomly assigned (1:1 ratio) to receive either MEC (50 mg, TID; n = 20) or placebo (n = 20) for 60 days. Reports of adverse or serious adverse events (AEs), abnormal results of vital signs, abnormal findings during physical examination, and abnormal laboratory investigations were monitored closely. Efficacy measures were change in Short-Form Leeds Dyspepsia Questionnaire (SF-LDQ), Nepean Dyspepsia Index-Short Form (NDI-SF), Visual Analog Scale (VAS), Clinical Global Impression Severity Rating Scale (CGI-S), and Glasgow Dyspepsia Severity Score (GDSS) at baseline and follow-up visits on day 15, 30, and 60. Supplementation with MEC was associated with statistically significant differences (P value ranging from .0401 to .0033) in all efficacy parameters compared with placebo. The between-group comparison also revealed that MEC supplement had a significantly greater effect (P < .001) versus placebo. No investigation product-related AEs were reported. There were no clinically significant abnormalities in physical findings and no statistically significant changes in biochemical and hematological parameters, vital signs, body weight, and body mass index observed between the two groups at baseline and follow-up visits. MEC supplementation represents an effective and safe alternative to manage dyspepsia symptoms in FD patients.

Bacillus coagulans MTCC 5856 for the management of major depression with irritable bowel syndrome: a randomised, double-blind, placebo controlled, multi-centre, pilot clinical study.

BACKGROUND: The modification of microbial ecology in human gut by supplementing probiotics may be an alternative strategy to ameliorate or prevent depression. OBJECTIVE: The current study was conducted to assess the safety and efficacy of the probiotic strain Bacillus coagulans MTCC 5856 for major depressive disorder (MDD) in IBS patients. METHOD: Patients (n = 40) diagnosed for MDD with IBS were randomized (1:1) to receive placebo or B. coagulans MTCC 5856 at a daily dose of 2 × 109 cfu (2 billion spores) and were maintained to the end of double-blind treatment (90 days). Changes from baseline in clinical symptoms of MDD and IBS were evaluated through questionnaires. RESULTS: Significant change (p = 0.01) in favour of the B. coagulans MTCC 5856 was observed for the primary efficacy measure Hamilton Rating Scale for Depression (HAM-D), Montgomery-Asberg Depression Rating Scale (MADRS), Center for Epidemiological Studies Depression Scale (CES-D) and Irritable bowel syndrome quality of life questionnaire (IBS-QOL). Secondary efficacy measures i.e. Clinical Global Impression-Improvement rating Scale (CGI-I), Clinical Global Impression Severity rating Scale (CGI-S), Gastrointestinal Discomfort Questionnaire (GI-DQ) and Modified Epworth Sleepiness Scale (mESS) also showed significant results (p = 0.01) in B. coagulans MTCC 5856 group compared to placebo group except dementia total reaction scoring. Serum myeloperoxidase, an inflammatory biomarker was also significantly reduced (p < 0.01) when compared with the baseline and end of the study. All the safety parameters remained well within the normal clinical range and had no clinically significant difference between the screening and at the end of the study. CONCLUSION: B. coagulans MTCC 5856 showed robust efficacy for the treatment of patients experiencing IBS symptoms with major depressive disorder. The improvement in depression and IBS symptoms was statistically significant and clinically meaningful. These findings support B. coagulans MTCC 5856 as an important new treatment option for major depressive disorder in IBS patients.

Galactomannan from Trigonella foenum-graecum L. seed: Prebiotic application and its fermentation by the probiotic Bacillus coagulans strain MTCC 5856.

Health benefits of dietary fibers are currently being widely recognized. However, the assessment of dietary fiber as a prebiotic is essential and also important for the development of an improved synbiotic commercial preparation. Thus, the aim of this study was to evaluate the potential of galactomannan extracted from fenugreek seeds as a prebiotic fiber and also its fermentation by the probiotic strain Bacillus coagulans MTCC 5856. Nondigestibility by the gastric acid and pancreatic enzyme hydrolysis of galactomannan were determined using an in vitro model mimicking the in vivo conditions. Further, anaerobic fermentation and utilization of galactomannan by the B. coagulans MTCC 5856 was investigated followed by selective inhibition of Escherichia coli ATCC 25922. The galactomannan from fenugreek seeds was found to be nondigestible to gastric acid and also to pancreatic enzymatic hydrolysis. The galactomannan was fermented and utilized (71.4%) by the B. coagulans MTCC 5856, and also significant amount of short-chain fatty acids production was also observed. Furthermore, B. coagulans MTCC 5856 inhibited the E. coli ATCC 25922 growth when cocultured with galactomannan suggesting competitive fermentation of probiotic bacteria. Galactomannan exhibited prebiotic activity and also showed suitability with probiotic B. coagulans MTCC 5856 in a synbiotic combination. This study provides the first scientific evidence of galactomannan from fenugreek seeds as a prebiotic that may play an important role in modulating gut flora by acting as substrate to beneficial microbes.

Central Diabetes Insipidus and Hyperglycemic Hyperosmolar State Following Accidental Carbon Monoxide Poisoning.

Carbon monoxide poisoning is common and carries significant morbidity and mortality. The nervous system, particularly the brain, is frequently affected by it, owing to its high metabolic activity and oxygen requirements. Carbon monoxide damages the nervous system by both hypoxic and inflammatory mechanisms. Central diabetes insipidus is an extremely rare complication of carbon monoxide poisoning. Herein, we report the case of a young lady, who developed this complication and severe hypernatremia after accidental carbon monoxide poisoning. She also developed a hyperglycemic hyperosmolar state during the treatment for hypernatremia. To the best of our knowledge, both these entities have not been reported together in association with carbon monoxide poisoning. The purpose of this article is to emphasize the anticipation and early recognition of central diabetes insipidus in carbon monoxide poisoning. This can prevent severe hypernatremia and complications associated with its presence and treatment.

Evaluation of genetic and phenotypic consistency of Bacillus coagulans MTCC 5856: a commercial probiotic strain.

Commercial probiotics preparation containing Bacillus coagulans have been sold in the market for several decades. Due to its high intra-species genomic diversity, it is very likely that B. coagulans strain may alter in different ways over multiple years of production. Therefore, the present study focuses to evaluate the genetic consistency and probiotic potential of B. coagulans MTCC 5856. Phenotypic and genotypic techniques including biochemical profiling, 16S rRNA sequencing, GTG 5″, BOX PCR fingerprinting, and Multi-Locus-Sequence typing (MLST) were carried out to evaluate the identity and consistency of the B. coagulans MTCC 5856. Further, in vitro probiotic potential, safety and stability at ambient temperature conditions of B. coagulans MTCC 5856 were evaluated. All the samples were identified as B. coagulans by biochemical profiling and 16S rRNA sequencing. GTG 5″, BOX PCR fingerprints and MLST studies revealed that the same strain was present over 3 years of commercial production. B. coagulans MTCC 5856 showed resistance to gastric acid, bile salt and exhibited antimicrobial activity in in-vitro studies. Additionally, B. coagulans MTCC 5856 was found to be non-mutagenic, non-cytotoxic, negative for enterotoxin genes and stable at ambient temperature (25 ± 2 °C) for 36 months. The data of the study verified that the same strain of B. coagulans MTCC 5856 was present in commercial preparation over multiple years of production.

Bacillus coagulans MTCC 5856 supplementation in the management of diarrhea predominant Irritable Bowel Syndrome: a double blind randomized placebo controlled pilot clinical study.

BACKGROUND: Bacillus coagulans MTCC 5856 has been marketed as a dietary ingredient, but its efficacy in diarrhea predominant irritable bowel syndrome (IBS) condition has not been clinically elucidated till date. Thus, a double blind placebo controlled multi-centered trial was planned to evaluate the safety and efficacy of B. coagulans MTCC 5856 in diarrhea predominant IBS patients. METHODS: Thirty six newly diagnosed diarrhea predominant IBS patients were enrolled in three clinical centres. Along with standard care of treatment, 18 patients in group one received placebo while in group two 18 patients received B. coagulans MTCC 5856 tablet containing 2 × 10(9) cfu/day as active for 90 days. Clinical symptoms of IBS were considered as primary end point measures and were evaluated through questionnaires. The visual analog scale (VAS) was used for abdominal pain. Physician's global assessment and IBS quality of life were considered as secondary efficacy measures and were monitored through questionnaires. RESULTS: Laboratory parameters, anthropometric and vital signs were within the normal clinical range during the 90 days of supplementation in placebo and B. coagulans MTCC 5856 group. There was a significant decrease in the clinical symptoms like bloating, vomiting, diarrhea, abdominal pain and stool frequency in a patient group receiving B. coagulans MTCC 5856 when compared to placebo group (p < 0.01). Similarly, disease severity also decreased and the quality of life increased in the patient group receiving B. coagulans MTCC 5856 when compared to placebo group. CONCLUSIONS: The study concluded that the B. coagulans MTCC 5856 at a dose of 2 × 10(9) cfu/day along with standard care of treatment was found to be safe and effective in diarrhea predominant IBS patients for 90 days of supplementation. Hence, B. coagulans MTCC 5856 could be a potential agent in the management of diarrhea predominant IBS patients.

Acute Abdominal Aorta Thrombosis and Ischemic Rhabdomyolysis Secondary to Severe Alcohol Intoxication.

Acute alcohol intoxication is a common cause of emergency visits worldwide. Although moderate alcohol consumption is protective against coronary artery disease, binge drinking is associated with adverse cardiovascular and neurological outcomes and may even cause sudden death. Although, few past accounts of venous thrombosis with alcohol binge drinking are available, arterial thrombosis with the condition has never been reported in the literature. We present the unusual case of a young Afghan male, who presented to us with painful, tender and swollen legs three days after a heavy alcohol binge on a Saturday night. He was diagnosed as a case of acute limb ischemia secondary to massive abdominal aorta and bilateral femoral artery thrombosis. He also had acute renal failure secondary to rhabdomyolysis. Cardiac workup revealed new onset paroxysmal atrial fibrillation and a large thrombus in the left ventricular cavity. His blood ethanol level was high. He was treated by a multidisciplinary team; urgent surgical thrombectomy for thrombotic complications, intravenous fluid hydration and later renal replacement therapy for acute renal failure. To the best of our knowledge, such a constellation of clinical features in association with severe acute alcohol intoxication has not been reported in the literature. We believe, the procoagulant nature of high blood ethanol levels and the onset of atrial fibrillation after the heavy alcohol binge, known as the holiday heart syndrome, precipitated the thrombotic events leading to rhabdomyolysis and acute renal failure. Through this case, we conclude that a very heavy alcohol binge may cause thrombotic occlusion of the abdominal aorta and femoral arteries resulting in ischemic rhabdomyolysis and acute renal failure. A high index of suspicion must be kept, especially for a patient presenting with tender, swollen lower limbs and acute renal failure after an alcohol binge.

ULTRASOUND--A USEFUL COMPLEMENTARY TOOL TO MAMMOGRAPHY IN ASSESSMENT OF SYMPTOMATIC BREAST DISEASES.

BACKGROUND: Breast cancer is the most common female malignancy worldwide. Pakistan has the highest incidence rate of breast cancer than any other Asian population. The purpose of the study was to evaluate the worth of sono-mammography in diagnosis of symptomatic breast diseases by comparing it with mammogram. METHODS: In this cross-sectional validation study, 45 subjects with mean age of 45 +/- 12.07 were included. Majority of the patients presented with complaint of breast lump. After complete history and clinical examination, all the patients had high resolution ultrasound of bilateral breasts and axilla followed by bilateral mammography. Histopathology was taken as gold standard in this study. The exclusion criteria were pregnancy and patients having direct clinical signs of breast malignancy. RESULTS: Based on histopathology, out of 45 patients with breast symptoms, 12 patients had benign lesions, whereas 32 patients were diagnosed as the cases of breast cancers. Finally one patient did not have biopsy proven final diagnosis. Sensitivity and specificity of ultrasound were calculated to be 100% and 67% as compared to sensitivity and specificity of 90.6% and 91.7% for that of mammography. CONCLUSIONS: Ultrasound is a useful complementary tool to mammography in assessment of symptomatic breast diseases since it helps in characterization and localization of breast lesions seen on mammogram and it is not limited by dense breasts. Also it should be the considered as initial imaging technique for assessment of palpable breast lumps.

Solid neuroendocrine carcinoma of the breast.

Primary neuroendocrine carcinoma of the breast is a rare disease that accounts for less than 5% of all cancers arising from the breast. The tumour cells stain positively for chromogranin and synaptophysin. This report describes the occurrence of infiltrating ductal carcinoma of breast with neuroendocrine differentiated tumour in 37 year old female. Early small cell neuroendocrine cancer of the breast that is treated with surgery and adjuvant chemotherapy shows an increased disease-free survival. She is planned for anthracycline/cyclophosphamide based chemotherapy followed by etoposide/platinum based chemotherapy. As her tumour showed ER/PR positivity, she will be given hormonal therapy subsequently, however, more extensive review is required to define a standard treatment protocol for this rare neoplasm.