Assessment of the biosorption characteristics of lychee (Litchi chinensis) peel waste for the removal of Acid Blue 25 dye from water.

The aim of this study was to examine the adsorption potential of lychee (Litchi chinensis) peel waste for the removal of Acid Blue 25 dye from aqueous solutions. The adsorption was studied as a function of contact time, initial dye concentration and temperature by batch method. Equilibrium sorption isotherms showed that the lychee peel adsorbent possessed a high affinity and sorption capacity for Acid Blue 25, with a monolayer sorption capacity of ca. 200 mg g(-1). The equilibrium adsorption data were well described by the Langmuir model. Kinetic studies revealed that the present system of dye adsorption on lychee peel adsorbent could be described more favourably by the pseudo-second-order kinetic model. The thermodynamic parameters, namely free energy (deltaG degrees), enthalpy (deltaH degrees) and entropy (deltaS degrees) changes, were determined for the process. The results of the present study suggest that lychee peel waste can be used beneficially as an adsorbent in treating industrial effluents containing dyes.

Despite high satisfaction, majority of gastro-oesophageal reflux disease patients continue to use proton pump inhibitors after antireflux surgery.

BACKGROUND: While antireflux surgery is effective in controlling symptoms of gastro-oesophageal reflux, its role in eliminating the use of antireflux medicines after surgery and as such its long-term cost-effectiveness remains controversial. AIM: To assess the patient satisfaction and the continued medication use following laparoscopic Nissen fundoplication at a tertiary level community hospital. METHODS: Adult patients who underwent laparoscopic Nissen fundoplication at our institution over a period of over 3 years were asked to complete a questionnaire recording their demographic information, date and reason for the surgery, preprocedure and postprocedure symptoms, smoking and alcohol use, and medication use preoperatively and post-operatively. Patients were also asked about their satisfaction with surgery. RESULTS: One hundred patients participated in the study. Overall, 90% patients experienced satisfaction with their surgery. Eighty percentage patients were willing to undergo surgery again, if needed. Over two-thirds (67%) patients had decrease in the severity of their symptoms. None of the patients had worsening of symptoms post-operatively. However, 80% patients were still taking antireflux medications including proton pump inhibitors (53%). CONCLUSIONS: Most patients continue to use antireflux medications including after laparoscopic Nissen fundoplication despite high satisfaction with surgery.

Postinfectious gastroparesis related to autonomic failure: a case report.

BACKGROUND AND AIM: Severe dysautonomia may be secondary to viral infections, resulting in impaired autoimmune, cardiovascular, urinary and digestive dysfunction. Herein, we present a case of a 31-year-old white female patient who had severe gastroparesis related to autonomic failure following an episode of acute gastroenteritis. This seems to be the first report providing thorough assessment of the enteric and autonomic nervous system by analysis of full-thickness small intestinal biopsies, cardiovagal testing and autopsy. HOSPITAL COURSE: This patient affected by a severe gastroparesis was treated with antiemetics, prokinetics, analgesics and gastric electrical stimulation to control symptoms. Nutritional support was made using jejunal feeding tube and, in the final stage of disease, with total parenteral nutrition. Autonomic studies revealed minimal heart rate variability and a disordered Valsalva manoeuvre although the enteric nervous system and the smooth muscle layer showed a normal appearance. Hospital courses were complicated by episodes of bacteraemia and fungemia. Serum antiphospholipid antibodies were noted but despite anticoagulation, she developed a pulmonary embolism and shortly thereafter the patient died. Autopsy revealed acute haemorrhagic Candida pneumonia with left main pulmonary artery thrombus. Sympathetic chain analysis revealed decreased myelinated axons with vacuolar degeneration and patchy inflammation consistent with Guillain-Barre syndrome. The evaluation of the enteric nervous system in the stomach and small bowel revealed no evidence of enteric neuropathy or myopathy. CONCLUSION: A Guillain-Barre-like disease with gastroparesis following acute gastroenteritis is supported by physiological and autonomic studies with histological findings.

Modulation of ethanol-induced central nervous system depression by ibuprofen.

We investigated the effect of pretreatment with a prostaglandin synthetase inhibitor, ibuprofen, on the pharmacokinetics and pharmacodynamics of ethanol in six fasting subjects. Ibuprofen caused a 10% decrease in the maximum rate of elimination of ethanol. Visual memory, which is a function primarily mediated by the right cerebral hemisphere, was measured by the Benton Visual Retention test and was more impaired during combined ibuprofen and ethanol dosing than during ethanol dosing alone (P = 0.05). The auditory-verbal memory of the subjects, which is primarily a function of the left cerebral hemisphere, was assessed by the Selective Reminding Test and showed decreased impairment during combined ibuprofen and ethanol dosing as compared with ethanol dosing alone (P = 0.04). The opposite effect of ibuprofen on ethanol-induced cognitive impairment as measured by two lateralized functions is consistent with the reports in tissue and animal models that central nervous system effects of ethanol may be mediated at least in part by prostaglandins.

Erythromycin shortens orocaecal transit time in diabetic male subjects: a double-blind placebo-controlled study.

BACKGROUND: The effects of erythromycin on small bowel motility are controversial. Orocaecal transit time (OCTT) is considered to be a valid measure of small bowel motility. METHODS: We studied the effect of erythromycin on OCTT in diabetic male subjects in a double-blind placebo-controlled crossover fashion. After an overnight fast, subjects received erythromycin 500 mg, 250 mg or placebo, on 3 different days. A standard solid meal containing 20 g lactulose was administered 30 min after the erythromycin ingestion. Exhaled breath was collected and hydrogen concentration was assessed over 5 h. Breath hydrogen concentrations for each session were analysed over time by a generalized logistic function generating a sigmoidal curve. Front transit time was recorded as the time point when a sustained rise in breath hydrogen concentration of at least 5 p.p.m. was first observed. RESULTS: The mean +/- S.E.M. time taken for the front of the meal to reach the caecum was 92.5 +/- 9.5, 86.1 +/- 16.5 and 62.3 +/- 12.1 min for placebo, erythromycin 250 mg and erythromycin 500 mg, respectively. The OCTT was significantly decreased with erythromycin 500 mg compared to placebo (P < 0.05). CONCLUSION: Oral administration of 500 mg erythromycin has prokinetic effect on orocaecal transit in male patients with diabetes mellitus.

Lack of delay in hepatic insulin transit as indicated by concordance of insulin secretory and peripheral insulin pulses.

The liver is an important site of insulin metabolism and action. It has often been assumed that the liver may diminish the amplitude of the insulin secretory waveform without altering hepatic insulin transit time. However, the significant extraction and metabolism of hepatic insulin has the potential to delay hepatic insulin transit. To examine hepatic insulin transit, we studied the concordance of calculated insulin secretory peaks with peripheral insulin peaks in 12 healthy men of varying body weight and fat distribution. Adiposity was determined by percent body fat, and fat distribution by the waist to hip ratio. Arterialized peripheral venous samples for insulin and C-peptide assays were obtained every 2 minutes for 90 minutes. Pancreatic insulin secretion rates were estimated with individual C-peptide kinetics using a two-compartment model. Concordance between insulin secretory peaks and peripheral insulin peaks was assessed by the hypergeometric probability model. A significant concordance between secretory and peripheral insulin pulses was demonstrated in seven of 12 subjects (P < .00001). The mean pulse intervals for insulin secretion were similar to the mean pulse intervals for peripheral insulin. The degree of concordance between the insulin secretory peaks and peripheral insulin pulses was unrelated to adiposity or body fat distribution. Significant synchronicity exists between insulin secretory peaks and peripheral insulin peaks in healthy men. We conclude that despite significant hepatic insulin extraction and metabolism, hepatic insulin transit may not be delayed in healthy men.

Excitatory and inhibitory responses mediated by GABAA and GABAB receptors in guinea pig distal colon.

The actions of gamma-aminobutyric acid (GABA) and the receptor selective agonists, muscimol (GABAA) and baclofen (GABAB), on motor activity of the longitudinal muscle-myenteric plexus of guinea-pig distal colon were studied in vitro. Preparations exhibited spontaneous contractions that were blocked by scopolamine (1 microM) or tetrodotoxin (1 microM). GABA (3-100 microM) inhibited these contractions; the EC50 was 8 microM. GABA-induced relaxations were not blocked by picrotoxin (30 microM). The GABAA receptor antagonist, bicuculline (3-30 microM), increased the amplitude of spontaneous contractions; this response was not blocked by tetrodotoxin. Baclofen (3-100 microM; EC50 = 14 microM) mimicked the GABA-induced relaxation. Baclofen-induced relaxations were not blocked by the GABAB antagonist, phaclofen (30-100 microM). Muscimol (10-100 microM) induced a contraction followed by a relaxation; both responses faded in the presence of muscimol. The muscimol EC50's for contraction and relaxation were 12.5 and 11 microM, respectively. The muscimol contraction was blocked by tetrodotoxin, scopolamine and picrotoxin and was reduced by hexamethonium (30 microM). Muscimol relaxations were blocked by tetrodotoxin, picrotoxin and apamin (0.1 microM). Muscimol responses were not altered after preincubation of the tissues with cortisol (10 pM-1 microM). These data indicate that GABA can act at presynaptic GABAB receptors to inhibit acetylcholine release from enteric neurons and reduce spontaneous contractions. There are also GABAA receptors on excitatory and inhibitory neurons and agonist action at these receptors results in contraction and relaxation.

Toxicodynamic approach to management of the poisoned patient.

We recommend a toxicodynamic approach to the management of the poisoned patient. We define the period between ingestion and onset of toxic manifestations (clinical or laboratory) as the preclinical phase, during which the management of the patient necessarily depends solely on the history of ingestion and the predicted toxicity. In the toxic phase during which the patient shows clinical or laboratory evidence of toxicity, the history, clinical status (signs, symptoms, drug levels, laboratory parameters), and toxicodynamics should guide the therapy. In the resolution phase, when the patient shows clinical improvement and declining drug levels, treatment should be based on clinical status. Gastrointestinal decontamination is critical in the first two phases and may be of value during the resolution phase until the body drug burden declines to safe levels. We recommend an aggressive approach to gastrointestinal decontamination, especially in the preclinical phase. With a history of a potentially toxic ingestion of an absorbable drug, an observation period until passage of a charcoal-laden stool should be achieved before discharge of the patient.

Pneumomediastinum as a complication of upper gastrointestinal endoscopy.

Secondary or complex pneumomediastinum following esophagoscopy is due to an esophageal perforation. Primary or simple pneumomediastinum may be caused by maneuvers such as coughing, gagging, swallowing, choking, and valsalva. These maneuvers are common during upper gastrointestinal endoscopy. Esophageal perforation is a potentially life threatening event, while simple pneumomediastinum is usually a benign self-limited disorder. Although the presentation may be similar, different morbidities compel prompt evaluation for distinction between these two entities and appropriate management. We present a case of pneumomediastinum that developed immediately following upper gastrointestinal endoscopy. Implications of diagnosis, management, and prognosis are discussed.

Noncardiac chest pain: where does it start?

The pathogenesis of recurrent noncardiac chest pain remains an enigma. The literature suggests that it may be caused by a heightened state of visceral nociperception. Coronary atherosclerosis must first be excluded with a reasonable degree of certainty. The physician can then focus on reassuring the patient and continuing management, bearing in mind the caveat, first do no harm. Polypharmacy and hazardous procedures should be avoided. Aggressive acid suppression is helpful in patients with gastroesophageal reflux disease, and antidepressants have shown promise in otherwise unexplained cases of chest pain. Despite significant morbidity in patients with the disorder, the long-term prognosis is excellent.

When to suspect lactose intolerance. Symptomatic, ethnic, and laboratory clues.

Lactose intolerance is widespread, with adult-type hypolactasia being the predominant cause of lactose malabsorption. Daily ingestion of less than 240 mL of milk is well tolerated by most lactose-intolerant adults. Some persons with normal lactase activity may become symptomatic on consumption of products containing lactose. Lactose maldigestion may coexist in adults with irritable bowel syndrome and in children with recurrent abdominal pain. Management consists primarily of dietary changes. People who avoid dairy products should receive calcium supplementation and should be advised to read ingredient labels carefully. Several lactase replacement products are available, but their efficacy varies.

Degradation of predigested distillery effluent by isolated bacterial strains.

Batch studies were conducted on degradation of anaerobically digested distillery wastewater by three bacterial strains, viz. Xanthomonas fragariae, Bacillus megaterium and Bacillus cereus in free and immobilized form, isolated from the activated sludge of a distillery wastewater treatment plant. The removal of COD and colour with all the three strains increased with time up to 48 hr and only marginal increase in COD and colour removal efficiency was observed beyond this period up to 72 hr. After this period removal efficiency remained fairly constant up to 120 hr. The maximum COD and colour removal efficiency varied from 66 to 81% and 65 to 75%, respectively for both free and immobilized cells of all the three strains. The strain Bacillus cereus showed the maximum efficiency of COD (81%) and colour (75%) removal out of the three strains. An interrelationship between the percent COD and colour removal was carried out by correlation and regression analysis and was justified by high values of coefficient of correlation (r = 0.99) for all the cases. The first order removal rate kinetics was also applied and rate constants were evaluated for COD and colour removal efficiencies.

Isolation, screening and identification of bacterial strains for degradation of predigested distillery wastewater.

Three bacterial isolates from the activated sludge of a distillery wastewater treatment plant identified as Xanthomonas fragariae, Bacillus megaterium and Bacillus cereus were found to remove COD and colour from anaerobically digested distillery wastewater in the range of 55 to 68% and 38 to 58% respectively.

Pathophysiology and management of noncardiac chest pain.

Noncardiac chest pain is a common but important clinical challenge with respect to diagnostic strategy as well as therapeutic intervention. The most common esophageal disorder associated with chest pain syndrome is gastroesophageal reflux; 24-hour ambulatory monitoring of esophageal pH and the determination of the symptom index are useful in patient evaluation. A high frequency of abnormal esophageal motility has been reported in noncardiac chest pain, but its clinical significance remains controversial. Patients with chest pain and normal coronary angiogram may have microvascular angina. Musculoskeletal conditions account for at least 10% of the cases of noncardiac chest pain. The potential effects of stress and altered psychological states in this phenomenon must be considered. The role of panic attacks in the production of pain needs to be clarified. Investigations to elucidate the exact cause of chest pain as well as its treatment should be individualized to the patient.

Lactose intolerance: diagnosis and management.

Lactose intolerance affects hundreds of millions of people worldwide. Although the presentation is frequently atypical, it should be part of the differential diagnosis when evaluating nonspecific gastrointestinal symptoms. We review the terminology, types of lactase deficiencies, diagnostic procedures, and management.

The global paediatric surgery network: early measures of interest in the website.

PURPOSE: The Global Paediatric Surgery Network (GPSN) website was launched in May 2010, with the following goals: to serve as a clearing house for pediatric surgery volunteer work performed worldwide, to provide online resources for surgeons working in areas of limited medical resources, and to provide practical and educational information for surgeons who wish to volunteer. The purpose of this study was to assess use of the website over the first year since its launch (May 6, 2010-May 5, 2011). METHODS: The GPSN website was examined for number of pages, number of listings in Past Work, Present Work, and Help Needed categories, as well as number of volunteers available. The online tool Google Analytics was used to assess parameters that measure use of the website, such as number of visits, number of page views, number of visitors, time on the website, and geographic origin of visitors. RESULTS: The GPSN website consists of 30 pages. There are 9 listings in Past Work, 23 listings in Present Work, and 13 listings in Help Needed categories. 118 people have registered as willing to volunteer, and 96 have indicated that they are able to work in times of a natural disaster. There were 8437 visits to the website, with 28 916 page views by 5170 visitors from 145 countries, with an average number of page views of 3.43 and an average time on the website of 4:05 min. The most visited pages were the homepage, the meetings page, and the pediatric surgery organizations page. 4 websites of pediatric surgery organizations have links to the GPSN website. CONCLUSIONS: Based on early website use, we conclude that there is an interest in the GPSN. We speculate that participation in the GPSN will continue to grow, but that there is a continued need to promote the website in the global pediatric surgery community.

Biosorption optimization of nickel removal from water using Punica granatum peel waste.

The present study was undertaken to evaluate the feasibility of Punica granatum (pomegranate) peel waste for the removal of nickel from water. Batch experiments were performed to study the biosorption of nickel on prepared pomegranate peel adsorbent. The sorption process was well explained with pseudo-second-order kinetic model. The maximum sorption capacity of pomegranate peel adsorbent for nickel removal was ca. 52 mg g(-1). The sorption has been found to be endothermic and data conform to the Langmuir model. The Gibbs free energy was determined to be negative, indicating the spontaneous nature of the sorption process. The results of the present study suggest that pomegranate peel waste can be used beneficially for nickel removal from aqueous solution.

Adsorptive removal of 2,4-dichlorophenol from water utilizing Punica granatum peel waste and stabilization with cement.

The present study investigates the adsorption potential of Punica granatum (pomegranate) peel as an adsorbent for the removal of 2,4-dichlorophenol (2,4-DCP) from aqueous solutions. The adsorption was studied as a function of contact time, initial concentration and temperature by batch method. The adsorption capacity of pomegranate peel adsorbent for 2,4-DCP was found to be 65.7 mg g(-1). The equilibrium adsorption data was well described by the Langmuir model. Kinetic studies suggest that the present system of phenol adsorption on pomegranate peel adsorbent could be described more favorably by pseudo-first-order kinetic model. Column studies were also undertaken in order to test the practical utility of prepared adsorbent and found promising. After the adsorption studies, the phenol-laden adsorbent was stabilized in cement for its ultimate disposal. The results of the present study clearly reveal that prepared adsorbent can be used beneficially in treating industrial effluents containing phenols and safely disposed of by stabilizing into cement.