Biomass fly ash as nanofiller to improve the dielectric properties of low-density polyethylene for possible high-voltage applications.

Flexible capacitive energy storage applications require polymer nanocomposites with high dielectric properties, which can be accomplished by addition of inorganic nanofillers to the polymer matrix. Low-density polyethylene (LDPE), known for its good dielectric characteristics and wide use in electrical insulation have been investigated for the desired applications. However, the improvement of its breakdown strength still continues with the use of various nanomaterials employed as nanofillers. In this study, a waste-derived material known as biomass fly ash (BFA) as a nanofiller to improve the dielectric properties of LDPE has been explored. BFA exhibits versatility in its composition with various metal oxides, making it an attractive choice as a nanofiller. The BFA-LDPE sheets were prepared using a conventional solvent mixing and subsequent hot-pressing process, incorporating BFA loadings ranging from 1 % to 4 wt%. The effects of different BFA loadings were carefully examined, and the synthesized nanocomposites were extensively characterized using various characterization methods, such as XRD, SEM, FTIR, TGA and dielectric constant measurements, to investigate the crystallographic properties, morphology, chemical composition, and thermal stability. Among all the nanocomposites, 4 wt%BFA-LDPE exhibited the highest dielectric constant, with a value of 11.58, compared to simple LDPE that had a dielectric constant of 8.33. This improvement is ascribed to the synergistic effects of different inorganic metal oxides (SiO2, MgO, and Fe2O3) present in BFA. The results showed a significant enhancement in dielectric properties, indicating that the waste-derived BFA can be purposefully applied as an effective nanofiller in the LDPE-based composites with even less than 4% loading for electrical insulating applications in future studies.

Effect of body weight at photostimulation on productive performance and welfare aspects of commercial layers.

OBJECTIVE: Due to current selection practices for increased egg production and peak persistency, the production profile, age at maturity, and body weight criteria for commercial layers are constantly changing. Body weight and age at the time of photostimulation will thus always be the factors that need to be adequately addressed among various production systems. The current study was carried out to determine the effects of pullets' body weight (low, medium, and heavy) on their performance, welfare, physiological response, and hormonal profile. METHODS: With regard to live weight, 150 16-week-old pullets were divided into three groups using a completely randomized design (CRD) and held until the 50th week. One-way analysis of variance was used to evaluate the data under the CRD, and the least significant difference test was used to distinguish between treatment means. RESULTS: In comparison to the medium and light birds, the heavy birds had higher body weight at maturity, an earlier age at maturity, and higher egg weight, eggshell weight, eggshell thickness, egg yolk index, breaking strength, egg surface area, egg shape index, egg volume, and hormonal profile except corticosterone. However, the medium and light birds had lower feed consumption rates per dozen eggs and per kilogram of egg mass than the heavy birds. Light birds showed greater body weight gain, egg production, and egg specific gravity than the other categories. At 20 weeks of age, physiological response, welfare aspects, and catalase were non-significant; however, at 50 weeks of age, all these factors-aside from catalase-were extremely significant. CONCLUSION: The findings of this study indicate that layers can function at lower body weights during photostimulation; hence, dietary regimens that result in lighter pullets may be preferable. Additionally, the welfare of the birds was not compromised by the lighter weight group.

Experimental and numerical techniques to evaluate coal/biomass fly ash blend characteristics and potentials.

Fossil and renewable fuels are used by industrial units that produce energy-intensive products. Competitive fuel pricing encourages these fuel sources' usage globally, particularly in developing nations, which leads to large volumes of byproducts like fly ash among thermal power plant operators. The elements and compounds found in coal fly ash (CFA) and biomass fly ash (BFA) can be utilized through several engineering applications. This study aims to assess typical CFA and BFA samples quantitatively and qualitatively via techniques such as ultimate analysis (CH-S), Fourier transform infrared spectroscopy (FTIR), thermogravimetric analysis (TGA), X-ray diffraction (XRD), X-ray fluorescence (XRF) elemental analysis, and ash fusion temperature (AFT), to anticipate the ideal ratios of coal to biomass blends for combustion applications while adhering to environmental regulations. The optimal blend, consisting of 75 % CFA and 25 % BFA, exhibited improved carbon (C%) and hydrogen (H%) percentages, increasing from 2.5 % to 4.67 % and from 0 % to 0.12 %, respectively. These improvements were further confirmed by the observed functional groups in FTIR, indicating a rising trend in both carbon and hydroxyl groups from BFA to CFA. XRF and XRD also confirmed it and TGA also showed optimum mass loss (ML%) behavior of 14.55 % for 75CFA + 25BFA. According to slagging and fouling indices, the values of RB/A, Rs, and Fu indicate a reduction in slagging and fouling issues through the blending of CFA with BFA. Simultaneously, the fusion temperature increased from 1181 °C to 1207 °C. CFA was found to increase the AFT of the BFA from 1197 °C to 1247 °C, mitigating their propensity. This suggests that a blend of 75CFA + 25BFA results in lower to medium range of slagging and fouling. However, AFI and BAI indicate a slightly higher range. AFT analysis further validates the conclusions drawn from the indices. The ternary phase diagram shows that the ash's melting point increases in the optimum blend. This is attributed to a reduced content of K2O (<15 %) and increased proportions of >50 % CaO and SiO2, effectively inhibiting slagging, agglomeration, and deposition. Meanwhile, the blend maintains a medium level of acidity and susceptively to corrosion, as observed in the case of 75CFA + 25BFA. The identification of optimal blend ratios can be anticipated to offer essential solutions for future research, aiming to ensure smooth industrial operations and regulatory compliance in power plants.

Corrosion behavior of SiC coated HX with MoSi2 interlayer to be utilized in iodine-sulfur cycle for hydrogen production.

In this era, renewable energy technologies are suitable to meet the challenges of fossil fuel depletion and global warming. Thus, hydrogen is gaining attention as an alternative clean energy carrier that can be produced from various methods, one of them is the iodine-sulfur (I-S) cycle which is a thermochemical process. The I-S cycle requires a material that can withstand an extremely corrosive environment at high temperatures. Immersion tests were conducted on bare superalloy Hastelloy X (HX), MoSi2, and SiC-MoSi2 coated HX, deposited in physical vapor deposition (PVD) to evaluate their corrosion resistance. Bare HX exhibited a high corrosion rate of 208.1 mm yr-1 when exposed to 98 wt% sulfuric acid at 300 °C. In contrast, HX with MoSi2 coating showed a much lower corrosion rate of 23.5 mm yr-1, and HX with SiC-MoSi2 coating demonstrated the lowest corrosion rate at 6.5 mm yr-1 under the same conditions. The coated samples were analyzed via FESEM before and after corrosion testing. The FESEM images reveal the formation of coalescent particles on the surface of the coating. The elemental analysis illustrates an increased concentration of silicon and oxygen in the corroded samples. Elemental mapping of these samples show a uniform distribution of elements over the sample. These findings contribute not only to materials science understanding but also to practical applications in hydrogen production via the I-S cycle, where corrosion-resistant materials are critical.

Molecular docking analysis of MCL-1 inhibitors for breast cancer management.

Myeloid leukemia 1 (MCL-1), a BCL-2 protein family member, acts as an anti-apoptotic protein by interacting with pro-apoptotic BCL-2 proteins. Its overexpression is frequently observed in numerous cancer types including breast cancer, and is closely linked to the initiation and progression of tumors as well as poor prognosis and resistance to therapeutic interventions. Here, a database of 3402 chemicals with established therapeutic activity against various diseases was chosen and systematically screened against the MCL-1 protein. Visual inspection and binding energy analysis revealed that the compounds OSU-03012, Raltitrexed, Ostarine (MK-2866), Dovitinib (TKI-258), and Varespladib (LY315920) had strong binding affinity for the MCL-1 protein. Notably, their binding affinity was higher than that of the control compounds. These compounds exhibited strong interactions with critical amino acid residues of the MCL-1 protein. Furthermore, these compounds shared several common amino acid residue interactions with the control compounds. These findings suggest that these compounds may be useful as MCL-1 inhibitors in the treatment of breast cancer. However, additional experimental validation is required to confirm these findings.

Potential biomarkers in Japanese encephalitis from different hosts and geographical locations.

Japanese encephalitis (JE) is a single-stranded, mosquito-borne, positive-sense RNA flavivirus that causes one of the most severe encephalitides. There are treatments available for those who contact this illness; however, there are no known cures. This disease has a 30% fatality rate, and of the people who survive, 30-50% develops neurologic and psychiatric sequelae. The JE virus genome size is 10.98 kb and contains two coding DNA sequences (CDS), two genes, and 15 mature peptides; the CDS polyprotein is 10.3 kb. In this study, we used 29 genomics sequences of the JE virus reported from different countries and infecting different animals and analysed vast dimensions of the genomic annotation of JE comparatively to understand its evolutionary aspects. The extensive SNPs analysis revealed that KF907505.1, reported from Taiwan, has only three SNPs, similar to sequences reported from India. Repeat and polymorphism analyses revealed that the genome tends to be similar in most JE sequences.

Molecular docking analysis of KRAS inhibitors for cancer management.

The majority of human tumors are characterized by abnormal signaling caused by oncogenic RAS proteins. KRAS is a member of the RAS family and is currently one of the most thoroughly researched targets for cancer treatment due to its prevalence in a variety of deadly malignancies. Targeting the KRAS protein, which plays a crucial role in regulating cell growth, differentiation, and apoptosis, shows great potential as a strategy for fighting cancer. Herein, in silico screening of 530 natural compounds against KRAS protein was performed. The top-scoring hits, namely ZINC32502206, ZINC98363763, ZINC85645815, and ZINC98364259 displayed a robust affinity towards KRAS as evidenced by their respective binding affinity values of -10.50, -10.01, -9.80, and -9.70 kcal/mol, respectively which were notably higher than that of the control compound AMG 510 (-9.10 kcal/mol). Through virtual screening and visual inspection, it was observed that these hits effectively interacted with the essential residues located within the active site of KRAS. Based on the findings of this study, it can be inferred that these compounds may have the potential to be employed in the treatment of cancer by targeting KRAS.

Mitigation of microbial nitrogen-derived metabolic hazards as a driver for safer alcoholic beverage choices: An evidence-based review and future perspectives.

Alcoholic beverages have been enjoyed worldwide as hedonistic commodities for thousands of years. The unique quality and flavor are attributed to the rich microbiota and nutritional materials involved in fermentation. However, the metabolism of these microbiota can also introduce toxic compounds into foods. Nitrogen-derived metabolic hazards (NMH) are toxic metabolic hazards produced by microorganisms metabolizing nitrogen sources that can contaminate alcoholic beverages during fermentation and processing. NMH contamination poses a risk to dietary safety and human health without effective preventive strategies. Existing literature has primarily focused on investigating the causes of NMH formation, detection methods, and abatement techniques for NMH in fermentation end-products. Devising effective process regulation strategies represents a major challenge for the alcoholic beverage industry considering our current lack of understanding regarding the processes whereby NMH are generated, real-time and online detection, and the high degradation rate after NMH formation. This review summarizes the types and mechanisms of nitrogenous hazard contamination, the potential risk points, and the analytical techniques to detect NMH contamination. We discussed the changing patterns of NMH contamination and effective strategies to prevent contamination at different stages in the production of alcoholic beverages. Moreover, we also discussed the advanced technologies and methods to control NMH contamination in alcoholic beverages based on intelligent monitoring, synthetic ecology, and computational assistance. Overall, this review highlights the risks of NMH contamination during alcoholic beverage production and proposes promising strategies that could be adopted to eliminate the risk of NMH contamination.

Underground geological sequestration of carbon dioxide (CO2) and its effect on possible enhanced gas and oil recovery in a fractured reservoir of Eastern Potwar Basin, Pakistan.

Due to concerns over rising emissions of carbon dioxide (CO2) from fossil fuel utilization, there has been a strong emphasis on the development of a safe, economical, practical method of carbon capture utilization and storage (CCUS). One way to reduce these CO2 emissions is underground geological sequestration in depleted oil fields or exhausted reservoirs. CO2 injection into oil reservoirs is an established technology, these reservoirs not only offer the potential for high storage of CO2 but this process could also target a large amount of oil and gas recovery through a technique called enhanced oil recovery (EOR). The main objective of this research was to evaluate the storage potential of CO2 in the depleted oil field while also investigating the effect of CO2 injection on reservoir pressure maintenance, and additional oil and gas recovery, in the same field. This paper presented the model of CO2 flooding based on the CO2 displacement mechanism with different scenarios of natural depletion, CO2 injection, and water injection simulated by the ECLIPSE 300 reservoir simulator, and the results of different scenarios were compared. Results of this study showed the site selected for CO2 injection has the potential to store more than 9 billion cubic feet (BCF) of CO2 in each case and witnessed improved gas recovery, while also having a major effect on reservoir pressure maintenance where pressure increased from 2120 psi to 6584 psi. The finding of this work ought to help in preparing for future improvement in underground geological sequestration of CO2 in depleted fields with the same field specifications.

Synergistic effect of plasma power and temperature on the cracking of toluene in the N2 based product gas.

In this research, a dielectric barrier discharge (DBD) reactor is used to study the cracking of the toluene into C1-C6 hydrocarbons. The combined effect of parameters such as temperature (20-400 °C) and plasma power (10-40 W) was investigated to evaluate the DBD reactor performance. The main gaseous products from the decomposition of toluene include lower hydrocarbon (C1-C6). The cracking of toluene increases with power at all temperatures (20-400 °C). On the otherhand, it decreases from 92.8 to 73.1% at 10 W, 97.2 to 80.5% at 20, 97.5 to 86.5% at 30 W, and 98.4 to 93.7% at 40 W with raising the temperature from 20 to 400 °C. Nonetheless, as the temperature and plasma input power increase, the methane yield increases. At 40 W, the maximum methane yield was 5.1%. At 10 and 20 W, the selectivity to C2 increases as the temperature rises up to 400 °C. At 30 and 40 W, it began to drop after 300 °C due to the formation of methane and the yield of methane increases significantly beyond this temperature.

A Comprehensive Review on Zeolite Chemistry for Catalytic Conversion of Biomass/Waste into Green Fuels.

Numerous attempts have been made to produce new materials and technology for renewable energy and environmental improvements in response to global sustainable solutions stemming from fast industrial expansion and population growth. Zeolites are a group of crystalline materials having molecularly ordered micropore arrangements. Over the past few years, progress in zeolites has been observed in transforming biomass and waste into fuels. To ensure effective transition of fossil energy carriers into chemicals and fuels, zeolite catalysts play a key role; however, their function in biomass usage is more obscure. Herein, the effectiveness of zeolites has been discussed in the context of biomass transformation into valuable products. Established zeolites emphasise conversion of lignocellulosic materials into green fuels. Lewis acidic zeolites employ transition of carbohydrates into significant chemical production. Zeolites utilise several procedures, such as catalytic pyrolysis, hydrothermal liquefaction, and hydro-pyrolysis, to convert biomass and lignocelluloses. Zeolites exhibit distinctive features and encounter significant obstacles, such as mesoporosity, pore interconnectivity, and stability of zeolites in the liquid phase. In order to complete these transformations successfully, it is necessary to have a thorough understanding of the chemistry of zeolites. Hence, further examination of the technical difficulties associated with catalytic transformation in zeolites will be required. This review article highlights the reaction pathways for biomass conversion using zeolites, their challenges, and their potential utilisation. Future recommendations for zeolite-based biomass conversion are also presented.

A Review of X-ray Photoelectron Spectroscopy Technique to Analyze the Stability and Degradation Mechanism of Solid Oxide Fuel Cell Cathode Materials.

Nondestructive characterization of solid oxide fuel cell (SOFC) materials has drawn attention owing to the advances in instrumentation that enable in situ characterization during high-temperature cell operation. X-ray photoelectron spectroscopy (XPS) is widely used to investigate the surface of SOFC cathode materials because of its excellent chemical specificity and surface sensitivity. The XPS can be used to analyze the elemental composition and oxidation state of cathode layers from the surface to a depth of approximately 5-10 nm. Any change in the chemical state of the SOFC cathode at the surface affects the migration of oxygen ions to the cathode/electrolyte interface via the cathode layer and causes performance degradation. The objective of this article is to provide a comprehensive review of the adoption of XPS for the characterization of SOFC cathode materials to understand its degradation mechanism in absolute terms. The use of XPS to confirm the chemical stability at the interface and the enrichment of cations on the surface is reviewed. Finally, the strategies adopted to improve the structural stability and electrochemical performance of the LSCF cathode are also discussed.

Reutilizing Methane Reforming Spent Catalysts as Efficient Overall Water-Splitting Electrocatalysts.

It is extremely prudent and highly challenging to design a greener bifunctional electrocatalyst that shows effective electrocatalytic activity and high stability toward electrochemical water splitting. As several hundred tons of catalysts are annually deactivated by deposition of carbon, herein, we came up with a strategy to reutilize spent methane reforming catalysts that were deactivated by the formation of graphitic carbon (GC) and carbon nanofibers (CNF). An electrocatalyst was successfully synthesized by in situ deposition of noble metal-free MoS2 over spent catalysts via a hydrothermal method that showed exceptional performance regarding the hydrogen evolution reaction (HER) and the oxygen evolution reaction (OER). At 25 mA cm-2, phenomenal OER overpotentials (η25) of 128 and 154 mV and modest HER overpotentials of 186 and 207 mV were achieved for MoS2@CNF and MoS2@GC, respectively. Moreover, OER Tafel slopes of 41 and 71 mV dec-1 and HER Tafel slopes of 99 and 107 mV dec-1 were obtained for MoS2@CNF and MoS2@GC, respectively. Furthermore, the synthesized catalysts exhibited good long-term durability for about 18 h at 100 µA cm-2 with unnoticeable changes in the linear sweep voltammetry (LSV) curve of the HER after 1000 cycles. The carbon on the spent catalyst increased the conductivity, while MoS2 enhanced the electrocatalytic activity; hence, the synergistic effect of both materials resulted in enhanced electrocatalysts for overall water splitting. This work of synthesizing enhanced nanostructured electrocatalysts with minimal usage of inexpensive MoS2 gives a rationale for engineering potent greener electrocatalysts.

A performance evaluation study of nano-biochar as a potential slow-release nano-fertilizer from wheat straw residue for sustainable agriculture.

Agro-Wastes are identified as to manufacture potential valuable organic biochar fertilizer product economically while also managing the waste. Biochar (BC) produced from agriculture waste is helps to improve the soil because of its neutral pH, addition of organic carbon to the soil and lower salt index values. This study focused on the development of nano-biochar into a more enhanced biochar product where it was checked whether the biochar derived from wheat straw can absorb nutrients and then act as support matter for releasing micro-nutrients and macro-nutrients for the plants on slow liberation basis. Wheat biochar (WBC) and wheat nano-biochar (WBNC) were synthesized by pyrolysis at two different temperatures and nutrients were fused into the WBC via impregnation technique. Physical parameters such as Proximate, Ultimate analysis & other were also studied and inspected by standard control procedures. Studies were also carried out on water retention (WR), water absorbance (WA), swelling ratio (SR) and equilibrium water content (EWC) for all samples; data was collected and compared for the better sample. Slow-release studies performed portrayed the release pattern of nutrients for prolonged periods, which are very important for the plant growth, yield and productivity. Overall, the experimental results displayed that BNC produced at 350 °C showed promising features of (SI:0.05, SR: 3.67, WA:64%, EWC:78.6%, FC:53.05% and pH:7.22), is a good substance however the nano-biochar has improved results; environmental friendly & could be utilized as a potential fertilizer on slow release for sustainable and green agriculture application.

Assessing the impact of COVID-19 and safety parameters on energy project performance with an analytical hierarchy process.

COVID-19 has destabilized the global economy, disrupted the lives of billions of people globally, and caused the workforce to suffer. Furthermore, the spread of this disease has caused most nations to impose strict lockdown regulations and shutdown most industries. This study aimed to highlight the key issues of energy project performance alongside construction activities that were halted during the COVID-19 outbreak to follow social distancing, lockdown, and public safety parameters. A questionnaire survey was administered to accomplish the purpose of this study. The responses of 42 energy project professionals and experts were evaluated using the analytical hierarchy process (AHP) for group decision-making. AHP shows that the biggest influences on project performance during COVID-19 pandemic were government measures and personal factors. The findings provide insight to support energy project planning and management during and after the pandemic, including prioritization of labor force health and safety.

Removal of toluene as a toxic VOC from methane gas using a non-thermal plasma dielectric barrier discharge reactor.

Methane is the main component of biogas, which could be used as a renewable energy source for electricity, source of heat, and biofuel production after upgrading from biogas. It also contains toxic compounds which cause environmental and human health problems. Therefore, in this work, the removal of a toxic compound (toluene) from methane gas was studied using a dielectric barrier discharge (DBD) reactor. It was observed that the removal of the toxic compound could be achieved from methane carrier gas using a dielectric barrier discharge reactor, and it depends on plasma input power. The maximum removal of the toxic compound was 85.9% at 40 W and 2.86 s. The major gaseous products were H2 and lower hydrocarbons (LHC) and the yield of these products also increases with input power. In the current study, the yield of gaseous products depends on the decomposition of toxic compounds and methane, because the decomposition of methane also produces H2 and lower hydrocarbons. The percentage yield of H2 increases from 0.43-4.74%. Similarly, the yield of LHC increases from 0.56-7.54% under the same reaction conditions. Hence, input power promoted the decomposition of the toxic compound and enhanced the yield of gaseous products.

Investigating the potential of locally sourced wastewater as a feedstock of microbial desalination cell (MDC) for bioenergy production.

Freshwater sources are limited and access to clean water is an acute challenge in recent decades. The sustainable water treatments methods are need of time and water desalination is one of the most interesting technology. Most desalination technologies are required high energy input while Microbial Desalination Cells (MDCs) represent a sustainable option that has added benefit of solving the ever-increasing wastewater treatment and management problem. MDCs are a customized type of Microbial Fuel Cells (MFCs) that depend on the electric potential generated by organic media to decrease salt concentration by electro-dialysis and give an unconventional way of clean water production. In this research, various experiments were conducted to examine the desalination ability of an indigenously designed experimental setup using domestic wastewater inoculated with sewage sludge under identical conditions. The electrochemical properties of the system, comprising the polarization curve and Electrochemical Impedance Spectroscopy (EIS), were examined along with the scope of chemical oxygen demand (COD) exclusion, to distinguish the cell behaviour. Furthermore, acidic water and Phosphate Buffer Solution (PBS) were tested as potential catholytes compared to the performance of the wastewater was gauged at various salt concentrations. The maximum salt removal efficiency was 31%, power density and current density were 32 mW-m-2 and 246 mA-m-2 respectively at a salt concentration of 35 g-L-1 that decreases with a decline in salt concentration. The maximum achieved power density and current density were 32 mW-m-2 and 246 mA-m-2 respectively. The applied method has huge potential to scaleup for large scale application in coastal regions.

Physical abrasion method using submerged spike balls to remove algal biofilm from photobioreactors.

OBJECTIVE: A major factor in practical application of photobioreactors (PBR) is the adhesion of algal cells onto their inner walls. Optimized algal growth requires an adequate sunlight for the photosynthesis and cell growth. Limitation in light exposure adversely affects the algal biomass yield. The removal of the biofilm from PBR is a challenging and expansive task. This study was designed to develop an inexpensive technique to prevent adhesion of algal biofilm on tubular PBR to ensure high efficiency of light utilization. Rubber balls with surface projections were introduced into the reactor, to remove the adherent biofilm by physical abrasion technique. RESULTS: The floatation of spike balls created a turbulent flow, thereby inhibiting further biofilm formation. The parameters such as, specific growth rate and doubling time of the algae before introducing the balls were 0.451 day-1 and 1.5 days respectively. Visible biofilm impeding light transmission was formed by 15-20 days. The removal of the biofilm commenced immediately after the introduction of the spike balls with visibly reduced deposits in 3 days. This was also validated by enhance cell count (6.95 × 106 cells mL-1) in the medium. The employment of spike balls in PBR is an environmental friendly and economical method for the removal of biofilm.

Warm Autoimmune Hemolytic Anemia: Clinical Profile and Management.

BACKGROUND: Autoimmune hemolytic anemia (AIHA) is a rare autoimmune disease in which autoantibodies target red blood cells leading to marked decrease in their lifespan. The classification of AIHA is based on the immunochemical properties of the RBC autoantibody. Warm antibody AIHA (wAIHA) accounts for 75-80% of all adult AIHA cases. The treatment of wAIHA is mainly corticosteroids. Our retrospective study aimed to study the clinical profile and management of wAIHA. METHODS: Data of 75 patients admitted with wAIHA or presented to outpatient department (previous medical records) with wAIHA between January 2003 and January 2016 were analyzed. RESULTS: In our study, females constituted 12 and 26 patients of primary and secondary wAIHA, while males constituted 17 and 20 patients of primary and secondary wAIHA, respectively. Mean hemoglobin level at AIHA onset was found to be 7.1 ± 1.7 g/dL in primary wAIHA group and 6.3 ± 1.2 g/dL in secondary wAIHA group, which is statistically significant. Splenectomy was used as mode of treatment in one (3.4%) patient of primary wAIHA group and 15 (32.60%) patients of secondary wAIHA group, which is statistically significant. Mean age of wAIHA onset was 69.7 ± 21.5 years in wAIHA group secondary to lymphoma and 54.3 ± 25.7 years in other wAIHA group, which is statistically significant. CONCLUSION: The most common causes of secondary wAIHA are B-cell lymphoma, systemic lupus erythematosus, rheumatoid arthritis, chronic lymphocytic leukemia (CLL), common variable immune deficiency, renal cell carcinoma and secondary to drug usage (alpha methyldopa and carbamazepine), respectively. Reducing the cumulative dose of corticosteroids with second line treatment whenever possible and therefore reducing the risk of sepsis, specifically in older patients with comorbidities will reduce morbidity and mortality.

Role of autologous non-vascularised intramedullary fibular strut graft in humeral shaft nonunions following failed plating.

BACKGROUND: Non-union humeral shaft fractures are seen frequently in clinical practice at about 2-10% in conservative management and 30% in surgically operated patients. Osteosynthesis using dynamic compression plate (DCP), intramedullary nailing, locking compression plate (LCP), Ilizarov technique along with bone grafting have been reported previously. In cases of prior failed plate-screw osteosynthesis the resultant osteopenia, cortical defect, bone loss, scalloping around screws and metallosis, make the management of non-union more complicated. Fibular graft as an intramedullary strut is useful in these conditions by increasing screw purchase, union and mechanical stability. This study is a retrospective and prospective follow up of revision plating along with autologous non-vascularised intramedullary fibular strut graft (ANVFG) for humeral non-unions following failed plate osteosynthesis. MATERIALS AND METHODS: Seventy eight cases of nonunion humeral shaft fractures were managed in our institute between 2008 and 2015. Of these, 57 cases were failed plate osteosynthesis, in which 15 cases were infected and 42 cases were noninfected. Out of the 78 cases, bone grafting was done in 55 cases. Fibular strut graft was used in 22 patients, of which 4 cases were of primary nonunion with osteoporotic bone. Applying the exclusion criteria of infection and inclusion criteria of failed plate osteosynthesis managed with revision plating using either LCP or DCP and ANVFG, 17 cases were studied. The mean age of the patients was 40.11 yrs (range: 26-57 yrs). The mean duration of non-union was 4.43 yrs (range: 0.5-14 yrs). The mean follow-up period was 33.41 months (range: 12-94 months). The average length of fibula was 10.7 cm (range: 6-15 cm). Main outcome measurements included bony union by radiographic assessment and pre- and postoperative functional evaluation using the DASH (Disabilities of the Arm, Shoulder and Hand) score. Results: Sixteen out of 17 fractures united following revision plating and fibular strut grafting. Average time taken for union was 3.5 months (range: 3-5 months). Complications included one each of implant failure with bending, transient radial nerve palsy and transient ulnar nerve palsy. No case had infection, graft site morbidity or peroneal nerve palsy. Functional assessment by DASH score improved from 59.14 (range: 43.6-73.21) preoperatively to 23.39 (range: 8.03-34.2) postoperatively (p = 0.0003). Conclusion: The results of our study indicate that revision plating along with ANVFG is a reliable option in humeral diaphyseal non-unions with failed plate-screw osteosynthesis providing adequate screw purchase, mechanical stability and high chances of union with good functional outcome.