Role of specific nutritional biomarkers in predicting post-operative complications among patients undergoing elective abdominal surgery.

PURPOSE: Nutritional biomarkers like serum prealbumin, transferrin, retinol-binding protein (RBP), C-reactive protein (CRP), leptin, and insulin-like growth factor 1 (IGF1) have the inherent ability to diagnose undernutrition objectively before it is clinically manifested. The primary objective of the study was to evaluate the diagnostic efficacy of the specific nutritional biomarkers in predicting post-operative complications. METHODS: A prospective cohort study was conducted in the department of surgery and included all patients aged 18 years and above who underwent elective abdominal surgery. Demographic details and clinical and surgical details were documented from the case records. Nutritional biomarker assay was done at admission. The post-operative complications occurring until discharge were graded using the Clavien-Dindo classification. The diagnostic accuracy of the specific nutritional biomarkers in predicting post-operative complications was assessed. RESULTS: A total of 320 patients were included in the study. Of these, 126 (39.38%) developed post-operative complications. Major complications accounted for 19.05% of the complications, while 80.95% were minor complications. Patients with blood prealbumin level less than 17.287 mg/dL had a higher incidence of complications (p < 0.001). Serum transferrin levels less than 168.04 mg/dL and IGF1 levels less than < 44.51 ng/ml showed increased incidence of complications (p < 0.001). The AUC was found to be the highest for serum IGF1 with 0.7782. Sensitivity was equally high for IGF1 and serum transferrin, with 76.98% for the former and 76.19% for the latter. CONCLUSION: Specific nutritional biomarkers, like serum prealbumin and transferrin, were efficient in predicting postoperative complications of patients before undergoing elective abdominal surgeries even after adjusting for confounders. This can facilitate preoperative corrective measures to lower the overall postoperative complications.

Association Between Helicobacter pylori and Periampullary and Pancreatic Cancer: a Case-Control Study.

INTRODUCTION: Helicobacter pylori has been implicated in the etiopathogenesis of various malignant conditions; however, there is a dearth of studies on the correlation between H. pylori infection and pancreatic cancers. Hence, this study was carried out to evaluate the association between H. pylori infection and periampullary and pancreatic cancer. METHODS: This was a single-centre, retrospective, case-control study in which all consecutive patients of periampullary or pancreatic cancer were included. The demographic details with tumour characteristics were recorded. Age and gender-matched controls were patients with other extra-abdominal benign conditions. H. pylori and the Cag A status were determined using IgG antibodies and Cag A antibodies respectively. The association between H. pylori infection and periampullary and pancreatic cancer was the primary outcome. RESULTS: A total of 155 patients, 61 in the study and 94 in the control group were included. The overall prevalence of H. pylori in the study group (78.6%) was similar to that of the control group (76.5%) (p = 0.76). Although a higher trend of IgG and Cag A seropositivity was seen in the study group, the difference was not significant. The correlation of H. pylori and Cag A seropositivity showed a higher trend with site-specificity, differentiation, and nodal status. However, the difference was not significant. CONCLUSION: There was no association between H. pylori infection and Cag A seropositivity with periampullary and pancreatic cancers. The various tumour characteristics were also not associated with H. pylori infection. Thus, routine eradication of H. pylori infection may not be recommended in periampullary and pancreatic cancers.

Ascendancy of electromagnetic force and Hall currents on blood flow carrying Cu-Au NPs in a non-uniform endoscopic annulus having wall slip.

This article aims to outline the characteristics of the blood flow conveying copper (Cu) and gold (Au) nanoparticles (NPs) through a non-uniform endoscopic annulus with wall slip under the action of electromagnetic force and Hall currents. The flow of blood with the suspension of hybrid nanoparticles in the annulus is induced by the peristaltic pumping. The governing equations are modeled and then simplified with the postulate of lubrication theory. The resulting non-dimensional momentum equation after simplification is solved analytically by employing the He's homotopy perturbation method (HPM) with the computational software Mathematica program (version 11). The influential role of emerging physical parameters on the physiological features related to the blood flow is inferred graphically and physically. The analytical outcomes reveal that Hall parameter has a diminishing behavior on the blood flow while the inverse impact is endured for mounting Hartmann number. Electromagnetic field and Hall currents offer a superlative mode for regulating blood flow at the time of surgery. An increment in the volume fraction of nanoparticles causes a drop in the blood temperature profile. The trapping phenomenon is also explored with the help of contours. An expansion in Hartmann number reduces the size of entrapped bolus and ultimately vanishes when Hartmann number is very large. This prospective model may be applicable in electromagnetic micro-pumps, medical simulation devices, heart-lung machine (HLM), drug carrying and drug transport systems, cancer diagnosis, tumor selective photothermal therapy, etc.

Significance of Hall currents on hybrid nano-blood flow through an inclined artery having mild stenosis: Homotopy perturbation approach.

The rheological perspective of blood flow with the suspension of metallic or non-metallic nanoparticles through arteries having cardiovascular diseases is getting more attention due to momentous applications in obstructed hemodynamics, nano-hemodynamics, nano-pharmacology, blood purification system, treatment of hemodynamic ailments, etc. Motivated by the novel significance and research in this direction, a mathematical hemodynamics model is developed to mimic the hemodynamic features of blood flow under the concentration of hybrid nanoparticles through an inclined artery with mild stenosis in the existence of dominating electromagnetic field force, Hall currents, heat source, and porous substance. Copper (Cu) and copper oxide (CuO) nanoparticles are submerged into the blood to form hybrid nano-blood suspension (Cu-CuO/blood). The attribute of the medium porosity on the blood flow is featured by Darcy's law. The mathematical equations describing the flow are formulated and simplified under mild stenosis and small Reynolds number assumptions. To determine the analytical solution of the resulting nonlinear momentum equation, the homotopy perturbation method (HPM) is employed. Several figures are graphed to assess the hemodynamical contributions of various intricate physical parameters on blood flow phenomena through the inclined stenosed artery. Significant outcomes from graphical elucidation envisage that the hemodynamic resistance to the blood flow is reduced due to the dispersion of more hybrid nanoparticles in the blood. The hemodynamic resistance (impedance) increases approximately two times by dispersing 0.11% hybrid nanoparticles in the blood flow. The temperature of Cu-CuO/blood is found to be lower in comparison to Cu-blood and pure blood. Intensification of Hall parameter attenuates the wall shear stress at the arterial wall. The trapping phenomena are also outlined via streamline plots which exemplify the blood flow pattern in the stenosed artery under the variation of the emerging parameters. As anticipated, the addition of a large number of hybrid nanoparticles significantly modulates the blood flow pattern in the stenotic region. The novel feature of this model is the impressive impact of Hall currents on hybrid nanoparticle doped blood flow through the stenosed artery. There is another piece of significance is that HPM is the most suitable method to handle the nonlinear momentum equation under the aforementioned flow constraints. Outcomes of this simulation may be valuable for advanced study and research in biomedical engineering, bio-nanofluid mechanics, nano-pharmacodynamics.

Collective removal of phenol and ammonia in a moving bed biofilm reactor using modified bio-carriers: Process optimization and kinetic study.

The performance of a moving bed biofilm reactor (MBBR) with bio-carriers made of polypropylene-polyurethane foam (PP-PUF) was evaluated for the collective removal of phenol and ammonia. Three independent variables, including pH (5.0-8.0), retention time (2.0-12.0 h), and airflow rate (0.8-3.5 L/min) were optimized using central composite design (CCD) of response surface methodology (RSM). The maximum removal of phenol and ammonia was obtained to be 92.6, and 91.8%, respectively, in addition to the removal of 72.3% in the chemical oxygen demand (COD) level at optimum conditions. First-order and second-order kinetic models were analyzed to evaluate the pollutants removal kinetics in a MBBR. Finally, a second-order model was found to be appropriate for predicting reaction kinetics. The values of second-order rate constants were obtained to be 2.35, 0.25, and 1.85 L2/gVSS gCOD h for phenol, COD, and ammonia removal, respectively.

Bioremediation of Congo red dye in immobilized batch and continuous packed bed bioreactor by Brevibacillus parabrevis using coconut shell bio-char.

In the present study, bacterial species capable of degrading colour waste were isolated from the water bodies located near the carpet cluster in the Bhadohi district of U.P., India. Among the isolated species best one was selected on the basis of its capability to degrade Congo red in batch experiments using NaCl-Yeast as the nutrient media and further it was identified as Brevibacillus parabrevis using 16S rDNA sequencing. The process parameters were optimized for maximum degradation in batch experiments and found out to be: Inoculum size: 3 ml, Temperature: 30 °C, Time: 6 days leading to a removal of 95.71% of dye sample. The experiment showed that bacteria immobilized with coconut shell biochar in continuous mode showed much better degradation than batch study without immobilization. The kinetics parameters µmax, Ks, and µmaxKs were found to be 0.461 per day, 39.44 mg/day, and 0.0117 L/mg/day using Monod model.

Biodegradation and kinetic study of benzene in bioreactor packed with PUF and alginate beads and immobilized with Bacillus sp. M3.

Benzene removal in free and immobilized cells on polyurethane foam (PUF) and polyvinyl alcohol (PVA)-alginate beads was studied using an indigenous soil bacterium Bacillus sp. M3 isolated from petroleum-contaminated soil. The important process parameters (pH, temperature and inoculums size) were optimized and found to be 7, 37°C and 6.0×108CFU/mL, respectively. Benzene removals were observed to be 70, 84 and 90% within 9days in a free cell, immobilized PVA-alginate beads and PUF, respectively under optimum operating conditions. FT-IR and GC-MS analysis confirm the presence of phenol, 1,2-benzenediol, hydroquinone and benzoate as metabolites. The important kinetic parameter ratios (µmax/Ks; L/mg·day) calculated using Monod model was found to be 0.00123 for free cell, 0.00159 for immobilized alginate beads and 0.002016 for immobilized PUF. Similarly inhibition constants (Ki; mg/L) calculated using Andrew-Haldane model was found to be 435.84 for free cell, 664.25 for immobilized alginate beads and 724.93 for immobilized PUF.

Biofiltration of xylene using wood charcoal as the biofilter media under transient and high loading conditions.

The main objective of this study was to evaluate the performance of wood charcoal as biofilter media under transient and high loading condition. Biofiltration of xylene was investigated for 150days in a laboratory scale unit packed with wood charcoal and inoculated with mixed microbial culture at the xylene loading rates ranged from 12 to 553gm-3h-1. The kinetic analysis of the xylene revealed absence of substrate inhibition and possibility of achieving higher elimination under optimum condition. The pH, temperature, pressure drop and CO2 production rate were regularly monitored during the experiments. Throughout experimental period, the removal efficiency (RE) was found to be in the range of 65-98.7% and the maximum elimination capacity (EC) was 405.7gm-3h-1. Molecular characterization results show Bacillus sp. as dominating microbial group in the biofilm.

Performance evaluation of Malathion biodegradation in batch and continuous packed bed bioreactor (PBBR).

The aim of this work was to study the biodegradation of Malathion in batch and continuous packed bed (Polyurethane foam; PUF) bioreactor (PBBR). After 10days, 89% Malathion removal was observed in batch PBBR. Continuous PBBR was operated at various flow rates (5-30mL/h) under optimum condition over a period of 75days. Inlet loading rates and elimination capacities were observed in the range of 36-216 and 7.20-145.4mg/L/day with an average removal efficiency of more than 90% under steady state conditions. GC/MS analysis confirms phosphorodithionicacid,O,O,S-trimethylester and diethylmercaptosuccinate as metabolites. Biodegradation of Malathion under inhibitory and non-inhibitory conditions was studied using Monod and Andrew-Haldane models and the kinetic constants were calculated and found to be µmax: 0.271 per day; Ks: 126.3mg/L using Monod and µmax: 0.315 per day; Ks: 151.32mg/L; Ki: 594.75mg/L using Andrew-Haldane models.

Bacteriological Profile of Neonatal Sepsis in Neonatal Intermediate Care Unit of Central Paediatric Referral Hospital in Nepal.

BACKGROUND: Sepsis is one of the leading causes of neonatal morbidity and mortality. Because of difference in local epidemiology and possible variation with time, regular monitoring and updates on pathogen and their antimicrobial sensitivity pattern is important for prevention and treatment. METHODS: A retrospective descriptive study was carried out among cases of neonatal sepsis admitted in neonatal intermediate care unit of Kanti Children's hospital from August 2014 to August 2015. The data was collected from medical records of neonatal intermediate care unit and microbiology department and analyzed using SPSS version 20. RESULTS: There were 644 admissions, among which 210 (32%)were suspected of having neonatal sepsis. Thirty(14%) of the suspected cases had positive blood culture. Proportions of late and early onset were 25 (83.3%) and 5(17.7%) respectively.In blood culture Staphylococcus aureus was the most common organism(80%),followed by Coagulase negative Staphylococcus (6.66%), Acinetobacter (6.66%), Enterobacter species(3.33%) and Morgonellamorgoni (3.33.5%).Gram positive organisms were isolated in all cases of early onset sepsis and in 84% of late onset sepsis. Most of the isolated organisms showed sensitivity to amikacin, cloxacillin, ciprofloxacin and vancomycin. CONCLUSIONS: This study has indicated possible emergence of Staphylococcus aureus as the dominant cause of neonatal sepsis. Cloxacillin, amikacin, ciprofloxacin have high proportion of efficacy against the commonly isolated bacteria in neonatal sepsis.

Surface topographical and ultrastructural alterations of Raillietina echinobothrida and Ascaridia galli induced by a compound isolated from Acacia oxyphylla.

The stem bark of Acacia oxyphylla Graham ex Bentham is used as an anthelmintic by the natives of Mizoram (North-East India). Therefore, the aim of the study was to assess the effect of the active compound isolated from A. oxyphylla on the tegument of adult Raillietina echinobothrida and Ascaridia galli. The test parasites R. echinobothrida and A. galli were incubated in physiological buffered saline containing 0.0005, 0.001, 0.05, 0.1 and 1mg/ml of the isolated compound. The alterations in the tegument of the parasites post paralysis were examined using electron microscopes. The compound reduced the cestode's motility soon after incubation, but did not induce paralysis in the nematodes till about 11-14 h at highest concentration. The compound caused extensive digestion of cestode tegument as evident by electron microscopy. Disorganization of muscle bundles, loss of cell-cell contact, extreme vacuolization and oedema were some of the changes observed. Loss of cellular organelles combined with distortion of those present was markedly noted throughout the parasite tissue. Deformation and disorganization of epicuticle, disruption of mitochondrial and nuclear membrane were also observed in nematode exposed to the active compound of the plant. Substantial structural deformities in the treated parasites are indicative of an efficient vermicidal activity of the isolated compound against cestodes and nematodes.

A shock tube and theoretical study on the pyrolysis of 1,4-dioxane.

The dissociation of 1, 2 and 4% 1,4-dioxane dilute in krypton was studied in a shock tube using laser schlieren densitometry, LS, for 1550-2100 K with 56 ± 4 and 123 ± 3 Torr. Products were identified by time-of-flight mass spectrometry, TOF-MS. 1,4-dioxane was found to initially dissociate via C-O bond fission followed by nearly equal contributions from pathways involving 2,6 H-atom transfers to either the O or C atom at the scission site. The 'linear' species thus formed (ethylene glycol vinyl ether and 2-ethoxyacetaldehyde) then dissociate by central fission at rates too fast to resolve. The radicals produced in this fission break down further to generate H, CH(3) and OH, driving a chain decomposition and subsequent exothermic recombination. High-level ab initio calculations were used to develop a potential energy surface for the dissociation. These results were incorporated into an 83 reaction mechanism used to simulate the LS profiles with excellent agreement. Simulations of the TOF-MS experiments were also performed with good agreement for consumption of 1,4-dioxane. Rate coefficients for the overall initial dissociation yielded k(123Torr) = (1.58 ± 0.50) × 10(59) × T(-13.63) × exp(-43970/T) s(-1) and k(58Torr) = (3.16 ± 1.10) × 10(79) × T(-19.13) × exp(-51326/T) s(-1) for 1600 < T < 2100 K.

Treatment of waste gas containing low concentration of dimethyl sulphide (DMS) in a bench-scale biofilter.

Biological treatment of dimethyl sulphide (DMS) was investigated in a bench-scale biofilter, packed with compost along with wood chips, and enriched with DMS degrading microorganism Bacillus sphaericus. The biofilter could remove 62-74% of the inlet DMS, at an optimum loading of 0.484 g/m(3)/h with optimum empty bed contact time (EBCT) of 384 s and an average moisture range of 65-70%. The biodegradative products of DMS were sulphide, thiosulphate and sulphate. Evaluation of microbiological status of the biofilter indicated the presence of other bacterial cultures viz. Paenibacillus polymyxa, and Bacillus megaterium, besides B. sphaericus.

Distributions of metals in the food web of fishponds of Kolleru Lake, India.

The distributions of trace metals (Pb, Cd, Cr Mn, Zn and Cu) in water, sediment, plankton and four fish species (Labeo rohita, Catla catla, Pangasius pangasius and Cirrhinus mrigala) from fishponds of Kolleru Lake, India were determined using atomic absorption spectroscopy. The concentrations of lead (0.01-0.03mg/l) and copper (0.01-0.08mg/l) in water and cadmium (3.0-9.0mg/kg), chromium (47-211mg/kg) and copper (10-64mg/kg) in sediment were above the EPA threshold effects level (TEL) and are of biological concern. The abundance orders of metals were Mn>Cd>Cu>Pb in water, Mn>Cr>Zn>Cu >Pb>Cd in sediment and Cu>Mn>Cr>Zn>Pb>Cd in plankton. The concentrations of the metals in the muscles of these four fish species apparently decrease in the order Zn>Cu>Cr>Mn=Pb>Cd and were well below WHO permissible limits that were safe for human consumption.

Antiproliferative, cytotoxic and apoptogenic activity of Indian toad (Bufo melanostictus, Schneider) skin extract on U937 and K562 cells.

The antiproliferative, cytotoxic and apoptogenic activities of Bufo melanostictus (Indian common toad) skin extract (TSE) on U937 and K562 leukemic cell line has been investigated. TSE significantly (P<0.001) reduced the time-dependent cell proliferation and decreased MTT values in U937 and K562 cells. TSE (IC50 doses) suppressed the proliferating cell nuclear antigen expression in both the cells. It was demonstrated that, TSE (IC50 doses) primarily arrested the U937 and K562 cells at G1 phase of the cell cycle. Confocal microscopy showed the altered fragmented nuclei and apoptotic bodies formation in TSE (IC50 doses) treated U937 and K562 cells. Membrane blebbing, cell surface shrinkage and perforation were observed through scanning electron microscope. TSE-induced DNA fragmentation in U937 and K562 cells was reflected in single-cell gel electrophoresis. TSE significantly (P<0.001) increase the length-width ratio of DNA mass as compared to control in comet assay. The flow cytometric analysis of annexin-V binding to the cancer cells further supported the apoptotogenic activity of TSE. The effect of TSE on normal human peripheral blood mononuclear cells viability and cytotoxicity was studied in culture and found to be less cytotoxic than on the U937 and K562 cells. The findings from the present study suggested that TSE might possess potent antineoplastic agent having antiproliferative, cytotoxic and apoptogenic activity against U937 and K562 myeloid leukemic cells.

Occurrence of non-protein low molecular weight cardiotoxin in Indian King Cobra (Ophiophagus hannah) Cantor 1836, venom.

Pathophysiology due to snakebite is a combined effect of various actions of the complex venom constituents. Importance of protein toxins in snake envenomation is well known. The present investigation reports the existence of nonprotein/nonpetide low molecular weight toxin in Indian King Cobra venom, which plays an important role in envenomation consequences in experimental animal models. A group of non-peptidic toxins (OH-NPT1) was isolated from Indian King Cobra Ophiophagus hannah by thin layer chromatography and silica gel column chromatography. UV, IR, NMR and (ESI) TOF-MS studies characterized the OH-NPT1 as a mixture of aliphatic acids having molecular weights 256, 326 and 340Da. The minimum lethal dose of OH-NPT1 was found to be 2.5 microg/20g (iv) and 4microg/20g (ip) in male albino mice. The cardiotoxic property of OH-NPT1 was established through studies on isolated guinea pig heart and auricle preparations, ECG studies in albino rat and estimation of LDH1/LDH and CPK-MB/CPK ratio in Swiss albino mice. Commercial antiserum failed to neutralize the lethality and cardiotoxicity of the toxin. However, calcium and magnesium effectively neutralized the lethal action.

CNS and anticonvulsant activity of a non-protein toxin (KC-MMTx) isolated from King Cobra (Ophiophagus hannah) venom.

In the present study, King Cobra (Ophiophagus hannah) venom was subjected to TLC followed by column chromatography/HPLC to isolate and purify a non-protein toxin designated as KC-MMTx. (1)H NMR, IR and EIMS studies showed KC-MMTx likely to be a 282 D unsaturated aliphatic acid having molecular formula C18H34O2. The minimum lethal dose of KC-MMTx was 200 microg/kg (i.v.) and 350 microg/kg (i.p.) in Swiss albino male mice. It significantly increased pentobarbitone induced sleeping time and significantly decreased the body temperature of male albino mice. It provided protection against amphetamine aggregate toxicity in mice but failed to protect amphetamine stereotypy in male albino rats. KC-MMTx provided significant protection against drug (strychnine, pentylenetetrazole, yohimbine) induced convulsions in male albino mice. It increased serum Na+ and decreased serum Ca2+ significantly in male mice. MAO activity and brain neurotransmitter levels in male mice were altered significantly. Further detailed study is warranted on the CNS, anticonvulsant potential of KC-MMTx, which may lead to the development of newer therapeutic tools in the near future.

Morbidity profile and prescribing patterns among outpatients in a teaching hospital in Western Nepal.

BACKGROUND: Recent studies on prescribing among outpatients in hospitals in Western Nepal are lacking. The main objectives of the study were to obtain information on the morbidity pattern among outpatients and to analyze prescribing using drug use indicators. METHODS: A retrospective hospital record based study from 01.01.2004 to 31.12.2004 was carried out among individuals attending the outpatient department (OPD) of the Manipal Teaching hospital, Pokhara, Western Nepal. A total of 32,017 new patients attended the OPD during the study period. Systematic random sampling (1 in every 20 patients) was done and 1600 patients selected. After excluding patients visiting the emergency department, those who got admitted and whose records were not available, 1261 cases were analyzed. The demographic details, morbidity pattern, average number of drugs prescribed, percentage of drugs prescribed by generic names and from the Essential drug list of Nepal (Essential drugs are those which satisfy the priority healthcare needs of the population), percentage of encounters with an antibiotic and an injection prescribed were noted. RESULTS: 1261 patients made 1772 visits. Upper respiratory tract infection and acid peptic disease were the most common diagnoses. The mean number of drugs was 1.99. Only 19.5% and 39.6% of drugs were prescribed by generic name and from the Essential drug list. Antibiotics and injections were prescribed in 26.4% and 0.96% of encounters. Cetrizine, vitamins, amoxicillin, the combination of paracetamol and ibuprofen and ranitidine were most commonly prescribed. CONCLUSIONS: Upper respiratory tract infections and acid peptic disease were the common illnesses. Generic prescribing and use of essential drugs were low. Some of the drug combinations being used were irrational. Prescriber education may be helpful in encouraging rational prescribing.

Modeling and Monte Carlo simulation of TCDD transport in a river.

A one-dimensional water quality model to assess the long-term fate of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) in three compartments (water, sediment, fish) of a river has been developed using the literature data on various model parameters. The transient deterministic model with constant or nonrandom parameters is solved numerically by the method of orthogonal collocation, while an analytical solution is developed for the steady-state model. The impact of uncertainty in several model parameters has been studied by means of Monte Carlo simulations assuming that the uncertain parameters are uncorrelated and can be modeled by three probability distributions (uniform, normal and lognormal). For the case of a high TCDD discharge into a small, shallow river, we find that the maximum TCDD contents of water and fish are well below the prescribed safe limits. We also find that the effects of uncertainty on water quality metrics are quite complex or nonintuitive and can be substantial. This is especially true for TCDD in fish, which can be higher by as much as 50-70% than the deterministic predictions, if the parameter uncertainties follow uniform distributions.