Molecular and serological evidence of chikungunya virus infection with high case fatality among pediatric population with acute encephalitis syndrome: first report from Eastern Uttar Pradesh, India.

Acute encephalitis syndrome (AES) outbreaks in children of Eastern Uttar Pradesh (E-UP) region of India have been a longstanding public health issue, with a significant case fatality rate of 20-25%. Since past decade, a rise in chikungunya (CHIK) cases has been occurring, which is a reported etiology of AES. However, the burden of chikungunya virus (CHIKV) among pediatric AES (pAES) is unknown from E-UP. We included 238 hospitalized pAES cases. The presence of IgM antibodies for CHIKV, and Dengue virus (DENV) was tested, and RT-PCR was performed for CHIKV and DENV in serologically confirmed CHIKV and DENV pAES cases. Positive samples were sequenced using Sangers sequencing. Further, to check for co-infection, IgM antibodies for other AES etiologies including Japanese encephalitis virus (JEV), Leptospira and Orientia tsutsugamushi (OT) in serum were also investigated. IgM ELISA demonstrated 5.04% (12) positivity for CHIKV. Among CHIKV IgM positive, 3 (25%, 3/12) pAES patients died. CHIKV genome was detected in 3 pAES specimens. Among which, 2 CHIKV cases were also positive for OT DNA. Partially sequenced CHIKV were genotyped as ECSA. The overall finding indicates evidence of CHIKV infection with high case fatality among pAES patients from E-UP. This study advocates constant serological and molecular surveillance of CHIKV in AES endemic regions of India.

Electroosmotic and Gyrotactic Microorganisms Effects on MHD Al2O3-Cu/Blood Hybrid Nanofluid Flow through Multi-Stenosed Bifurcated Artery.

BACKGROUND: The purpose of this study is to investigate the electroosmotic flow of a hybrid nanofluid (Al2O3-Cu/Blood) with gyrotactic microorganisms through a bifurcated artery with mild stenosis in both parent and daughter arteries. The flow is subjected to a uniform magnetic field, viscous dissipation, and a heat source. METHODS: The governing equations undergo the non-dimensional transformation and coordinate conversion to regularize irregular boundaries, then solve the resulting system using the Crank-Nicolson method. RESULTS: In both sections of the bifurcated artery (parent and daughter artery), the wall shear stress (WSS) profile decreases with increasing stenotic depth. Nusselt profile increases with an increase in the heat source parameter. CONCLUSIONS: The present endeavour can be beneficial for designing better biomedical devices and gaining insight into the hemodynamic flow for therapeutic applications in the biomedical sciences.

A Review on Novel Therapeutic Modalities and Evidence-based Drug Treatments Against Allergic Rhinitis.

Allergic rhinitis (AR) is an IgE-mediated atopic disease that occurs due to inhaled antigens in the immediate phase. Misdiagnosis, insufficient treatment, or no treatment at all are frequent problems associated with the widespread condition known as chronic allergic rhinitis. AR symptoms include runny, itchy, stuffy, and sneezing noses. Asthma and nasal polyps, for example, sometimes occur simultaneously in patients. In order for people living with AR to be as comfortable and productive as possible, treatment should center on reducing their symptoms. The online sources and literature, such as Pubmed, ScienceDirect, and Medline, were reviewed to gather information regarding therapeutic modalities of AR and evidence-based treatments for the disease as the objectives of the present study. An increasing number of people are suffering from AR, resulting in a heavy financial and medical burden on healthcare systems around the world. Undertreating AR frequently results in a decline in quality of life. Treatment compliance is a critical challenge in the administration of AR. Innovative therapies are needed for RA to provide patients with symptom alleviation that is less expensive, more effective, and longer duration of action. Evidence-based guidelines are helpful for managing AR illness. Treating AR according to evidence-based standards can help in disease management. AR treatment includes allergen avoidance, drug therapy, immunotherapy, patient education, and follow-up. However, AR treatment with intranasal corticosteroids is more popular. Hence, in this review article, treatment options for AR are discussed in depth. We also discussed the incidence, causes, and new treatments for this clinical condition.

Electroosmotic MHD ternary hybrid Jeffery nanofluid flow through a ciliated vertical channel with gyrotactic microorganisms: Entropy generation optimization.

In this study, the computational analysis of entropy generation optimization for synthetic cilia regulated ternary hybrid Jeffery nanofluid (Ag-Au-TiO2/PVA) flow through a peristaltic vertical channel with swimming motile Gyrotactic microorganisms is investigated. Understanding the intricate interaction of multiple physical phenomena in biomedical applications is essential for optimizing entropy generation and advancing microfluidic systems. The characteristics of nanofluid are explored for the electroosmotic MHD fluid flow in the presence of thermophoresis and Brownian motion, viscous dissipation, Ohmic heating and chemical reaction. Using the appropriate transformations, a set of ordinary differential equations are created from the governing partial differential equations. The resulting ODEs are numerically solved using the shooting technique using BVP5C in MATLAB after applying the long-wavelength and low Reynolds number approximation. The velocity, temperature, concentration, electroosmosis, and microorganism density profiles are analyzed graphically for different emerging parameters. Graphical investigation of engineering interest quantities like heat transfer rate, mass transfer rate, skin friction coefficient, and entropy generation optimization are also presented. It is observed that the rate of mass transfer increases for increasing thermophoretic parameter, while reverse effect is noted for Brownian motion parameter, Schmidt number, and chemical reaction number. The outcomes of present study can be pertinent in studying Cilia properties of respiratory tract, reproductive system, and brain ventricles.

Entropy generation optimization of cilia regulated MHD ternary hybrid Jeffery nanofluid with Arrhenius activation energy and induced magnetic field.

This study deals with the entropy generation analysis of synthetic cilia using a ternary hybrid nanofluid (Al-Cu-Fe2O3/Blood) flow through an inclined channel. The objective of the current study is to investigate the effects of entropy generation optimization, heat, and mass transfer on ternary hybrid nanofluid passing through an inclined channel in the proximity of the induced magnetic field. The novelty of the current study is present in studying the combined effect of viscous dissipation, thermophoresis, Brownian motion, exponential heat sink/source, porous medium, endothermic-exothermic chemical reactions, and activation energy in the proximity of induced magnetic field is examined. The governing partial differential equations (PDEs) are transformed into the ordinary differential equations (ODEs) using appropriate transformations. Applying the low Reynolds number and the long-wavelength approximation, resultant ODEs are numerically solved using shooting technique via BVP5C in MATLAB. The velocity, temperature, concentration, and induced magnetism profiles are visually discussed and graphically analyzed for various fluid flow parameters. Graphical analysis of physical interest quantities like mass transfer rate, heat transfer rate, entropy generation optimization, and skin friction coefficient are also graphically discussed. The entropy generation improves for enhancing values of Reynolds number, solutal Grashof number, heat sink/source parameter, Brinkman number, magnetic Prandtl number, and endothermic-exothermic reaction parameter while the reverse effect is noticed for chemical reaction and induced magnetic field parameter. The findings of this study can be applied to enhance heat transfer efficiency in biomedical devices, optimizing cooling systems, designing efficient energy conversion processes, and spanning from renewable energy technologies to aerospace propulsion systems.

Entropy generation optimization for the electroosmotic MHD fluid flow over the curved stenosis artery in the presence of thrombosis.

The present study deals with the entropy generation analysis on the flow of an electrically conductive fluid (Blood) with [Formula: see text]-suspended nanoparticles through the irregular stenosed artery with thrombosis on the catheter. The fluid flow can be actuated by the interactions of different physical phenomena like electroosmosis, radiation, Joule heating and a uniform radial magnetic field. The analysis of different shapes and sizes of the nanoparticle is considered by taking the Crocine model. The velocity, temperature, and concentration distributions are computed using the Crank-Nicholson method within the framework of the Debye-Huckel linearization approximation. In order to see how blood flow changes in response to different parameters, the velocity contour is calculated. The aluminium oxide nanoparticles employed in this research have several potential uses in biomedicine and biosensing. The surface's stability, biocompatibility, and reactivity may be enhanced by surface engineering, making the material effective for deoxyribonucleic acid sensing. It may be deduced that the velocity profile reduces as the nanoparticle's size grows while depicts the reverse trend for the shape size. In a region close to the walls, the entropy profile decreases, while in the region in the middle, it rises as the magnetic field parameter rises. The present endeavour can be beneficial in biomedical sciences in designing better biomedical devices and gaining insight into the hemodynamic flow for treatment modalities.

An Overview of Nanotechnological Approaches for the Diagnosis and Treatment of Allergic Illness.

Allergies are a major health issue. Allergen avoidance, antihistamines, and corticosteroids do not treat the pathology's causes, therefore long-term therapy is essential. Long-term allergen-specific immunotherapy builds immune tolerance to the allergen. Unfortunately, immunotherapies for all allergens are not available, and adverse reactions during therapy, especially in severely allergic persons, remain a worry. In this regard, cell and bio- or nanomaterial-based allergy treatments are promising. This overview covers the most important tactics from these two strategies with examples. Nanotechnology encompasses science, engineering, and technology at 1-100 nm. Due to their one-of-a-kind characteristics, nanomaterials can be used in healthcare. Small molecules' chemical and physical properties are modified by the system's size, shape, content, and function. Toxicity and hypersensitivity reactions need to be evaluated. Regulating the physico-chemical properties of numerous accessible structures would make clinical diagnosis and therapy safer and more successful. Dendrimeric antigens, nanoallergens, and nanoparticles can mimic carrier proteins, boost specific IgE binding, and improve signal detection in allergy diagnosis. In immunotherapy, several allergenic structures like glycodendrimers, liposomes, polymers, and nanoparticles have been used as adjuvants, protectors, or depots for allergens. Nanotechnology has the potential to substantially improve both the diagnosis and treatment of allergies.

Computer Simulations of EMHD Casson Nanofluid Flow of Blood through an Irregular Stenotic Permeable Artery: Application of Koo-Kleinstreuer-Li Correlations.

A novel analysis of the electromagnetohydrodynamic (EMHD) non-Newtonian nanofluid blood flow incorporating CuO and Al2O3 nanoparticles through a permeable walled diseased artery having irregular stenosis and an aneurysm is analyzed in this paper. The non-Newtonian behavior of blood flow is addressed by the Casson fluid model. The effective viscosity and thermal conductivity of nanofluids are calculated using the Koo-Kleinstreuer-Li model, which takes into account the Brownian motion of nanoparticles. The mild stenosis approximation is employed to reduce the bi-directional flow of blood to uni-directional. The blood flow is influenced by an electric field along with a magnetic field perpendicular to the blood flow. The governing mathematical equations are solved using Crank-Nicolson finite difference approach. The model has been developed and validated by comparing the current results to previously published benchmarks that are peculiar to this study. The results are utilized to investigate the impact of physical factors on momentum diffusion and heat transfer. The Nusselt number escalates with increasing CuO nanoparticle diameter and diminishing the diameter of Al2O3 nanoparticles. The relative % variation in Nusselt number enhances with Magnetic number, whereas a declining trend is obtained for the electric field parameter. The present study's findings may be helpful in the diagnosis of hemodynamic abnormalities and the fields of nano-hemodynamics, nano-pharmacology, drug delivery, tissue regeneration, wound healing, and blood purification systems.

Entropy Generation and Thermal Radiation Analysis of EMHD Jeffrey Nanofluid Flow: Applications in Solar Energy.

This article examines the effects of entropy generation, heat transmission, and mass transfer on the flow of Jeffrey fluid under the influence of solar radiation in the presence of copper nanoparticles and gyrotactic microorganisms, with polyvinyl alcohol-water serving as the base fluid. The impact of source terms such as Joule heating, viscous dissipation, and the exponential heat source is analyzed via a nonlinear elongating surface of nonuniform thickness. The development of an efficient numerical model describing the flow and thermal characteristics of a parabolic trough solar collector (PTSC) installed on a solar plate is underway as the use of solar plates in various devices continues to increase. Governing PDEs are first converted into ODEs using a suitable similarity transformation. The resulting higher-order coupled ODEs are converted into a system of first-order ODEs and then solved using the RK 4th-order method with shooting technique. The remarkable impacts of pertinent parameters such as Deborah number, magnetic field parameter, electric field parameter, Grashof number, solutal Grashof number, Prandtl number, Eckert number, exponential heat source parameter, Lewis number, chemical reaction parameter, bioconvection Lewis number, and Peclet number associated with the flow properties are discussed graphically. The increase in the radiation parameter and volume fraction of the nanoparticles enhances the temperature profile. The Bejan number and entropy generation rate increase with the rise in diffusion parameter and bioconvection diffusion parameter. The novelty of the present work is analyzing the entropy generation and solar radiation effects in the presence of motile gyrotactic microorganisms and copper nanoparticles with polyvinyl alcohol-water as the base fluid under the influence of the source terms, such as viscous dissipation, Ohmic heating, exponential heat source, and chemical reaction of the electromagnetohydrodynamic (EMHD) Jeffrey fluid flow. The non-Newtonian nanofluids have proven their great potential for heat transfer processes, which have various applications in cooling microchips, solar energy systems, and thermal energy technologies.

Fabrication of Copper of Harmonic Structure: Mechanical Property-Based Optimization of the Milling Parameters and Fracture Mechanism.

A severe plastic deformation process for the achievement of favorable mechanical properties for metallic powder is mechanical milling. However, to obtain the highest productivity while maintaining reasonable manufacturing costs, the process parameters must be optimized to achieve the best mechanical properties. This study involved the use of response surface methodology to optimize the mechanical milling process parameters of harmonic-structure pure Cu. Certain critical parameters that affect the properties and fracture mechanisms of harmonic-structure pure Cu were investigated and are discussed in detail. The Box-Behnken design was used to design the experiments to determine the correlation between the process parameters and mechanical properties. The results show that the parameters (rotation speed, mechanical milling time, and powder-to-ball ratio) affect the microstructure characteristics and influence the mechanical performance, including the fracture mechanisms of harmonic-structure pure Cu specimens. The best combination values of the ultimate tensile strength (UTS) and elongation were found to be 272 MPa and 46.85%, respectively. This combination of properties can be achieved by applying an optimum set of process parameters: a rotation speed of 200 rpm; mechanical milling time of 17.78 h; and powder-to-ball ratio of 0.065. The superior UTS and elongation of the harmonic-structure pure Cu were found to be related to the delay of void and crack initiation in the core and shell interface regions, which in turn were controlled by the degree of strength variation between these regions.

Switching nanoprecipitates to resist hydrogen embrittlement in high-strength aluminum alloys.

Hydrogen drastically embrittles high-strength aluminum alloys, which impedes efforts to develop ultrastrong components in the aerospace and transportation industries. Understanding and utilizing the interaction of hydrogen with core strengthening elements in aluminum alloys, particularly nanoprecipitates, are critical to break this bottleneck. Herein, we show that hydrogen embrittlement of aluminum alloys can be largely suppressed by switching nanoprecipitates from the η phase to the T phase without changing the overall chemical composition. The T phase strongly traps hydrogen and resists hydrogen-assisted crack growth, with a more than 60% reduction in the areal fractions of cracks. The T phase-induced reduction in the concentration of hydrogen at defects and interfaces, which facilitates crack growth, primarily contributes to the suppressed hydrogen embrittlement. Transforming precipitates into strong hydrogen traps is proven to be a potential mitigation strategy for hydrogen embrittlement in aluminum alloys.

Single-dose instillation of povidone iodine for chyluria: A safe and effective therapy.

INTRODUCTION: Management of chyluria with initial conservative approach and then using endoscopic sclerotherapy is a mainstay approach. However, a wide range of sclerosants are available with differential success rates and complication rates. This study evaluated the safety and efficacy of a single-dose instillation of 1% povidone iodine for the treatment of chyluria. MATERIALS AND METHODS: This was a prospective, observational study conducted on patients with chyluria who did not respond to conservative management with dietary restriction and diethylcarbamazine. The site of chyle efflux was identified by cystoscopy. A 6 Fr ureteral stent was inserted into effluxing side, diluted contrast was injected to delineate the pelvicalyceal system and the pyelolymphatic connection (arborization of the pelvicalyceal system), and a single-dose of 1% povidone iodine was instilled. Patients were observed for loin pain, fever, and disappearance of milky urine postinstillation and followed up at intervals of 3 months for a total duration of 1 year. RESULTS: Of a total 50 patients included, 35 were men and 15 were women, with a mean age of 37 years. Pyelolymphatic connections were noted in 48% of the patients. All patients showed an immediate disappearance of milky urine. During 1-year follow-up, 92% of the patients were symptom-free till the last follow-up while only 8% of the patients experienced recurrence of chyluria which were treated with other treatment modalities. The mean duration of recurrence was 8 weeks. CONCLUSION: Single dose of 1% povidone iodine was effective in immediate clearance of milky urine and well tolerated in patients with chyluria during 1-year follow-up.

Life cycle cost analysis of municipal solid waste management scenarios for Mumbai, India.

This study quantifies and compares the cost of municipal solid waste (MSW) management systems under different scenarios using life cycle cost (LCC) analysis approach. LCC analysis was performed for six integrated MSW management scenarios for Mumbai city, India which generates over 9000 metric tonnes of MSW daily and disposes most of it in open dumps. The scenarios are the combinations of recycling, composting, anaerobic digestion, incineration with electricity generation, and landfill with biogas recovery. To perform LCC analysis of scenarios, present worth method was used. The present worth of operations and maintenance (O&M) cost and revenue generated was estimated using a discount rate of 11.25% for a 20-year life span. Results show that the incineration based scenario is the most cost-intensive option with a net LCC of US$38 per tonne of MSW due to the high capital cost involved in case of incineration. While the scenario with a combination of recycling and sanitary landfill was the most economically viable option with a net LCC of US$19 per tonne of MSW due to comparative lower operating cost. The sensitivity analysis shows that the O&M cost was the most sensitive parameter and a change of ±10% and ±20% in O&M cost, the net LCC of scenarios changes in the range of 14-33% and 29-65%, respectively. This study provides an economic comparison of MSW treatment scenarios from a life cycle perspective, which facilitates the decision-making process for improvement in cost estimation and planning of waste management strategies in India.

Spectrum and Immediate Outcome of Acute Kidney Injury in a Pediatric Intensive Care Unit: A Snapshot Study from Indian Subcontinent.

BACKGROUND AND AIMS: Acute kidney injury (AKI) became an important cause of mortality and morbidity in critically ill children, despite advancement in its management. In developing countries etiology of AKI are different from that of developed countries. MATERIALS AND METHODS: This observational study was carried out in pediatric intensive care unit (PICU) in 2 months to18 years of critically ill children. Kidney injury was defined and categorized by the pRIFLE criteria. RESULTS: Out of 361children, 86 children (23.8%) developed AKI at some point during admission, 275 children (age and sex matched) who did not develop kidney injury during hospitalization served as non-AKI children. Maximum cases of AKI were seen in 1-5 years of age. Maximum children of AKI were of viral encephalitis (n = 43, 50.0%) followed by scrub typhus (n = 14, 16.3%). Risk factors for the development of AKI were shock, PRISM score and longer hospital stay. In our study the mortality in AKI children (n = 30, 34.8%) was significantly higher (p = 0.005) as compared to non-AKI children (n = 56, 20.3%)). Duration on mechanical ventilation, PICU stay and hospital stay were also significantly (p = 0.001) higher in AKI children. CONCLUSION: AKI is common in critically ill children and associated with high mortality and morbidity. HOW TO CITE THIS ARTICLE: Bharat A, Mehta A, Tiwari HC, Sharma B, Singh A, Singh V. Spectrum and Immediate Outcome of Acute Kidney Injury in a Pediatric Intensive Care Unit: A Snapshot Study from Indian Subcontinent. Indian J Crit Care Med 2019;23(8):352-355.

Stretchable Electroluminescent Display Enabled by Graphene-Based Hybrid Electrode.

Stretchable alternating-current electroluminescent (ACEL) devices are required due to their potential in wearable, biomedical, e-skin, robotic, lighting, and display applications; however, one of the main hurdles is to achieve uniform electroluminescence with an optimal combination of transparency, conductivity, and stretchability in electrodes. We therefore propose a fabrication scheme involving strategically combining two-dimensional graphene layers with a silver nanowire (Ag NW)-embedded PEDOT:PSS film. The developed hybrid electrode overcomes the limitations of commonly known metallic NWs and ionic conductor-based electrodes for ACEL applications. Furthermore, the potential of the hybrid electrode is realized in demonstrating large-area stretchable ACEL devices composed of an 8 × 8 passive array. The prototype ACEL passive array demonstrates efficient and uniform electroluminescence under high levels of mechanical deformation such as bending, rolling, twisting, and stretching.

All MoS2-Based Large Area, Skin-Attachable Active-Matrix Tactile Sensor.

Large-area, ultrathin flexible tactile sensors with conformal adherence are becoming crucial for advances in wearable electronics, electronic skins and biorobotics. However, normal passive tactile sensors suffer from high crosstalk, resulting in inaccurate sensing, which consequently limits their use in such advanced applications. Active-matrix-driven tactile sensors could potentially overcome such hurdles, but it demands the high performance and reliable operations of the thin-film-transistor array that could efficiently control integrated pressure gauges. Herein, we utilized the benefit of the semiconducting and mechanical excellence of MoS2 and placed it between high- k Al2O3 dielectric sandwich layers to achieve the high and reliable performance of MoS2-based back-plane circuitry and strain sensor. This strategical combination reduces the fabrication complexity and enables the demonstration of an all MoS2-based large area (8 × 8 array) active-matrix tactile sensor offering a wide sensing range (1-120 kPa), sensitivity value (Δ R/ R0: 0.011 kPa-1), and a response time (180 ms) with excellent linearity. In addition, it showed potential in sensing multitouch accurately, tracking a stylus trajectory, and detecting the shape of an external object by grasping it using the palm of the human hand.

High-Performance All-Printed Amorphous Oxide FETs and Logics with Electronically Compatible Electrode/Channel Interface.

Oxide semiconductors typically show superior device performance compared to amorphous silicon or organic counterparts, especially when they are physical vapor deposited. However, it is not easy to reproduce identical device characteristics when the oxide field-effect transistors (FETs) are solution-processed/printed; the level of complexity further intensifies with the need to print the passive elements as well. Here, we developed a protocol for designing the most electronically compatible electrode/channel interface based on the judicious material selection. Exploiting this newly developed fabrication schemes, we are now able to demonstrate high-performance all-printed FETs and logic circuits using amorphous indium-gallium-zinc oxide (a-IGZO) semiconductor, indium tin oxide (ITO) as electrodes, and composite solid polymer electrolyte as the gate insulator. Interestingly, all-printed FETs demonstrate an optimal electrical performance in terms of threshold voltages and device mobility and may very well be compared with devices fabricated using sputtered ITO electrodes. This observation originates from the selection of electrode/channel materials from the same transparent semiconductor oxide family, resulting in the formation of In-Sn-Zn-O (ITZO)-based-diffused a-IGZO-ITO interface that controls doping density while ensuring high electrical performance. Compressive spectroscopic studies reveal that Sn doping-mediated excellent band alignment of IGZO with ITO electrodes is responsible for the excellent device performance observed. All-printed n-MOS-based logic circuits have also been demonstrated toward new-generation portable electronics.

Flexible active-matrix organic light-emitting diode display enabled by MoS2 thin-film transistor.

Atomically thin molybdenum disulfide (MoS2) has been extensively investigated in semiconductor electronics but has not been applied in a backplane circuitry of organic light-emitting diode (OLED) display. Its applicability as an active drive element is hampered by the large contact resistance at the metal/MoS2 interface, which hinders the transport of carriers at the dielectric surface, which in turn considerably deteriorates the mobility. Modified switching device architecture is proposed for efficiently exploiting the high-k dielectric Al2O3 layer, which, when integrated in an active matrix, can drive the ultrathin OLED display even in dynamic folding states. The proposed architecture exhibits 28 times increase in mobility compared to a normal back-gated thin-film transistor, and its potential as a wearable display attached to a human wrist is demonstrated.

Two-dimensional materials in functional three-dimensional architectures with applications in photodetection and imaging.

Efficient and highly functional three-dimensional systems that are ubiquitous in biology suggest that similar design architectures could be useful in electronic and optoelectronic technologies, extending their levels of functionality beyond those achievable with traditional, planar two-dimensional platforms. Complex three-dimensional structures inspired by origami, kirigami have promise as routes for two-dimensional to three-dimensional transformation, but current examples lack the necessary combination of functional materials, mechanics designs, system-level architectures, and integration capabilities for practical devices with unique operational features. Here, we show that two-dimensional semiconductor/semi-metal materials can play critical roles in this context, through demonstrations of complex, mechanically assembled three-dimensional systems for light-imaging capabilities that can encompass measurements of the direction, intensity and angular divergence properties of incident light. Specifically, the mechanics of graphene and MoS2, together with strategically configured supporting polymer films, can yield arrays of photodetectors in distinct, engineered three-dimensional geometries, including octagonal prisms, octagonal prismoids, and hemispherical domes.

Can Non-Selective Beta-Blockers (NSBBs) Prevent Enlargement of Small Esophageal Varices in Patients with Cirrhosis? A Meta-analysis.

BACKGROUND: Non-selective beta-blockers (NSBBs) are recommended for prophylaxis of first variceal bleeding in patients of cirrhosis with large esophageal varices. However, the data is conflicting whether NSBBs can also prevent growth of small esophageal varices to large size. AIM: To perform a meta-analysis of the randomized clinical trials comparing NSBBs with placebo for prevention of development of large esophageal varices in patients of cirrhosis with small esophageal varices. METHODS: The PubMed, EMBASE, Science Direct, and Cochrane library databases were searched for relevant papers. A meta-analysis was performed using risk ratios (RRs) with 95% confidence interval (CI) as the effect sizes. RESULTS: Overall, 314 trials were initially retrieved from the database searches, of which five randomized controlled trials were included in the meta-analysis. The incidence of development of large varices (RR = 0.91, 95%CI: 0.29-2.86; P = 0.87) was similar between NSBB and placebo groups. However, the heterogeneity among studies was significant (P < 0.01) with an I2 of 93%. The incidences of first variceal bleeding (RR = 0.72, 95%CI: 0.25-2.12; P = 0.55) and death (RR = 0.76, 95%CI: 0.50-1.15; P = 0.19) were also similar between NSBB and placebo groups; with no heterogeneity. The incidence of adverse events was significantly higher in the NSBB group compared with the placebo group (RR = 4.66, 95%CI: 1.36-15.91; P = 0.01). CONCLUSION: The results of this meta-analysis indicate that NSBBs are not effective in preventing growth of small varices and may lead to significant adverse effects. Hence, NSBBs should not be recommended for cirrhotic patients with small varices.