Comprehensive characterization of unscientifically disposed municipal solid waste (MSW) in Kashmir Region, India.

Unscientific dumping of municipal solid waste (MSW) is a common practice in Kashmir. To have an environmentally friendly and sustainable waste management system, MSW was collected from nine study locations of this region. They were air-dried, then oven-dried at 105 °C for 24 h, segregated, and characterized for various components. The overall average organic waste was > 55%, plastic waste about 17%, inert material about 10%, paper 9%, and cloth waste 7%. The calorific value of paper and plastic wastes exhibited was 4910 kcal/kg, while organic waste had a calorific value of 1980 kcal/kg. The proximate analysis showed that the moisture content ranged from 16 to 29%, volatile matter ranged from 49 to 72%, ash content ranged from 0.03 to 5%, and fixed carbon ranged from 5 to 20%. In S7, the volatile matter content recorded the lowest value at 49.15%, while in S5, the volatile matter content was notably higher at 71.84%, indicating easier ignition. Further, elemental analysis revealed that the major elements in MSW were carbon and oxygen, 53% and 37%, respectively, with small traces of heavy metals with an average of 0.02% cadmium (Cd) and 0.006% lead (Pb). Moreover, field emission scanning electron microscopy (FESEM) micrographs provided confirmation that the majority of components in the MSW exhibited either partial or complete degradation, resulting in a rough surface texture. In addition, the presence of silica and other silicate groups was also detected. Fourier transform infrared spectroscopy (FT-IR) analysis revealed that the main functional groups were alcohol. In the X-ray diffraction (XRD) analysis, all the major mineral phases were detected between 20 and 30° 2θ, except for the peaks at 50-60° 2θ in S3 and S9 where catalysts such as zeolite Y and zeolite X were detected. Overall, the MSW had low moisture content but higher calorific value, making it a viable feedstock.

Investigating the Impact of Cannabis Consumption on Hospital Outcomes in Patients With Primary Spontaneous Pneumothorax: A Nationwide Analysis.

Introduction Existing data suggest an association between primary spontaneous pneumothorax (PSP) and cannabis consumption, although evidence remains controversial. Methods This study used the 2016-2019 National Inpatient Sample Database to examine inpatients with PSP, categorizing them as cannabis users and non-users. Multivariate regression analyzed continuous variables, chi-square assessed categorical variables, and logistic regression models were built. Propensity score matching (PSM) mitigated the confounding bias. Results A total of 399,495 patients with PSP were admitted during the study period (13,415 cannabis users and 386,080 non-cannabis users). Cannabis users were more likely to be younger (p<0.001) and male (p<0.001) with a lower risk of baseline comorbidities than non-users. Cannabis users had a lower risk of sudden cardiac arrest, vasopressor use, the development of acute kidney injury, venous thromboembolism, the requirement for invasive and non-invasive mechanical ventilation, hemodialysis, ventilator-associated pneumonia, and the need for a tracheostomy. Cannabis use was associated with a 3.4 days shorter hospital stay (p<0.001), as confirmed by PSM analysis (2.3 days shorter, p<0.001). Additionally, cannabis users showed a lower risk of in-hospital mortality (p<0.001), a trend maintained in the PSM analysis (p<0.001). Conclusions Our study revealed correlations suggesting that cannabis users with PSP might experience lower in-hospital mortality and fewer complications than non-cannabis users.

Outcomes of COVID-19-Associated Hospitalizations in Geriatric Patients with Dementia in the United States: A Propensity Score Matched Analysis.

Previous studies have convincingly demonstrated the negative impact of dementia on overall health outcomes. In the context of the COVID-19 pandemic, there is burgeoning evidence suggesting a possible association between dementia and adverse outcomes, however the relationship has not been conclusively established. We conducted a retrospective cohort study involving 816,960 hospitalized COVID-19 patients aged 65 or older from the 2020 national inpatient sample. The cohort was bifurcated into patients with dementia (n = 180,845) and those without (n = 636,115). Multivariate regression and propensity score matched analyses (PSM) assessed in-hospital mortality and complications. We observed that COVID-19 patients with dementia had a notably higher risk of in-hospital mortality (23.1% vs. 18.6%; aOR = 1.2 [95% CI 1.1-1.2]). This elevated risk persisted even after PSM. Interestingly, dementia patients had a reduced risk of several acute in-hospital complications, including liver failure and sudden cardiac arrest. Nevertheless, they had longer hospital stays and lower total hospital charges. Our findings conclusively demonstrate that dementia patients face a heightened risk of mortality when hospitalized with COVID-19 but are less likely to experience certain complications. This complexity underscores the urgent need for individualized care strategies for this vulnerable group.

Impact of COVID-19 on Pregnancy Outcomes across Trimesters in the United States.

BACKGROUND: Current knowledge regarding the association between trimester-specific changes during pregnancy and COVID-19 infection is limited. We utilized the National Inpatient Sample (NIS) database to investigate trimester-specific outcomes among hospitalized pregnant women diagnosed with COVID-19. RESULTS: Out of 3,447,771 pregnant women identified, those with COVID-19 exhibited higher in-hospital mortality rates in their third trimester compared with those without the virus. Notably, rates of mechanical ventilation, acute kidney injury, renal replacement therapy, and perinatal complications (preeclampsia, HELLP syndrome, and preterm birth) were significantly elevated across all trimesters for COVID-19 patients. COVID-19 was found to be more prevalent among low-income, Hispanic pregnant women. CONCLUSIONS: Our findings suggest that COVID-19 during pregnancy is associated with increased risk of maternal mortality and complications, particularly in the third trimester. Furthermore, we observed significant racial and socioeconomic disparities in both COVID-19 prevalence and pregnancy outcomes. These findings emphasize the need for equitable healthcare strategies to improve care for diverse and socioeconomically marginalized groups, ultimately aiming to reduce adverse COVID-19-associated maternal and fetal outcomes.

COVID-19 Outcomes in Inflammatory Bowel Disease Hospitalized Patients: A Comprehensive Analysis Using the National Inpatient Sample.

Background: There is no uniformity in the available literature concerning the effects of coronavirus disease 2019 (COVID-19) viral illness on people with inflammatory bowel disease (IBD). Methods: We conducted an analysis using the 2020 National Inpatient Sample (NIS) database to compare the outcomes of COVID-19 hospitalized patients with and without IBD. Results: Of 1,050,040 patients admitted with COVID-19, 5,750 (0.5%) also had IBD. The group with COVID-19 and IBD had higher percentages of females and White individuals and a greater prevalence of chronic lung disease, peripheral vascular disease, and liver disease. However, after accounting for confounding variables, there was no significant difference in mortality rates, length of hospital stays, or hospitalization costs between the two groups. Conclusion: According to our findings, the presence of IBD does not appear to elevate the risk of COVID-19 complications.

COVID-19 and HIV: Clinical Outcomes among Hospitalized Patients in the United States.

The concurrence of HIV and COVID-19 yields unique challenges and considerations for healthcare providers, patients living with HIV, and healthcare systems at-large. Persons living with HIV may face a higher risk of acquiring SARS-CoV-2 infection and experiencing worse clinical outcomes compared to those without. Notably, COVID-19 may have a disproportionate impact on historically disadvantaged populations, including African Americans and those stratified in a lower socio-economic status. Using the National Inpatient Sample (NIS) database, we compared patients with a diagnosis of both HIV and COVID-19 and those who exclusively had a diagnosis of COVID-19. The primary outcome was in-hospital mortality. Secondary outcomes were intubation rate and vasopressor use; acute MI, acute kidney injury (AKI); AKI requiring hemodialysis (HD); venous thromboembolism (VTE); septic shock and cardiac arrest; length of stay; financial burden on healthcare; and resource utilization. A total of 1,572,815 patients were included in this study; a COVID-19-positive sample that did not have HIV (n = 1,564,875, 99.4%) and another sample with HIV and COVID-19 (n = 7940, 0.56%). Patients with COVID-19 and HIV did not have a significant difference in mortality compared to COVID-19 alone (10.2% vs. 11.3%, respectively, p = 0.35); however, that patient cohort did have a significantly higher rate of AKI (33.6% vs. 28.6%, aOR: 1.26 [95% CI 1.13-1.41], p < 0.001). Given the complex interplay between HIV and COVID-19, more prospective studies investigating the factors such as the contribution of viral burden, CD4 cell count, and the details of patients' anti-retroviral therapeutic regimens should be pursued.

COVID-19 Patients With Pulmonary Hypertension Hospitalized in the United States During the Early Pandemic: Analysis of In-Hospital Mortality, Clinical Outcomes, and Racial Disparities.

Coronavirus Disease 2019 (COVID-19) has been linked to severe consequences among hospitalized patients diagnosed with pulmonary hypertension (PH), as evidenced by a limited number of studies. Our retrospective study employed the National Inpatient Sample (NIS) database to evaluate in-hospital mortality and various clinical outcomes in COVID-19 patients with and without PH. This study included all patients ages 18 years and above who were hospitalized in the United States from January 1,2020 to December 31, 2020 with a COVID-19 diagnosis. The patients were then divided into 2 cohorts based on their PH status. After multivariate adjustment, we discovered that COVID-19 patients with PH experienced considerably higher in-hospital mortality, longer hospital stays, and higher costs of hospitalization when compared to COVID-19 patients without PH. Moreover, we observed an increased dependence on invasive and noninvasive positive pressure ventilation among COVID-19 patients with PH, indicating more severe respiratory failure. Our findings suggest that COVID-19 patients with PH had a heightened risk of acute pulmonary embolism and myocardial infarction while hospitalized. Lastly, among COVID-19 patients with PH, Hispanic and Native American patients demonstrated a persistently higher risk of in-hospital mortality compared to other racial groups. To our knowledge, this is the most comprehensive study of outcomes for COVID-19 patients with PH. The observed inpatient mortality appears to be driven by in-hospital complications, particularly pulmonary embolism. Given the substantial mortality and complications associated with COVID-19 and PH, we advocate for SARS-CoV-2 vaccination and the implementation of aggressive nonpharmacological preventive measures.

COVID-19 With Stress Cardiomyopathy Mortality and Outcomes Among Patients Hospitalized in the United States: A Propensity Matched Analysis Using the National Inpatient Sample Database.

Takotsubo syndrome (stress cardiomyopathy) has become a well-known complication of COVID-19 infections, with limited large-scale studies evaluating outcomes. We used the National Inpatient Sample (NIS) database to compare COVID-19 patients with and without stress cardiomyopathy. A total of 1,659,040 patients were included in the study: COVID-19 with stress cardiomyopathy (n = 1665, 0.1%) and COVID-19 without stress cardiomyopathy (n = 1657, 375, and 99.9%). The primary outcome was in-hospital mortality, with secondary analysis with propensity matching performed to confirm results from traditional multivariate analysis. COVID-19 patients with stress cardiomyopathy had significantly increased in-hospital mortality compared to COVID-19 patients without stress cardiomyopathy (32.8% vs 14.6%, adjusted OR [aOR]: 2.3 [95% CI, 1.2-4.5], P = 0.01) along with significantly increased mechanical ventilation and vasopressor support, hospitalization charge, acute kidney injury requiring hemodialysis, cardiogenic shock, and cardiac arrest. These results emphasize the need for more research to reduce worse outcomes with COVID-19-related stress cardiomyopathy patients.

COVID-19 Associated Myocarditis Clinical Outcomes among Hospitalized Patients in the United States: A Propensity Matched Analysis of National Inpatient Sample.

Coronavirus-19 (COVID-19), preliminarily a respiratory virus, can affect multiple organs, including the heart. Myocarditis is a well-known complication among COVID-19 infections, with limited large-scale studies evaluating outcomes associated with COVID-19-related Myocarditis. We used the National Inpatient Sample (NIS) database to compare COVID-19 patients with and without Myocarditis. A total of 1,659,040 patients were included in the study: COVID-19 with Myocarditis (n = 6,455, 0.4%) and COVID-19 without Myocarditis (n = 1,652,585, 99.6%). The primary outcome was in-hospital mortality. Secondary outcomes included mechanical ventilation, vasopressor use, sudden cardiac arrest, cardiogenic shock, acute kidney injury requiring hemodialysis, length of stay, health care utilization costs, and disposition. We conducted a secondary analysis with propensity matching to confirm results obtained by traditional multivariate analysis. COVID-19 patients with Myocarditis had significantly higher in-hospital mortality compared to COVID-19 patients without Myocarditis (30.5% vs. 13.1%, adjusted OR: 3 [95% CI 2.1-4.2], p < 0.001). This cohort also had significantly increased cardiogenic shock, acute kidney injury requiring hemodialysis, sudden cardiac death, required more mechanical ventilation and vasopressor support and higher hospitalization cost. Vaccination and more research for treatment strategies will be critical for reducing worse outcomes in patients with COVID-19-related Myocarditis.

Acute Esophageal Necrosis: An In-depth Review of Pathogenesis, Diagnosis and Management.

Introduction: Acute esophageal necrosis (AEN) is an uncommon but fatal cause of upper gastrointestinal bleeding. The complex pathophysiology of the disorder provides multiple points for intervention. Therefore, it is important to discuss the many multifaceted aspects of the disease. Methods: A scoping review was performed using PubMed, Google Scholar, and ClinicalTrials.gov. We reviewed literature from 1990 to 2021. The keywords used were 'acute esophageal necrosis', 'upper GI bleed', 'pathogenesis', 'EGD', 'prognosis'. Results and conclusions: The review summarized findings of 46 studies. AEN usually targets older males who have underlying cardiovascular disease. The middle part of the esophagus is commonly involved. The pathogenesis of AEN depends on conditions that increase risk of mucosal damage such as ischemia, lack of mucosal protection and excessive gastric reflux. Some medications are also responsible for the disease. Esophagogastroduodenoscopy is usually the gold standard for diagnosis. Findings suggestive of AEN include darkened, sharply demarcated circumferential areas. Supportive measures, including bowel rest, fluid supplementation and proton pump inhibitors are the cornerstone of therapy. A high index of suspicion should be maintained in patients with chronic health problems presenting with signs and symptoms of upper gastrointestinal bleeding because AEN can carry an unfavorable prognosis in these patients.

Pet-Assisted Therapy for Delirium and Agitation in Hospitalized Patients with Neurocognitive Impairment: A Review of Literature.

Delirium leading to agitation is a common issue in elderly people and patients with underlying neurocognitive impairment. Despite use of medications to treat agitation, polypharmacy is a major concern and might lead to multiple side effects in this patient population. Therefore, it is imperative to investigate non-pharmacological methods that can provide solutions to the problem. The objective of this review was to evaluate the impact of pet-assisted therapy on elderly patients, with a major focus on agitation and delirium. For the purposes of this study, a scoping review was performed using PubMed, Google Scholar, and ClinicalTrials. We reviewed literature from 1980 to 2021. Out of the 31 studies reviewed, 14 commented on agitation with respect to pet-assisted interventions. Of these, eight studies (57%) reported a statistically significant reduction in agitation and/or delirium in patients who were exposed to pet therapy. Pet-assisted therapy can improve the standardized care in hospital-based settings for patients with neurocognitive impairment because of better companionship, reduced agitation and mood disorders, and better stability of hemodynamic status. These interventions can pave the way for better patient and hospital satisfaction.

Behcet's Disease: An In-Depth Review about Pathogenesis, Gastrointestinal Manifestations, and Management.

BACKGROUND: Behcet's disease (BD) is a complex inflammatory vascular disorder that follows a relapsing-remitting course with diverse clinical manifestations. The prevalence of the disease varies throughout the globe and targets different age-groups. There are many variations of BD; however, intestinal BD is not only more common but has many signs and symptoms. SUMMARY: BD is a relapsing-remitting inflammatory vascular disorder with multiple system involvement, affecting vessels of all types and sizes that targets young adults. The etiology of BD is unknown but many factors including genetic mechanisms, vascular changes, hypercoagulability, and dysregulation of immune function are believed to be responsible. BD usually presents with signs and symptoms of ulcerative disease of the small intestine; endoscopy being consistent with the clinical manifestations. The mainstay of treatment depends upon the severity of the disease. Corticosteroids are recommended for severe forms of the disease and aminosalicylic acids are used in maintaining remission in mild to moderate forms of the disease. KEY MESSAGES: In this review, we have tried to summarize in the present review the clinical manifestations, differential diagnoses, and management of intestinal BD. Hopefully, this review will enable health policymakers to ponder over establishing clear endpoints for treatment, surveillance investigations, and creating robust algorithms.

Mushroom Poisoning Mimicking Painless Progressive Jaundice: A Case Report with Review of the Literature.

Mushroom poisoning is common in the United States. The severity of mushroom poisoning may vary, depending on the geographic location, the amount of toxin delivered, and the genetic characteristics of the mushroom. Though they could have varied presentation, early identification with careful history could be helpful in triage. We present a case of a 69-year-old female of false morel mushroom poisoning leading to hepatotoxicity with painless jaundice and biochemical pancreatitis.

Stretching health diplomacy beyond 'Global' problem solving: Bringing the regional normative dimension in.

The importance of the regional dimension of health diplomacy is only gaining slow and uneven recognition. This is in many ways surprising. As demonstrated in the work of Deacon on the 'globalization of social policy', global social policy has been animated and debated not only at the multilateral level but at the regional level as well. But at least in the diplomatic literature, the importance of this regional dynamic (with a focus on diverse sites and actors and the pursuit of democratic control) has been missed. The objective of this article is to explore whether health diplomacy is catching up to this larger debate re-shaping the conceptualization and practice of diplomacy more generally. In some ways, the results may be counter-productive in that this shift may encourage an increasingly fragmented process. Yet, it may also point to some breakthroughs, with diplomats, acting as 'go to' personnel on the front lines of operational activity, enabling actors to integrate with one another to produce effective governance. In doing so, the regional dimension is given greater recognition as a component of health diplomacy, albeit in an uneven and sometimes awkward manner. Whereas global diplomacy generally emphasizes problem solving, the regional dimension is animated by a normative orientation.

Ruptured hydatid cyst in biliary tract.

A lady aged 26 years reported with a 2 months history of fever, upper abdominal pain and weight loss. Her abdominal ultrasonographic scan revealed a complex cystic mass in left lobe of liver suggestive of hydatid cyst that was confirmed on magnetic resonance imaging of abdomen and magnetic resonance cholangiopancreatogram. With strong suspicion of a hydatid cyst, endoscopic retrograde cholangiogram was performed which confirmed the diagnosis. During the procedure, hydatid membranes protruding from the papilla were removed after sphincterotomy. She was put on albendazole 400 mg twice daily after the procedure and showed a remarkable clinical improvement.

Endoscopic findings and treatment outcome in cases presenting with dysphagia.

BACKGROUND: Dysphagia results from impeded transport of liquids, solids, or both from the pharynx to the stomach. Among the malignant lesions, carcinoma of oesophagus is the commonest cause. Our objective was to find out the frequency of different endoscopic lesions and outcome of the endoscopic therapeutic interventions in patients presenting with dysphagia. METHODS: This descriptive study was conducted at Department of Gastroenterology, Military Hospital Rawalpindi from June 2008 to May 2009. Patients of dysphagia after their consent were interviewed about the symptoms. Relevant biochemical investigations were done. Barium swallow and upper Gastrointestinal (GI) Endoscopy were carried out. Benign strictures were dilated with Savary Gilliard Dilators. Malignant strictures were further evaluated to decide treatment plan. In patients considered to have oesophageal dysmotility, pressure manometery was done before specific therapy. RESULTS: Seventy nine patients were enrolled. Twenty-five had malignant strictures, out of those commonest was adenocarcinoma 14 (56%). Twenty-nine had benign strictures the commonest being Gastro-oesophageal Reflux Disease (GERD) related peptic stricture 9 (31%). Fifteen had oesophageal dysmotility, and achalasia was present in 10 out of them. After evaluation 12 out of 25 patients with malignant strictures were considered fit for surgery. Self-expanding metal stents (SEMS) were passed in 5. All benign strictures were dilated with Savary-Gillard dilators. Pneumatic balloon dilation was done in patients of achalasia. CONCLUSION: The commonest malignant lesion resulting in dysphagia was adenocarcinoma while in benign it was GERD related peptic stricture. Achalasia was most frequent in oesophageal motility disorders. Standard of treatment for early oesophageal malignancy is surgical resection. SEMS is a reliable way to allay dysphagia in inoperable cases. Savary Gillard dilatation in benign, and pneumatic balloon achalasia dilatations are effective ways of treatment.