Perforated peptic ulcer disease in transferred patients is associated with significant increase in length of stay.

BACKGROUND: Perforated peptic ulcer disease (PPUD) has a prevalence of 0.004-0.014% with mortality of 23.5% (Tarasconi et al. in World J Emerg Surg 15(PG-3):3, 2020). In this single center study, we examined the impact associated with patient transfer from outside facilities to our center for definitive surgical intervention (exploratory laparotomy). METHODS: Using EPIC report workbench, we identified 27 patients between 2018 and 2021 undergoing exploratory laparotomy with a concurrent diagnosis of peptic ulcer disease, nine of which were transferred to our institution for care. We queried this population for markers of disease severity including mortality, length of stay, intensive care unit (ICU) length of stay, and readmission rates. Manual chart reviews were performed to examine these outcomes in more detail and identify patients who had been transferred to our facility for surgery from an outside hospital. RESULTS: A total of 27 patients were identified undergoing exploratory laparotomy for definitive treatment of PPUD. The majority of patients queried underwent level A operations, the most urgent level of activation. In our institution, a Level A operation needs to go to the operating room within one hour of arrival to the hospital. Average mortality for this patient population was 14.8%. The readmission rate was 40.1%, and average length of ICU stay post-operatively was 16 days, with 83% of non-transfer patients requiring ICU admission and 100% of transfer patients requiring ICU admission, although this was not found to be statistically significant. Average length of hospital stay was 27 days overall. For non-transfer patients and transfer patients, LOS was 20 days and 41 days, respectively, which was statistically significant by one-sided t-test (p = 0.05). CONCLUSION: Patients transferred for definitive care of PPUD in a population otherwise notable for high mortality and high readmission rates: their average length of stay compared to non-transfer patients was over twice the length, which was statistically significant. Transferred patients also had higher rates of ICU care requirement although this was not statistically significant. Further inquiry to identify modifiable variables to facilitate the care of transferred patients is warranted, especially in the context of improving quality metrics known to enhance patient outcomes, satisfaction, and value.

Correction: Structural, electronic, optical, elastic, thermodynamic and thermal transport properties of Cs2AgInCl6 and Cs2AgSbCl6 double perovskite semiconductors using a first-principles study.

Correction for 'Structural, electronic, optical, elastic, thermodynamic and thermal transport properties of Cs2AgInCl6 and Cs2AgSbCl6 double perovskite semiconductors using a first-principles study' by Keqing Zhang et al., Phys. Chem. Chem. Phys., 2023, 25, 31848-31868, https://doi.org/10.1039/d3cp03795a.

Structural, electronic, optical, elastic, thermodynamic and thermal transport properties of Cs2AgInCl6 and Cs2AgSbCl6 double perovskite semiconductors using a first-principles study.

In this study, we employ the framework of first-principles density functional theory (DFT) computations to investigate the physical, electrical, bandgap and thermal conductivity of Cs2AgInCl6-CAIC (type I) and Cs2AgSbCl6-CASC (type II) using the GGA-PBE method. CAIC possesses a direct band gap energy of 1.812 eV, while CASC demonstrates an indirect band gap energy of 0.926 eV. The CAIC and CASC exhibit intriguingly reduced thermal conductivity, which can be attributed to the notable reduction in their respective Debye temperatures, measuring 182 K and 135 K, respectively. The Raman active modes computed under ambient conditions have been compared with real-world data, showing excellent agreement. The thermal conductivity values of CAIC and CASC compounds exhibit quantum mechanical characteristics, with values of 0.075 and 0.25 W m-1 K-1, respectively, at 300 K. It is foreseen that these outcomes will generate investigations concerning phosphors and diodes that rely on single emitters, with the aim of advancing lighting and display technologies in the forthcoming generations.

Intra-operative Safety of an Autonomous Robotic System for Total Knee Replacement: A Review of 500 Cases in India.

Background: Manual total knee arthroplasty (TKA) has been documented several times for their safety and complications data. In contrast, there is a limited evidence-based analysis for safety and complications of autonomous robotic-assisted (RA)-TKA. This study aimed to evaluate the safety features and intra-operative surgical complications associated with the use of Cuvis Joint™ autonomous robotic system for TKA. Methods: The study included 500 consecutive patients who underwent TKA using the Cuvis Joint™ autonomous robotic system from November 2020 to November 2021. All surgeries were performed by a senior surgeon. Patients in whom the surgery was abandoned midway due to technical errors, were excluded from the analysis. In case of unilateral abandonment of the robotic arm during a bilateral RA-TKA, data of the side on which the surgery was completed with robotic assistance was recorded. Results: There was no incidence of neurological injury, vascular injury, extensor mechanism disruption, or medial collateral ligament injury. There was one case of superficial abrasion of the patellar tendon; however, it did not require any intervention. There were no cases of midway abandonment due to threatened soft tissue injury. There was no intra-operative pin loosening or stress-related fractures at the pin sites. There was one case of Steinmann pin breakage and another case of drill bit breakage, which were removed without any damage to the bone. Conclusion: The Cuvis Joint™ autonomous robotic system for TKA is safe with no significant intra-operative complications.

Optimization of biogas potential using kinetic models, response surface methodology, and instrumental evidence for biodegradation of tannery fleshings during anaerobic digestion.

The optimization of the batch size experiment was run for a hydraulic retention time of 45 days using proteolytic enzyme pretreatment. The highest amounts of biogas were produced in comparison to conventional BDS (25:75), which is not processed with enzymes, and there was an increase in the biogas generation of 13.9 and 18.57%. The kinetic models show the goodness of fit between 0.993 and 0.998 and the correlation coefficient's value domain was [-1, 1] from a statistical perspective. The Box-Behnken design was carried out using the response surface methodology at different levels of independent parameters to optimize the process. Different instruments were evaluated to determine the chemical structure change and the contamination of the different treatments and the raw sample of tannery fleshings was determined. Thermogravimetric analysis was conducted to determine the loss of weight on thermal degradation. The Fourier transform infrared spectrometry was carried out to determine the different functional groups, such as -OH, -CH, -NH, and C-O, present in the samples of tannery fleshings. Scanning electron microscopy and energy dispersive X-ray analysis were carried out to determine the morphological alterations in the substrate, digestate, enzyme-pretreated fleshings, and the chemical composition of samples.

A Retrospective Study to Evaluate the Perioperative Clinical Characteristics and Outcomes of Rhino-Orbital Cerebral Mucormycosis in COVID-19 Patients at a Tertiary Care Hospital in India.

Background and aims A descriptive analysis of patients who underwent surgical debridement for coronavirus disease 2019 (COVID-19) related mucormycosis was described, which aimed at the evaluation of perioperative clinical characteristics, perioperative complications, and outcomes. Methods We conducted a retrospective study on patients who underwent surgical intervention for mucormycosis during the COVID-19 pandemic at a tertiary care institute in India from March 1, 2021, to June 30, 2021. The medical records of 92 patients were reviewed and analyzed. Results There was a male predominance with a mean age of 50.86 years. The most common comorbidity was diabetes mellitus (DM) (98.9%). Intra-operative complications included hypotension, hyperglycemia, and hypokalemia. Most of the patients (88%) were extubated inside the operation theater, and 48% of patients had mortality. Serum ferritin levels, computed tomography severity score (CTSS), and D-dimers were significantly high in the patient who had mortality. Conclusion The perioperative mortality in patients with COVID-19 associated mucormycosis was very high. DM was the most common comorbidity followed by hypertension. Pre-operative elevated serum ferritin, D-dimer, and high CTSS were associated with higher mortality; hypokalemia, followed by hypocalcemia, was the most common perioperative and post-operative electrolyte imbalance. Thorough pre-operative optimization, multidisciplinary involvement, and perioperative care are of the utmost importance to decrease mortality and improve outcomes.

Correction: An efficient metal free synthesis of 2-aminobenzothiozoles - a greener approach.

Correction for 'An efficient metal free synthesis of 2-aminobenzothiozoles - a greener approach' by Krithika Ganesh et al., Org. Biomol. Chem., 2023, 21, 564-568, https://doi.org/10.1039/D2OB01981G.

Catalytic response and molecular simulation studies in the development of synthetic routes in trimeric triaryl pyridinium type ionic liquids.

Under conventional and silica-supported Muffle furnace methods, water-soluble substituted trimeric triaryl pyridinium cations with various inorganic counter anions are synthesized. The solvent-free synthesis method is superior to the conventional method in terms of non-toxicity, quicker reaction times, ease of workup, and higher yields. Trimeric substituted pyridinium salts acted as excellent catalytic responses for the preparation of Gem-bisamide derivatives compared with available literature. To evaluate the molecular docking, benzyl/4-nitrobenzyl substituted triaryl pyridinium salt compounds with VEGFR-2 kinase were used with H-bonds, π-π stacking, salt bridges, and hydrophobic contacts. The results showed that the VEGFR-2 kinase protein had the most potent inhibitory activity. Intriguingly, the compound [NBTAPy]PF6- had a strongly binds to VEGFR-2 kinase and controlled its activity in cancer treatment and prevention.

Developing Outstanding Bifunctional Electrocatalysts for Rechargeable Zn-Air Batteries Using High-Purity Spinel-Type ZnCo2 Se4 Nanoparticles.

Zinc-air batteries are gaining popularity as viable energy sources for green energy storage technologies. The cost and performance of Zn-air batteries are mostly determined by the air electrodes in combination with an oxygen electrocatalyst. This research aims at the particular innovations and challenges relating to air electrodes and related materials. Here, a nanocomposite of ZnCo2 Se4 @rGO that exhibits excellent electrocatalytic activity for the oxygen reduction reaction, ORR (E1/2  = 0.802 V), and oxygen evolution reaction, OER (η10  = 298 mV@10 mA cm-2 ) is synthesized. In addition, a rechargeable zinc-air battery with ZnCo2 Se4 @rGO as the cathode showed a high open circuit voltage (OCV) of 1.38 V, a peak power density of 210.4 mW cm-2 , and outstanding long-term cycling stability. The electronic structure and oxygen reduction/evolution reaction mechanism of the catalysts ZnCo2 Se4 and Co3 Se4 are further investigated using density functional theory calculations. Finally, a perspective for designing, preparing, and assembling air electrodes is suggested for the future developments of high-performance Zn-air batteries.

An efficient metal free synthesis of 2-aminobenzothiozoles - a greener approach.

A facile one-pot, metal-free method for the synthesis of 2-aminobenzothiazoles was developed, which includes an initial reaction of electron-deficient 2-haloanilines with aromatic isothiocyanates and the subsequent intramolecular cyclization of the resulting thioureas through the SNAr mechanism. This one-pot, atom-economical, robust, and scalable method avoids the use of reagents such as acid chlorides and Lawesson's reagent that are difficult to handle.

Efficacy and Safety of Diethylcarbamazine in Treatment of Allergic Rhinitis: A Double Blind Randomised Controlled Trial.

There are many evidences showing diethylcarbamazine as a potential drug for the treatment of allergic rhinitis. This study evaluated the effectiveness of diethylcarbamazine in the treatment of allergic rhinitis and compared it with montelukast and levocetirizine. This parallel double-blind randomized clinical trial was done in allergic rhinitis patients. Seven hundred and twelve participants who met the inclusion criteria and provided informed written consent were randomized and divided into 2 equal groups. Diethylcarbamazine 300 mg/day orally in divided doses was given to group A, and montelukast 10 mg and levocetirizine 5 mg/day orally at night for 21 days was given to group B. Primary outcomes were the change in symptoms, absolute eosinophil count, serum total IgE, phadiatop and response in skin prick from baseline to 21 days and 3 months after treatment. Secondary outcome was to compare it with montelukast and levocetirizine. The mean (SD) age of the patients was 33 (10.6) years, with 374 (52.5%) males and 338 (47.5%) females. There was statistically significant improvement in all the parameters in both groups. Improvement was better with diethylcarbamazine compared to montelukast and levocetirizine and the effects were sustained for 3 months in diethylcarbamazine group. The findings suggest that diethylcarbamazine is effective in the treatment of allergic rhinitis. It gives better control and is cost-effective than montelukast and levocetirizine. Trial Registration: https://www.ctri.nic.in Identifier: CTRI/2020/03/024145 registered on 20-03-2020.

Isolation, screening, characterization, and optimization of bacteria isolated from calcareous soils for siderophore production.

The most effective agricultural practice to prevent iron deficiency in calcareous soils is fertilizing with synthetic chelates. These compounds are non-biodegradable, and persistent in the environment; hence, there is a risk of leaching metals into the soil horizon. To tackle iron deficiency-induced chlorosis (IDC) in crops grown on calcareous soils, environmentally friendly solutions are needed rather than chemical application as it affects the soil health further. Hence, the present work focused on isolating and screening calcareous soil-specific bacteria capable of producing iron-chelating siderophores. Siderophore-producing bacteria (SPB) was isolated from the groundnut (Arachis hypogea L.) rhizosphere region, collected from Coimbatore district, Tamil Nadu, of which 17 bacterial isolates were positive for siderophore production assayed by chrome azurol sulphonate. The performance of SPB isolates was compared for siderophore kinetics, level of siderophore production, type of siderophore produced and iron-chelating capacity under 15 mM KHCO3. Four best performing isolates were screened, with average siderophores yield ranging ∼60-80% under pH 8, with sucrose as carbon source and NH2SO4 as nitrogen source at 37 °C. The four efficient SPB were molecularly identified as B. licheniformis, B. subtilis, B. licheniformis, and O. grignonense based on 16S rDNA sequencing. The simultaneous inhibition method showed T.viride has the highest antagonistic effect against S.rolfsii, and M.phaseolina with a reduction of mycelial growth by 69.3 and 65.1%, respectively, compared to control. Our results indicate that the optimized conditions enhanced siderophores chelation by suppressing the stem and root rot fungi, which could help in a cost-effective and environmentally friendly manner.

Modified Uvulopalatopharyngoplasty with Tonsillectomy in Treatment of Obstructive Sleep Apnoea.

Obstructive sleep apnoea is a common problem with many long-term consequences if left untreated. The purpose of this study is to find the efficacy of modified uvulopalatopharyngoplasty with tonsillectomy in the treatment of OSA symptoms, apnoea-hypopnoea index, Epworth sleepiness scale and its effect on blood pressure and cardiac status. Patients with obstructive sleep apnoea with apnoea-hypopnoea index more than 15 with tonsillar hypertrophy, Friedman stage < 3 and palatal collapse or obstruction at the level of velum as diagnosed by DISE were included in this prospective analytical cross-sectional study. Modified uvulopalatopharyngoplasty with tonsillectomy was done in all patients. History of nocturnal and daytime OSA symptoms, Epworth sleepiness scale, snoring score, polysomnogram, drug induced sleep endoscopy, blood pressure, echocardiogram to measure velocity across pulmonary and aortic valve and ECG were taken preoperatively and 6 months postoperatively. A total of 129 participants were recruited. 82 of the 129 patients (63.5%) were men; mean (SD) age was 44.2 (6.78) years. The patients were post operatively classified as responders and non-responders by the DISE finding. 107 patients (82.9%)-responders, had no narrowing and 22 patients (17.1%)-non-responders, had persistent narrowing of velum. Non-responders had increased baseline BMI when compared to responders. All the parameters were statistically improved in responders (p < 0.001). In non-responders, there was no statistical improvement in any of the parameters. Modified uvulopalatopharyngoplasty provides significant improvement in sleep parameters like AHI, Epworth sleepiness scale and other polysomnographic parameters. It significantly reduces the cardiac burden in OSA patients without any complications. Trial registration www.ctri.nic.in identifier: CTRI/2020/06/025759.

A study to determine the impact of IMPT optimization techniques on prostate synthetic CT image sets dose comparison against CT image sets.

Background: The objective of this study is to determine the impact of intensity modulated proton therapty (IMPT) optimization techniques on the proton dose comparison of commercially available magnetic resonance for calculating attenuation (MRCA T) images, a synthetic computed tomography CT (sCT) based on magnetic resonance imaging (MRI) scan against the CT images and find out the optimization technique which creates plans with the least dose differences against the regular CT image sets. Material and methods: Regular CT data sets and sCT image sets were obtained for 10 prostate patients for the study. Six plans were created using six distinct IMPT optimization techniques including multi-field optimization (MFO), single field uniform dose (SFUD) optimization, and robust optimization (RO) in CT image sets. These plans were copied to MRCA T, sCT datasets and doses were computed. Doses from CT and MRCA T data sets were compared for each patient using 2D dose distribution display, dose volume histograms (DVH), homogeneity index (HI), conformation number (CN) and 3D gamma analysis. A two tailed t-test was conducted on HI and CN with 5% significance level with a null hypothesis for CT and sCT image sets. Results: Analysis of ten CT and sCT image sets with different IMPT optimization techniques shows that a few of the techniques show significant differences between plans for a few evaluation parameters. Isodose lines, DVH, HI, CN and t-test analysis shows that robust optimizations with 2% range error incorporated results in plans, when re-computed in sCT image sets results in the least dose differences against CT plans compared to other optimization techniques. The second best optimization technique with the least dose differences was robust optimization with 5% range error. Conclusion: This study affirmatively demonstrates the impact of IMPT optimization techniques on synthetic CT image sets dose comparison against CT images and determines the robust optimization with 2% range error as the optimization technique which gives the least dose difference when compared to CT plans.

Mycotic contamination and aflatoxin potential of molds in Capsicum annum (chili), and chili powder commercialized in south Indian markets.

Chili (Capsicum annum) and chili powder are widely consumed in south India. The inherent and eco physiological factors with unusual nutritional characteristics of chili favors the growth of molds, during harvest and post-harvest processing. Chilies have been identified as one of the commodities with the highest Aflatoxin contamination levels. On safety perspective, the presence of fungi and the co-occurrence of mycotoxins in the chili available at market level may pose a major threat on human health. A study was conducted to assess the mycotic impact on the quality of dried red chili and chili powder available in the markets of Kerala, Tamil Nadu, Karnataka, and Andhra Pradesh. The common molds like Aspergillus flavus and Aspergillus niger were present in dried chilies and chili powder and the level of green mold contamination ranges from 15.71 × 103 cfu/g to 39.75 × 103 cfu/g in all the samples. Scanning Electron Microscopic examinations on morphological characteristics of conidia and spores, as well as molecular characterisation, identified the isolates as A.flavus. Chili contained more fungal spores than chili powder. The total aflatoxin potential of five A.flavus isolates were investigated. Aflatoxigenicity was found in all five isolates. All the isolates were tested positive for aflatoxin B1, with levels ranging from 0.22 to 555.11 ppb. Aflatoxin B2 has been identified in 60 percent of the isolates. Aflatoxin G1 was found in trace amounts in isolate AF1. Aflatoxin G2 was not detected in any of the isolates. Improper storage may have a significant influence in the growth of molds in chili and chili powder. The ability of fungal species to generate more than one aflatoxin should be taken into account. It has the potential to cause serious health risks. In conclusion, because single Aspergillus flavus may produce a variety of aflatoxins, there is a need for effective methods to eliminate molds and mycotoxins from food items.

A Novel Deep Learning-Based Black Fungus Disease Identification Using Modified Hybrid Learning Methodology.

Currently, countries across the world are suffering from a prominent viral infection called COVID-19. Most countries are still facing several issues due to this disease, which has resulted in several fatalities. The first COVID-19 wave caused devastation across the world owing to its virulence and led to a massive loss in human lives, impacting the country's economy drastically. A dangerous disease called mucormycosis was discovered worldwide during the second COVID-19 wave, in 2021, which lasted from April to July. The mucormycosis disease is commonly known as "black fungus," which belongs to the fungus family Mucorales. It is usually a rare disease, but the level of destruction caused by the disease is vast and unpredictable. This disease mainly targets people already suffering from other diseases and consuming heavy medication to counter the disease they are suffering from. This is because of the reduction in antibodies in the affected people. Therefore, the patient's body does not have the ability to act against fungus-oriented infections. This black fungus is more commonly identified in patients with coronavirus disease in certain country. The condition frequently manifests on skin, but it can also harm organs such as eyes and brain. This study intends to design a modified neural network logic for an artificial intelligence (AI) strategy with learning principles, called a hybrid learning-based neural network classifier (HLNNC). The proposed method is based on well-known techniques such as convolutional neural network (CNN) and support vector machine (SVM). This article discusses a dataset containing several eye photographs of patients with and without black fungus infection. These images were collected from the real-time records of people afflicted with COVID followed by the black fungus. This proposed HLNNC scheme identifies the black fungus disease based on the following image processing procedures: image acquisition, preprocessing, feature extraction, and classification; these procedures were performed considering the dataset training and testing principles with proper performance analysis. The results of the procedure are provided in a graphical format with the precise specification, and the efficacy of the proposed method is established.

Management of tibial shaft fractures with closed intra medullary interlocking nail among Indians.

It is of interest to document data on the well Reamed Intramedullary Nailing in Isolated Tibial Diaphyseal Fractures without Fibular Osteotomy among Indians. 120 patients with isolated tibial diaphyseal fractures were treated with IMIL nail (84 closed fractures, 16 type I open fractures, and 20 type II open fractures) were involved in this study. Research was carried out over a five-and-a-half-year period, from July 2013 to December 2018.According to Johner and Wruh's criteria, good functional findings were achieved in 70% of patients, better operational results in 15%, reasonable functional results in 5%, and poor functional results in 10% of cases after surgery. The percentage of union in the present analysis was 90%. The average time for union was 5 months, with 84 fractures healing before 5 months. Intramedullary Interlocking Nailing reduces length of stay in hospital, lowers the financial load, and promotes early return to work without the need for further surgical treatment such as partial fibular osteotomy.

Synthesis, spectroscopic, DFT, and molecular docking studies on 1,4-dihydropyridine derivative compounds: a combined experimental and theoretical study.

Dihydropyridines are the most extensively used drugs in the treatment of hypertension. Nifedipine is the prototype of calcium channel blocker. The dihydropyridine derivative compounds of diethyl 4-(4-bromophenyl)-2,6-dimethyl-1,4-dihydropyridine-3,5-dicarboxylate (DHPB), diethyl 4-(furan-2yl)-2,6-dimethyl-1,4-dihydropyridine-3,5-dicarboxylate (DHPF), and diethyl-4-phenyl-2,6-dimethyl-1,4-dihydropyridine-3,5-dicarboxylate (DHPP) were synthesized using the Hantzsch reaction. The DFT/B3LYP exchange-correlation function was employed to perform quantum chemical calculations such as molecular geometry optimization, vibrational analysis, frontier molecular orbital (FMO), molecular electrostatic potential (MEP), natural bond order (NBO), global reactive descriptors, and Fukui functions to determine the structural characteristics related to biological activity of the compounds. The molecular docking and molecular dynamics were employed to study the binding interaction and stability of protein-ligand complex in the docked site.

Predictable Treatment of Gingival Recession Using Titanium Prepared Platelet-Rich Fibrin in Combination with Coronally Advanced Flap.

Treatment for receding gums is always a challenging task for a periodontist. To fulfill this, many surgical techniques such as free gingival grafts, connective tissue grafts, pedicle flaps, and lateral sliding flaps have been used. For better prevention of relapse of these procedures and to improve the gingival biotype, various biomaterials such as platelet-rich fibrin, collagen matrix, and amnion chorion membranes have been additionally utilized. Due to advancements in preparation of platelet concentrates titanium platelet-rich fibrin, a third-generation platelet concentrate was introduced. Unlike other biomaterials, it has thicker fibrin meshwork with greater cellular entrapment and thicker membrane. Present case reports depict the usage of titanium platelet-rich fibrin as a biomaterial along with coronally advanced flap in the treatment of millers Class-I gingival recessions. Patients were followed up to 6 months after performing recession coverage treatments.