An unusual angiogram finding in a patient with rheumatic heart disease

A woman in her early fifties with a known case of severe rheumatic mitral stenosis presented to the out-patient department with increasing breathlessness.

Fingers on the Wrist and Taming the Funny Current, Rejuvenate the Wounded Heart: Ivabradine-Responsive Atrial Tachycardia

A 19-year-old male presented with dyspnea on exertion (New York Heart Association [NYHA] class II) and occasional palpitations for six months. He had initially been evaluated at another facility and diagnosed with dilated cardiomyopathy. Despite treatment, there was no improvement in his symptoms. On evaluation at our centre, his previous electrocardiograms appeared normal. However, palpation of his radial pulse for one minute revealed runs of regular tachycardia, interspersed with a normal pulse rate. A 30-second rhythm strip electrocardiogram (ECG) showed multiple runs of ectopic tachycardia originating from the right atrial appendage, interspersed with ectopic atrial rhythms. Echocardiography showed severe left ventricle (LV) dysfunction with an ejection fraction of 20-25%. Radio-frequency ablation was recommended, but the patient declined. Instead, he was started on Ivabradine. After a month, his symptoms fully resolved. The ECG displayed a normal sinus rhythm with no tachycardia, and his left ventricular ejection function improved.

Point-of-Care Ultrasonography in Suspected Acute Coronary Syndrome

This case report presents the ECG findings of a patient in their 40s with post-tubercular bronchiectasis who presented with acute exacerbation of dyspnea and no chest pain.

Augmenting Prediction of Intracranial Aneurysms' Risk Status Using Velocity-Informatics: Initial Experience

Our primary goal here is to demonstrate that innovative analytics of aneurismal velocities, named velocity-informatics, enhances intracranial aneurysm (IA) rupture status prediction. 3D computer models were generated using imaging data from 112 subjects harboring anterior IAs (4-25 mm; 44 ruptured and 68 unruptured). Computational fluid dynamics simulations and geometrical analyses were performed. Then, computed 3D velocity vector fields within the IA dome were processed for velocity-informatics. Four machine learning methods (support vector machine, random forest, generalized linear model, and GLM with Lasso or elastic net regularization) were employed to assess the merits of the proposed velocity-informatics. All 4 ML methods consistently showed that, with velocity-informatics metrics, the area under the curve and prediction accuracy both improved by approximately 0.03. Overall, with velocity-informatics, the support vector machine's prediction was most promising: an AUC of 0.86 and total accuracy of 77%, with 60% and 88% of ruptured and unruptured IAs being correctly identified, respectively.

Alanda (Ephedra foeminea) nanoparticles as a modulator of genomic DNA degradation in mice: new inspiration for treating Ehrlich solid tumour-induced kidney and liver toxicity

OBJECTIVE

The limitations faced by conventional drug delivery systems are being overcome through the use of rapidly evolving cancer nanotherapeutics. Determining the manner in which the Ehrlich solid tumor (EST) is impacted by the new bioactive Alanda-loaded flax seed gum nanoparticles (Alanda NPs) functioning as an anti-carcinogenic agent represents the research objective of this paper.

MATERIALS AND METHODS

Identification of the functional groups, surface morphology, particle size, and zeta potential were among the characterizations and preparations made for the prepared nanoparticles. A Control group, a Flax Seed Gum group, a raw Alanda group, an Alanda NPs group, an EST group, and an induced EST treated with Alanda NPs group comprised the six groups respectively which the 60 female mice were separated into in this in vivo study.

RESULTS

Toxicity assessments for kidneys and liver were performed alongside the detection of total genomic DNA degradation. The zeta potential and the particle sizes for Alanda NPs were -25.60±0.38 mv and 40±0.28 nm, respectively, where the latter demonstrated a monodisperse spherical shape, per the findings. The use of Alanda NPs to treat EST was found to alle te the DNA damage, apoptosis, and renal and hepatic toxicity that EST induces. Additionally, the activation of oxidative stress and apoptosis causing the renal and hepatic toxicity induced by EST is counteracted by the scavenging of free radicals by the Alanda NPs.

CONCLUSIONS

A high degree of safety for effective cancer treatment was displayed by the newly developed oral nanoparticles while also demonstrating strong potential in vivo.

Comparison of electrocardiographic parameters between left bundle optimized cardiac resynchronization therapy (LOT-CRT) and left bundle branch pacing-cardiac resynchronization therapy (LBBP-CRT)

BACKGROUND

In patients undergoing cardiac resynchronization therapy using left bundle branch area pacing (LBBP-CRT), the addition of a coronary sinus lead, that is, Left bundle optimized CRT (LOT-CRT) might confer additional benefits.

OBJECTIVES

To compare the electrocardiographic characteristics between LBBP-CRT and LOT-CRT MATERIALS AND METHODS: Patients with non-ischemic cardiomyopathy (NICMP) and left bundle branch block (LBBB) with left ventricular ejection fraction <35% who underwent implantation of an atrial lead, a left bundle lead, and a coronary sinus lead were included in this prospective study. Digital 12-lead electrocardiograms were recorded in three pacing modes-AAI, DDD with pacing from the LBB lead (LBBP-CRT), and DDD with pacing from both left bundle and coronary sinus leads (LOT-CRT). QRS duration (QRSd), QRS area, QT interval, and T peak-T end (TpTe) intervals were compared.

RESULTS

Among 24 patients, QRSd reduced from 167 ± 21.2 ms to 134.5 ± 23.6 ms with LBBP-CRT (p < .001) and 129.5 ± 18.6 ms with LOT-CRT (p < .001) without a significant difference between LBBP-CRT and LOT-CRT (p = .15). Patients with QRS duration with LBBP-CRT > 131 ms showed a significant reduction in QRSd with LOT-CRT (p = .03). QT interval was reduced with both modes of CRT. LOT-CRT was associated with a greater reduction in QRS area (p = .001), TpTe interval (p = .03), and TpTe/QT ratio (p = .013) compared to LBBP-CRT.

CONCLUSIONS

In patients with NICMP and LBBB, there was no significant difference in QRSd with LOT-CRT compared to LBBP-CRT. However, in patients with QRSd > 131 ms after LBBP-CRT, LOT-CRT resulted in a significantly narrower QRS.

Virtual reality-based exercises' effects on pulmonary functions, cardiopulmonary capacity, functional performance, and quality of life in children with repaired congenital diaphragmatic hernia

OBJECTIVE

The long-term consequences of congenital diaphragmatic hernia (CDH), which include altered lung functions and compromised cardiopulmonary capacity, impact functional performance and quality of life. This study investigates the effects of virtual reality-based exercise programs on pulmonary functions, cardiopulmonary capacity, functional performance, and quality of life in children with repaired CDH.

PATIENTS AND METHODS

A randomized controlled clinical trial was performed. Fifty-two children with repaired CDH (aged 6-10 years) were enrolled and randomly allocated to virtual reality-based exercises plus traditional physical therapy (VR-EX group, n = 26) or traditional physical therapy alone (control group, n = 26). Interventions were conducted three times a week for 12 weeks. Pulmonary functions, cardiopulmonary capacity, functional performance, and quality of life were assessed before and after the intervention.

RESULTS

The VR-EX group demonstrated significantly enhanced post-treatment pulmonary functions and cardiopulmonary capacity compared to the control group after accounting for the pre-treatment values (p < 0.05). In addition, the values in functional performance and quality of life measures showed significantly larger improvements in the VR-EX group (p < 0.05).

CONCLUSIONS

Children with repaired CDH may benefit more from VR-based exercises when combined with traditional physical therapy than from traditional physical therapy alone regarding their pulmonary functions, cardiopulmonary capacity, functional performance, and quality of life.

The interplay of cardiac hemodynamics in rheumatic triple valve stenosis

Rheumatic heart disease is among the common causes of cardiovascular morbidity in developing countries. Here we present the hemodynamic interplay of stenotic rhematic involvement of aortic, mitral, and tricuspid valves in a 35-year-old female. Though noninvasive imaging by echocardiography and doppler has taken the upper hand today, this case illustrates the crucial role of cardiac catheterization in understanding the hemodynamics and patient management of rheumatic multivalvular heart disease.

Evaluation of Early Renal Involvement in Essential Hypertension by Measuring Urinary Biomarkers

Hypertensive kidney damage results in glomerular as well as tubular dysfunction. Albuminuria is a well-known marker of glomerular damage. On the other hand, urinary uromodulin is increasingly considered as a potential biomarker of early tubular dysfunction. The aim of the study was to assess glomerular and tubular function of the kidney by measuring urinary albumin and uromodulin excretion in hypertensive subjects. This cross-sectional study was conducted from July 2018 to June 2019 in Hypertension Clinic of Dhaka Medical College Hospital, Dhaka and Kidney Care and Research Centre, Sonargaon, Narayanganj, Bangladesh. In this study 122 hypertensive subjects with age >30 years, duration of hypertension <5 years, without accelerated or malignant BP, absence of dipstick proteinuria and eGFR >60ml/min were included. There were also 33 normotensive individuals included as healthy controls. Albumin-creatinine ratio (uACR mg/g), urine uromodulin-creatinine ratio (uUMODμg/g), urinary sodium-creatinine ratio (mEq/g) and potassium-creatinine ratio (mEq/g) were measured from single morning spot urine sample. Urinary uromodulin levels were measured by ELISA method. The hypertensive and normotensive subjects were age matched 49.0±12.0 vs. 48.0±11.0, years (p=NS). The mean uACR was 29.0±65.0 versus 5.6±2.7mg/g, (p<0.001) respectively. The median uUMOD in hypertensive subjects was 3.38 (1.73-9.06) and in normotensives 3.85(2.28-5.69) μg/g (p=non significant). Multivariate analysis showed significant inverse association between diastolic blood pressure and urinary uromodulin excretion. A uUMOD cut-off of 2.9 (25th percentile) showed eGFR, urinary sodium and potassium excretions were significantly lower at low uromodulin group. The glomerular involvement was found in 21.0% of hypertensive subjects as evidenced by albuminuria. No difference was observed in urinary uromodulin level between hypertensive and normotensive subjects. Low urinary uromodulin level was associated with lower eGFR, Na+ and K+ excretion which indicate simultaneous tubular and glomerular involvement.

Left Ventricular Angiogram in Constrictive Pericarditis

A 14-year-old boy presented with dyspnea on exertion and easy fatiguability for 1 year. He also had an episode of pedal edema 6 months prior, which resolved with diuretics. He had a history of tuberculosis treated with a 6-month course of antitubercular therapy. After a series of tests and analyses, it was evident that longitudinal contraction of the left ventricle was preserved, whereas the circumferential contraction was severely impaired. Pericardial calcification also could be seen encircling the left and right ventricles. Pericardial calcification is evident in around 25% of cases of constrictive pericarditis and predominantly seen in those with tubercular and pyogenic etiology. The subepicardial myocardial fibers are responsible for radial shortening and subendocardial fibers are responsible for longitudinal shortening. In constrictive pericarditis, the involvement of the subepicardial fibers leads to reduction in the circumferential shortening. The patient was referred for pericardiectomy.

A curious case of pulmonary hypertension in a child

Background

Pulmonary hypertension in young children can be due to a myriad of conditions. Few aetiologies of pulmonary hypertension are potentially reversible. An extensive workup for the cause of pulmonary hypertension is a must before attributing it to idiopathic pulmonary hypertension. We describe an uncommon aetiology of pulmonary hypertension in a young boy.

Case presentation

A 12-year-old child, with past history of tubercular pleural effusion, presented with dyspnoea on exertion and easy fatiguability for 2 years. He was evaluated elsewhere and was being treated as primary pulmonary hypertension with pulmonary vasodilators. The child was revaluated since the clinical features were not completely favouring the diagnosis. On detailed evaluation, a diagnosis of constrictive pericarditis was made. He was referred for pericardiectomy.

Conclusions

Constrictive pericarditis presenting with severe pulmonary hypertension without congestive symptoms is very rare. In patients presenting with pulmonary hypertension, always look for a reversible cause before labeling them as idiopathic PAH.

Supplementary Information

The online version contains supplementary material available at 10.1186/s43044-022-00294-6.

Evaluation of hepatoprotective effect of Nebivolol and sodium copper Chlorophyllin on CCL4-induced hepatotoxicity in mice

OBJECTIVE

In this study, the protective effect of sodium copper chlorophyllin and nebivolol was evaluated in a mice model of CCL4 induced hepatotoxicity. Silymarin was used as a traditional hepatoprotective drug.

MATERIALS AND METHODS

Thirty (30) mice were used as they were divided into five groups: the first group was the control group which received distilled water + olive oil, the second group which received 1.5 ml/kg of CCl4 diluted in olive oil three times a week, the third group which received CCl4 + Silymarin 50 mg/kg/day, the fourth group which received CCl4 + nebivolol 4 mg/kg/day, and the fifth group which received 1.5 ml/kg of CCl4+ Cu-chlorophyllin 50 mg/kg/day. The drugs were given by intraperitoneal route for 5 weeks. The detection, quantification of CCl4 induced hepatotoxicity and possible protective effect of either silymarin, nebivolol, or sodium copper chlorophyllin were assessed using biochemical analysis of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), total protein, lipid profile, an assay of oxidants and antioxidants, assay of interleukin 6 (IL6) and tumor necrosis factor-alpha (TNF-α), and histopathological examination.

RESULTS

The administration of carbon tetrachloride (CCl4) produced pronounced liver impairment. It significantly increased ALT, AST, ALP, malondialdehyde, and serum nitric oxide levels compared to normal control group besides a decrease in total protein, serum catalase, tissue SOD, and GSH levels. IL-6 and TNF-α levels were significantly higher while total cholesterol was significantly lower in mice receiving CCL4 compared to the normal control group. CCL4 induced severe hyperemia and congestion inside the portal area with leukocytic infiltration, hepatic degeneration, and bridge fibrosis.

CONCLUSIONS

Co-administration of either silymarin, nebivolol, or sodium copper chlorophyllin with CCl4 was able to ameliorate up to almost contradict CCl4 induced hepatic injury through their anti-inflammatory and antioxidant activities.

Effect of Yoga on Clinical Outcomes and Quality of Life in Patients With Vasovagal Syncope (LIVE-Yoga)

OBJECTIVES

This study aims to determine the impact of yoga as an adjunct to standard therapy versus standard therapy alone on the symptomatic burden in patients with recurrent vasovagal syncope (VVS).

BACKGROUND

There is a significant reduction in the quality of life (QoL) of patients with recurrent VVS. Existing management therapies have been largely ineffective. Recent trials have demonstrated the efficacy of yoga in diseases with autonomic imbalance, suggesting its possible utility in VVS.

METHODS

Patients with recurrent VVS were randomized to receive either a specialized yoga training program in addition to current guideline-based therapy (intervention arm, group 1) or current guideline-based therapy alone (control arm, group 2). The primary outcome was a composite of the number of episodes of syncope and presyncope at 12 months. Secondary outcomes included QoL assessment by World Health Organization Quality of Life Brief Field questionnaire (WHOQoL-BREF) scores and Syncope Functional Status Questionnaire scores at 12 months, head up tilt test, and heart rate variability at 6 weeks.

RESULTS

A total of 55 patients underwent randomization. The mean number of syncopal or presyncopal events at 12 months was 0.7 ± 0.7 in the intervention arm compared to 2.52 ± 1.93 in the control arm (P < 0.01). In the intervention arm, 13 (43.3%) patients remained free of events versus 4 (16.0%) patients in the control arm (P = 0.02). QoL at 12 months showed significant improvement of all Syncope Functional Status Questionnaire scores and 2 domains of WHOQoL-BREF scores (P < 0.05).

CONCLUSIONS

Yoga as adjunctive therapy is superior to standard therapy alone in reducing the symptomatic burden and improving QoL in patients with recurrent VVS.

Acute Dyspnea After Inferior-Wall Myocardial Infarction

A 57-year-old woman presented with acute-onset dyspea with a duration of more than 2 days. Four days earlier, she had been thrombolyzed with streptokinase for inferior wall myocardial infarction in a nearby hospital. On examination, we found that the patient had elevated jugular venous pressure and systolic murmur in left lower parasternal region. In addition, there was a ventricular septal rupture in the posterobasal interventricular septum, with at least 2 exit points into the right ventricle. Timely identification of ventricular septal rupture before PCI is of paramount importance, as it has major implications in management of the patient.

Acute Vessel Closure in Rescue Percutaneous Coronary Intervention

Guidewire-induced coronary spasm might be life threatening, as demonstrated in the present case. Balloon dilation might worsen the situation by enhancing the spasm. Prompt recognition and generous administration of coronary vasodilators are the mainstay of management.

A novel source of the cardiac glycoside digoxin from the endophytic fungus Epicoccum nigrum: isolation, characterization, production enhancement by gamma irradiation mutagenesis and anticancer activity evaluation

AIMS

Different endophytic fungi were isolated and screened for their digoxin-producing ability. Strain improvement and different culture conditions were studied for more effective production of digoxin.

METHODS AND RESULTS

Among the isolated fungi, an isolate produced digoxin in a concentration of 2·07 mg l^-1 . The digoxin-producing fungal isolate was identified as Epicoccum nigrum Link according to the morphological features and phylogenetic analyses. The potentiality of the fungal strain for production enhancement of digoxin was performed by gamma radiation mutagenesis. Gamma irradiation dose of 1000 Gy intensified the digoxin yield by five-fold. Using this dose, a stable mutant strain with improved digoxin productivity was isolated and the stability for digoxin production was followed up across four successive generations. In the effort to increase digoxin magnitude, selection of the proper cultivation medium, addition of some elicitors to the most proper medium and several physical fermentation conditions were tested. Fermentation process carried out in malt extract autolysate medium (pH 6·5) supplemented by methyl jasmonate and inoculated with 2 ml of 6-day-old culture and incubated at 25°C for 10 days stimulated the highest production of digoxin to attain 50·14 mg l^-1 . Moreover, cytotoxicity of digoxin separated from the fungal culture was tested against five different cancer cell lines. Based on the MTT assay, digoxin inhibited the proliferation of the five different cancer cell lines and the recorded 50% inhibitory concentration ranged from 10·76 to 35·14 μg ml^-1 .

CONCLUSIONS

This is the first report on the production and enhancement of digoxin using fungal fermentation as a new and alternate source with high productivity.

SIGNIFICANCE AND IMPACT OF THE STUDY

These findings offer new and alternate sources with excellent biotechnological potential for digoxin production by fungal fermentation. Moreover, digoxin proved to be a promising anticancer agent whose anticancer potential should be assessed in prospective cancer therapy.

A novel source of the cardiac glycoside digoxin from the endophytic fungus Epicoccum nigrum: isolation, characterization, production enhancement by gamma irradiation mutagenesis and anticancer activity evaluation

AIMS

Different endophytic fungi were isolated and screened for their digoxin-producing ability. Strain improvement and different culture conditions were studied for more effective production of digoxin.

METHODS AND RESULTS

Among the isolated fungi, an isolate produced digoxin in a concentration of 2·07 mg l^-1 . The digoxin-producing fungal isolate was identified as Epicoccum nigrum Link according to the morphological features and phylogenetic analyses. The potentiality of the fungal strain for production enhancement of digoxin was performed by gamma radiation mutagenesis. Gamma irradiation dose of 1000 Gy intensified the digoxin yield by five-fold. Using this dose, a stable mutant strain with improved digoxin productivity was isolated and the stability for digoxin production was followed up across four successive generations. In the effort to increase digoxin magnitude, selection of the proper cultivation medium, addition of some elicitors to the most proper medium and several physical fermentation conditions were tested. Fermentation process carried out in malt extract autolysate medium (pH 6·5) supplemented by methyl jasmonate and inoculated with 2 ml of 6-day-old culture and incubated at 25°C for 10 days stimulated the highest production of digoxin to attain 50·14 mg l^-1 . Moreover, cytotoxicity of digoxin separated from the fungal culture was tested against five different cancer cell lines. Based on the MTT assay, digoxin inhibited the proliferation of the five different cancer cell lines and the recorded 50% inhibitory concentration ranged from 10·76 to 35·14 μg ml^-1 .

CONCLUSIONS

This is the first report on the production and enhancement of digoxin using fungal fermentation as a new and alternate source with high productivity.

SIGNIFICANCE AND IMPACT OF THE STUDY

These findings offer new and alternate sources with excellent biotechnological potential for digoxin production by fungal fermentation. Moreover, digoxin proved to be a promising anticancer agent whose anticancer potential should be assessed in prospective cancer therapy.

Ultrastructure changes induced by the phloroglucinol derivative agrimol G isolated from Leucosidea sericea in Haemonchus contortus

Plant extracts used for the treatment of helminth infections in sheep are an alternative to chemical anthelmintic drugs. Previous studies have reported the anthelmintic activity of acetone leaf extracts of Leucosidea sericea. For this study, we evaluate the ultrastructure changes induced by the acetone leaf extract of L. sericea and the component agrimol G (AG) that was isolated for the first time on adult haemonchus parasites. Adult haemonchus parasites harvested from sheep were incubated with the plant extract and AG for 3 h and evaluated by both scanning and transmission electron microscopy in comparison and in combination with albendazole or ivermectin. In all cases the method of evaluation shows ultrastructural changes, with albendazole inducing mitochondrial damage and ivermectin inducing muscle degeneration, both as previously described. Incubation with the plant extract and AG resulted in the formation of numerous non-membrane bound multi-vesicular like bodies and evenly spread disruptions/erosion in the epicuticle. Combining AG with ivermectin or albendazole resulted in an absence of effect of AG. Based on the structural changes induced by AG, together with the absence of an effect in combination with ivermectin and albendazole would suggest a disrupted microtubular network. The latter does however require biochemical confirmation.

Supreme dominance of right coronary artery in a patient with typical angina

A 50-year-old woman presented to our hospital with Canadian Cardiovascular Society grade III angina of 4 months duration. Coronary angiography of the patient showed the absence of left main coronary artery from the left coronary sinus. There was a single right coronary artery (RCA) with a super dominant course from right coronary sinus. It also showed a left main coronary and left anterior descending artery arising separately from proximal RCA, with retroaortic and prepulmonic course, respectively. There was another independently arising small septal branch from the proximal RCA that supplied the proximal interventricular septum. The patient was managed with optimal medical therapy and had symptomatic relief.

Ultrasound as a Diagnostic Tool in Paediatric Distal Forearm Fractures

Aims To evaluate the accuracy of ultrasound in pediatric distal forearm fractures as well as the effect on the ED waiting time for these patients. Methods Convenience sample of 42 pediatric patients presented with wrist injury. All patients underwent US examination followed by 2-views radiographs of the wrist with recording the time to US. In addition, the time to X-ray were calculated, retrospectively, on 95 pediatric patients for comparison. Results Forty-two patients were examined, 25 males (60%) and 17 females (40%), mean age 7.2 years. On X-Ray, 30 patients (71%) were confirmed to have a distal forearm fractures, of which, 28 (93%) were diagnosed by US. The sensitivity of ultrasound diagnosis was 93.3% (95% CI, 83%-100%), and the specificity was 92% (95% CI, 76%-100%). The positive and negative likelihood ratios were 11.6 and 0.07, respectively. Conclusions Ultrasound is a reliable diagnostic tool in the diagnosis of distal forearm fractures in children. Ultrasound has radiation free and decreases the length of stay in ED.

Immune and vascular dysfunction in diabetic wound healing

The diminished capacity for wound healing in patients with diabetes contributes to morbidity through ulceration and recurrent infections, loss of function and decreased workplace productivity, increased hospitalisation rates, and rising health-care costs. These are due to diabetes' effects on signalling molecules, cellular cascades, different cell populations, and the vasculature. The function of multiple immune system components including cellular response, blood factors, and vascular tone are all negatively impacted by diabetes. The purpose of this paper is to review the current understanding of immune and vascular dysfunction contributing to impaired wound healing mechanisms in the diabetic population. Normal wound healing mechanisms are reviewed followed by diabetic aberrations to immune and inflammatory function and atherogenesis and angiopathy.

DECLARATION OF INTEREST

The authors have no financial or personal relationships to people or organisations that could potentially and inappropriately influence their work and conclusions.

ALUMINA PHASE TRANSFORMATION FROM THERMAL DECOMPOSITION OF AMMONIUM ALUM SYNTHESIZED FROM KANKARA KAOLIN

Thermal stability of transitional alumina phases produced from ammonium alum using Kankara kaolin as starting material was studied. Wet beneficiation method was employed to purify the starting material, after which it was calcined and dealuminated with sulphuric acid. The elemental composition, mineralogical, and physiological analyses were carried out using X-ray fluorescence (XRF), X-ray diffraction (XRD) and Brunauer-Emmett-Teller (BET) techniques respectively. The ammonium alum was thermally treated by varying the calcination temperature from 700 to 1200°C and varying the time of calcination from 1 to 4 h. The formation of gamma alumina began at calcination temperature of 825°C for calcination time of 3 h, which was found to be lower than reported works of 900°C. It was found to be stable at higher temperature of 1125°C, above which phase transformation to alpha alumina was observed. The observed wide range of thermal stability of the gamma alumina phase gives it good advantage to be used for high temperature applications, such as support for catalyst promoters. Alpha alumina phase formation began at 1150°C and was fully formed at 1200°C. BET specific surface area of 166 m2/g was obtained for the gamma alumina phase which was high enough for it application as support for catalyst, catalyst and adsorbent. http://dx.doi.org/10.4314/njt.v36i3.23

DEVELOPMEMT OF PILOT SCALE DEALUMINATION UNIT OF 2.5 kg METAKAOLIN PER BATCH CAPACITY

A pilot-size dealumination unit to handle 2.5kg of metakaolin per batch was designed and fabricated and test run. The metakaolin was prepared from Kankara kaolin. The metakaolin was completely split into silica and alumina. The silica component which was inert to the sulphuric acid used during the reaction and was obtained as a solid product. While the alumina which reacted with the sulphuric acid was obtained in liquid form as aluminum sulphate, known as alum. The dealumination unit comprises of the dealumination reactor, known as dealuminator, acid holding tank and metakaolin slurry mixing tank. The material of construction selected for the dealumination reactor was stainless steel type 304 lined internally with glass to withstand the corrosive environment of the concentrated sulphuric acid at the reaction temperature > 140°C. The capacity of the componentsare; acid holding tank 5 liters;metakaolin slurry mixing tank 20 liters, with 70 W capacity motor and the dealuminator 50 liters, which had pressure relief valve, pressure gauge (0-10 bars) and temperature gauge (0 - 300°C) on the cover. Woven glass fiber cloth was used as lagging material to minimize heat lossto the surrounding. The purity level of the silica obtained from the reaction was above 95%.The endothermic nature of the dealumination process was void of external heating. http://dx.doi.org/10.4314/njt.v36i3.24

Implementation of enhanced recovery after surgery (ERAS) in gynaecological oncology

OBJECTIVES

To evaluate the outcomes of enhanced recovery after surgery (ERAS) implementation in a gynaecological oncology centre.

METHOD

Non-randomised control trial, evaluating morbidity outcomes, before and after implementation of ERAS programme. All consecutive major gynaecological oncology operations performed during two specified periods were included. Data were collected prospectively for a study group in the initial 7.5 months of ERAS implementation and compared with a consecutive historic control group from the exact same period, the year before. Patients' characteristics and perioperative outcomes were compared. Further analysis stratified abdominal and laparoscopic surgery.

RESULTS

In total, 265 cases identified; 99 patients followed ERAS and 99 historic controls, managed with a traditional peri-operative approach, the exact same period the year before (vulval surgery excluded, 67 cases). Groups were comparable in demographics and co-morbidities (age, BMI, ASA, WHO), level of surgery and 30 days post-operative complication (grading Clavien-Dindo classification) and readmission rates (p > 0.05). Overall, the post-operative length of hospital stay (LOS) was significantly reduced for patients who followed ERAS (4.29 ± 2.78 days versus 7.23 ± 5.68 days, p < 0.001). Stratification to subgroups was based on the type of surgery, abdominal versus laparoscopic. Those who underwent abdominal surgery and followed ERAS benefited the maximum (LOS: 5.09 ± 2.74 days versus 8.70 ± 5.75, p < 0.001) CONCLUSIONS: ERAS programme is feasible and safe in Gynae-oncology. In this study, there was a reduction of 3.61 (SE: 0.78, CI 95 %) days in the total LOS, in major abdominal Gynae-oncology surgery (level 3 and 4) without affecting complication or readmission rates.

Verbal and physical abuse against Jordanian nurses in the work environment

This descriptive cross-sectional study determined the prevalence and sources of verbal and physical workplace abuse in the last 6 months, the nurses' reactions to abuse, and their opinions about it. Datawere collected by questionnaire from 447 nurses working in various departments in 3 hospitals in Amman. The prevalence of verbal and physical abuse was 37.1% and 18.3% respectively. Younger, less experienced nurses and those in emergency and intensive care departments experienced more abuse. Patients and their relatives were the usual abusers. Only 35.1% of the abused nurses reported it; of those that did not, 57.1% thought it was useless to do so, while 34.2% thought they could handle the incident without help. Over half of the abused nurses considered leaving nursing and felt their quality of work decreased because of the abuse. Negative societal image of nurses (64%) and poor support from hospital authorities (60%) were the factors the nurses believed most contributed to abuse.

Effect of short-term water restriction in hot season on some blood parameters and immune response to Newcastle disease vaccine of local and commercial layers in the late phase of production

Forty-five Hisex commercial layers and forty-five local Saudi breed layers were used to compare and assess the effect of water restriction under hot conditions on blood constituents and immune response to Newcastle disease (ND) vaccine. The trial was divided into three periods: control (7 day), water restriction (14 day) and rehydration (7 day). During water restriction, layers from each breed were divided into three groups that received 0%, 20% and 40% restriction of drinking water relative to the control period. The immune response against ND was affected by breed; it also declined significantly with 40% water restriction 10 days post-restriction. Water restriction did not affect haematocrit value, plasma total protein, albumin, glucose or osmolality, which may not suggest a reduction in plasma volume. However, plasma creatinine increased in both breeds because of water restriction that remained elevated during rehydration. Water restriction increased plasma urea in the local group, while it decreased in the commercial group. Irrespective of rate of water restriction, it can be concluded that the two breeds can withstand up to 40% water restriction during high environmental temperature. However, the local breed may be superior in water conservation in relation to the commercial layers.

Size-dependent oriented attachment in the growth of pure and defect-free hexagonal boron nitride nanocrystals

Pure and defect-free hexagonal boron nitride (hBN) nanocrystals with deep-ultraviolet light emissions at around 215 nm were prepared via a solid state reaction. This involved preparing a precursor from potassium borohydride and ammonium chloride powders, and then heating the precursor and additional ammonium chloride to 1000 °C within a nitrogen atmosphere. The hBN nanocrystals were studied using a variety of characterization techniques (e.g., TEM, AFM, N(2) absorption/desorption). A growth mechanism based on size-dependent oriented attachment was proposed for the nanocrystals.