Improved Electrochemical Performance in an Exfoliated Tetracyanonickelate-Based Metal-Organic Framework

Tetracyanonickelate (TCN)-based metal-organic frameworks (MOFs) show great potential in electrochemical applications such as supercapacitors due to their layered morphology and tunable structure. This study reports on improved electrochemical performance of exfoliated manganese tetracyanonickelate (Mn-TCN) nanosheets produced by the heat-assisted liquid-phase exfoliation (LPE) technique. The structural change was confirmed by the Raman frequency shift of the C≡N band from 2177 to 2182 cm-1 and increased band gap from 3.15 to 4.33 eV in the exfoliated phase. Statistical distribution obtained from atomic force microscopy (AFM) shows that 50% of the nanosheets are single-to-four-layered and have an average lateral size of ∼240 nm2 and thickness of ∼1.2-4.8 nm. High-resolution transmission electron microscopy (HRTEM) and selected area electron diffraction (SAED) patterns suggest that the material maintains its crystallinity after exfoliation. It exhibits an almost 6-fold improvement in specific capacitance (from 13.0 to 72.5 F g-1) measured at a scan rate of 5 mV s-1 in 1 M KOH solution. Galvanostatic charge-discharge (GCD) measurement shows a capacity enhancement from ∼18 F g-1 in the bulk phase to ∼45 F g-1 in the exfoliated phase at a current density of 1 A g-1. Bulk crystals exhibit an increasing trend of capacitance retention by ∼125% over 1000 charge-discharge cycles attributed to electrochemical exfoliation. Electrochemical impedance spectroscopy (EIS) demonstrates a 5-fold reduction in the total equivalent series resistance (ESR) from 4864 Ω (bulk) to 1089 Ω (exfoliated). The enhanced storage capacity in the exfoliated phase results from the combined effect of the electrochemical double-layer charge storage mechanism at the nanosheet-electrolyte interface and the Faradic process characteristic of the pseudocapacitive charge storage behavior.

Q-Carbon as a Corrosion-Resistant Coating

A newly discovered quenched form of carbon, widely known as Q-carbon, thin films are synthesized by the direct conversion of the amorphous carbon layer using the nanosecond pulsed laser annealing technique, and its corrosion-resistant properties, that is, potentiodynamic polarization (PDP) and electrochemical impedance spectroscopy technique, are investigated. The unique microstructure and the existence of defects (sp2 content) in sp3-rich Q-carbon are highly desirable for efficient corrosion-resistant performance. The sp3 percentage of the as-grown Q-carbon is measured to be ∼80.5% from the D and G peaks of the Raman and C-1S X-ray photoelectron spectrum. The anti-corrosion properties with inhibition durability of Q-carbon thin films are systematically investigated in various concentrations of Na2SO4 solutions, and the corrosion potential, corrosion current, and corrosion rate of Q-carbon are determined to be -253 V, 30.1 × 10-5 A/cm2, and 0.00528, respectively, for 1 M Na2SO4 solution. Both series and contact resistance decrease from 5498.6 and 821.1 Ω to 698.8 and 124.3 Ω with an increase of Na2SO4 concentration from 0.1 to 1 M, respectively. The small shift of PDP curves toward more negative potential, the shrinkage of the radius of semicircular arcs in the Nyquist plot (Z″ vs Z'), and negligible loss in corrosion resistance (∼78%) are observed for Q-carbon thin film at the immersion time up to 48 h. The unique sp2-sp3 ratio, shorter bond length, compact atomic arrangement, and minimum porosity, along with the high adhesion strength, due to the ultrafast solid-liquid-solid growth route, of Q-carbon thin film on the substrate signify it as a better alternative compared to the existing corrosion-resistant materials.

Electric-Field Emission Mechanism in Q-Carbon Field Emitters

In this paper, we report the excellent field emission properties of Q-carbon and analyze its field emission characteristics through structural, morphological, and electronic property correlations, supported by density functional theory (DFT) simulation studies. The Q-carbon field emitters show impressive and stable field emission properties, such as a low turn-on electric field of ∼2.38 V/μm, a high emission current density of ∼33 μA/cm², and a critical field of ∼2.44 V/μm for the transition from a linear region to the saturation region in the F-N plot. The outstanding field emission properties of Q-carbon are attributed to (i) a unique sp²/sp³ mixture in Q-carbon, (ii) sp²-bonded highly conductive amorphous carbon-rich channels inside the Q-carbon cluster, (iii) a large local field enhancement due to the local geometry and microstructure of Q-carbon, and (iv) the presence of sp²-bonded amorphous carbon regions in the composite film. The temperature-dependent field emission properties, such as extreme sensitivity and an enhancement in the emission current density with temperature, can be explained by the local density of states near the Fermi level and the excellent thermal stability of the Q-carbon field emitters. From DFT simulation studies, the computed work function and the field-enhancement factor were determined to be 3.62 eV and ∼2300, respectively, which explains the excellent field emission characteristics of Q-carbon. The obtained field emission properties, in most cases, were superior to those from other carbon/diamond-based field emitters, which will open new frontiers in field emission-based electronic applications.

Highly Stable Electrochemical Supercapacitor Performance of Self-Assembled Ferromagnetic Q-Carbon

Novel phase Q-carbon thin films exhibit some intriguing features and have been explored for various potential applications. Herein, we report the growth of different Q-carbon structures (i.e., filaments, clusters, and microdots) by varying the laser energy density from 0.5 to 1.0 J/cm² during pulsed laser annealing of amorphous diamond-like carbon films with different sp³-sp² carbon compositions. These unique nano- and microstructures of Q-carbon demonstrate exceptionally stable electrochemical performance by cyclic voltammetry, galvanostatic charging-discharging, and electrochemical impedance spectroscopy for energy applications. The temperature-dependent magnetic studies (magnetization vs magnetic field and temperature) reveal the ferromagnetic nature of the Q-carbon microdots. The saturation magnetization and coercive field values decrease from 132 to 14 emu/cc and 155 to 92 Oe by increasing the temperature from 2 to 300 K, respectively. The electrochemical performances of Q-carbon filament, cluster, and microdot thin-film supercapacitors were investigated by two-electrode configurations, and the highest areal specific capacitance of ∼156 mF/cm² was observed at a current density of 0.15 mA/cm² in the Q-carbon microdot thin film. The Q-carbon microdot electrodes demonstrate an exceptional capacitance retention performance of ∼97.2% and Coulombic efficiency of ∼96.5% after 3000 cycles due to their expectational reversibility in the charging-discharging process. The kinetic feature of the ion diffusion associated with the charge storage property is also investigated, and small changes in equivalent series resistance of ∼9.5% and contact resistance of ∼9.1% confirm outstanding stability with active charge kinetics during the stability test. A high areal power density of ∼5.84 W/cm² was obtained at an areal energy density of ∼0.058 W h/cm² for the Q-carbon microdot structure. The theoretical quantum capacitance was obtained at ∼400 mF/cm² by density functional theory calculation, which gives an idea about the overall capacitance value. The obtained areal specific capacitance, power density, and impressive long-term cyclic stability of Q-carbon thin-film microdot electrodes endorse substantial promise in high-performance supercapacitor applications.

Correlated Electrical Conductivities to Chemical Configurations of Nitrogenated Nanocrystalline Diamond Films

Diamond is one of the fascinating films appropriate for optoelectronic applications due to its wide bandgap (5.45 eV), high thermal conductivity (3320 W m−1·K−1), and strong chemical stability. In this report, we synthesized a type of diamond film called nanocrystalline diamond (NCD) by employing a physical vapor deposition method. The synthesis process was performed in different ratios of nitrogen and hydrogen mixed gas atmospheres to form nitrogen-doped (n-type) NCD films. A high-resolution scanning electron microscope confirmed the nature of the deposited films to contain diamond nanograins embedded into the amorphous carbon matrix. Sensitive spectroscopic investigations, including X-ray photoemission (XPS) and near-edge X-ray absorption fine structure (NEXAFS), were performed using a synchrotron beam. XPS spectra indicated that the nitrogen content in the film increased with the inflow ratio of nitrogen and hydrogen gas (IN/H). NEXAFS spectra revealed that the σ*C–C peak weakened, accompanied by a π*C=N peak strengthened with nitrogen doping. This structural modification after nitrogen doping was found to generate unpaired electrons with the formation of C–N and C=N bonding in grain boundaries (GBs). The measured electrical conductivity increased with nitrogen content, which confirms the suggestion of structural investigations that nitrogen-doping generated free electrons at the GBs of the NCD films.

Integrating a community-based approach to non-communicable diseases care: a pilot programme in Bangladesh

Background

As the threat of non-communicable diseases grows in Bangladesh, BRAC, in partnership with Medtronic, launched a pilot programme in early 2020 to leverage community health workers to improve the health outcomes of patients with hypertension and diabetes. This project builds off of BRAC's existing non-communicable disease programme, established in 2016, but incorporates patient-centred approaches to monitor and improve both patient compliance and outcomes.

Methods

Activities included BRAC-run non-communicable disease centres to diagnose and treat patients with non-communicable diseases and specially trained community health workers to provide community-level care and strengthen referral linkages with NCD centres. BRAC also worked diligently to adapt its programming to the context of COVID-19, including equipping a subset of enrolled patients with machines to record their blood pressure and blood glucose levels at home with additional supervision by community health workers.

Findings

Preliminary results were promising—on average, 90% of both home-based and clinic-based patients showed clinical improvements, and 91% were retained in care. About 98% of community health workers had on-time follow-up of patients with non-communicable diseases, showing routine compliance of care at the household level.

Interpretation

Despite the pandemic, community health workers proved to be an effective tool in chronic disease management because the community trusts them and is receptive to their guidance, empowering health workers to deliver non-communicable disease care and promote lifestyle modifications. Contingent on further funding, BRAC will evaluate the effectiveness of this model in sustaining clinical outcomes and identifying pathways to scale across BRAC's large-scale health programme of over 40 000 community health workers.

Funding

Medtronic (formerly known as Medtronic Foundation).

Physical and mental health impact of COVID-19 on children, adolescents, and their families: The Collaborative Outcomes study on Health and Functioning during Infection Times - Children and Adolescents (COH-FIT-C&A)

BACKGROUND

The COVID-19 pandemic has altered daily routines and family functioning, led to closing schools, and dramatically limited social interactions worldwide. Measuring its impact on mental health of vulnerable children and adolescents is crucial.

METHODS

The Collaborative Outcomes study on Health and Functioning during Infection Times (COH-FIT - www.coh-fit.com) is an on-line anonymous survey, available in 30 languages, involving >230 investigators from 49 countries supported by national/international professional associations. COH-FIT has thee waves (until the pandemic is declared over by the WHO, and 6-18 months plus 24-36 months after its end). In addition to adults, COH-FIT also includes adolescents (age 14-17 years), and children (age 6-13 years), recruited via non-probability/snowball and representative sampling and assessed via self-rating and parental rating. Non-modifiable/modifiable risk factors/treatment targets to inform prevention/intervention programs to promote health and prevent mental and physical illness in children and adolescents will be generated by COH-FIT. Co-primary outcomes are changes in well-being (WHO-5) and a composite psychopathology P-Score. Multiple behavioral, family, coping strategy and service utilization factors are also assessed, including functioning and quality of life.

RESULTS

Up to June 2021, over 13,000 children and adolescents from 59 countries have participated in the COH-FIT project, with representative samples from eleven countries.

LIMITATIONS

Cross-sectional and anonymous design.

CONCLUSIONS

Evidence generated by COH-FIT will provide an international estimate of the COVID-19 effect on children's, adolescents' and families', mental and physical health, well-being, functioning and quality of life, informing the formulation of present and future evidence-based interventions and policies to minimize adverse effects of the present and future pandemics on youth.

The collaborative outcomes study on health and functioning during infection times in adults (COH-FIT-Adults): Design and methods of an international online survey targeting physical and mental health effects of the COVID-19 pandemic

BACKGROUND

. High-quality comprehensive data on short-/long-term physical/mental health effects of the COVID-19 pandemic are needed.

METHODS

. The Collaborative Outcomes study on Health and Functioning during Infection Times (COH-FIT) is an international, multi-language (n=30) project involving >230 investigators from 49 countries/territories/regions, endorsed by national/international professional associations. COH-FIT is a multi-wave, on-line anonymous, cross-sectional survey [wave 1: 04/2020 until the end of the pandemic, 12 months waves 2/3 starting 6/24 months threreafter] for adults, adolescents (14-17), and children (6-13), utilizing non-probability/snowball and representative sampling. COH-FIT aims to identify non-modifiable/modifiable risk factors/treatment targets to inform prevention/intervention programs to improve social/health outcomes in the general population/vulnerable subgrous during/after COVID-19. In adults, co-primary outcomes are change from pre-COVID-19 to intra-COVID-19 in well-being (WHO-5) and a composite psychopathology P-Score. Key secondary outcomes are a P-extended score, global mental and physical health. Secondary outcomes include health-service utilization/functioning, treatment adherence, functioning, symptoms/behaviors/emotions, substance use, violence, among others.

RESULTS

. Starting 04/26/2020, up to 14/07/2021 >151,000 people from 155 countries/territories/regions and six continents have participated. Representative samples of ≥1,000 adults have been collected in 15 countries. Overall, 43.0% had prior physical disorders, 16.3% had prior mental disorders, 26.5% were health care workers, 8.2% were aged ≥65 years, 19.3% were exposed to someone infected with COVID-19, 76.1% had been in quarantine, and 2.1% had been COVID 19-positive.

LIMITATIONS

. Cross-sectional survey, preponderance of non-representative participants.

CONCLUSIONS

. Results from COH-FIT will comprehensively quantify the impact of COVID-19, seeking to identify high-risk groups in need for acute and long-term intervention, and inform evidence-based health policies/strategies during this/future pandemics.

Few UK vascular centres offer a fully NICE-compliant supervised exercise programme: a national audit

INTRODUCTION

To determine the current (pre-COVID-19) provision of supervised exercise training (SET) for patients with peripheral arterial disease (PAD) in UK Vascular Centres.

METHODS

Hospital Trusts delivering vascular care to patients with PAD were identified from the National Vascular Registry and asked to complete an online questionnaire on their provisions for SET. If a centre offered SET, they were asked questions to determine whether the programme was compliant with NICE guidelines and the difficulties they faced delivering the service. If centres did not offer SET, they were asked what obstacles prevented them implement SET.

RESULTS

Of the 78 UK vascular centres, 59 (76%) responded and were included in the audit. Of these, 27 (46%) were able to offer SET but only 21 (36%) could offer it to all their patients with PAD. Only four (6.8%) offered SET that was fully compliant with current NICE guidelines. Reasons identified included insufficient funding, lack of resource and poor patient compliance.

CONCLUSIONS

The benefits of SET are well established yet the availability of the service in the UK is poor. The reasons for this are readily identified but have not yet been overcome. Research on novel methods of delivering supervised exercise that mitigates existing barriers, such as home exercise with remote monitoring, should be prioritised to facilitate optimal management for our patients with PAD.

Inorganic nitrate attenuates the systemic inflammatory response in typhoid vaccine-induced endothelial dysfunction in healthy volunteers

Background

Inflammatory responses underlie the development of endothelial dysfunction in CVD, however, therapeutics that might target this pathway have not been forthcoming. A key pathogenic mechanism mediating endothelial dysfunction is a reduction in bioavailable (eNOS-derived) nitric oxide (NO). Activation of the non-canonical pathway for in-vivo NO generation might offer an approach to improve NO levels and recover vascular function in pre-clinical models of CVD. Whether this might occur in humans is unknown.

Purpose

We hypothesize that consumption of inorganic nitrate will lead to increases in bioavailable NO and thus attenuate the inflammatory pathways leading to typhoid vaccine-induced endothelial dysfunction in healthy volunteers.

Methods

Healthy male volunteers were recruited (n=78) and randomized to receive either beetroot juice containing 8–10mmol nitrate or placebo (nitrate-deplete) juice once daily for 6 days. Participants underwent serial measurements of BP, FMD and GTN-induced brachial artery dilatation, and haematology and biochemistry, before and after typhoid vaccination. Blood, urine and saliva nitrite and nitrate were quantified using ozone chemiluminescence, and leukocyte flow cytometry analysis was conducted.

Results

8-hours post-vaccine endothelial function was depressed in placebo-treated volunteers, however this was prevented in nitrate-treated volunteers. This dysfunction was due to impaired endothelial function since responses to GTN were unaffected either by vaccination or dietary intervention (p=0.981). Dietary nitrate resulted in an increase in plasma (p<0.0001), urine (p=0.0006) and saliva (p<0.0001) nitrate, and urine (p=0.0354) and saliva (p<0.0001) nitrite levels. There was a reduction in the proportions of CD14++/CD16+intermediate monocytes in nitrate-treated participants after vaccine (p=0.016, change from baseline between groups). In the nitrate-treated group, less CD14++/CD16+ intermediate monocyte CD62L expression was identified post-vaccine (p=0.0122), compared to placebo, with no difference in soluble plasma CD62L between groups (p=0.875). CD11b median fluorescence intensity was increased in CD3+/CD4+ T-lymphocytes in nitrate-treated volunteers (p=0.0095).

Conclusions

Dietary nitrate reduced BP, as previously shown, indicating efficacy of the intervention. Importantly, we also now show for the first time that inorganic nitrate suppresses the systemic inflammatory response, specifically by reducing the numbers and activation state of CD14++/CD16+ intermediate monocytes. Furthermore, an increased expression of CD3+/CD4+ T-cell CD11b and preserved FMD in healthy volunteers treated with nitrate, suggests an anti-inflammatory phenotype, induced by the intervention, leading to improved endothelial function. Inorganic dietary nitrate modulates endothelial function through the attenuation of inflammatory responses and may be of potential therapeutic benefit in patients with established CAD.

Funding Acknowledgement

Type of funding sources: None.

Nanoparticles Modified With Cationic Thiol Surfactant as Efficient Inhibitors for the Corrosion of Carbon Steel

In this work, we report synthesis, characterization and corrosion inhibition properties of cationic thiol surfactant-capped silver (SC-Ag-NPs) and gold (SC-Au-NPs) nanoparticles. SC-Ag-NPs and SC-Au-NPs were characterized using regular techniques include TEM. Corrosion study was carried out using carbon steel (CS) in 3.5% NaCl aqueous solution and characterized using multiple electrochemical techniques. Our results suggest that the paint containing SC-Ag-NPs and SC-Au-NPs endow efficient corrosion protection to the CS. Especially, SC-Au-NPs based paint form a stronger barrier between the metal and the corrosive ions, leading to better inhibition properties.

A Comparative Study Between 20% Mannitol and 3% Hypertonic Saline for Brain Oedema Reduction during Elective Brain Tumour Surgery

Cerebral oedema is an important manifestation of brain tumour. The significant reduction of cerebral oedema can show rapid improvement of the patients. Hypertonic saline solution and mannitol both are commonly used for this action. It is now time to choose the better one. This was a prospective randomized comparative study designed to evaluate the efficacy of 3% hypertonic saline (NaCl) in reduction of brain oedema during brain tumour surgery and compare it with that of 20% Mannitol. The study was conducted in the department of Anaesthesiology, Combined Military Hospital, Dhaka, Bangladesh from July 2016 to December 2016. A total number of 47 patients for brain tumour surgery were selected. After screening 40 patients were finalized. Then the patients were divided into 2 equal groups 20 patients in each. Patients of Group A received 3% hypertonic saline and Group B 20% mannitol. Uniform anaesthetic technique applied for all patients, fixed surgeon/group of surgeons carried out the surgery. Heart rate and noninvasive blood pressure were monitored and kept with in ±20% baseline values different means. ETCO2 were kept in between 28-32mm of Hg by adjusting ventilator setting. Reduction of brain oedema was monitored by subjective assessment of surgeons using a 3 point scale of brain relaxation. The data were recorded in preformed data sheet. The results were tested by chi-square test to see their level of significance i.e. p value <0.05 was considered as significant. At the opening of dura, the number of brain conditions classified as soft, adequate and tight were statistically non-significant between groups. After 0.5 hour and 1.0 hour 10% patient's brain was tight in Group A whereas it was 35% and 40% in Group B respectively. Reduction of brain oedema or brain relaxation was significantly better in Group A compared to Group B (p<0.05). Urine output was higher with mannitol than hypertonic saline (p<0.05). Duration of ICU and hospital stay in both Group A and Group B were statistically similar (p>0.05). Compared to mannitol, hypertonic saline caused an increase in serum sodium concentration over time (p<0.05). From the available data, use of 20% mannitol and 3% hypertonic saline for brain oedema reduction, it is suggested that hypertonic saline significantly reduces the risk of tight brain and produce the brain more soft than mannitol during brain tumour surgery.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

SAT0234 SERUM AXL, FERRITIN, IGFBP4 AND STNFR2 AS BIOMARKERS OF PEDIATRIC SLE

Background:

Proteomic screening is an efficient approach for identifying protein biomarkers in various inflammatory diseases. Our preliminary proteomic analysis revealed elevated levels of serum Axl, Ferritin, IGFBP4 and sTNFR2 in adult patients with active lupus nephritis (LN) (1). However, the role of these serum biomarkers in pediatric systemic lupus erythematosus (SLE) patients has not been examined.

Objectives:

To evaluate the performance of 4 serum protein markers for detecting disease activity in pediatric patients with SLE.

Methods:

83 pediatric patients who fulfilled ≥4 ACR criteria for SLE and 25 healthy controls were recruited for serological testing of 4 protein markers identified by antibody-coated microarray screen, namely Axl, ferritin, IGFBP4 and sTNFR2. SLE disease activity was assessed using the SLEDAI-2k score, renal disease activity was assessed by the renal SLEDAI (range 0-16; 0= inactive LN, ≥ 8= active renal). 57 patients had clinically active SLE (SLEDAI score ≥ 4 or having a flare) (28 active renal and 29 active non-renal SLE patients). In active renal patients, concurrent renal biopsy was performed, unless contraindicated. The ISN/RPS criteria were used to assess the histopathologic features of LN. Those Patients were further subcategorized into 2 groups; active proliferative (ISN/RPS classes III/IV) and non-proliferative (classes I/II/V).

Results:

The serum concentrations of Axl and ferritin were significantly higher in patients with active SLE than inactive SLE (3765±235 vs. 2513±130 pg/ml,P= 0.001) and (111±26 vs. 18±4 ng/ml,P =0.0001) respectively. Serum Axl levels were significantly higher in active renal versus active non-renal SLE patients (3765±235.3 vs. 2825±200.7 pg/ml,P= 0.04). In the active renal patients with paired kidney tissue and blood samples, none of the biomarkers tested discriminated classes of LN, although serum Axl, ferritin and IGBPB4 levels were higher in the proliferative subgroup. The levels of Axl, ferritin and IGFBP4 correlated significantly with SLEDAI scores (Axl, r= 0.58,P<0.0001; ferritin, r= 0.53,P<0.0001; IGFBP4, r= 0.229,P= 0.03). However, only serum Axl levels correlated significantly with the renal SLEDAI (r= 0.46,P= 0.01). The levels of Axl, IFGBP4 and sTNFR2 correlated with decreased C3 levels (r= - 0.54,P<0.0001; r= - 0.29,P= 0.007; r= - 0.29,P= 0.007) respectively. Only serum Axl and ferritin correlated with urinary PCR (r= 0.42,P<0.0001; r= 0.22,P=0.04) respectively. These markers were more specific, but less sensitive, in detecting concurrent SLE activity than elevated anti-dsDNA or decreased C3. The specificity values of serum ferritin and IGFBP4 for concurrent active lupus nephritis were higher than anti-dsDNA or C3. Serum ferritin was the best predictor of global SLE activity (AUC 0.81,P<0.0001), followed by C3 (AUC 0.79,P<0.0001) then Axl (AUC 0.71,P= 0.002), while both Axl and C3 were the best predictors of lupus nephritis activity (AUC 0.72, both).

Conclusion:

In pediatric SLE patients, serum ferritin and Axl perform better than traditional yardsticks in identifying disease activity, either global or renal. The performance of these serum markers should be explored further in a longitudinal cohort of pediatric SLE patients.

References:

[1]Wu T, Ding H, Han J, et al. Antibody-Array-Based Proteomic Screening of Serum Markers in Systemic Lupus Erythematosus: A Discovery Study. J Proteome Res. 2016 Jul 1;15 (7): 2102-14.

Disclosure of Interests:

None declared

Arbuscular mycorrhizal fungi alleviate Fe-deficiency symptoms in sunflower by increasing iron uptake and its availability along with antioxidant defense

Iron (Fe)-deficiency causes chlorosis and growth inhibition in sunflower, an important commercial crop. This study examines whether and how arbuscular mycorrhizal fungi (AMF) ameliorate Fe-deficiency symptoms in Fe-deficiency sensitive sunflower plants. AMF supplementation showed a significant improvement in plant biomass, chlorophyll score, Fv/Fm (quantum efficiency of photosystem II), and Pi_ABS (photosynthesis performance index), suggesting its beneficial effect under Fe deficiency. This AM-driven amelioration of Fe deficiency was further supported by the improvement of biochemical stress indicators, such as cell death, electrolyte leakage, superoxide anion, and hydrogen peroxide. In this study, the AMF supplementations resulted in significant improvement in Fe as well as Zn concentrations in root and shoot of sunflower under Fe deficiency. One of the primary Strategy-I responses, ferric reductase activity along with the expression of its respective gene (HaFRO1), significantly increased in roots due to AMF ensuring Fe availability in the rhizosphere under Fe deficiency. Our qPCR analysis also showed a significant upregulation of HaIRT1, HaNramp1, and HaZIP1 in roots of sunflower in the presence of AMF, suggesting that Fe and Zn transporters are concurrently involved with AMF-mediated alleviation of Fe deficiency. Further, AMF accelerates the activities of CAT and SOD, predominantly in roots to protect sunflower plants from Fe-deficiency reactive oxygen species (ROS). This study unveils the mechanistic basis of AMF to limit Fe deficiency retardation in sunflower.

Effect of Citrus macroptera Fruit Pulp Juice on Alteration of Caspase Pathway Rendering Anti-Proliferative Activity against Ehrlich's Ascites Carcinoma in Mice

Citrus macroptera (Rutaceae) has long been used in folk medicine in Bangladesh. Considering the folkloric context, this study was aimed to scrutinize anti-proliferative activity of C. macroptera fruit pulp juice (CMFPJ) against Ehrlich's ascites carcinoma (EAC). The anti-proliferative capacity of CMFPJ was investigated and confirmed primarily using MTT assay. In vivo anti-proliferative aptitude of CMFPJ was investigated with 25, 50, and 100 mg/kg/day intraperitoneal (i.p.) treatment. Anti-proliferative efficacy of CMFPJ was assessed based on EAC growth inhibition. CMFPJ inhibited EAC growth in vitro in a dose-dependent manner. And the percentages of in vivo EAC growth inhibition were 19.53, 49.2, and 68.9% at 25, 50, and 100 mg/kg CMFPJ respectively. CMFPJ significantly induced expression of apoptosis regulatory genes caspase-8, caspase-9, cytochrome-c, and caspase-3. This considerable anti-cancer activity was perhaps due to combinatorial effect of lectin, polyphenols, and flavonoids present in CMFPJ.

A revisit to the effect of annealing temperature on magnetic properties of LaFe0.5Mn0.5O3

We report an experimental study for the structural and magnetic properties of highly pure LaFe_0.5Mn_0.5O₃ perovskite phase. The impurity free LaFe_0.5Mn_0.5O₃ has been prepared by sol-gel technique at 500 °C and annealed at different temperatures up to 1000 °C. Previous works on LaFe_0.5Mn_0.5O₃ revealed presence of secondary phases along with contradicting magnetic properties. Such as, Bhame et al (2005 Phys. Rev. B 72 054426-7) reported the superparamagnetic or spin-glass like behavior for 200 °C treated sample that persisted even at 700 °C sample. However, Wei et al (2012 Mater. Chem. Phys. 136 755-61) claimed room temperature ferromagnetism in all the samples annealed in the range of 600 °C-700 °C where the saturation magnetization decreases with the increase in temperature. These contradicting results lead us to revisit the effect of annealing temperature on the magnetic properties of LaFe_0.5Mn_0.5O₃. We noticed a gradual increase in magnetization with increase in annealing temperatures without any signature of long range spin ordering for pure single phase samples. The increased magnetic moment with annealing temperatures has been attributed to the suppression of surface contribution of disordered spin. The low temperature magnetic behaviors can be explained by the interacting cluster glass behavior for the pristine as well as for 1000 °C annealed samples.

Significant Reduction of Defect States and Surface Tailoring in ZnO Nanoparticles via Nano-Bio Interaction With Glucose for Bio-Applications

In this study, we have investigated the structural and optical properties of nanoconjugates (NJs) consisting of phase pure zinc oxide (ZnO) nanoparticles (NPs) with glucose biomolecules. All NJs were fabricated using a standard biochemical synthesis process. Structural, optical, vibrational, and biochemical interface properties of nano-bio composites are probed by different complementary characterization techniques. The XRD patterns of the NPs and NJs illustrate a highly phase pure ZnO structure. A visible green emission in the photoluminescence spectrum, mainly associated with the oxygen vacancies on the surface of ZnO nanostructure, is significantly reduced by the incorporation of glucose biomolecules. The strong binding interaction of glucose biomolecule on the surface of ZnO NPs results in the reduction in green-yellow-orange emission intensities. The interaction of glucose molecules modifies oxygen vacancies by capturing free electrons from the ZnO surface region. Significant changes in the peak intensity and relative peak position of some of the glucose and ZnO NPs in Raman spectra refer to the direct binding between these two nano- and bio-components. In the X-ray photoelectron spectroscopy, the binding energy of O 1s core level in NJs increases from 531 eV (O 1s core level position for ZnO) and the increment is more with higher initial glucose concentration in the solution during synthesis. This study serves as a promising platform for the development of new kinds of NJs and investigation of their interfacial properties which can take the frontier forward for integration and multifunctionality.

Direct conversion of carbon nanofibers and nanotubes into diamond nanofibers and the subsequent growth of large-sized diamonds

We report a pulsed laser annealing method to convert carbon fibers and nanotubes into diamond fibers at ambient temperature and pressure in air. The conversion of carbon nanofibers and nanotubes into diamond nanofibers involves melting in a super undercooled state using nanosecond laser pulses, and quenching rapidly to convert into phase-pure diamond. The conversion process occurs at ambient temperature and pressure, and can be carried out in air. The structure of diamond fibers has been confirmed by selected-area electron diffraction in transmission electron microscopy, electron-back-scatter-diffraction in high-resolution scanning electron microscopy, all showing characteristic diffraction lines for the diamond structure. The bonding characteristics were determined by Raman spectroscopy with a strong peak near 1332 cm-1, and high-resolution electron-energy-loss spectroscopy in transmission electron microscopy with a characteristic peak at 292 eV for σ* for sp3 bonding and the absence of π* for sp2 bonding. The Raman peak at 1332 cm-1 downshifts to 1321 cm-1 for diamond nanofibers due to the phonon confinement in nanodiamonds. These laser-treated carbon fibers with diamond seeds are used to grow larger diamond crystallites further by using standard hot-filament chemical vapor deposition (HFCVD). We compare these results with those obtained without laser treating the carbon fibers. The details of diamond conversion and HFCVD growth are presented in this paper.

Perineal closure following extralevator abdominoperineal excision for cancer of the rectum

AIM

Extralevator abdominoperineal resection (ELAPE) may be complicated by perineal wound healing problems and herniation. We report a consecutive series of 38 such patients with selective use of a fasciocutaneous V-Y buttock advancement flap (BAF).

METHOD

Data were collected on a series of patients undergoing ELAPE for rectal malignancy between August 2011 and July 2017. Demographics, management and outcomes were recorded prospectively. Perineal wound problems were considered as 'major' if they required packing; otherwise, they were classed as 'minor'.

RESULTS

Thirty-eight patients [eight female and 30 male; median age 63 (range: 35-89) years] underwent ELAPE. Thirty-seven had an adenocarcinoma of the rectum and one had a malignant melanoma. The median tumour height (from the anal verge) was 30 (range: 0-80) mm. Sixteen patients had a BAF. The median length of stay was 10 (range: 6-25) days. Primary perineal healing occurred in 18 (47%) patients. Major wound breakdown occurred in three (10%) patients and minor wound breakdown in 17 (45%). Two of the 16 patients having a BAF had major wound breakdown: one wound took 9 weeks to heal completely and the other took 9 months. Of the 22 patients who did not have a BAF, one had a major wound breakdown which closed by 3 months. There were no perineal fistulae or chronic sinuses. There were two perineal herniae that were successfully repaired by perineal insertion of biological mesh (Permacol™; Covidien, Dublin, Ireland).

CONCLUSIONS

Selective use of a BAF for perineal closure can give good results in terms of healing and an acceptably low early perineal herniation rate.

Comparative Study of Alginate and Omeprazole in Symptomatic Treatment of Non-erosive Gastroesophageal Reflux Disease

Gastroesophageal reflux disease is widely reported most prevalent disease of the gastrointestinal tract. The burden of gastroesophageal reflux disease (GERD) is increasing in Asia and the majority of patients have non-erosive reflux disease. This prospective, open label, non random (consecutive), experimental study was performed due to compare the therapeutic efficacy of alginate and omeprazole in relieving symptoms of non erosive reflux disease (NERD) and was carried out in the Outpatient Department of Gastroenterology, Dhaka Medical College Hospital, Dhaka, Bangladesh from December 2013 to May 2014. Sixty patients were enrolled for this study and were divided into two groups. Among them, 30 subjects were assigned to the omeprazole group (Group I) and 30 subjects to the alginate group (Group II). Omeprazole 20mg enteric coated capsule daily and alginate 10ml three times daily were administered 14 days in this study. In ITT analysis, achieving complete symptom relief (heart burn) was 56.7% in alginate group & 60% in omeprazole group. Statistically which was not significant (p=0.793). In PP analysis, this was 65.4% and 66.7% respectively. In this study, the overall satisfaction of omeprazole & alginate was more than 86% and the mean duration of heart burn free was found 5.0±4.0 days in Group I and 3.65±2.8 days in Group II. The difference was not statistically (p>0.05) significant between two groups in this study. Therapeutic efficacy and safety profiles of alginate were comparable to omeprazole after two weeks treatment in NERD subjects. So alginate may be considered as a relevant and effective alternative medication in non-erosive reflux.

Role of Liver Biopsy in the Diagnosis of Neonatal Cholestasis due to Biliary Atresia

Biliary atresia is the commonest cause of cholestatic jaundice. Early diagnosis & surgical correction helps long time survival & prevent development of cirrhosis. This study was conducted to find out the role of liver biopsy in the diagnosis of biliary atresia having positive hepatobiliary scintigraphy as there is chance of false positivity. This cross sectional study was carried out in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh at Paediatric Gastroenterology & Nutrition Department from January 2014 to June 2015. All admitted patients with the diagnosis of neonatal cholestasis were evaluated clinically and by scintigraphy for biliary atresia. Having positive hepatobiliary scintigraphy but highly suggestive of biliary atresia were enrolled for this study. A total of 108 cases were initially selected. Among them 33 patients showed no excretion of tracer during hepatobiliary scintigraphy. Liver biopsy was done in these 33 cases. All cases (100%) had history of passage of pale or acholic stool. Fractionated serum bilirubin of >2mg/dl was found all of the cases. Histological scoring system reveals typical features of biliary atresia in 27(81.8%). Two had no conclusive histology of biliary atresia, four had features of neonatal hepatitis (12.1%). In this study, percutaneous liver biopsy with histological analysis by scoring system was found useful for the correct diagnosis of biliary atresia.

Ultra-high sensitivity of luminescent ZnCr2O4 nanoparticles toward nitroaromatic explosives sensing

Here, we report the luminescence based sensing of trace amounts of nitroaromatic explosive organic compounds. The luminescence emission of nanosized spinel oxide ZnCr2O4 with high chemical and thermal stabilities has been used as a potential probe to detect such organic explosives. Low temperature solution combustion synthesized ZnCr2O4 oxide with an average particle size of ∼9 nm exhibits strong luminescence emission at 410 nm upon excitation at 260 nm in an aqueous suspension. The presence of nitroaromatics in ZnCr2O4 suspension dramatically suppresses the luminescence emission providing an opportunity to detect it quantitatively. The detection limit for 2,4,6-trinitrophenol (TNP) is as low as 23 ppb. A number of organic compounds have been investigated for a comprehensive understanding. The astonishing sensitivity of ZnCr2O4 nanoparticles towards nitro explosives is appealing for sensing application. A plausible explanation of such luminescence quenching has been ascribed to a two-fold mechanism. The underling mechanism is further substantiated by a similar study on ZnO nanoparticles.

A Systematic Study on the Structural and Optical Properties of Vertically Aligned Zinc Oxide Nanorods Grown by High Pressure Assisted Pulsed Laser Deposition Technique

In this study, we synthesize high quality vertically aligned ZnO (VAZO) nanorods on silicon, sapphire, and indium tin oxide (ITO) substrates by using pulsed laser deposition (PLD) technique at high growth pressure (0.3 Torr). Systematic changes in structural and optical properties of VAZO nanorods are studied by varying the substrate temperature (500-600 °C) and number of pulsed laser shots during the deposition. ZnO nanoparticles deposited at high pressure act as nucleation sites, eliminating requirement of catalyst to fabricate VAZO nanorods. Two sharp ZnO peaks with high intensity correspond to the (0002) and (0004) planes in X-ray diffraction pattern confirm the growth of ZnO nanorods, oriented along the c-axis. Scanning Electron Microscopy (SEM) images indicate a regular arrangement of vertically aligned hexagonal closed pack nano-structures of ZnO. The vertical alignment of ZnO nanorods is also supported by the presence of E₂ (high) and A₁ (LO) modes in Raman spectra. We can tune the diameter of VAZO nanorods by changing growth temperature and annealing environments. Photoluminescence spectroscopy illustrates reduction in defect level peak intensities with increase in diameter of VAZO nanorods. This study signifies that high pressure PLD technique can be used more efficiently for controlled and efficient growth of VAZO nanorods on different substrates.

First characterization of immunogenic conjugates of Vi negative Salmonella Typhi O-specific polysaccharides with rEPA protein for vaccine development

Efficacious typhoid vaccines for young children will significantly reduce the disease burden in developing world. The Vi polysaccharide based conjugate vaccines (Vi-rEPA) against Salmonella Typhi Vi positive strains has shown high efficacy but may be ineffective against Vi negative S. Typhi. In this study, for the first time, we report the synthesis and evaluation of polysaccharide-protein conjugates of Vi negative S. Typhi as potential vaccine candidates. Four different conjugates were synthesized using recombinant exoprotein A of Pseudomonas aeruginosa (rEPA) and human serum albumin (HSA) as the carrier proteins, using either direct reductive amination or an intermediate linker molecule, adipic acid dihydrazide (ADH). Upon injection into mice, a significantly higher antibody titer was observed in mice administrated with conjugate-1 (OSP-HSA) (P=0.0001) and conjugate 2 (OSP-rEPA) (P≤0.0001) as compared to OSP alone. In contrast, the antibody titer elicited by conjugate 3 (OSPADH-HSA) and conjugate 4 (OSPADH-rEPA) were insignificant (P=0.1684 and P=0.3794, respectively). We conclude that reductive amination is the superior method to prepare the S. Typhi OSP glycoconjugate. Moreover, rEPA was a better carrier protein than HSA. Thus OSP-rEPA conjugate seems to be efficacious typhoid vaccines candidate, it may be evaluated further and recommended for the clinical trials.

IL-6 promotes CD4+ T-cell and B-cell activation during Plasmodium infection

Humoral immunity develops in the spleen during blood-stage Plasmodium infection. This elicits parasite-specific IgM and IgG, which control parasites and protect against malaria. Studies in mice have elucidated cells and molecules driving humoral immunity to Plasmodium, including CD4⁺ T cells, B cells, interleukin (IL)-21 and ICOS. IL-6, a cytokine readily detected in Plasmodium-infected mice and humans, is recognized in other systems as a driver of humoral immunity. Here, we examined the effect of infection-induced IL-6 on humoral immunity to Plasmodium. Using P. chabaudi chabaudi AS (PcAS) infection of wild-type and IL-6^-/- mice, we found that IL-6 helped to control parasites during primary infection. IL-6 promoted early production of parasite-specific IgM but not IgG. Notably, splenic CD138⁺ plasmablast development was more dependent on IL-6 than germinal centre (GC) B-cell differentiation. IL-6 also promoted ICOS expression by CD4⁺ T cells, as well as their localization close to splenic B cells, but was not required for early Tfh-cell development. Finally, IL-6 promoted parasite control, IgM and IgG production, GC B-cell development and ICOS expression by Tfh cells in a second model, Py17XNL infection. IL-6 promotes CD4⁺ T-cell activation and B-cell responses during blood-stage Plasmodium infection, which encourages parasite-specific antibody production.

Device-associated infections in a paediatric intensive care unit in Pakistan

This study assessed the effect of implementation of active infection control and surveillance on the occurrence of device-associated infections (DAIs) in a paediatric intensive care unit (PICU) from 2012 to 2015. There were 1378 patients, equating to 4632 patient-days, on the PICU, and 29 DAI episodes, giving an incidence rate of 2.1% and an incidence density rate of 6.26 per 1000 patient-days. The rates of central-line-associated bloodstream infections, ventilator-associated pneumonia and catheter-related urinary tract infections were 7/1000 central-line-days, 1.17/1000 ventilator-days and 0.24/1000 urinary-catheter-days, respectively. Despite the overall low rate of DAIs in the PICU, there was a relatively high rate of central-line-associated bloodstream infections.

Genetic variation in Fe toxicity tolerance is associated with the regulation of translocation and chelation of iron along with antioxidant defence in shoots of rice

Excess iron (Fe) is phytotoxic and causes reduced growth and productivity in rice. In this study we elucidated the mechanisms conferring differential tolerance to Fe-toxicity in rice seedlings. Excess Fe caused retardation in roots of both Pokkali and BRRI 51, but it caused no significant changes on growth parameters, Fe accumulation and OsIRT1 expression in shoots of Pokkali only compared with control plants. These results suggest that the Pokkali genotype does have mechanisms in shoots to withstand Fe toxicity. Pokkali maintained membrane stability and total soluble protein in shoots due to Fe toxicity, further confirming its ability to tolerate excess Fe. Furthermore, a significant decrease of Fe-chelate reductase activity and OsFRO1 expression in shoots of Pokkali suggests that limiting Fe accumulation is possibly regulated by Fe-reductase activity. Our extensive expression analysis on the expression pattern of three chelators (OsDMAS1, OsYSL15, OsYSL2 and OsFRDL1) showed no significant changes in expression in shoots of Pokkali due to Fe toxicity, whereas these genes were significantly upregulated under Fe-toxicity in sensitive BRRI 51. These results imply that regulation of Fe chelation in shoots of Pokkali contributes to its tolerance to Fe toxicity. Finally, increased catalase (CAT), peroxidase (POD), glutathione reductase (GR) and superoxide dismutase (SOD), along with elevated ascorbic acid, glutathione, cysteine, methionine and proline in shoots of Pokkali caused by Fe toxicity suggests that strong antioxidant defence protects rice plants from oxidative injury under Fe toxicity. Taking these results together, we propose that genetic variation in Fe-toxicity tolerance in rice is shoot based, and is mainly associated with the regulation of translocation and chelation of Fe together with elevated antioxidant metabolites in shoots.

Processable PMR-Type Polyimides: Process-Property Relationships, Curing Kinetics, and Thermooxidative Stability

The rheological and structural characteristics of polyimides with enhanced melt flow have been investigated. The polyimides were based on 2,3,3′,4′-biphenyltertracarboxylic dianhydride (PBDA) and a mixture of a diamine, 4,4′ (1,4-phenylene-bismethylene) bisaniline (BAX) and a triamine, 1,3,5-Tris (4-aminophenoxybenzene), TAB, where the amount of TAB was 4 and 8%. Melt viscosities of these polymers suggest that they are processable by resin infusion methods. Although curing occurs through the phenylethynyl endcap, the steric and electronic differences of the three amines results in different cure kinetics and heterogeneous crosslinking. This is manifested in multiple Tg values in the differential scanning calorimetry (DSC) scan of the cured samples. Rheological and DSC kinetic studies of the cure behavior indicate that the sample with 4% TAB cures more quickly than the system with 8% TAB and it has a lower activation energy (147 versus 185 kJ mole-1). Thermal gravimetric analysis (TGA) scans indicate that both TAB based samples are more thermally stable than PMR-15. The lower activation energy for 8% TAB, relative to 4% TAB (147.0 versus 170.2 kJ mole-1) suggests the additional branching present decreases the thermal stability.

Mental Health Systems Development in UAE

Background

This paper examines the historical development of mental health services in the UAE including formation of federal laws associated with mental health and ministerial decrees. It also discusses cultural considerations in mental health practice in a society that is highly pluralistic and populated mainly by foreigners. The sharia aspects of mental health are also addressed.

Aims

The aims of the paper are to familiarize readers in above areas and encourage further work in the area of mental health in UAE.

Methods

The research is based on literature review.

Results

All federal laws and ministerial decrees are listed and local cultural considerations and sharia laws discussed, as they are unique to his country and region.

Conclusion

Although mental health is traditionally neglected in this country it is developing very fast and it is essential to keep track of and encourage such growth for the benefit of consumers and mental health professionals.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Transfer of aflatoxins from naturally contaminated feed to milk of Nili-Ravi buffaloes fed a mycotoxin binder

The objectives of this study were to observe the extent of transfer of aflatoxin B1 in feed to the aflatoxin M1 metabolite in milk in Nili-Ravi buffaloes and to evaluate the efficacy of a commercial mycotoxin binder (Mycofix, Biomin Singapore) incorporated into feed to minimise this transfer. Multiparous animals (n = 28) were randomly distributed to four groups corresponding to two treatments each with two levels of aflatoxin B1. Individual animals were exposed to naturally contaminated feed providing a total of 1475 µg/day (Groups A and B) or 2950 µg/day (Groups C and D) of aflatoxin B1. Groups B and D were given 50 g of mycotoxin binder daily mixed with feed whereas Groups A and C were kept as controls. Feed samples were analysed by reverse phase high performance liquid chromatography for aflatoxin B1 and milk samples were evaluated by enzyme-linked immunosorbent assay for the liver metabolite aflatoxin M1. The mean value of total daily aflatoxin M1 excretion for animals fed 2950 µg/day of aflatoxin B1 (112.6 µg/day) was almost double (P < 0.001) than the excretion in buffaloes fed 1475 µg/day (62.2 µg/day). The mean daily concentration of aflatoxin M1 in milk of animals from both treatment groups supplemented with 50 g/day of mycotoxin binder was 76.5 µg/day, nearly 22 µg lower than those without binder at 98.3 µg/day (s.e.d. = 5.99: P < 0.01). The interaction of binder and treatment was not significant i.e. the 50 g/day of binder was able to sequester aflatoxin B1 with the same efficiency in groups fed with high and low concentrations of aflatoxin B1. Carry over was (3.44%) lower (P = 0.001) in animals supplemented with 50 g/day of mycotoxin binder than those fed no binder (4.60%). Thus buffaloes are highly efficient at transferring aflatoxins in feed to the aflatoxin M1 metabolite in milk, whereas mycotoxin binder is capable of alleviating without preventing this contamination risk.

Association between vasoactive-inotropic score and mortality in pediatric septic shock

OBJECTIVE

To assess the association between Vasoactive Inotrope Score (vis) and mortality in children with fluid-refractory septic shock.

METHODS

A retrospective chart review of 71 children (age 1 mo-16y) admitted with fluid-refractory septic shock in pediatric intensive care unit during a two year period was done. We divided our cohort into two groups viz High vasoactive inotrope score (Group-H) and Low-vasoactive inotrope score (Group-L) based on a cut-off value of 20.

RESULTS

73% of the children were in Group-L. The mortality rate was 44% and 100% in Group L and Group H, respectively.

CONCLUSIONS

High inotropic score in children with septic shock is associated with high mortality rate.

Modelling the increased frequency of extreme sea levels in the Ganges-Brahmaputra-Meghna delta due to sea level rise and other effects of climate change

Coastal flooding due to storm surge and high tides is a serious risk for inhabitants of the Ganges-Brahmaputra-Meghna (GBM) delta, as much of the land is close to sea level. Climate change could lead to large areas of land being subject to increased flooding, salinization and ultimate abandonment in West Bengal, India, and Bangladesh. IPCC 5th assessment modelling of sea level rise and estimates of subsidence rates from the EU IMPACT2C project suggest that sea level in the GBM delta region may rise by 0.63 to 0.88 m by 2090, with some studies suggesting this could be up to 0.5 m higher if potential substantial melting of the West Antarctic ice sheet is included. These sea level rise scenarios lead to increased frequency of high water coastal events. Any effect of climate change on the frequency and severity of storms can also have an effect on extreme sea levels. A shelf-sea model of the Bay of Bengal has been used to investigate how the combined effect of sea level rise and changes in other environmental conditions under climate change may alter the frequency of extreme sea level events for the period 1971 to 2099. The model was forced using atmospheric and oceanic boundary conditions derived from climate model projections and the future scenario increase in sea level was applied at its ocean boundary. The model results show an increased likelihood of extreme sea level events through the 21st century, with the frequency of events increasing greatly in the second half of the century: water levels that occurred at decadal time intervals under present-day model conditions occurred in most years by the middle of the 21st century and 3-15 times per year by 2100. The heights of the most extreme events tend to increase more in the first half of the century than the second. The modelled scenarios provide a case study of how sea level rise and other effects of climate change may combine to produce a greatly increased threat to life and property in the GBM delta by the end of this century.

Is malnutrition a risk factor of stroke?

Obesity is an established risk factor of stroke. Malnutrition in post-stroke period is common and can influence outcome. But malnutrition, though predicted, has not yet been established as a risk factor of stroke. This descriptive study was carried out in the Department of Neurology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka and Department of Neurology, Dhaka Medical College (DMC), from January 2009 to December 2010 to explore whether malnutrition is an independent risk factor of stroke. Nutritional status of 100 stroke patients and 100 healthy controls were assessed in this study. Anthropometric measurements including Body Mass Index (BMI), Triceps skin fold (TSF), Mid-arm circumference (MAC) and Arm-muscle circumference (AMC) were measured within 7 days of stroke. Haemoglobin and haematocrit percentage, serum iron and serum albumin were measured at the same time. No significant difference was observed regarding TSF thickness, MAC, AMC, mean Hb and mean albumin level between the stroke patients and the control group, although iron level was significantly lower in stroke group. Multiple logistic regressions analysis showed that increase in age, smoking and decreased serum iron level has a positive association with stroke. Malnutrition is, according to this study, not a significant risk factor of stroke and triceps skin fold (TSF) thickness, mid-arm circumference (MAC), arm-muscle circumference (AMC), hemoglobin and serum albumin are not appropriate predictor of stroke.

An additional strip of mesh minimizes hernia recurrence after laparoscopic totally extraperitoneal (TEP) inguinal hernia repair. An analysis of 490 cases over 10 years

AIM

The laparoscopic inguinal hernia repair has gained significant interest over the years as an alternative to the conventional open technique as a result of its faster recovery time, reduced postoperative pain and numbness. However the recurrence rates are in the order of 2.3% compared to the 1.3% quoted for the equivalent open approach. Much of these recurrences occur either caudal to the fold created in the mesh once in-situ or lateral to the border of the mesh. This technique aims to address both these areas of concern using an additional strip of mesh across the centre to brace the mesh and create a bolster to maintain mesh stability.

METHODS

The technique involves cutting a 2 cm strip from the 15x15 cm mesh which is laid length-ways over the remaining 13x15 cm mesh, keeping the longest dimension in the medial to lateral plane, and loosely tacked. The strip over hangs the lateral border of the mesh to control the lateral space. Recurrence rates were evaluated from a prospectively collected data series as well as outcomes collected from a questionnaire over a 10 year period between January 2001 and October 2011. Primary outcomes were confirmed hernia recurrence requiring surgical repair.

RESULTS

Four hundred ninety-one patients underwent laparoscopic totally extraperitoneal (TEP) hernia repair with outcomes including recurrence rates were retrospectively examined through a prospectively collected database. Subsequently 400 patients were sent a validated questionnaire. 246 responded (62% response rate). One recurrence (0.3%), which occurred 4 years after the original laparoscopic repair, was described across the series.

CONCLUSION

The use of the additional mesh strip potentially reduces TEP hernia recurrence rates beyond simply the benefits of the learning curve. Although, questionnaires are notoriously inaccurate, the value and consistency between both evaluation techniques suggests that this level of reduction is significant to warrant further prospective trials.