Identification of prevalent leachate percolation of municipal solid waste landfill: a case study in India

Landfill leachate forms when waste-inherent water and percolated rainfall transfer are highly toxic, corrosive, acidic, and full of environmental pollutants. The release of leachate from municipal solid waste (MSW) landfill sites poses a severe hazard to human health and aquatic life. This study examined the impact of leachate from Delhi's Ghazipur landfill on the nearby groundwater quality. Analysis of leachate samples was done to determine various parameters such as total dissolved solids (TDS), hardness, alkalinity, electrical conductivity, pH, BOD5, COD, nitrate, sulphate, chloride and iron, and presence of coliform bacteria. Significant dissolved elements (22,690-34,525 mg/L) were observed in the samples, indicated by the high conductivity value (1156-1405 mho/cm). However, a stable pH range (6.90-7.80) of leachate samples was observed due to high alkalinity concentrations between 2123 and 3256 mg/L. The inverse distance weighing (IDW) interpolation tool from QGIS 3.22.7 developed spatial interpolated models for each parameter across the Ghazipur area. The IDW interpolated graphs of various parameters over the whole study area confirmed these contaminations. In addition, leachate and groundwater samples were physio-chemically analyzed, and temporal fluctuation in landfill waste has also been studied. The temporal fluctuation results showed that when heat is produced, transmitted, and lost throughout the waste system, the maximum temperature position fluctuates over time. The findings of this study highlight the critical importance of landfill management in reducing groundwater contamination from MSW leachate.

Groundwater quality assessment using water quality index and principal component analysis in the Achnera block, Agra district, Uttar Pradesh, Northern India

The qualitative and quantitative assessment of groundwater is one of the important aspects for determining the suitability of potable water. Therefore, the present study has been performed to evaluate the groundwater quality for Achhnera block in the city of Taj, Agra, India, where groundwater is an important water resource. The groundwater samples, 50 in number were collected and analyzed for major ions along with some important trace element. This study has further investigated for the applicability of groundwater quality index (GWQI), and the principal component analysis (PCA) to mark out the major geochemical solutes responsible for origin and release of geochemical solutes into the groundwater. The results confirm that, majority of the collected groundwater samples were alkaline in nature. The variation of concentration of anions in collected groundwater samples were varied in the sequence as, HCO3- > Cl- > SO42- > F- while in contrast the sequence of cations in the groundwater as Na > Ca > Mg > K. The Piper diagram demonstrated the major hydro chemical facies which were found in groundwater (sodium bicarbonate or calcium chloride type). The plot of Schoellar diagram reconfirmed that the major cations were Na+ and Ca2+ ions, while in contrast; major anions were bicarbonates and chloride. The results showed water quality index mostly ranged between 105 and 185, hence, the study area fell in the category of unsuitable for drinking purpose category. The PCA showed pH, Na+, Ca2+, HCO3- and fluoride with strong loading, which pointed out geogenic source of fluoride contamination. Therefore, it was inferred that the groundwater of the contaminated areas must be treated and made potable before consumption. The outcomes of the present study will be helpful for the regulatory boards and policymaker for defining the actual impact and remediation goal.

A Systematic Review Evaluating the Efficacy, Immunogenicity and Safety of the Biosimilar FKB327 in Treating Rheumatoid Arthritis

Biosimilars are known to be pharmaceutical products which are very similar to a biologic drug. FKB327 is one such biosimilar of the drug Adalimumab which is prescribed in treating autoimmune diseases like Rheumatoid Arthritis. The aim of this review is to evaluate the efficacy, immunogenicity and safety of the drug FKB327 in treating patients with mild to moderate Rheumatoid Arthritis and compare the same with that of the drug Adalimumab. Two databases (PubMed and Cochrane Library) were used to screen relevant publications using pre-determined inclusion and exclusion criteria. Of the 12 studies found to be relevant, 3 were found to be eligible for the review. The data were extracted for the study characteristics, outcome measures, complications, and safety. The quality of the papers was assessed through Jadad scoring. Three (3) papers were reviewed in the study although there were limitations in reviewing efficacy as one of the papers lacked required data for efficacy. Efficacy was observed through ACR20 response and DAS28 score in the 24th week of all the three studies and immunogenicity was reviewed through the presence of Anti-drug antibody in patients after administration of both the drugs in same dosage. Safety was assessed through the development of complications after the administration of the drugs. The review concludes that there are similarities in efficacy, immunogenicity and safety between FKB327 but could not adequately prove the superiority of FKB327 over Adalimumab.

Variability of groundwater fluoride and its proportionate risk quantification via Monte Carlo simulation in rural and urban areas of Agra district, India

This study quantifies the groundwater fluoride contamination and assesses associated health risks in fluoride-prone areas of the city of Taj Mahal, Agra, India. The United States Environmental Protection Agency (USEPA) risk model and Monte Carlo Simulations were employed for the assessment. Result revealed that, among various rural and urban areas Pachgain Kheda exhibited the highest average fluoride concentration (5.20 mg/L), while Bagda showed the lowest (0.33 mg/L). Similarly, K.K. Nagar recorded 4.38 mg/L, and Dayalbagh had 1.35 mg/L. Both urban and rural areas exceeded the WHO-recommended limit of 1.5 mg/L, signifying significant public health implications. Health risk assessment indicated a notably elevated probability of non-carcinogenic risk from oral groundwater fluoride exposure in the rural Baroli Ahir block. Risk simulations highlighted that children faced the highest health risks, followed by teenagers and adults. Further, Monte Carlo simulation addressed uncertainties, emphasizing escalated risks for for children and teenagers. The Hazard Quotient (HQ) values for the 5th and 95th percentile in rural areas ranged from was 0.28-5.58 for children, 0.15-2.58 for teenager, and 0.05-0.58 for adults. In urban areas, from the range was 0.53 to 5.26 for children, 0.27 to 2.41 for teenagers, and 0.1 to 0.53 for adults. Physiological and exposure variations rendered children and teenagers more susceptible. According to the mathematical model, calculations for the non-cancerous risk of drinking water (HQ-ing), the most significant parameters in all the targeted groups of rural areas were concentration (CW) and Ingestion rate (IR). These findings hold relevance for policymakers and regulatory boards in understanding the actual impact and setting pre-remediation goals.

How Did Mortality Rates from Covid-19 Differ between Vaccinated and Unvaccinated People in a Tertiary Level Hospital of Bangladesh?

This study aims to find out the difference in mortality rates between vaccinated & non-vaccinated Covid-19 positive patients who were admitted in a tertiary centre (Ward and Intensive care unit) of Bangladesh. Retrospective analysis of data over 6 weeks in February 2022- March 2022, 100 confirmed Covid-19 positive patients were included- 50 patients from ICU and 50 patients from ward irrespective of age, gender, vaccination status and co-morbidities. Seventy five percent (75.0%) of all confirmed Covid-19 positive patients were vaccinated. Mortality among vaccinated people was less compared to non-vaccinated population 41.3% vs. 52%. Interestingly it was found pregnancy was the most significant risk factor in childbearing age female group- 86.7% of patients (pregnant and peripartum) required Intensive care admission and mortality was 40.0% although none of them had any recorded co-morbidities. Again, mortality among vaccinated was significantly less (35.7%) compared to 100.0% mortality among unvaccinated. Mortality rate among patient admitted in intensive care was significantly high compared to patients treated in ward- 72.0% vs. 16.0%. In ICU 83.0% of patients who died were vaccinated (90.0% had 2 doses and 10.0% had 3 doses). On the other hand, 87.5% who died in ward were unvaccinated. Among the survivors from intensive care units- 93.0% were vaccinated compared to 7.0% unvaccinated. Pre-existing co-morbidities increased mortality (59.0%) compared to 40.9% mortality in patients without any previous medical conditions. We found vaccination against Covid-19 reduces the rate of death irrespective of co-morbidities or severity of disease. Recovery rate was significantly increased in vaccinated patients requiring intensive care support. Pregnancy was found to be the most important risk factor for Intensive care admission and mortality in otherwise healthy childbearing age females and mortality was significantly high (100.0% though limited data availability) in unvaccinated. These results require further revalidation on larger population.

An Observational Study of Fixed Drug Eruption in A Tertiary Care Hospital in Bangladesh

Fixed drug eruption (FDE) is a distinctive pattern of cutaneous adverse drug reaction. Characteristically the eruption recurs at the same site on re exposure to the offending agent. Aim of this study was to evaluate and identification of the various offending drugs causing FDE which may help the physician to limit the associate complication regarding the drug. This observational cross sectional study was conducted from 1st June 2021 to 31st May 2022 in the department of Dermatology & Venereology of Mymensingh Medical College Hospital after taking approval from institutional ethical committee. A detailed history with clinical evaluation were done for all patients with FDE and thereby recorded in a pre designed proforma. Analysis of data was done using Microsoft Excel 2010 Spread sheet. Out of 65 cases 36(55.38%) were male and 29(44.6%) were female. Majority of cases were found in the age group of 31 to 40 years. The most common group of drug causing FDE was NSAID (52.31%) followed by antimicrobials (44.61%) and anti epileptics (3.07%). Ibuprofen (20.0%) was the most common offending drug followed by doxycycline (18.46%), diclofenac and fluconazole (13.84%), naproxen (9.23%), ciprofloxacin (7.69%), paracetamol (6.15%), metronidazole (4.61%), carbamazepine (3.07%) and aspirin (3.07%) respectively. Extremities (43.07%) were the most frequently involved site followed by trunk (29.23%) and face (10.77%). Generalized FDE found in 16.92% cases. Although FDE are very common the offending drugs show some regional variation as a result of changing trends of pharmacotherapy.

Seroprevalence of SARS-CoV-2 antibodies among Forcibly Displaced Myanmar Nationals in Cox's Bazar, Bangladesh 2020: a population-based cross-sectional study

OBJECTIVES

The study aimed to determine the seroprevalence, the fraction of asymptomatic infections, and risk factors of SARS-CoV-2 infections among the Forcibly Displaced Myanmar Nationals (FDMNs).

DESIGN

It was a population-based two-stage cross-sectional study at the level of households.

SETTING

The study was conducted in December 2020 among household members of the FDMN population living in the 34 camps of Ukhia and Teknaf Upazila of Cox's Bazar district in Bangladesh.

PARTICIPANTS

Among 860 697 FDMNs residing in 187 517 households, 3446 were recruited for the study. One individual aged 1 year or older was randomly selected from each targeted household.

PRIMARY AND SECONDARY OUTCOME MEASURES

Blood samples from respondents were tested for total antibodies for SARS-CoV-2 using Wantai ELISA kits, and later positive samples were validated by Kantaro kits.

RESULTS

More than half (55.3%) of the respondents were females, aged 23 median (IQR 14-35) years and more than half (58.4%) had no formal education. Overall, 2090 of 3446 study participants tested positive for SARS-CoV-2 antibody. The weighted and test adjusted seroprevalence (95% CI) was 48.3% (45.3% to 51.4%), which did not differ by the sexes. Children (aged 1-17 years) had a significantly lower seroprevalence 38.6% (95% CI 33.8% to 43.4%) compared with adults (58.1%, 95% CI 55.2% to 61.1%). Almost half (45.7%, 95% CI 41.9% to 49.5%) of seropositive individuals reported no relevant symptoms since March 2020. Antibody seroprevalence was higher in those with any comorbidity (57.8%, 95% CI 50.4% to 64.5%) than those without (47.2%, 95% CI 43.9% to 50.4%). Multivariate logistic regression analysis of all subjects identified increasing age and education as risk factors for seropositivity. In children (≤17 years), only age was significantly associated with the infection.

CONCLUSIONS

In December 2020, about half of the FDMNs had antibodies against SARS-CoV-2, including those who reported no history of symptoms. Periodic serosurveys are necessary to recommend appropriate public health measures to limit transmission.

Coping strategies and barriers to coping in climate- vulnerable Bangladesh: a qualitative study

 

With the mental wellbeing of billions of people at risk due to climate change, more research is required to better understand mental health and psychological implications of climate vulnerability. This research contributes to understanding how people in climate vulnerable populations psychologically cope with stress with crucial implications for adaptation efforts. We conducted n = 60 qualitative in-depth interviews with men and women in Bhola, Bangladesh to elicit the lived experiences of a climate vulnerable population. We analysed data following the tenets of Grounded Theory. Through our inductive analysis, we found coping strategies where participants highlighted what they did when encountering stress, such as ‘Resignation’ or ‘Help Seeking'. Barriers to coping were, among others, limited ‘Efficacy', ‘Time’ or ‘Stigma'. We categorized coping strategies with barriers as high-barrier coping strategies and, those without reported barriers, as low- barrier coping strategies. High-barriers restricted participants - especially women - in their coping efforts and led them to using low-barrier coping strategies. Some low-barrier coping strategies can be interpreted as maladaptive if used frequently, as they are unhealthy and draw upon resources needed to adapt for the future. Maladaptive coping strategies can thus impede long-term adaptation by reducing motivation and the ability and willingness to act. To enable adaptive coping, we recommend lifting the barriers to coping through community-led interventions where community workers create platforms for sharing problems and knowledge, such as group support meetings. Sharing and discussing could strengthen efficacy and open new opportunities for functional, adaptive coping. As the negative impacts of climate change will be felt globally with more intensity and frequency, enabling adaptive coping and removing barriers to coping in frontline communities will be essential to supporting physical and mental wellbeing.

Key messages

• Barriers to adaptive coping strategies can lead people to using maladaptive low-barrier coping strategies, which draw upon resources needed for long-term adaptation.

• Enabling adaptive coping by lifting barriers to coping in climate vulnerable populations is crucial to strengthen adaptation efforts.

P-109 A RETROSPECTIVE AUDIT OF THE DEPARTMENTAL USE OF PROPHYLACTIC ANTIBIOTICS IN ELECTIVE VENTRAL HERNIA SURGERY AS COMPARED TO NATIONAL AND INTERNATIONAL GUIDELINES

The routine use of prophylactic antibiotics for the prevention of surgical site infection is no longer recommended in all types of elective ventral hernia repairs, according to national and international guidelines.NICE recommends that prophylactic antibiotics are given only in clean surgeries that involve the use of a prothesis or implant. The British Hernia Society and European Hernia Society state that there is no indication for antibiotic prophylaxis in both open and laparoscopic elective groin hernia repairs with mesh in patients that are healthy and considered low risk for surgical site infection.

This is a retrospective audit of patients who underwent elective ventral hernia repairs at Ealing Hospital between June 2021 and December 2021 to assess the compliance of antibiotic prophylaxis with the current guidelines.

Forty-nine patients underwent elective ventral hernia repair, of which 44 was with the use of a mesh.Thirty-five of these cases (79.5%) received prophylactic antibiotics. All cases that underwent laparoscopic hernia repair received prophylactic antibiotics. Five cases underwent an elective open ventral hernia repair without a mesh.Three cases who were considered low risk received prophylactic antibiotics.

In conclusion, majority of patients along with those who were considered high risk received prophylactic antibiotics, which is compliant with guidelines. However, patients who did not have a mesh repair, or were not considered high risk also received prophylactic antibiotics.It would be useful to improve the awareness of the guidelines by creating clear local guidelines and improving documentation of reasons to give antibiotics against the recommendations.

TIMo—A Dataset for Indoor Building Monitoring with a Time-of-Flight Camera

We present TIMo (Time-of-flight Indoor Monitoring), a dataset for video-based monitoring of indoor spaces captured using a time-of-flight (ToF) camera. The resulting depth videos feature people performing a set of different predefined actions, for which we provide detailed annotations. Person detection for people counting and anomaly detection are the two targeted applications. Most existing surveillance video datasets provide either grayscale or RGB videos. Depth information, on the other hand, is still a rarity in this class of datasets in spite of being popular and much more common in other research fields within computer vision. Our dataset addresses this gap in the landscape of surveillance video datasets. The recordings took place at two different locations with the ToF camera set up either in a top-down or a tilted perspective on the scene. Moreover, we provide experimental evaluation results from baseline algorithms.

Direct measurement of nanoscale filamentary hot spots in resistive memory devices

Resistive random access memory (RRAM) is an important candidate for both digital, high-density data storage and for analog, neuromorphic computing. RRAM operation relies on the formation and rupture of nanoscale conductive filaments that carry enormous current densities and whose behavior lies at the heart of this technology. Here, we directly measure the temperature of these filaments in realistic RRAM with nanoscale resolution using scanning thermal microscopy. We use both conventional metal and ultrathin graphene electrodes, which enable the most thermally intimate measurement to date. Filaments can reach 1300°C during steady-state operation, but electrode temperatures seldom exceed 350°C because of thermal interface resistance. These results reveal the importance of thermal engineering for nanoscale RRAM toward ultradense data storage or neuromorphic operation.

184 Group and Save Studies Prior to Appendicectomy

Aim

Group and save studies prior to appendicectomy

Method

219 appendicectomy cases from Jan 2018 until Dec 2020. This was to look for whether patients had a blood transfusion post appendicectomy. Whether this was cost effective?

Results

19/219 did not have G and S studies performed. None of the patients required a blood transfusion post operatively. Price per bottle £20

Conclusions

Based on the above results we referred to the study performed by the RCS

Royal College of Surgeons did a study on ‘blood group and antibody screening prior to emergency laparoscopy’. Study included 562 cases. Concluded that routine G&S studies are not required and ‘majority of patients had a low risk of major intraoperative haemorrhage’ and thus G&S was not warranted O –ve blood can be used in cases of acute haemorrhage from major vessel injury Time taken to receive O neg blood = minutes.

188 Quality of Documentation of Patient Notes in the Surgical Department

Aim

Quality of documentation of patient notes

Method

Guidance for standards was taken from ‘The importance of Clinical Documentation, Ann R Coll Surg Engl(Suppl) 2014; 96:18–20’

Data of 100 patients over 2 weeks. Assessed:

Results

Availability of notes:

15/100 notes were not available on the wards at the time of data collection

Conclusions

Based on above results the significances of:

Results

Unable to provide proof of treatment if any abnormalities were found and medical negligence

263 Tuberculosis of the Bile Duct: A Rare Cause of Obstructive Jaundice

Tuberculosis (TB) is a very rare cause of biliary stricture that is difficult to diagnose and usually requires surgical intervention in order to rule out underlying malignant etiology. A 28-years old woman with obstructive jaundice, who was originally thought to have cholangio-carcinoma. Diagnosis of tuberculosis was made on PCR testing of bile. Patient was started on antitubercular treatment, and she responded well. This case presented a rare case of common bile duct stricture due to biliary tuberculosis. This is an important condition to diagnose because early recognition with prompt treatment results in complete resolution. Even though biliary tuberculosis is a rare cause of obstructive jaundice, in endemic areas, it should be considered as a differential diagnosis and investigated, as it can be potentially curable.

262 Full Cycle Audit on Definitive Management of Biliary Pancreatitis

Aim

To reaudit the practice of definitive management of gall stones pancreatitis in our trust for the period of 1st May-31st October and compare the result with previous one (1st June 2019–31st Dec 2019).

Method

It was a retrospective collection of data of patients admitted to our trust with biliary pancreatitis. Electronic notes, PACS for US report, Electronic discharge summary and Operative notes analysed.

Results

We identified 4 patients admitted with biliary pancreatitis during the re-audit period. US report was checked for confirmation of diagnosis of gall stones. The EDN was checked for date for Laparoscopic cholecystectomy. Unfortunately, none of them had their procedure time in 2 weeks’ time of their diagnosis. The reason behind this was because of COVID-19 pandemic, we were backlogging with our elective list. All the patients eventually underwent their procedure, but not in 2 weeks’ time as per the guidelines. All suitable patients had their cholecystectomy in a timely manner during first audit. None had it in timely manner during second audit.

Conclusions

Early Laparoscopic cholecystectomy for simple gallstone pancreatitis prevents life threatening Pancreatitis and readmissions.

The UK guidelines on management of pancreatitis issued by British society guidelines (BSG) states that all mild gall stones pancreatitis should have definitive management of lithiasis on the same admission or within 2 weeks (Recommendation B). In our practice, all our suitable patients during first audit had timely Laparoscopic cholecystectomy, however, no one had it in timely manner on the next audit for COVID-19 pandemic.

274 Peri-Operative Communication with Next of Kin (NOK) for Patients Receiving Laparotomies: A Complete Audit Loop with an Educational intervention

Aim

NICE Clinical Guidelines (CG138) specify the importance of involvement of family members and carers at key patient care junctures. Furthermore, published literature and our own experience reaffirm that ‘low-quality communication causes profound distress to families that can affect the quality of dying and bereavement'. There is little evidence on NOK’s experience for surgical patients, so we sought to assess whether NOK details were available and whether they had been contacted peri-operatively for patients receiving laparotomies.

Method

We performed a closed loop audit using NELA database to identify patients admitted for laparotomies between February 1st to July 31st, 2021. The initial data was collated, analysed, and presented during educational meetings with informal reminders for a week to implement changes. Thereafter, data was collected to complete the audit cycle on communication with NOK.

Results

A total of 70 patients were included. Prior to the implementation, 86% of patients undergoing laparotomies had NOK information documented in clinical records, with only 75% of telephone numbers reachable and 33% had documented evidence of contact within 48 hours post-operation. Post-implementation, 97% of patients had their NOK information in their clinical records, with 97% telephone numbers reachable and 41% had documented evidence of contact with 48hours.

Conclusions

The importance of clerical staff and clerking doctors establishing NOK’s details, documenting these within iCare/notes and establishing whether patient are happy with NOK being contacted for updates on patient management, could reduce distress and potentially improve the experiences of hospital admission, recovery and in some cases, bereavement.

Assessment of hygienic and sanitation practices among poultry butchers in selected Municipality areas of Assam (India)

A study was conducted in Dhubri and Biswanath Chariali Municipality areas to assess the adoption of hygienic and sanitation practices being followed by poultry butchers. A total of 60 poultry butchers were selected randomly, 30 from each Municipality area so that the final sample consisted of 60 poultry butchers. Data were collected using a pre-tested structured interview schedule by personal interviews. The schedule was designed to collect information on the socioeconomic profile of the butchers, personal and meat shop hygiene, maintenance of meat shop and its equipment. The data revealed that all the poultry butchers were male among which (75%) of them had an education level only up to eight standard. The overall mean age of the poultry butchers was found to be 39.95±8.64 years of which majority (75%) of them belong to middle age group. The present study indicated that none of the poultry butchers underwent any formal training for hygienic meat handling. It was also pointed out that most (85%) of the butcheries were located at market area, while only a few (15%) were found in the residential area. Only 18.33 per cent of the poultry butchers wore clean clothes while 81.67 per cent of them did not adopt this practice during working. Majority (88.33%) of them did not wash their hands after smoking/ chewing tobacco.It was also revealed that majority (88.33%) of the butchers did not clean knives before and after cutting of meat. Majority of the butchers agreed that cleanliness of equipment (71.67%), the meat shop and its surrounding (68.33%) and personal hygiene (68.33%) were some of the important factors that were essential to ensure wholesome meat production. From the above study, it may be concluded that appropriate interventional measures by the concerned agencies such as awareness trainings for poultry butchers on crucial areas of food safety, hygienic practices relating to meat handling and personal safety are imperative. The results of the study also shed light on the need for measures to improve the infrastructural facilities in poultry meat butcheries and for appropriate interventions to strengthen the food quality control system by the government regulatory authorities.

Metallic boro-carbides of A2BC (A = Ti, Zr, Hf and W): a comprehensive theoretical study for thermo-mechanical and optoelectronic applications

The Ti2BC reflectivity spectra never fall below 53% in the 0 to 10.3 eV photon range, showing as a coating material to reduce solar heating. The W2BC has a Vickers hardness of ∼36 GPa with ductility, showing potential for hard coating application.

Contagion or interdependence? Comparing spillover indices

We propose a novel risk measure that is built on comparing high-frequency time-varying volatility and low-frequency return spillover estimates. This measure permits to identify the markets that are epidemic in their complex interdependence. We conjecture that initially a highly volatile market experiences episodes of risk transmission, but only later absorbs risk and becomes an epidemic market. Moreover, we can detect newly emerging 'contagion' in the system. We examine the behaviour of 30 global equity markets and compare spillover measures, which encapsulate many large and small crises episodes. Instead of relying on ex post crisis information, our model identifies crises periods. An important implication of the proposed approach is that highly interrelated markets, such as China, are less likely to transmit a global economic crisis under the current interdependence setting.

Ultralow-switching current density multilevel phase-change memory on a flexible substrate

[Figure: see text].

Potential Drugs for the Treatment of COVID-19: Synthesis, Brief History and Application

Coronaviruses (CoVs) belonging to the Betacoronavirus group, an unusually large RNA genome, are characterized by club-like spikes that project from their surface. An outbreak of a novel coronavirus 2019 (nCOVID-19) showing a unique replication strategy and infection has posed a significant threat to international health and the economy around the globe. Scientists around the world are investigating few previously used clinical drugs for the treatment of COVID-19. This review provides synthesis and mode of action of recently investigated drugs like Chloroquine, Hydroxychloroquine, Ivermectin, Selamectin, Remdesivir, Baricitinib, Darunavir, Favipiravir, Lopinavir/ritonavir and Mefloquine hydrochloride that constitute an option for COVID-19 treatment.

946 Introduction: Closed Loop Audit Looking at How We Are Complying with Paediatric Supracondylar Fracture (BOAST 11) Management; Results Compared With 2018 To 2019 (Full Cycle)

Background

Supracondylar fractures. Most common childhood elbow fracture. Can be difficult to manage. Risk of significant complications

Method

Results

• NV documentation, 2018:2019, Improved (36%à45%), Inadequate (45%) in comparison to BOAST guideline.

Night ops

• Appropriate as per BOAST guideline

Surgical technique

Conclusions

Recommendations:

743 Inflammatory Pseudotumor (IPT) Of the Liver, A Diagnostic Dilemma with Therapeutic Uncertainty in A cohort of Bangladeshi patients (Observational Cohort Study)

Background

IPT a benign lesion seldom encountered in clinical practice. It’s mysterious in origin & remains ambiguous.Infection, stone,autoimmune disease,systemic inflammatory response,trauma,foreign body and neoplasm attributes to etiological factors.Advanced imaging modalities help in increased detection of focal liver lesion.

Aim

Method

Retrospective observational cohort study.

Results

14 male & 19 female were studied, mostly in 3rd decade of life. Clinically only 21% of them presented with fever.In 24 patients the lesions were located in left lobe of liver.The operative procedures were: wedge resection in 3 patients,limited resection in 5 patients,Left Hepatectomy 7 patients,Left lateral hepatic segmentectomy in 17 patients, right hepatectomy in 2 patients & central hepatectomy in 1 patient. 8patients required bilioenteric anastomosis as additional procedure.Histopathological study revealed Tuberculosis in 7 patients(21.21%),fungal granuloma in 3 patients, foreign body granuloma in 3 patients, Ductal calculi with abscess in 9 patients and idiopathic in 7 patients.

Conclusions

IPT of liver represents a rare entity usually mistaken as malignant lesion.Despite the low prevalence, it often creates a diagnostic dilemma resulting into therapeutic uncertainty.

950 Experience of Inguinal Mesh Hernioplasty Under Local Anaesthesia: A 3-Year Experience in A Teaching Hospital

Objective

To prove Inguinal mesh hernioplasty under L/A is safe and acceptable. Helps with post-operative pain and enables rapid recovery as a day case.

Method

All patients who underwent inguinal hernia repair under local anaesthesia were retrospectively analysed in our hospital between July 2014- July 2017. Clinical judgement was used for inclusion and exclusion parameters.

Results

From July 2014- July 2017, 260 patients were included in study who underwent Inguinal mesh hernioplasty under L/A. ASA grade for all patients ranged between I-III. The mean age was 37 (20-65). Intraoperatively (9.1) 3.5% patients had problems such as pain, hypotension or sweating. About (86.3%) 224 patients were discharged home the same day and remaining stayed overnight for less than 24 hours. Hematoma was seen in 5 (1.92%) patients, Urinary retention in 2 (0.7%) patients, Wound infection seen in 24(9.2%) patients, Readmission in 10 (3.8%) patients. Chronic groin pain was seen in 10 (3.9%) patients and no recurrence on 6 months follow up.

Conclusions

Our results showed that this procedure is feasible under L/A and can be performed safely. It showed satisfactory acceptance by the operating surgeon and patient, without significant perioperative issues. It is reliable and showed shorter hospital stay.

957 Comparison of Inguinodynia In Patients Undergoing Prophylactic Ilioinguinal Neurectomy vs No Neurectomy In Lichtenstein Mesh Hernioplasty

Objective

The objective of this study is to compare the frequency of inguinodynia in ilioinguinal neurectomy VS no neurectomy in patients undergoing Lichtenstein mesh hernioplasty.

Method

200 male patients with unilateral, primary, reducible inguinal hernia were randomly distributed in to two groups by using lottery method to undergo Lichtenstein’s hernia repair i.e., with and without ilioinguinal neurectomy. All the operation were carried out under local anesthesia. Pain score was calculated using the VAS system at 3rd month and inguinodynia was labelled if it is more than 1 on VAS scale.

Results

200 male patients with mean age of 53.25 ± 6.768 were included. 42 (21%) had Inguinodynia after surgery. When we cross tabulated both groups with inguinodynia, results came up significant (p = 0.001). In neurectomy group 10 patients had inguinodynia while in no neurectomy group, 32 patients were having Inguinodynia. There was no effect of malnutrition on outcome. Younger age group benefitted more from procedure.

Conclusions

It is concluded that there is difference in frequency of inguinodynia in ilioinguinal neurectomy versus no neurectomy in patients undergoing Lichtenstein hernia repair. Patients with ilioinguinal neurectomy had reduced incidence of inguinodynia.

677 Incidental Diagnosis of Metastatic Prostate Cancer by Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA) In the Absence of Pelvic Lymphadenopathy

Metastasis pattern of prostate cancer varies widely; however, predominant affinity is towards regional lymph nodes. Mediastinal lymphadenopathy as the initial presentation, in absence of any pelvic lymph node involvement, remains extremely rare. Most patients are incidentally diagnosed and often have widespread metastatic disease on confirmation of diagnosis. A high index of clinical suspicion is necessary and routine clinical examination such as a digital rectal examination (DRE) can aid in earlier diagnosis and prompt clinical intervention can improve disease outcome. We present this case study of a 53-year-old patient who was incidentally diagnosed with metastatic adenocarcinoma of prostatic origin by TBUS-EBNA of hilar lymph nodes in the absence of pelvic lymphadenopathy.

High-Performance p-n Junction Transition Metal Dichalcogenide Photovoltaic Cells Enabled by MoOx Doping and Passivation

Layered semiconducting transition metal dichalcogenides (TMDs) are promising materials for high-specific-power photovoltaics due to their excellent optoelectronic properties. However, in practice, contacts to TMDs have poor charge carrier selectivity, while imperfect surfaces cause recombination, leading to a low open-circuit voltage (V_OC) and therefore limited power conversion efficiency (PCE) in TMD photovoltaics. Here, we simultaneously address these fundamental issues with a simple MoO_x (x ≈ 3) surface charge-transfer doping and passivation method, applying it to multilayer tungsten disulfide (WS₂) Schottky-junction solar cells with initially near-zero V_OC. Doping and passivation turn these into lateral p-n junction photovoltaic cells with a record V_OC of 681 mV under AM 1.5G illumination, the highest among all p-n junction TMD solar cells with a practical design. The enhanced V_OC also leads to record PCE in ultrathin (<90 nm) WS₂ photovoltaics. This easily scalable doping and passivation scheme is expected to enable further advances in TMD electronics and optoelectronics.

Fetomaternal Outcome of Pregnancy in Women with Tetralogy of Fallot

This prospective study was done to determine fetomaternal outcomes of pregnancy in women with Tetralogy of Fallot (TOF) and carried out in two centres especially in the care of patients with adult congenital heart disease (CHD) from January 2005 to December 2009. Clinical, haemodynamic and obstetric data were reviewed for pregnant women with TOF. Ten (10) pregnant women were identified in the age range 18 to 47 years. Most of the patients were in the age group of 18 to 27 years, 34 to 36 weeks gestational age (in week) and primi gravida (60%). Right-sided aortic arch (20%) and major anomalies of pulmonary collaterals (30%) were common anomalies anatomical association. Normal vaginal delivery was the mode of delivery (70%) in the majority of the patients. Spontaneous abortions were occurred in 3(30%) patients. Primary maternal cardiac events complicating pregnancies were congestive heart failure (20%), arrhythmias and cardiovascular events (10%). Premature labor (40%) was the most common obstetric complication. Premature birth (40%), fetal demise (20%), neonatal death (10%) and cardiac anomaly at birth (10%) were the offspring complications in the study. Women with TOF can go through pregnancy with a low risk to themselves with frequent treatable complications, but there is a high incidence of miscarriage, premature births and low birth weight. An incidence of congenital anomaly in the fetus is higher than that found in the normal population.

Biological Applications of Isoniazid Derived Schiff Base Complexes: An Overview

Antibiotic resistance has been growing at an alarming rate and consequently the activity of antibiotics against Gram-negative and Gram-positive bacteria has dropped dramatically day by day. In this sense there is a strong need to synthesis new substances that not only have good field of activity, but having new appliances of action. Inorganic compounds particularly metal complexes have played a significant role in the development of new metal based drugs. Like few compounds, isonicotinic acid hydrazide (Isoniazid INH) is well known as first-line anti-tuberculosis (TB) drug to treat TB infection worldwide for more than 60 years. Unfortunately, people are only dependent on this drug and consequently, the rate of use of this drug has been increasing day by day. As the bacterial strains resistant to isoniazid are getting same for the long-term extensive use and even abuse so there is an urgent need to synthesis new drugs not only for anti-tuberculosis properties but also for having significant activity in various biological areas with mechanisms of action. Isoniazid derivatives and their metal complexes, particularly medicinal inorganic metal complexes have been considered as new drugs for their antimicrobial activities like anti-bacterial, anti-fungal, anti-tuberculosis, DNA binding, antioxidant, cytotoxic, scavenging and antiviral activities. In this review, we have focused on the various synthesized metal complexes of isoniazid and its hydrazones and have compared their biological activities which are more or less strong against microorganisms. It is found that INH has moderate to strong antimicrobial activity.

Genetic diversity and population structure in multiple Chinese goat populations using a SNP panel

Information about genetic diversity and population structure among goat breeds is essential for genetic improvement, understanding of environmental adaptation as well as utilization and conservation of goat breeds. Here, we measured genetic diversity and population structure in multiple Chinese goat populations, namely, Nanjiang, Qinggeda, Arbas Cashmere, Jining Grey, Luoping Yellow and Guangfeng goats. A total of 193 individuals were genotyped for about 47 401 autosomal single nucleotide polymorphisms (SNPs). We found a high proportion of informative SNPs, ranging from 69.5% in the Luoping Yellow to 93.9% in the Jining Grey goat breeds with an average mean of 84.7%. Diversity, as measured by expected heterozygosity, ranged from 0.371 in Luoping Yellow to 0.405 in Jining Grey goat populations. The average estimated pair-wise genetic differentiation (F_ST ) among the populations was 8.6%, ranging from 0.2% to 16% and indicating low to moderate genetic differentiation. Principal component analysis, genetic structure and phylogenetic tree analysis revealed a clustering of six Chinese goat populations according to geographic distribution. The results from this study can contribute valuable genetic information and can properly assist with within-breed diversity, which provides a good opportunity for sustainable utilization of and maintenance of genetic resource improvements in the Chinese goat populations.

The direct and indirect effects of kisspeptin-54 on granulosa lutein cell function

STUDY QUESTION

What are the in vivo and in vitro actions of kisspeptin-54 on the expression of genes involved in ovarian reproductive function, steroidogenesis and ovarian hyperstimulation syndrome (OHSS) in granulosa lutein (GL) cells when compared with traditional triggers of oocyte maturation?

SUMMARY ANSWER

The use of kisspeptin-54 as an oocyte maturation trigger augmented expression of genes involved in ovarian steroidogenesis in human GL cells including, FSH receptor (FSHR), LH/hCG receptor (LHCGR), steroid acute regulatory protein (STAR), aromatase, estrogen receptors alpha and beta (ESR1, ESR2), 3-beta-hydroxysteroid dehydrogenase type 2 (3BHSD2) and inhibin A (INHBA), when compared to traditional maturation triggers, but did not alter markers of OHSS.

WHAT IS KNOWN ALREADY

hCG is the most widely used trigger of oocyte maturation, but is associated with an increased risk of OHSS. The use of GnRH agonists to trigger oocyte maturation is a safer alternative to hCG. More recently, kisspeptin-54 has emerged as a novel therapeutic option that safely triggers oocyte maturation even in women at high risk of OHSS. Kisspeptin indirectly stimulates gonadotropin secretion by acting on hypothalamic GnRH neurons. Kisspeptin and its receptor are also expressed in the human ovary, but there is limited data on the direct action of kisspeptin on the ovary.

STUDY DESIGN SIZE, DURATION

Forty-eight women undergoing IVF treatment for infertility consented to kisspeptin-54 triggering and/or granulosa cell collection and were included in the study. Twelve women received hCG, 12 received GnRH agonist and 24 received kisspeptin-54 to trigger oocyte maturation. In the kisspeptin-54 group, 12 received one injection of kisseptin-54 (9.6 nmol/kg) and 12 received two injections of kisspeptin-54 at a 10 h interval (9.6 nmol/kg × 2).

PARTICIPANTS/MATERIALS, SETTING, METHODS

Follicular fluid was aspirated and pooled from follicles during the retrieval of oocytes for IVF/ICSI. GL cells were isolated and either RNA extracted immediately or cultured in vitro ± kisspeptin or hCG.

MAIN RESULTS AND THE ROLE OF CHANCE

GL cells from women who had received kisspeptin-54 had a 14-fold and 8-fold higher gene expression of FSHR and a 2-fold (ns) and 2.5-fold (P < 0.05) higher expression of LHCGR than GL cells from women who had received hCG or GnRH agonist, respectively. CYP19A1 expression was 3.6-fold (P < 0.05) and 4.5-fold (P < 0.05) higher, STAR expression was 3.4-fold (P < 0.01) and 1.8-fold (P < 0.05) higher, HSD3B2 expression was 7.5- (P < 0.01) and 2.5-fold higher (P < 0.05), INHBA was 2.5-fold (P < 0.01) and 2.5-fold (P < 0.01) higher in GL cells from women who had received kisspeptin-54 than hCG or GnRHa, respectively. ESR1 (P < 0.05) and ESR2 (P < 0.05) both showed 3-fold higher expression in cells from kisspeptin treated than GnRHa treated women. Markers of vascular permeability and oocyte growth factors were unchanged (VEGFA, SERPINF1, CDH5, amphiregulin, epiregulin). Gene expression of kisspeptin receptor was unchanged. Whereas treating GL cells in vitro with hCG induced steroidogenic gene expression, kisspeptin-54 had no significant direct effects on either OHSS genes or steroidogenic genes.

LIMITATIONS REASONS FOR CAUTION

Most women in the study had PCOS, which may limit applicability to other patient groups. For the analysis of the in vitro effects of kisspeptin-54, it is important to note that GL cells had already been exposed in vivo to an alternate maturation trigger.

WIDER IMPLICATIONS OF THE FINDINGS

The profile of serum gonadotropins seen with kisspeptin administration compared to other triggers more closely resemble that of the natural cycle as compared with hCG. Thus, kisspeptin could potentially permit an ovarian environment augmented for steroidogenesis, in particular progesterone synthesis, which is required for embryo implantation.

STUDY FUNDING/COMPETING INTEREST(S)

Dr Owens is supported by an Imperial College London PhD Scholarship. Dr Abbara is supported by an National Institute of Health Research Academic Clinical Lectureship. The authors do not have any conflict of interest to declare.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov NCT01667406.

Clinical parameters of ovarian hyperstimulation syndrome following different hormonal triggers of oocyte maturation in IVF treatment

OBJECTIVE

Ovarian hyperstimulation syndrome (OHSS) is a serious iatrogenic condition, predominantly related to the hormone used to induce oocyte maturation during IVF treatment. Kisspeptin is a hypothalamic neuropeptide that has recently been demonstrated to safely trigger final oocyte maturation during IVF treatment even in women at high risk of OHSS. However, to date, the safety of kisspeptin has not been compared to current hormonal triggers of oocyte maturation.

DESIGN

We conducted a retrospective single-centre cohort study investigating symptoms and clinical parameters of early OHSS in women at high risk of OHSS (antral follicle count or total number of follicles on day of trigger ≥23) triggered with human chorionic gonadotrophin (hCG) (n = 40), GnRH agonist (GnRHa; n = 99) or kisspeptin (n = 122) at Hammersmith Hospital IVF unit, London, UK (2013-2016).

RESULTS

Clinical Parameters of OHSS: Median ovarian volume was larger following hCG (138 ml) than GnRHa (73 ml; P < .0001), and in turn kisspeptin (44 ml; P < .0001). Median ovarian volume remained enlarged 20-fold following hCG, 8-fold following GnRHa and 5-fold following kisspeptin compared to prestimulation ovarian volumes. Mean (±SD) ascitic volumes were lesser following GnRHa (9 ± 44 ml) and kisspeptin (5 ± 8 ml) than hCG (62 ± 84 ml; P < .0001). Symptoms of OHSS were most frequent following hCG and least frequent following kisspeptin. Diagnosis of OHSS: The odds ratio for OHSS diagnosis was 33.6 (CI 12.6-89.5) following hCG and 3.6 (CI 1.8-7.1) following GnRHa, when compared to kisspeptin.

CONCLUSION

Triggering oocyte maturation by inducing endogenous gonadotrophin release is preferable to the use of exogenous hCG in women at high risk of OHSS.

Contact Selectivity Engineering in a 2 μm Thick Ultrathin c-Si Solar Cell Using Transition-Metal Oxides Achieving an Efficiency of 10.8

In this paper, the integration of metal oxides as carrier-selective contacts for ultrathin crystalline silicon (c-Si) solar cells is demonstrated which results in an ∼13% relative improvement in efficiency. The improvement in efficiency originates from the suppression of the contact recombination current due to the band offset asymmetry of these oxides with Si. First, an ultrathin c-Si solar cell having a total thickness of 2 μm is shown to have >10% efficiency without any light-trapping scheme. This is achieved by the integration of nickel oxide (NiO_x) as a hole-selective contact interlayer material, which has a low valence band offset and high conduction band offset with Si. Second, we show a champion cell efficiency of 10.8% with the additional integration of titanium oxide (TiO_x), a well-known material for an electron-selective contact interlayer. Key parameters including V_oc and J_sc also show different degrees of enhancement if single (NiO_x only) or double (both NiO_x and TiO_x) carrier-selective contacts are integrated. The fabrication process for TiO_x and NiO_x layer integration is scalable and shows good compatibility with the device.

Effect of pellet from total mixed ration on growth performance, blood metabolomics, carcass and meat characteristics of Bangladeshi garole sheep

Six indigenous Bangladeshi Garole sheep (Ovis aries) (BW: 8±0.5 kg; Age: 1yr) were divided into two groups using a randomized block design to investigate the effect of total mixed ration (TMR) pellet feeding on growth parameter, blood metabolomics, carcass and meat characteristics. Control diet was composed of road side grass, rice straw, wheat bran, mustard oil cake, molasses, common salt which considered as loose total mixed ration (L-TMR) and treatment diet was pelleted form of L-TMR (P-TMR).In both the dietary treatments the animals were fed at 1.5 times of maintenance energy and protein requirement. P-TMR revealed a positive impact (p < 0.05) on live weight gain and feed conversion ratio than L-TMR. Total digestible nutrients (TDN) and digestible crude fibre (DCF) was significantly higher (p < 0.05) in P-TMR group whereas there was no significant difference (p < 0.05) in other digestible nutrients as well as plasma metabolites like plasma glucose, triglyceride, total cholesterol, HDL-cholesterol and LDL- cholesterol concentration between two dietary group. Dressing percentage and eye muscle area was significantly higher (p < 0.05) in P-TMR group but no significant difference was found between dietary treatments in term of disposition of body fat, proximate composition of mutton, all the sensory parameters except tenderness and overall acceptability. So, it could be concluded that, the P-TMR might be fed to sheep for better growth performance and higher meat production rather than production of functional mutton.Progressive Agriculture 28 (3): 222-229, 2017 

Cubic-phase zirconia nano-island growth using atomic layer deposition and application in low-power charge-trapping nonvolatile-memory devices

The manipulation of matter at the nanoscale enables the generation of properties in a material that would otherwise be challenging or impossible to realize in the bulk state. Here, we demonstrate growth of zirconia nano-islands using atomic layer deposition on different substrate terminations. Transmission electron microscopy and Raman measurements indicate that the nano-islands consist of nano-crystallites of the cubic-crystalline phase, which results in a higher dielectric constant (κ ∼ 35) than the amorphous phase case (κ ∼ 20). X-ray photoelectron spectroscopy measurements show that a deep quantum well is formed in the Al₂O₃/ZrO₂/Al₂O₃ system, which is substantially different to that in the bulk state of zirconia and is more favorable for memory application. Finally, a memory device with a ZrO₂ nano-island charge-trapping layer is fabricated, and a wide memory window of 4.5 V is obtained at a low programming voltage of 5 V due to the large dielectric constant of the islands in addition to excellent endurance and retention characteristics.

Investigation of the Changes in Electronic Properties of Nickel Oxide (NiOx) Due to UV/Ozone Treatment

Drastic reduction in nickel oxide (NiO_x) film resistivity and ionization potential is observed when subjected to ultraviolet (UV)/ozone (O₃) treatment. X-ray photoemission spectroscopy suggests that UV/O₃ treatment changes the film stoichiometry by introducing Ni vacancy defects. Oxygen-rich NiO_x having Ni vacancy defects behaves as a p-type semiconductor. Therefore, in this work, a simple and effective technique to introduce doping in NiO_x is shown. Angle-resolved XPS reveals that the effect of UV/O₃ treatment does not only alter the film surface property but also introduces oxygen-rich stoichiometry throughout the depth of the film. Finally, simple metal/interlayer/semiconductor (MIS) contacts are fabricated on p-type Si using NiO_x as the interlayer and different metals. Significant barrier height reduction is observed with respect to the control sample following UV/O₃ treatment, which is in agreement with the observed reduction in film resistivity. From an energy band diagram point of view, the introduction of the UV/O₃ treatment changes the defect state distribution, resulting in a change in the pinning of the Fermi level. Therefore, this work also shows that the Fermi level pinning property of NiO_x can be controlled using UV/O₃ treatment.

Fibroids that do not distort the uterine cavity and IVF success rates: an observational study using extensive matching criteria

OBJECTIVE

To assess the impact of non-cavity-distorting fibroids on in vitro fertilisation (IVF) pregnancy outcomes.

DESIGN

A retrospective, matched, single-centre, cohort study was performed.

SETTING

The IVF unit of a tertiary, university hospital.

POPULATION

We analysed all women with non-cavity-distorting uterine fibroids undergoing IVF/intracytoplasmic sperm injection (ICSI) cycles from 1 January 2011 to 1 May 2015.

METHODS

Each woman was matched with two separate controls of the same age (±6 months), stimulation protocol (gonadotropin-releasing hormone agonist or antagonist), starting dose of follicle-stimulating hormone (FSH), number of embryos transferred (one or two), day of transfer (day 3 or day 5), and no uterine fibroids identified by transvaginal ultrasound.

MAIN OUTCOME MEASURES

Clinical pregnancy and live birth rates.

RESULTS

Our study demonstrates that the presence of non-cavity-distorting fibroids appears to negatively affect clinical pregnancy (odds ratio, OR 0.62; 95% confidence interval, 95% CI 0.41-0.94) and live birth rates (OR 0.58; 95% CI 0.48-0.78) in patients undergoing their first IVF/ICSI cycle, when matched with controls of the same age, starting dose of FSH, stimulation protocol, number of embryos, and day of embryo transfer. The deleterious effect of fibroids on live birth rates was significant in women with two or more fibroids (OR 0.47; 95% CI 0.26-0.83) and in women with fibroids of ≥30 mm in diameter (OR 0.41; 95% CI 0.19-0.89). The negative impact of non-cavity-distorting fibroids was also present in women with an embryo transfer on day 5 (OR 0.58; 95% CI 0.35-0.94). Conversely, in women with single fibroids of <30 mm in diameter, no difference in pregnancy outcomes was identified.

CONCLUSIONS

A well-designed, adequately powered, randomised controlled trial is required to address the role of medical or surgical interventions in patients with intramural and subserosal fibroids before undergoing fertility treatment.

TWEETABLE ABSTRACT

Non-cavity-distorting fibroids negatively affect pregnancy rates after IVF.