National Outcomes of Liver Transplantation for Model for End-Stage Liver Disease Score ≥40: The Impact of Share 35

In certain regions of the United States in which organ donor shortages are persistent and competition is high, recipients wait longer and are critically ill with Model for End-Stage Liver Disease (MELD) scores ≥40 when they undergo liver transplantation. Recent implementation of Share 35 has increased the percentage of recipients transplanted at these higher MELD scores. The purpose of our study was to examine national data of liver transplant recipients with MELD scores ≥40 and to identify risk factors that affect graft and recipient survival. During the 12-year study period, 5002 adult recipients underwent deceased donor whole-liver transplantation. The 1-, 3-, 5- and 10-year graft survival rates were 77%, 69%, 64% and 50%, respectively. The 1-, 3-, 5- and 10-year patient survival rates were 80%, 72%, 67% and 53%, respectively. Multivariable analysis identified previous transplant, ventilator dependence, diabetes, hepatitis C virus, age >60 years and prolonged hospitalization prior to transplant as recipient factors increasing the risk of graft failure and death. Donor age >30 years was associated with an incrementally increased risk of graft failure and death. Recipients after implementation of Share 35 had shorter waiting times and higher graft and patient survival compared with pre-Share 35 recipients, demonstrating that some risk factors can be mitigated by policy changes that increase organ accessibility.

Follow-up with primary care providers for elevated glycated haemoglobin identified at the dental visit

OBJECTIVES

This study examined patient experiences after receiving elevated diabetes screening values using blood collected at a dental clinic. It explores patients' reactions to screening, whether or not they sought recommended medical follow-up, and facilitating factors and barriers to obtaining follow-up care.

METHODS

At the comprehensive care clinics at a large, urban College of Dentistry in the United States, haemoglobin A1C (HbA1C) values were obtained from 379 study participants who had not been previously diagnosed with diabetes. In all, 169 (44.6%) had elevated HbA1C values. We analysed quantitative and qualitative data concerning these patients' follow-up with primary care providers (PCPs).

RESULTS

We were able to contact 112 (66.3%) of the 169 study participants who had an elevated HbA1C reading. Of that group, 61 (54.5%) received recommended follow-up care from a PCP within 3 months, and an additional 28 (25.0%) said they intended to seek such care. Qualitative themes included the following: the screening letter - opportunity or burden, appreciation for the 3-month follow-up call and barriers to medical follow-up that included the following: lack of knowledge about diabetes, not understanding the importance of follow-up, busyness, financial concerns, fear and denial.

CONCLUSIONS

Quantitative and qualitative data demonstrate that dentists, dental hygienists and nurses are well poised to discover and translate new models of patient-centred, comprehensive care to patients with oral and systemic illness.

Breast reconstruction in low resource settings: Autologous latissimus dorsi flap provides a viable option

BACKGROUND

Breast reconstruction (BR) plays a significant role in the woman's physical, emotional and psychological recovery from breast cancer. However, the current most accepted methods of reconstruction are expensive, may require microsurgical skills and can be offered to a very small number of patients seeking treatment in tertiary care centers. For the large majority of women seeking treatment in public hospitals, solution lies in finding a method of reconstruction, which is autologous, produces a reasonable match to the contralateral breast in size, shape and symmetry and produces minimal donor site morbidity. It should also be a technique, which is cost effective and can withstand the effects of radiotherapy (RT). The autologous latissimus dorsi (LD) flap is one such versatile technique, which can serve as an ideal reconstructive option for the majority of patients.

MATERIALS AND METHODS

During a period of 6 years, 19 patients underwent immediate BR using this flap in the Department of General Surgery. Patients who were young (mean age 37.4 years), had small to medium sized breasts, with operable breast cancer (Stage II and IIIa) were selected for the procedure.

RESULTS

Satisfactory cosmetic results as rated by patients as well as surgeons were achieved in the majority. Donor site morbidities were seroma formation (78%) and donor site wound breakdown (21%). Post-operative RT was well-tolerated by the reconstructed breast.

CONCLUSION

Autologous LD flap reconstruction is a safe and economical option for BR in low resource settings and is suitable for women with small and medium sized breasts.

Screening difficult-to-reach populations for tuberculosis using a mobile medical unit, Punjab India

BACKGROUND

In India, the National Health Mission has provided one mobile medical unit (MMU) per district in the state of Punjab to provide primary health care services for difficult-to-reach populations.

OBJECTIVES

To determine the number of patients with presumptive tuberculosis (TB) and the number of TB cases detected and treated among patients who used the MMU services from May to December 2012 in Mohali district, Punjab, India.

METHODS

A cross-sectional study was conducted and registers of the out-patient, laboratory, radiology, and TB departments of the MMU were reviewed to determine the number of persons presumed to have TB and the number of persons diagnosed with TB.

RESULTS

Of 8346 patients who attended the MMUs, 663 (8%) had symptoms suggestive of TB. Among those with TB symptoms, 540 (81%) were evaluated for pulmonary TB using sputum examination or chest X-ray. In total, 58 (11%) patients had clinical or laboratory evidence of pulmonary TB, of whom 21 (36%) started anti-tuberculosis treatment.

CONCLUSION

As MMUs are an integral part of the general public health system, these units have the potential to detect TB cases among difficult-to-reach populations. Additional research is required to optimise the diagnosis of TB at MMUs and to increase rates of TB treatment initiation.

Combined application of FBG and PZT sensors for plantar pressure monitoring at low and high speed walking

BACKGROUND

Clinical monitoring of planar pressure is vital in several pathological conditions, such as diabetes, where excess pressure might have serious repercussions on health of the patient, even to the extent of amputation.

OBJECTIVE

The main objective of this paper is to experimentally evaluate the combined application of the Fibre Bragg Grating (FBG) and the lead zirconate titanate (PZT) piezoceramic sensors for plantar pressure monitoring during walk at low and high speeds.

METHODS

For fabrication of the pressure sensors, the FBGs are embedded within layers of carbon composite material and stacked in an arc shape. From this embedding technique, average pressure sensitivity of 1.3 pm/kPa and resolution of nearly 0.8 kPa is obtained. These sensors are found to be suitable for measuring the static and the low-speed walk generated foot pressure. Simultaneously, PZT patches of size 10 × 10 × 0.3 mm were used as sensors, utilizing the d<formula>_{33}</formula> (thickness) coupling mode. A sensitivity of 7.06 mV/kPa and a pressure resolution of 0.14 kPa is obtained from these sensors, which are found to be suitable for foot pressure measurement during high speed walking and running. Both types of sensors are attached to the underside of the sole of commercially available shoes. In the experiments, a healthy male subject walks/runs over the treadmill wearing the fabricated shoes at various speeds and the peak pressure is measured using both the sensors. Commercially available low-cost hardware is used for interrogation of the two sensor types.

RESULTS

The test results clearly show the feasibility of the FBG and the PZT sensors for measurement of plantar pressure. The PZT sensors are more accurate for measurement of pressure during walking at high speeds. The FBG sensors, on the other hand, are found to be suitable for static and quasi-dynamic (slow walking) conditions. Typically, the measured pressure varied from 400 to 600 kPa below the forefoot and 100 to 1000 kPa below the heel as the walking speed varied from 1 kilometer per hour (kmph) to 7 kmph.

CONCLUSIONS

When instrumented in combination, the two sensors can enable measurements ranging from static to high speed conditions Both the sensor types are rugged, small sized and can be easily embedded in commercial shoes and enable plantar pressure measurement in a cost-effective manner. This research is expected to have application in the treatment of patients suffering from diabetes and gonarthrosis.

Candidates for twin chiral bands in 102Rh

Excited states in 102Rh, populated in the fusion-evaporation reaction Zr94(11B,3n)102Rh at a beam energy of 36 MeV, were studied using the Indian National Gamma Array spectrometer at Inter University Accelerator Center, New Delhi. The angular correlations and the electromagnetic character of some of the gamma-ray transitions observed were investigated in detail. A new chiral candidate sister band was found. Lifetimes of exited states in both chiral candidate bands of 102Rh were measured for the first time in the A∼100 mass region by means of the Doppler-shift attenuation technique. The derived reduced transition probabilities are compared to the predictions of the two quasiparticles plus triaxial rotor model. Both experimental results and calculations do not support the presence of static chirality in 102Rh.

Chlorpyrifos degradation by the cyanobacterium Synechocystis sp. strain PUPCCC 64

BACKGROUND, AIM, AND SCOPE

Indiscriminate use of insecticides leads to environmental problems and poses a great threat to beneficial microorganisms. The aim of the present work was to study chlorpyrifos degradation by a rice field cyanobacterium Synechocystis sp. strain PUPCCC 64 so that the organism is able to reduce insecticide pollution in situ.

MATERIAL AND METHODS

The unicellular cyanobacterium isolated and purified from a rice field was identified by partial 16S rRNA gene sequence as Synechocystis sp. strain PUPCCC 64. Tolerance limit of the organism was determined by studying its growth in graded concentrations (2.5-20 mg/L) of chlorpyrifos. Chlorpyrifos removal was studied by its depletion from the insecticide supplemented growth medium, and its biodegradation products were identified in the cell extract, biomass wash, and growth medium.

RESULTS AND DISCUSSION

The organism tolerated chlorpyrifos up to 15 mg/L. Major fraction of chlorpyrifos was removed by the organism during the first day followed by slow uptake. Biomass, pH, and temperature influenced the insecticide removal and the organism exhibited maximum chlorpyrifos removal at 100 mg protein/L biomass, pH 7.0, and 30°C. The cyanobacterium metabolized chlorpyrifos producing a number of degradation products as evidenced by GC-MS chromatogram. One of the degradation products was identified as 3,5,6-trichloro-2-pyridinol.

CONCLUSION AND RECOMMENDATIONS

Present study reports the biodegradation of chlorpyrifos by Synechocystis sp. Biodegradation of the insecticide by the cyanobacterium is significant as it can be biologically removed from the environment. The cyanobacterium may be used for bioremediation of chlorpyrifos-contaminated soils.