Temporal evolution of electron cloud in a cylindrical Penning trap at room temperature

The temporal evolution of the electron cloud at room temperature has been recorded through a resonance circuit by observing the axial oscillation frequency of its center of mass. The electron cloud undergoes radial expansion by interacting with the residual gas molecules, and it is finally lost upon hitting the Penning trap electrodes. It has been confirmed through detailed experimental investigations that the unique temporal pattern of frequency variation is a consequence of the cloud's radial expansion. Consequently, this approach offers a non-destructive means for single-shot detection, enabling continuous monitoring of the electron cloud's radial expansion during the confinement time. This technique offers a significant advantage over its destructive alternatives.

Status of Serum Calcium in Patients with Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) remains a major public health problem with relatively high prevalence rates worldwide (5-13%). COPD is a major cause of morbidity and mortality worldwide and results in an economic and social burden that is both substantial and increasing. The purpose of the study was to explore the alteration of serum calcium in patients with COPD. This cross-sectional study was carried out in the Department of Biochemistry, Mymensingh Medical College, Bangladesh from January 2021 to December 2021. Data was collected from Medicine Department of Mymensingh Medical College Hospital, Mymensingh. A total number of 120 subjects participated in this study. Out of them, 60 apparently normal healthy individuals were selected as Group I and another 60 diagnosed COPD patients were selected as Group II. Serum calcium was measured by colorimetric method using the test kit. The results were calculated and analyzed by using statistical package for social science (SPSS), windows package version 21.0. Data were expressed in mean ±SD and statistical significance was done by Student's unpaired 't' test. In this study, the mean ±SD values of serum calcium were 9.21±1.06mg/dl and 8.26±0.95mg/dl in Group I and Group II respectively. The results were highly significant (p<0.001). The result suggested that there was significant relation between COPD and alteration of serum calcium. So, by this study we recommended that routine evaluation of serum calcium is important for prevention of exacerbations, reduction of morbidity and mortality in patients with COPD.

A 3D Deep Convolutional Neural Network for Dose Distribution Prediction of Intracavitary HDR Brachytherapy of Cervical Cancer

PURPOSE/OBJECTIVE(S)

The purpose of this work is to develop a voxel-wise dose prediction model using convolutional neural network (CNN) for cervical cancer high-dose-rate (HDR) intracavitary brachytherapy treatment planning with tandem-and-ovoid (T&O) or tandem-and-ring (T&R) applicators.

MATERIALS/METHODS

A 3D U-NET CNN was implemented to generate voxel-wise dose predictions based on high-risk clinical target volume (HRCTV) and organs at risk (OAR) contour information. A multi-institutional cohort of 77 retrospective clinical HDR brachytherapy plans treated to a prescription dose in the range of 4.8-7.0 Gy/fx was used in this study. Those plans were randomly divided into 60%/20%/20% as training, validating, and testing cohorts. Data augmentation techniques were implemented in the training and validation cohort data to increase the number of plans to 252. The model was trained using the mean-squared loss function, Adam optimization algorithm, a learning rate of 0.001, 250 epochs, and a batch size of 8. The model performance was evaluated on the testing dataset by analyzing the outcomes in terms of mean dose values and derived dose-volume-histogram (DVH) indices from 3D dose distributions and comparing the generated dose distributions against the ground-truth dose distributions using dose statistics and clinically meaningful dosimetric indices.

RESULTS

The proposed 3D U-Net model showed competitive accuracy in predicting 3D dose distributions that closely resemble the ground truth dose distributions. The average value of mean absolute error was 0.108±3.617 Gy for HRCTV, 0.074±1.315 Gy for bladder, 0.093±0.981 Gy for rectum, and 0.035±2.789 Gy for sigmoid. The median absolute error was 1.264 Gy for HRCTV, 0. 441 Gy for the bladder, 0.018 Gy for rectum, and 0.019 Gy for sigmoid. Our results showed that the predicted mean D2cc OAR doses in the bladder, rectum, and sigmoid were 4.02±0.93, 3.77±0.57 and 3.36±0.82 Gy in comparison to 4.35±0.98, 3.99±0.53, 3.75±0.83 Gy in clinical plans, respectively, and the mean individual differences (ΔD2cc) were 0.33±0.41, 0.22±0.16 and 0.39±0.45 Gy, respectively. The predicted D90 of the HRCTV was 6.72±0.99 Gy in comparison with 6.83±1.72 Gy in clinical plans. Results indicate a good potential to predict useful dosimetric indices and thus would facilitate an improvement in brachytherapy treatment planning workflow. The proposed model needs less than 5 seconds to predict a full 3D dose distribution of 64 × 64 × 64 voxels for any new patient plan, thus making it sufficient for near real-time applications and aid in decision-making in clinic.

CONCLUSION

The proposed model can be used to predict 3D dose distributions for near real-time decision-making, before planning, for planning quality assurance, and for guiding future automated planning for improved plan consistency, quality, and planning efficiency.

Direction Modulated Brachytherapy Tandem Model Applicators for Treatment Planning of Multi-Institutional Cervical Cancer Cases

PURPOSE/OBJECTIVE(S)

Direction Modulated Brachytherapy (DMBT) offers a means of utilizing an anisotropic source to create more conformal dose distributions when integrated with image-guided adaptive brachytherapy (IGABT). Authors sought to validate the implementation of nine unique six-channeled, MRI-compatible, novel DMBT tandem applicators of varying physical dimensions within Varian's BrachyVision® (v16.1) treatment planning system (BV-TPS).

MATERIALS/METHODS

A total of 110 retrospective clinically delivered high-dose-rate (HDR) cervical cancer brachytherapy plans, from three institutions, were re-planned for each of the nine DMBT tandem models within the BV-TPS, using the latest VEGO® inverse optimization algorithm, with dose heterogeneity accounted for through AcurosBV®. Plans consisted of both intracavitary (77 plans) and interstitial (33 plans) cases with an average prescription dose and high-risk clinical target volumes (CTVHR) of 607±113 cGy and 26.96±14.95 [range 6.70-69.58] cm3, respectively. During re-planning, the conventional tandems were replaced by one of the nine DMBT tandem models while leaving ovoids or rings, and needles (if present), in place. A two-step inverse optimization process was performed such that the lowest possible organs at risk (OAR) D2cc doses could be achieved while 1) keeping equivalent target coverage (ΔCTVHR-D90 to within ±0.5%) and, at the same time, 2) maintaining the general pear-shape dose distribution of the original plans.

RESULTS

Noteworthy improvements in plan quality were achieved by all nine DMBT tandem models, which are presented in Table 1. Irrespective of the model, about ∼50 cGy reduction in D2cc across all OARs appear feasible. There is also a general trend of D2cc reductions' magnitude becoming smaller as the CTVHR volume increased due to loss in modulation at distance. Additionally, D2cc reductions in terms of EQD2 [Gy] were calculated assuming each re-plan was delivered throughout the course of treatment, which includes the external beam radiotherapy dose of 45 Gy and showed significant reductions of -6.29±4.38 Gy, -3.80±2.06 Gy, and -4.86±3.02 Gy for the bladder, rectum, and sigmoid, respectively, for DMBT model #9 for example.

CONCLUSION

We have successfully incorporated nine DMBT tandem models into a commercial TPS and re-planned 110 cases, to a total of 990 plans. All nine DMBT tandem models were each able to generate notable D2cc reductions to OARs (∼50 cGy), without compromising target coverage, across plans from multiple institutions with various clinical/optimization practices. The results indicate both a promising impact and smooth integration of DMBT tandem technology into modern clinical IGABT workflow.

Direction Modulated Brachytherapy Tandem Model Applicators for Treatment Planning of Multi-Institutional Cervical Cancer Cases: Removing Needles in Intracavitary-Interstitial Techniques

PURPOSE/OBJECTIVE(S)

To evaluate the potential of nine direction modulated brachytherapy (DMBT) tandem applicator models of various designs to obviate the need for needles during intracavitary-interstitial (IC-IS) cervical cancer brachytherapy.

MATERIALS/METHODS

A cohort of 33 retrospective clinical high dose-rate (HDR) brachytherapy plans, from three institutions, were re-planned with Varian's BrachyVision® (v16.1) treatment planning system (BV-TPS), using the latest VEGO® inverse optimization algorithm, with dose heterogeneity accounted for through the AcurosBV® model-based dose calculation algorithm. All plans consisted of IC-IS cases, with a range of 2-4 freehand-loaded needles, with an average prescription dose of 706±54 cGy and average high-risk clinical target volume (HRCTV) of 36.0±17.4 [range 9.8-69.6] cm3. Nine novel DMBT tandem models of varying physical dimensions were integrated for the first time into the BV-TPS, with thicknesses (4-8 mm). During re-planning, the conventional tandems and all of the needles were replaced by one of the nine DMBT tandem models while leaving the ovoids/rings in place. An optimization process was performed such that the lowest possible organs at risk (OAR) D2cc doses could be achieved while keeping equivalent target coverage (ΔHRCTV-D90 to within ±0.5%) and maintaining a pear-shape dose distribution. The process was repeated for each of the nine DMBT tandem models resulting in (33 × 9 =) 297 plans.

RESULTS

Average ΔHRCTV-D90 was +0.35±0.39% (+2.8±3.1 cGy). OAR D2cc reductions were achieved by all models for all plans. The performance of the thickest DMBT model (8 mm) was the best in terms of achieving the lowest D2cc for all OARs, with 31 out of 33 plans (94%) achieving lower D2cc doses for all three OARs. The two cases in which the D2cc doses could not be reduced had HRCTV volumes ranging between 50 cm3 and 60 cm3. Additionally, D2cc reductions in terms of EQD2 [Gy] were calculated assuming each re-plan was delivered throughout the entire course of a patient's treatment, which included the external beam radiotherapy dose of 45 Gy, showed significant reductions of -2.64±2.67 Gy, -1.65±1.97 Gy, and -2.80±2.20 Gy for bladder, rectum, and sigmoid, respectively.

CONCLUSION

According to the results, it is clinically feasible to replace the conventional IC-IS cases, with 2-4 freehand-loaded needles, with the DMBT tandem technology, effectively avoiding the need for needle involvement.

Combining Novel Direction Modulated Brachytherapy Tandem-and-Ovoids Applicators for Treatment Planning of Multi-Institutional Cervical Cancer Cases: Removing Needles in Intracavitary-Interstitial Techniques

PURPOSE/OBJECTIVE(S)

Lack of standard guidelines for optimal needle insertion during high-dose-rate (HDR) intracavitary-interstitial (IC-IS) brachytherapy of the cervix means a sophisticated and technical skillset of inserting needles next to IC applicators must be developed to enhance plan quality. This study sought to evaluate the performance of two separate direction modulated brachytherapy (DMBT) tandem applicators used in conjunction with one set of novel DMBT ovoids, uniquely designed to effectively obviate the need for IS needles.

MATERIALS/METHODS

A cohort of 32 retrospective clinical HDR brachytherapy plans, from three institutions, were re-planned with Varian's BrachyVision® (v16.1) treatment planning system (BV-TPS), using the latest VEGO® inverse optimization algorithm, with dose heterogeneity accounted for through the AcurosBV®. All plans consisted of IC-IS cases, with a range of 2-4 freehand-loaded needles, with an average prescription dose of 709±53 cGy, and with an average high-risk clinical target volume (HRCTV) of 36.73±17.15 [range 9.8-69.6] cm3. Two DMBT tandem models of 5.4-mm and 8.0-mm thicknesses along with a novel DMBT ovoids design, introduced for the first time, with 9 equi-angled grooves and 10-mm-diameter thickness. During re-planning, the conventional tandems, ovoids/rings, and all of the needles were replaced by one of the two DMBT tandem models and a set of DMBT ovoids. A two-step inverse optimization process was performed to achieve the lowest possible OAR D2cc doses while 1) keeping equivalent target coverage (ΔHRCTV-D90 to within ±0.5%) and 2) maintaining the general pear-shape dose distribution used by the original plans. For all plans, this process was repeated using each of the two DMBT tandem-and-ovoids combinations for a total re-planning of (32×2 =) 64 cases.

RESULTS

On average, -47.15±29.61 (-40.40±34.90) cGy, -42.98±26.58 (-41.70±27.40) cGy, and -40.47±25.05 (-32.55±25.30) cGy reductions in D2cc across bladder, rectum, and sigmoid, respectively, were achieved for the 8-mm (5.4-mm) DMBT tandem-and-ovoids combinations while the average ΔHRCTV-D90 was +4.3±2.9 cGy (+0.5%±0.4%). Additionally, D2cc reductions in terms of EQD2 [Gy] were calculated and showed significant reductions of -4.05±2.47 (-3.37±2.83) Gy, -2.71±1.79 (-2.59±1.74) Gy, and -3.27±1.96 (-2.65±2.06) Gy for bladder, rectum, and sigmoid, respectively with an average net increase in total dwell times of 241.0±87.6 seconds at the luxury of avoiding IS needle insertions.

CONCLUSION

It is clinically feasible to obviate the need for IS needles by incorporating the DMBT tandem-and-ovoids while producing lower OAR D2cc doses and maintaining equivalent target coverage.

A comprehensive analysis of different types of databases reveals that CDH1 mRNA and E-cadherin protein are not downregulated in most carcinoma tissues and carcinoma cell lines

BACKGROUND

The CDH1 gene codes for the epithelial-cadherin (E-cad) protein, which is embedded in the plasma membrane of epithelial cells to form adherens junctions. E-cad is known to be essential for maintaining the integrity of epithelial tissues, and the loss of E-cad has been widely considered a hallmark of metastatic cancers enabling carcinoma cells to acquire the ability to migrate and invade nearby tissues. However, this conclusion has come under scrutiny.

METHODS

To assess how CDH1 and E-cad expression changes during cancer progression, we analyzed multiple large transcriptomics, proteomics, and immunohistochemistry datasets on clinical cancer samples and cancer cell lines to determine the CDH1 mRNA and E-cad protein expression profiles in tumor and normal cells.

RESULTS

In contrast to the textbook knowledge of the loss of E-cad during tumor progression and metastasis, the levels of CDH1 mRNA and E-cad protein are either upregulated or remain unchanged in most carcinoma cells compared to normal cells. In addition, the CDH1 mRNA upregulation occurs in the early stages of tumor development and the levels remain elevated as tumors progress to later stages across most carcinoma types. Furthermore, E-cad protein levels are not downregulated in most metastatic tumor cells compared to primary tumor cells. The CDH1 mRNA and E-cad protein levels are positively correlated, and the CDH1 mRNA levels are positively correlated to cancer patient's survival. We have discussed potential mechanisms underlying the observed expression changes in CDH1 and E-cad during tumor progression.

CONCLUSIONS

CDH1 mRNA and E-cadherin protein are not downregulated in most tumor tissues and cell lines derived from commonly occurring carcinomas. The role of E-cad in tumor progression and metastasis may have previously been oversimplified. CDH1 mRNA levels may serve as a reliable biomarker for the diagnosis of some tumors (such as colon and endometrial carcinomas) due to the marked upregulation of CDH1 mRNA in the early stages of tumor development of these carcinomas.

Comparative study between GRA and MEREC technique on an agricultural-based MCGDM problem in pentagonal neutrosophic environment

In this research article, an improved Multi-criteria group decision-making (MCGDM) strategy has been developed in pentagonal neutrosophic environment incorporating grey relational analysis and method on the removal effects of criteria (MEREC) techniques to address the relative advantages and disadvantages of these aspects in MCGDM. The aim of the study is to improve MCGDM technique which can capture the underlying uncertainties in robust way and can produce consistent results in a more rigorous way. Here, the conception of Hamming distance between two pentagonal neutrosophic number (PNN)s is introduced and the weighted arithmetic and geometric averaging operators in PNN arena are deployed to craft our computational technique more progressive and robust. An agriculture-based numerical problem is illustrated to demonstrate the ranking results of the alternatives by both of the techniques. After evaluating the problem by two aggregation operators, it is found that "plantation crop" is the best alternative under certain circumstances. Lastly, the sensitivity investigation is performed which reveals that with the appliance of arithmetic and geometric aggregation operators the best ranked alternative preserves its position by both of the ranking methods, which definitely exhibit the consistency and robustness of our executed methodology.

Study of Serum Calcium and Magnesium Levels in Type 2 Diabetes Mellitus Patients

The prevalence of diabetes mellitus is a significant global public health concern, particularly in emerging nations like Bangladesh. Bangladesh is already overrun with non-communicable diseases while still battling communicable diseases. About 90.0% of all cases of diabetes that have been diagnosed are type 2 diabetes. High calorie diet, age, sedentary lifestyle and obesity are the main risk factors for type 2 diabetes. Different micronutrients have been linked to an increased incidence of diabetes in addition to existing risk factors. The goal of the study was to assess the serum levels of calcium and magnesium in people with type 2 diabetes mellitus and compare them to those in healthy controls. This cross-sectional study was conducted from July 2018 to June 2019 at the Mymensingh Medical College, Mymensingh, Department of Biochemistry in cooperation with the Department of Endocrinology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh. Purposive (non-random) sampling was used to pick the subjects based on inclusion and exclusion criteria. This study had 100 individuals in total. Out of them, 50 people with type 2 diabetes mellitus who had been diagnosed were chosen as cases, and another 50 people who appeared to be in generally good health were chosen as controls. Serum calcium and magnesium levels were measured for this study's analytical purposes. The mean±SD was used to express all values. The statistical package for social science (SPSS), a Windows application, was used to conduct the statistical analyses. Using the Student's unpaired 't' test, the statistical significance of the difference between the case and control groups was assessed. Following comprehensive analysis, it was discovered that type 2 diabetes mellitus patients had considerably lower mean serum calcium (in case group was 8.46±0.63 and control group 8.86±0.64mg/dl) and magnesium levels (in case group was 2.09±0.42 and control group 2.24±0.16mg/dl) than healthy controls. According to the results of the current investigation, patients with type 2 diabetes mellitus had significantly altered serum calcium and magnesium levels. As a result, the study's hypothesis was accepted.

Study of Changes in Serum Copper Level in Patients with Acute Myocardial Infarction

Acute myocardial infarction (AMI) commonly known as heart attack is defined pathologically as the irreversible death of myocardial cells caused by ischemia. Risk factors include high blood pressure, smoking, diabetes, lack of exercise, obesity, high blood cholesterol and excessive alcohol intake. The major cause of acute MI is coronary atherosclerosis with superimposed luminal thrombus, which accounts for more than 80% of all infarcts. Micronutrients and trace elements are very essential for normal functioning of the body. Even though they are required in very small amount, an alteration in the level of this element may lead to serious diseases like CAD and its consequences. The injury induced by reperfusion of the ischemic myocardium could result partially from the cytotoxic effects of oxygen free radicals. Copper is involved in several of the reactions in the protection from free radical damage. So, this study was designed to evaluate serum cupper level in AMI patients. This case-control study was conducted in the Department of Biochemistry, Mymensingh Medical College, Mymensingh, Bangladesh from July 2016 to June 2017. Total number of subjects was 120 in number. Among them 60 were diagnosed case of acute myocardial infarction and 60 were apparently healthy volunteers. Data were collected using pre-designed data collection sheets. After proper counseling informed written consent was taken from the study population. The study revealed that mean serum copper level was higher in case group as compared to control group. The mean±SD values of copper were 105.44±24.15μg/dl and 146.49±23.52μg/dl in control and case group respectively. The level of significance was 0.001 (p<0.05). After analyzing the results of the study it is concluded that serum copper level was significantly higher in Acute Myocardial Infarction patients than normal individuals. Therefore, estimation of serum copper level in AMI patients might be useful to take appropriate measure to prevent free radical induced reperfusion injury.

Evaluation of Liver Function Tests in β-Thalassemia Major Children

Thalassemia is the most prevalent single gene defect in human beings worldwide. Repeated blood transfusions along with chelation therapy are mainstay of treatment in thalassemia patients. However these recurrent blood transfusions result in iron overload which along with chelation therapy causes deterioration of liver function. Aim of the study was to evaluate the liver function tests in β-thalassemia major patients. This cross sectional study was conducted in the Department of Biochemistry, Dhaka Medical College, Dhaka, Bangladesh from January 2017 to December 2017. In this study, 50 diagnosed patients of β Thalassemia major (Group A) and 50 apparently healthy children (Group B) of both sexes were selected from the department of Paediatrics, Dhaka medical college. The study parameters were serum ferritin, bilirubin, AST, ALT, ALP. The results were compared statistically between groups. Serum ferritin level (mean±SD) in thalassemic major patients in Group A (890±446.38 microgram/L) which is significantly higher above normal level. Serum bilirubin in Group A (3.27±2.62 mg/dl) and in Group B (0.48±0.24 mg/dl), Serum ALT in Group A (53.06±34.0 U/L) and in Group B (16.70±4.81 U/L), AST in Group A (84.56±33.54 U/L) and in Group B (11.60±2.72 U/L) and ALP levels in Group A (422.42±226.99 IU/L) and in Group B (221.86±80.54 IU/L). All the values were significantly higher (p<0.001) in β-thalassemia patient than that of normal children. This study concludes that liver function parameters are significantly higher in β thalassemia major patients. So routine evaluation of liver function tests may be advocated for thalassemic patients to predict early onset of hepatic dysfunction.

Human Bone Marrow Stromal Cell Exosomes Ameliorate Periodontitis

Human bone marrow stromal cell (hBMSC)-derived exosomes are promising therapeutics for inflammatory diseases due to their unique microRNA (miRNA) and protein cargos. Periodontal diseases often present with chronicity and corresponding exuberant inflammation, which leads to loss of tooth support. In this study, we explored whether hBMSC exosomes can affect periodontitis progression. hBMSC exosomes were isolated from cell culture medium through sequential ultracentrifugation. miRNAs and proteins that were enriched in hBMSC exosomes were characterized by RNA sequencing and protein array, respectively. hBMSC exosomes significantly suppressed periodontal keystone pathogen Porphyromonas gingivalis-triggered inflammatory response in macrophages in vitro. Transcriptomic analysis suggested that exosomes exerted their effects through regulating cell metabolism, differentiation, and inflammation resolution. In vivo, weekly exosome injection into the gingival tissues reduced the tissue destruction and immune cell infiltration in rat ligature-induced periodontitis model. Collectively, these findings suggest that hBMSC-derived exosomes can potentially be used as a host modulation agent in the management of periodontitis.

745 PROACTIVE INPUT FROM GERIATRICIAN LED SURGICAL LIAISON SERVICE FOR OLDER SURGICAL PATIENTS AT ROYAL BERKSHIRE HOSPITAL, READING

Introduction

Need for a geriatrician in the peri operative care of older surgical patients is evident by the NCEPOD reports in 2010 and 2011. Funding for Consultant Geriatrician led surgical liaison service for RBH was approved in 2014.We present a comparative review of the service during 2019/2020.

Methods

A retrospective audit of elective and emergency surgical patients over 65 years of age from January to March 2019 and June to September 2020 was done. Geriatrician input was provided on weekdays by Less than full time (80%) equivalent Consultant, 1 full time equivalent physician associate and a Gerontology Registrar on pro rota basis.

Results

We reviewed 76 patients in 2019 (Emergency 74/76 = 95% Vs Elective 2/76 = 3%) and 161patients in 2020 (Emergency134/161 = 83% Vs Elecetive27/161 = 17%). Majority of emergency presentations were small bowel obstruction, acute cholecystitis, and pancreatitis while laparoscopic right hemi colectomy was the commonest elective surgical admission. The average age of patients was 72 years (2019) and 79 years (2020). Length of stay up to 5 days reduced from 75% (51/76) in 2019 to 43% (70/161) in 2020. The overall length of stay reduced from 12 days to 8.5 days in 2019 and 2020, respectively 30 days readmission rate increased from 21% (16/76) in 2019 to 25.5% (41/161) in 2020. 75% (2019) and 96% (2020) of patients were discharged back to their usual residence and death rates reduced from 14% to 1% between the 2 audits.

Conclusion

There is an increase in patient number, age, and complexity. Number of elective surgical admissions after the 1st Covid wave has risen. Even with less than full time Consultant Geriatrician cover the service has helped to reduce the overall length of hospital, mortality rate and added to cost saving. There is need for senior cover for service to work efficiently and to meet its ever-increasing demand.

142 Amyand’s Hernia: An Extensive Review of History, Aetiopathogenesis, Symptomatology, and Management – Should We Scan, Scope & Snip?

Background

Amyand’s hernia, first described by Claudius Amyand in 1735, continues to remain a diagnostic & therapeutic challenge. By definition includes inguinal herniae that contain the vermiform appendix.

Aim

This up-to-date review aims to define and classify Amyand’s hernia and suggest appropriate management options in the current era. Aim to shed light on the value of pre-operative cross-sectional imaging and the use of laparoscopic surgery to provide a one stop solution.

Method

Published English literature was reviewed (1735–2021), using PubMed and Embase, combining the MeSH terms “hernia”, “inguinal”, “appendix”, “Amyand”, “low dose CT” and “laparoscopic herniotomy”. Most cited open access reviews, case series and case reports were chosen to provide a framework. A recent case is described with selected images (radiological, histology and intra operative).

Results

Since the original publication, by Claudius Amyand in 1735, there exists a gulf on this condition in the available British medical literature. Nearly 100,000 hernia repairs are performed in the UK annually. If Amyand’s hernia account for 1% of these (according to the most stated estimate), there should be a thousand Amyand’s herniae repaired annually in the UK alone. Unfortunately, the management options remain nonstandard.

Conclusions

Computerized tomography (CT) allows for pre-operative diagnosis and should be considered more often, even in children. Laparoscopic appendicectomy combined with a laparoscopic herniotomy is a safe one stop solution, in experienced hands, for paediatric patients.

Antioxidant potential and α-glucosidase inhibitory activity of onion (Allium cepa L.) peel and bulb extracts

Allium cepa L. is a commonly consumed vegetable that belongs to the Amaryllidaceae family and contains nutrients and antioxidants in ample amounts. In spite of the valuable food applications of onion bulb, its peel and outer fleshy layers are generally regarded as waste and exploration of their nutritional and therapeutic potential is still in progress with a very slow progression rate. The present study was designed with the purpose of doing a comparative analysis of the antioxidant potential of two parts of Allium cepa, i.g., bulb (edible part) and outer fleshy layers and dry peels (inedible part). Moreover, the inhibitory effect of the onion bulb and peel extracts on rat intestinal α-glucosidase and pancreatic α-amylase of porcine was also evaluated. The antioxidant potential of onion peel and bulb extracts were evaluated using 2,2-diphenyl- 1-picryl hydrazyl (DPPH), ferric-reducing antioxidant power assay (FRAP), 2,2'-azino-bis- 3-ethylbenzothiazoline-6-sulfonic acid (ABTS) radical scavenging assay, H2O2 radical scavenging activity and Fe2+ chelating activity. Total flavonoids and phenolic content of ethanolic extract of onion peel were significantly greater as compared to that of onion bulb. Ethanolic extract of onion peel also presented better antioxidant and free-radical scavenging activity as compared to the ethanolic extract of bulb, while the aqueous extract of bulb presented weakest antioxidative potential. Onion peel extract's α-glucosidase inhibition potential was also correlated with their phenolic and flavonoid contents. The current findings presented onion peel as a possible source of antioxidative agents and phenolic compounds that might be beneficial against development of various common chronic diseases that might have an association with oxidative stress. Besides, outer dry layers and fleshy peels of onion exhibited higher phenolic content and antioxidant activities, compared to the inner bulb. The information obtained by the present study can be useful in promoting the use of vegetable parts other than the edible mesocarp for several future food applications, rather than these being wasted.

Molecular Epidemiology of Plasmodium species in Conflicted Federally Administered Tribal Area (FATA) Pakistan

Military conflicts have been significant obstacles in detecting and treating infectious disease diseases due to the diminished public health infrastructure, resulting in malaria endemicity. A variety of violent and destructive incidents were experienced by FATA (Federally Administered Tribal Areas). It was a struggle to pursue an epidemiological analysis due to continuing conflict and Talibanization. Clinical isolates were collected from Bajaur, Mohmand, Khyber, Orakzai agencies from May 2017 to May 2018. For Giemsa staining, full blood EDTA blood samples have been collected from symptomatic participants. Malaria-positive microscopy isolates were spotted on filter papers for future Plasmodial molecular detection by nested polymerase chain reaction (nPCR) of small subunit ribosomal ribonucleic acid (ssrRNA) genes specific primers. Since reconfirming the nPCR, a malariometric study of 762 patients found 679 positive malaria cases. Plasmodium vivax was 523 (77%), Plasmodium falciparum 121 (18%), 35 (5%) were with mixed-species infection (P. vivax plus P. falciparum), and 83 were declared negative by PCR. Among the five agencies of FATA, Khyber agency has the highest malaria incidence (19%) with followed by P. vivax (19%) and P. falciparum (4.1%). In contrast, Kurram has about (14%), including (10.8%) P. vivax and (2.7%) P. falciparum cases, the lowest malaria epidemiology. Surprisingly, no significant differences in the distribution of mixed-species infection among all five agencies. P. falciparum and P. vivax were two prevalent FATA malaria species in Pakistan's war-torn area. To overcome this rising incidence of malaria, this study recommends that initiating malaria awareness campaigns in school should be supported by public health agencies and malaria-related education locally, targeting children and parents alike.

Payment for ecosystem services (PES): a holistic tool for sustainable forest management-a case study from Pakistan

Economic valuation of ecosystem services is a new concept in forest management. Economic valuation provides basis for payment for ecosystem services (PES). Therefore, objective of this study was to evaluate eco-tourism and carbon stock services of the Maindam valley, District Swat, Pakistan. For the carbon stock calculation, a sample size of 155 plots of 0.1 hectare (Ha) was taken using preliminary survey at 95% confidence interval and 10% allowable error. The data for tourism services was collected from owners of all the hotels, 100 tourists and key informants of the area at 10% sampling intensity on pretested questionnaire for twenty years period (1997-2017). Results showed that Miandam valley has carbon stock worth US$ 16,306,000 while the value of eco-tourism was US$ 1,578,458 on annual basis. The results also showed that trend of tourism has drastically declined after the 9/11 incident for foreigners and locals and the situation was further deteriorated during the era of Talibanization or militancy from 2008-2011. This study recommends implementation of PES strategy at the rate of 5%, thus a total of US$ 78,922 can be earned from eco-tourism and carbon crediting in the study area annually, which could play important role in sustainable forest management.

Major threats and habitat use status of Demoiselle crane (Anthropoides virgo), in district Bannu, Pakistan

Cranes are the large and attractive Creatures of nature with long necks, legs, and life-span. Adults of both sexes are the same with similar color patterns. Demoiselle cranes spend most of their lifespan on dry grasses. They are also found around the stream, rivers, shallow lakes, natural wetlands, and depressions. To evaluate the current status of habitat use and major threats a study was conducted in tehsil Domel district Bannu. Line transect method and water quality tests (temperature, PH, contamination of E-coli bacteria) were used. To determine the major threats questionnaire method was used. The whole data was analyzed by using SPSS 21 version. Based on the distribution four study sites were selected and four water samples from each study site were taken. Most sites were moderate to highly degraded except Kashoo and kurram river mixing point which was low degraded with livestock grazing and human activities. Water quality tests showed PH ranges from 7-9, temperature 6.5-8.5, and contamination of E-coli in all samples. The social survey revealed that hunting, habitat degradation, and pollution as major threats. Effective long-term conservation and management in the study area are needed to focus on the protection of disturbance-free habitat.

An ethno-botanical study of indigenous medicinal plants and their usage in rural valleys of Swabi and Hazara region of Pakistan

An ethnobotanical study was conducted to document indigenous medicinal plants and their usage from knowledgeable and elderly persons in Razzar and Gadoon valley of Swabi and Allai and Tanawal valley of Hazara region of Pakistan during 2016-2019. Several systematic field visits and questionnaire surveys were carried out in selected sites of the study area to gather relevant information from the local community. Rapid assessment method was adopted for data collection by interviewing the local people having enough knowledge of medicinal plants use for treatment of different ailments. UV (UV) formula was applied to calculate the relative importance of medicinal plant species in each site of the study area. In the present study, 221 medicinal plants belonging to 105 families have been reported through 580 respondents (385 males, 138 females and 57 local health healer) from the Swabi and Hazara region. The main sources of herbal medicines were leaves (21%) followed by fruits (21%), seeds (17%), whole plants (14%), roots (9%), bark (9%), flowers (7%) and gum (2%). Mentha spicata L. and Berberis lycium Royle were reported with highest UV (UV) i.e. 0.92 and 0.68 in Razzar tehsil and Gadoon valley of Swabi, whereas Mentha longifolia L and Geranium wallichianum D were reported with highest UV i.e. (0.65) and (0.88) in Allai and Tanawal valley of Hazara region, respectively. It was concluded that Swabi and Hazara region is rich in medicinal plants species and associated traditional knowledge. Moreover, ethno-medicines have played significant role in the indigenous healthcare system of the study area. However, uprooting the entire plant for ethno-medicine is a big threat to conservation of medicinal plants diversity in the study area.

Ethanol and isopropanol inactivation of human coronavirus on hard surfaces

BACKGROUND

The coronavirus disease 2019 pandemic has greatly increased the frequency of disinfecting surfaces in public places, causing a strain on the ability to obtain disinfectant solutions. An alternative is to use plain alcohols (EtOH and IPA) or sodium hypochlorite (SH).

AIM

To determine the efficacy of various concentrations of EtOH, IPA and SH on a human coronavirus (HCoV) dried on to surfaces using short contact times.

METHODS

High concentrations of infectious HCoV were dried on to porcelain and ceramic tiles, then treated with various concentrations of the alcohols for contact times of 15 s, 30 s and 1 min. Three concentrations of SH were also tested. Reductions in titres were measured using the tissue culture infectious dose 50 assay.

FINDINGS

Concentrations of EtOH and IPA from 62% to 80% were very efficient at inactivating high concentrations of HCoV dried on to tile surfaces, even with a 15-s contact time. Concentrations of 95% dehydrated the virus, allowing infectious virus to survive. The dilutions of SH recommended by the Centers for Disease Control and Prevention (1/10 and 1/50) were efficient at inactivating high concentrations of HCoV dried on to tile surfaces, whereas a 1/100 dilution had substantially lower activity.

CONCLUSIONS

Multiple concentrations of EtOH, IPA and SH efficiently inactivated infectious HCoV on hard surfaces, typical of those found in public places. Often no remaining infectious HCoV could be detected.

National Clinical Guidance for the Management of Cardiovascular Intervention in the COVID-19 Pandemic: From Bangladesh Society of Cardiovascular Interventions (BSCI)

Since the first recorded case of SARS-CoV-2 in Bangladesh on 8th March 2020, COVID-19 has spread widely through different regions of the country, resulting in a necessity to re-evaluate the delivery of cardiovascular services, particularly procedures pertaining to interventional cardiology in resource-limited settings. Given its robust capacity for human-to-human transmission and potential of being a nosocomial source of infection, the disease has specific implications on healthcare systems and health care professionals faced with performing essential cardiac procedures in patients with a suspected or confirmed diagnosis of COVID-19. The limited resources in terms of cardiac catheterization laboratories that can be designated to treat only COVID positive patients are further compounded by the additional challenges of unavailability of widespread rapid testing on-site at tertiary cardiac hospitals in Bangladesh. This document prepared for our nation by the Bangladesh Society of Cardiovascular Interventions (BSCI) is intended to serve as a clinical practice guideline for cardiovascular health care professionals, with a focus on modifying standard practice of care during the COVID-19 pandemic, in order to ensure continuation of adequate and timely treatment of cardiovascular emergencies avoiding hospital-based transmission of SARS-COV-2 among healthcare professionals and the patients. This is an evolving document based on currently available global data and is tailored to healthcare systems in Bangladesh with particular focus on, but not limited to, invasive cardiology facilities (cardiac catheterization, electrophysiology & pacing labs). This guideline is limited to the provision of cardiovascular care, and it is expected that specific targeted pharmaco-therapeutics against SARS-CoV-2 be prescribed as stipulated by the National Guidelines on Clinical Management of Corona virus Disease 2019 (COVID-19) published by the Director General of Health Services, Ministry of Health and Family Welfare of Bangladesh.

Sulphur doses and application times on yield and oil quality of canola grown in calcareous soil

Pakistan has been constantly deficient in its oil seed production and it is very difficult to meet the edible oil requirement of its ever-increasing population. A field experiment was conducted at the Agronomy Research Farm, The University of Agriculture Peshawar, Northern Pakistan during winter (2013–14). Five sulphur levels (15, 30, 45, 60 and 75 kg·ha-1) and times of application (at seedling, bolting and flowering stages) were used for the canola variety Abasin-95. The experiment was laid out in a randomized complete block design replicated four times on a 5 m × 3.2 m plot size. The results showed that the sulphur-applied plots gave the highest seed yield, biological yield, glucosinolate, erucic acid, oil content, protein content, oleic acid and linoleic acid compared to the control plots. Sulphur applied at the rate of 60 kg·ha-1 and applied at the bolting stage increased seed yield, biological yield, oil content, and protein content.

Incidence of central diabetes insipid us among the patients undergoing pituitary tumor surgery 06 through trans-sphenoidal approach

Background: Diabetes insipidus (DI) is a common complication following pituitary surgery. Thiscondition can be transient or permanent and the signs and symptoms of this disorder can bemimicked by the normal postoperative course. Objective: This study was carried out to find out the incidence of central diabetes insipidus (DI)among the patients undergoing pituitary tumor surgery through trans-sphenoidal approach eitherendoscopic or microsurgical for the first time.Study Design: Cross sectional observational study Methods: Patients with central (Neurogenic) diabetes insipidus prior to surgery, co-morbiditieslike diabetes mellitus, kidney diseases, electrolyte imbalance, recurrent cases were excludedfrom this study. Patients were followed up to 7th postoperative day by recording and analyzingfindings of postoperative serum electrolytes, urinary specific gravity, hourly urinary volume forestablishing diabetes insipid us. Results: 76.9% of patients developed diabetes insipidus and 70.0% of patients did not developdiabetes insipid us those who underwent pituitary tumour surgery by trans-sphenoidal endoscopicapproach; 23.1% of patients developed diabetes insipid us and 30.0% of patients did not developdiabetes insipid us those who underwent pituitary tumour surgery by trans-sphenoidal mlcrosurgicalapproach. Conclusion: Prediction of DI help us in pre-operative counseling and post-operative managementof the patients as well as to reduce complications related morbidity after pituitary tumor surgery. Journal of Surgical Sciences (2017) Vol. 21 (1) :6-10

Corrigendum to "Dietary administration of Nexrutine inhibits rat liver tumorigenesis and induces apoptotic cell death in human hepatocellular carcinoma cells". [Toxicol. Rep. 2 (2014) (November) 1-11]

[This corrects the article DOI: 10.1016/j.toxrep.2014.11.006.].

Regioselective synthesis of 7-acetyl-11c-methyl-4b,5,7,11c-tetrahydro[1]benzofuro[2′,3′:4,5]thiopyrano[2,3-b]indoles by sequential Claisen rearrangement of 2-(4′-aryloxybut-2′-ynylthio)-1-acetylindoles

Hitherto unreported indole-annulated pentacyclic heterocycles containing oxygen, nitrogen and sulfur have been synthesised by thermal Claisen rearrangement followed by Lewis acid catalysed Claisen rearrangement. 9-Acetyl-4-aryloxymethyl-2,9-dihydrothiopyrano[2,3- b]indoles are regioselectively synthesised in 80–85 % yield by thermal rearrangement of 2-(4′-aryloxybut-2′-ynylthio)-1-acetylindoles. A second, Lewis acid catalysed, rearrangement gave 7-acetyl-11c-methyl-4b,5,7,11c-tetrahydro[1]benzofuro[2′,3′: 4,5]thiopyrano[2,3- b]indoles in yields of 85–90 %. The thermal Claisen rearrangement in refluxing N,N-diethylaniline for 3 h gave the same products in lower yield (50–54 %).

Evaluation of Fixation for Distal Humeral Diaphyseal Fracture by Locking Compression Plate

Treatment of extra-articular distal humeral shaft fractures with plating techniques is often difficult. The recent development of LCP has improved the surgical treatment of fractures by overcoming the few drawbacks of older fixators. The aim of this prospective observational study was to assess the effectiveness of osteosynthesis of extra-articular diaphyseal fractures of the distal third of the humerus using a single locking compression plate (LCP) and was conducted from July 2016 to June 2018 at the National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka, Bangladesh. Thirty (30) patients with closed fracture distal 3rd extra-articular humeral shaft fractures were treated by open reduction and internal fixation by locking compression plate. Two cases were excluded from the evaluation of final outcome due to their discontinued follow up. Detailed clinical conditions of all patients, technical difficulty with the implant, postoperative hospital stay period were recorded. Patients were followed up at 2nd week, 4th week, then 4 weekly upto 6 months. The patients were evaluated clinically and radiologically for outcomes. The progresses of healing as well as occurrence of complications were recorded. The range of motion of the shoulder and elbow were evaluated according to the criteria by Rommens grading. Functional evaluation was made according to the criteria by Modified Constant and Murley Scoring System. Union was achieved in all the patients after a mean of 15 weeks (range 12-20 weeks). There were no complications like deep infection, nonunion, malunion, implant failure, or nerve injury occurs in any of the patients. Two patients had transient radial nerve palsy. Two patients developed superficial infection. All patients were relieved pain postoperatively. Functional outcome were excellent in 10 patients, good in 15 patients which constituted 89% satisfactory results. The study has shown that the LCP is an effective, dependable solution for the management of distal third diaphyseal fractures of the humerus.

'At the end of the day, it is more important that he stays happy': an interpretative phenomenological analysis of people who have a sibling with 22q11.2 deletion syndrome

BACKGROUND

22q11.2 deletion syndrome (22q11.2DS) is the most common microdeletion syndrome. However, there is little research examining the effect of this multisystem disorder on the family, particularly siblings. The current study was a phenomenological exploration of sense-making in siblings of a person with 22q11.2DS.

METHOD

Interpretative phenomenological analysis informed a detailed and open examination of being a sibling of a person with 22q11.2DS. Using in-depth semistructured interviews, five typically developing siblings (two men, three women) of people with 22q11.2DS were individually interviewed, providing the data set for transcription and thematic analysis.

RESULTS

The theme 'They are the priority' overarched two subordinate themes that emerged from participants' descriptions of the struggle with acceptance and finding positive meaning. Participants oscillated between conflicting feelings about their sibling with 22q11.2DS always taking centre stage. For example, they felt anger, guilt and resentment; yet, they also embraced patience, empathy and gratitude.

CONCLUSIONS

This phenomenological study provides a foundation for future research relating to 22q11.2DS and fostering family wellbeing, particularly around acceptance and psychological growth. The siblings in this study actively withdrew from their family to allow prioritisation of their affected sibling. However, this does not mean that their needs should be overlooked. There are easily accessible resources to support siblings of individuals with disabilities, and it is important for health professionals and parents to consider these options.

A rare case of Theileria annulata induced corneal opacity in a calf

A 10 months old male cross-bred calf was presented in OPD Medicine, Referral Veterinary Polyclinic, ICAR-Indian Veterinary Research Institute, Izatnagar with the history of anorexia, impaired vision, heavy tick infestation and diarrhoea for the last 1 week. The clinical examination revealed enlarged pre-scapular lymph nodes, prominent cloudiness in eyes and exophthalmos. The presence of Koch blue bodies in biopsied lymph nodes and a PCR assay confirmed it to be bovine tropical theileriosis associated with unique corneal opacity. Treatment with buparvaquone at a dose of 2.5 mg/kg i.m. two doses 48 h apart was successful and typical ocular manifestations completely subsided after 2 weeks of therapy.

Raman-shifted wavelength-selectable pulsed fiber laser with high repetition rate and high pulse energy in the visible

A high-pulse-energy, diffraction-limited, wavelength-selectable, visible source, based on Raman frequency shifting of a frequency-doubled Yb-doped fiber laser, has been studied. The relative length-scaling laws of Raman gain and self-phase modulation push the design towards short fiber lengths with large core size. It is experimentally demonstrated that the Raman clean-up effect in a graded-index multi-mode fiber is not sufficient to obtain diffraction-limited beam quality in the short fiber length. Thus, a large-core photonic crystal fiber is used to maintain diffraction-limited performance and output pulse energies of ~1 μJ, at a 1-MHz repetition rate and 1.3-ns pulse-width are successfully achieved. This step-tunable visible source should find applications in photoacoustic microscopy.

Regional Anesthesia: Preferred Technique for Venodilatation in the Creation of Upper Extremity Arteriovenous Fistulae

Owing to the overall poor medical health of patients with end-stage renal disease, we have sought alternatives to the use of general anesthesia for access procedures. Furthermore, since local anesthesia (1) does not offer the motor block that is sometimes desired and (2) can be difficult to maintain when a large amount of vein needs to be transposed, we examined whether regional blocks can be useful for the creation of new arteriovenous fistulae (AVF).

From August 2002 to January 2005, 41 patients scheduled for AVF placement underwent a regional block with the use of a lidocaine and ropivacaine mixture using a nerve stimulator. Either axillary, interscalene, or infraclavicular blocks or a combination was used. Intraoperative duplex ultrasonography was used to assess the degree of venodilatation of the basilic and cephalic veins before and after the block. The site of each measurement was marked on the skin and selected by a clearly identifiable branch point. Each measurement was recorded three times and was made in the (1) native state, (2) after application of a tourniquet with opening and closing of the hand for 15 seconds, and (3) after placement of the block.

The average age of the patients was 65 ± 14 years (SD), with ages ranging from 33 to 91 years, and the prevalence of diabetes mellitus was 50%. Complete brachial plexus block was achieved in 34 patients (83%). Sensory block was accomplished within 10 to 15 minutes and usually lasted 4 to 6 hours. Motor block was accomplished in 10 to 25 minutes. Venodilatation was not noted in patients whose blocks did not work ( n = 7) or whose vein was found to be phlebitic on exploration ( n = 3). The degree of venodilatation noted as a percentage increase after application of the tourniquet compared with the native state for these 34 patients (in whom the block worked) was 37% for the distal cephalic, 31% for the midcephalic, and 32% for the midbasilic vein. The degree of venodilatation noted as a percentage increase after placement of the block compared with after tourniquet application for these 34 patients was 42% for the distal cephalic, 19% for the midcephalic, and 26% for the midbasilic vein. No instances of systemic toxicity, hematomas, or nerve injury from the block were noted. Accesses placed included 20 radiocephalic AVF, 8 brachiobasilic AVF, 8 brachiocephalic AVF, 2 arteriovenous grafts, 2 radiobasilic AVF, and 1 brachial vein AVF.

Regional block is a safe and, in our opinion, preferred technique for providing anesthesia for upper extremity vascular surgery. The venodilatation observed is augmented compared with that using a tourniquet and may allow more options for access placements.

ID: 25: SOCIAL DETERMINANTS OF PATIENT ANTIBIOTIC MISUSE IN HARYANA, INDIA

Background

Antibiotic resistance is recognized globally as an urgent health crisis. Multidrug resistant organisms lead to deadly hospital and community acquired infections and complicate patients' underlying health issues. In the United States, antibiotic resistance causes 23,000 deaths and direct healthcare costs of $20 billion a year. In the developing world, the costs are estimated to be even higher. In India alone, antibiotic resistance is responsible for an estimated 58,000 infant deaths annually. While its severity is agreed upon, the causes and solutions to antibiotic misuse are complex. Antibiotic dispensing laws are poorly enforced in many developing nations, including India. Patient and provider contributions are intertwined, thus confronting the problem requires a better understanding of the motivations of several populations.

Methods

We conducted a mixed methods study in the northern state of Haryana, India, between June and August 2015. We qualitatively assessed the antibiotic knowledge and use practices of 20 local community members using semi-structured interviews. We also completed 64 surveys of community members and healthcare workers. Both populations were given the same survey, which focused on the participant's experience obtaining antibiotics as a patient. The interviews and surveys were conducted in English and Hindi, as applicable, by bilingual members of the research team. Interview data was coded for themes using NVivo software, and quantitative survey responses were analyzed in SAS. We used DAGitty software to construct a directed acyclic graph to determine the minimally sufficient adjustment sets needed to block confounders of the relationship between antibiotic knowledge and antibiotic misuse.

Results

Over a third of survey participants reported antibiotic misuse, defined as purchasing medication from a pharmacy without a doctor's prescription (36.5%). Furthermore, none of the 20 community member interviewees were able to correctly define antibiotics without prompting. The interviews also revealed that limited health education, inadequate access to a doctor, and poverty all influence patients' antibiotic decision making. Participants with these characteristics were more likely to bypass doctors and seek medical care directly from a pharmacist.

The effect of antibiotic knowledge on antibiotic misuse was significant in our pilot survey data, even after adjusting for the variables in the minimally sufficient adjustment set: first vs. fourth quartile of knowledge, OR=72.09, p=0.014; second vs. fourth quartile, OR=44.09, p=0.006. The covariates in the model include age, income, healthcare occupation, education, having a doctor in the family, and having access to a doctor in your local community.

Discussion

This study highlights the need for public health education regarding antibiotics and the extensive health implications of their misuse. Local and national governments should consider social factors when enacting future antibiotic policies.

The Role of Selective Nerve Root Block in the Treatment of Lumbar Radicular Leg Pain

The objective of this retrospective study was to investigate the clinical effectiveness of nerve root blocks (i.e., periradicular injection of Lidocaine and triamcinolone) for lumbar monoradiculopathy in patients with a mild neurological deficit in National Institute of Traumatology & Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh from March 2014 to December 2014. We Included 24 patients (32-74 years) with a minor sensory/motor deficit and an unequivocal MRI finding (18 disc herniations, 6 foraminal stenosis) treated with a selective nerve root block. Based on the clinical and imaging findings, surgery (decompression of the nerve root) was justifiable in all cases. Seventeen patients (87%) had rapid (1-4 days) and substantial regression of pain, four required a repeat injection. Sixty percent (60%) of the patients with disc herniation or foraminal stenosis had permanent resolution of pain, so that an operation was avoided over an average of 6 months (2-9 months) follow-up. Nerve root blocks are very effective in the non-operative treatment of minor monoradiculopathy and should be recommended as the initial treatment of choice for this condition.

Highly efficient Yb-free Er-La-Al doped ultra-low NA large mode area single-trench fiber laser

We demonstrate a 60µm core diameter Yb free Er-La-Al doped single-trench fiber having a 0.038 ultra-low-NA, fabricated using conventional MCVD process in conjunction with solution doping technique. Numerical simulations predict an effective single mode operation with effective area varying from 1,820µm(2) to 1,960µm(2) (taking bend-induced modal distortion into account) for different thicknesses of trenches and resonant rings at a constant bend radius of 25cm. Moreover, all solid structure favors easy cleaving and splicing. Experimental measurements demonstrate a robust effective single mode operation. Furthermore, with a 4%-4% laser cavity, this fiber shows a record efficiency of 46% with respect to the absorbed pump power.

High power, compact, picosecond MOPA based on single trench fiber with single polarized diffraction-limited output

We experimentally demonstrate an all-solid Yb-doped 30 μm core diameter single trench fiber. Measurements ensure a robust effective single-mode operation without the need of tight coiling as required for conventional fibers thanks to the ultralow NA (∼0.038) and resonant ring surrounding the core. All-solid and cylindrical design ensures the suitability for mass scale production with the added benefit of all-fiberized device structure. A compact master oscillator power amplifier (MOPA) has been built using this fiber delivering ∼23.5  ps pulses at 13.5 MHz repetition rate delivering up to ∼52  W of average output power corresponding to a pulse energy of ∼3.8  μJ and peak power of >160  kW, while maintaining ∼76% slope efficiency. The output beam exhibits a polarization extinction ratio of more than 15 dB and a M2 less than 1.15.

Review article: cytomegalovirus and inflammatory bowel disease

BACKGROUND

The association between ulcerative colitis and cytomegalovirus (CMV) has been recognised for over 50 years; and the role of CMV in ulcerative colitis in general, and steroid resistance in particular, remains a topic of ongoing controversy. The outcome for patients with CMV reactivation appears worse than that for patients without reactivation, but it is not entirely clear whether CMV is a contributor or a bystander and if treatment with anti-virals alters the course of inflammatory bowel disease (IBD).

AIM

To review the role of CMV associated with IBD, including epidemiology, clinical features, diagnosis and management strategies.

METHODS

By reviewing literature available on CMV associated with IBD in adult patients. A PubMed literature search was performed using the following terms individually or in combination: CMV colitis, cytomegalovirus colitis, IBD and CMV, CMV treatment.

RESULTS

Cytomegalovirus reactivation is common in patients with severe colitis, with a reported prevalence of 4.5-16.6%, and as high as 25% in patients requiring colectomy for severe colitis. The outcome for this group of patients appears worse than that for patients without reactivation; however, reported remission rates following treatment with anti-viral therapy are as high as 71-86%.

CONCLUSIONS

Evidence, although not conclusive, supports testing for CMV colonic disease in cases of moderate to severe colitis, by processing biopsies for haematoxylin and eosin staining with immunohistochemistry and/or, CMV DNA real-time polymerase chain reaction; and if present treating with ganciclovir.