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In the present work, 0.25 wt%GNP-Ti composites were prepared through powder metallurgy route by adopting three types of mixing modes to investigate the extent of mixing on the mechanical and tribological properties. Dry ball milling, wet ball milling, and rotator mixing were independently employed to homogenize the composite constituents. Three types of composite powders obtained were subsequently sintered into composite pellets by cold compaction followed by vacuum sintering. Morphological investigation of composite powders performed by SEM revealed better homogenization of GNPs in Ti matrix for dry ball milled composite powder, whereas wet ball milled and rotator mixed composite powders showed aggregation and bundling of GNPs. Micro Vickers hardness of composites produced via dry ball milling is 4.56% and 15.7% higher than wet ball milled and rotator mixed samples, respectively. Wear test performed by pin-on-disk tribometer showed higher wear loss for wet ball milled and rotator mixed composites in comparison to dry ball milled. [ABSTRACT FROM AUTHOR]

The herein reported study was conducted to evaluate the parasitic potential of Anisopteromalus calandrae (Howard) against larvae of Callosobruchus maculatus (F.), Rhyzopertha dominica (F.) and Sitophilus oryzae (L.) while, adult pests on the food medium treated with two formulations of diatomaceous earth (DE); Marine (Celite) and fresh water (Perma Guard) as grain protectants. The DE was applied at three dose rates i.e., 200, 400 and 600 ppm, at 25°C temperature and 65% relative humidity. Mortality and emergence of adults of tested insects and parasitoid were observed after 14 and 28 days of exposure respectivly. The highest mortality of C. maculatus was 43.37% against higher dose of Perma Guard (600 ppm) while the maximum mortality of S. oryzae was recorded 39.56% on application of Celite (600 ppm). The maximum mortality of A. calandrae parasitoid was observed 66.86% in S. oryzae infested grains treated with higher dose of Perma Guard (600 ppm), while 63.81% mortality of parasitoid was observed in S. oryzae infested grains at higher dose of Celite DE (600 ppm). The Perma Guard effectively controls population of tested insect's mortality than the Celite. The highest emergence of C maculatus observed was 62.44% at lower dose of 200 ppm of Perma Guard DE while the highest emergence recorded on application of Celite was 60.66% from C. maculatus. The highest emergence of A. calandrae was 65.65% from S. oryzae at lower dose of 200 ppm of Perma Guard DE while the highest emergence of parasitoid recorded on application of Celite was found 60.66% at lower dose of 200 ppm from C maculatus. The emergence of tested insects and parasitoid increased with the decrease in dose rate of DE in most of the tested combinations. Higher dose (600 ppm) of both DE (Celite and Perma Guard) used in experiment showed mortality of tested insects and parasitoid activity of Anisopteromalus calandrae and furthermore release of A. calandrae on host insects would be adversely affected by use of diatomaceous earth product on stored grains. The experiments were carried out in laboratory of Grain Research, Training and Storage Management cell, Department of Entomology, University of Agriculture Faisalabad. [ABSTRACT FROM AUTHOR]

[Display omitted] • Lean duplex stainless steel was heat treated at 1000℃ to 1350℃. • Pit nucleation and growth kinetics were obtained at room temperature. • Heat treatments at 1000℃ had the highest pitting corrosion resistance. • A new microstructure design containing isolated small ferrite grains is proposed. The corrosion performance of type 2101 lean duplex stainless steel (LDSS) after different solution annealing heat treatments is investigated. The austenite to ferrite phase ratios and morphologies are correlated to their localised corrosion responses, with the application of bipolar electrochemistry providing access to pit nucleation and growth kinetics. The propagation of pitting corrosion via selective dissolution of the ferrite phase is observed, pointing towards a direct effect of ferrite morphology on pit shape. The corrosion behaviour of solution heat treatments are compared and ranked, providing information for improving and optimising the corrosion resistance of LDSS 2101 microstructures. [ABSTRACT FROM AUTHOR]

The pitting corrosion behaviour of 27%Cr–7%Ni (2707) hyper‐duplex stainless steel (HDSS) at ambient temperature has been assessed using a novel bipolar electrochemistry test set‐up. Application of this technique generates a linear potential gradient at the surface of the HDSS 2707 test piece, which allows assessment of the pitting corrosion behaviour at ambient temperature. Pit nucleation and associated growth kinetics can be obtained and characterised. To assess pitting corrosion in high‐alloyed HDSS, the normal bipolar test method had to be modified by superimposing an auxiliary potential. This new test set‐up was demonstrated by characterising the nucleation of pits and associated pit growth kinetics. The latter occurred either at austenite/ferrite interphase or inside ferrite phase, with pit growth within the ferrite phase in the HCl environment. [ABSTRACT FROM AUTHOR]

The intent of the study was to investigate the effect of dietary inclusion of sodium bicarbonate (NaHCO3) on blood profile of caged layers during summer. One hundred sixty commercial layers were divided into 20 experimental units/replicates (8 layers/replicate), which were further allotted to five treatment groups (4 replicate/treatment). Five iso-nitrogenous (CP 17%) and iso-caloric (ME 2700 Kcal/Kg) diets (A, B, C, D and E) were prepared with or without addition of NaHCO3. Diet A, was without NaHCO3 and served as control whereas, diets B, C, D and E contained 0.5, 1.0, 1.5 and 2.0% NaHCO3, respectively. These diets were fed to the experimental birds from 26th - 37th weeks of age (12 weeks). At the end of the experiment, blood samples of two birds from each replicate were collected for the analysis of blood profile. Results of the study revealed that serum glucose, white blood cells count, serum urea, plasma chlorides, serum cortisol and serum glutamic-oxaloacetic transaminase concentrations were found to be significantly (P<0.05) higher in control group, whereas, blood hemoglobin concentration, red blood cells count, plasma sodium, potassium, bicarbonate, serum total protein and serum albumen concentrations were significantly (P<0.05) higher in the birds fed diet containing 1% NaHCO3. Whilst, Serum uric acid concentration was significantly (P<0.05) higher in those fed 2% NaHCO3. However, packed cell volume, erythrocyte sedimentation rate, serum creatinine, alkaline phosphatase, plasma calcium, plasma phosphorus, serum globulin and serum glutamic pyruvate transaminase concentrations were not affected due to the dietary treatments. Serum cholesterol, triglycerides and low density lipoprotein concentration were significantly (P<0.05) decreased, whereas, serum high density lipoprotein concentration was found to be significantly (P<0.05) increased by dietary inclusion of NaHCO3. Birds fed diet containing 1% NaHCO3 showed significantly (P<0.05) higher concentration of estrogen, progesterone, T3 and T4 hormones. It was concluded that being economical and easy to handle, dietary inclusion of NaHCO3 may be a better choice to reduce or at least ameliorate the harmful effects of heat stress on blood chemistry in caged layers reared in summer conditions. [ABSTRACT FROM AUTHOR]

Introduction: Transition from medical school into residency is difficult, particularly for foreign medical graduates (FMGs). Early career mentoring is known to be beneficial. Although mentorship is encouraged, formal programs are seldom in place and are often ineffective. Objective: To study the impact of resident driven mentorship program (Big Sister Big Brother Program) in improving medicine residency experience of new interns. Methods: The study was conducted in the Internal Medicine Residency Program in University of Oklahoma Health Sciences Centre between September 2012 and October 2013. Residents were assigned with incoming interns on 1:1 basis to act as their mentors. Residents were to meet with the interns every month and address their concerns in an informal atmosphere. We developed a 17-item questionnaire to assess participants' perceptions, satisfaction and experience with mentorship. Results: Overall 61% respondents were males and 43% were Caucasian. Majority (61%) were categorical internal medicine and 45% were FMGs. Only 57% interns reported satisfaction with mentorship and 60.5% said the transition was easy with respect to personal life. After introduction of mentorship program, interns reported improvement in ease of transition with respect to personal life (OR 4.5, CI 1.1-18.4), which was more pronounced in FMGs (OR 10.5, CI 1.1-98.9). Intern class also reported improvement in ease of approaching mentor (OR 4.5, CI 1.1-18.1). Conclusion: In traditional faculty driven mentorship, accessibility to faculty is the biggest hindrance. Our study showed resident mentors have a positive impact on quality of life, ease of approaching mentors, and improve comfort level of new interns. This is especially beneficial for FMGs who have to adapt to new culture, and workplace. We have formally incorporated this program into our orientation curriculum. [ABSTRACT FROM AUTHOR]

• Bipolar electrochemistry to probe localised corrosion in stainless steel rebars is introduced. • The full spectrum of anodic-to-cathodic corrosion response is accessible. • Pit growth kinetics and 3D pit ratio development are reported. • Trans-passive corrosion and selective phase dissolution are observed and discussed. The corrosion performance of stainless steel rebars is assessed by using bipolar electrochemistry. This method produces a quasi-linear potential gradient across the sample, with the technique providing rapid access to test for the nucleation and growth of pits across a wide range of applied potentials. The localised corrosion behaviour and resulting growth kinetics of Types 304L and 316L austenitic stainless steels (ASSs) are compared to Type 2101 and 2205 duplex stainless steels (DSSs). The difference in selective phase dissolution between pitting and trans-passive corrosion in DSSs is compared, with critical pitting potential, pit nucleation numbers, growth kinetics, volume loss, and aspect ratio of these four stainless steels discussed. [ABSTRACT FROM AUTHOR]

BACKGROUND & OBJECTIVES: Certain interventions have been carried out to reduce blood loss during thyroidectomy to a great extent. The study aims to compare the efficacy of LigaSure thyroidectomy with conventional thyroidectomy. METHODOLOGY: A quasi experimental study was conducted at Aziz Fatimah Hospital, Faisalabad, and 58 patients were divided into two groups. Group A underwent conventional thyroidectomy and Group B LigaSure thyroidectomy. Preoperative and postoperative variables were recorded and analyzed in SPSS 21. An Independent t-test was used to compare the mean difference between the two groups. A p-value less than 0.05 was considered statistically significant. RESULTS: A total of 58 patients were enrolled in the study and divided into two groups. The mean age of patients in group A undergoing conventional thyroidectomy was (43.1±9.23) and in group B was (41.23±9.23) with p-value=0.4419 (non significant result was found among the age groups) . Mean operative time calculated for LigaSure-assisted hemithyroidectomy (28.57±3.45) minutes, subtotal thyroidectomy (43.33±2.86) minutes, and total thyroidectomy (73.15±9) minutes were significantly lower than those undergoing conventional thyroidectomies 40.12±6.5 minutes, 66.25±6.29 minutes, 87.35±7.02 minutes respectively. The mean difference in mean operative time and number of sutures used in both techniques were statistically significant (p≤ 0.05). CONCLUSION: Less mean operative time and suture ligations have increased the surgeon's compliance toward the device. These devices are now the first choice for physicians and surgeons for thyroidectomies not only in Pakistan but also across the globe. [ABSTRACT FROM AUTHOR]

Background: Endoscopic procedures are frequently performed on patients chronically on opioids, raising concerns about the safety and efficacy of conventional sedation. Aims: We hypothesized that chronic opioid use is associated with longer procedure times, higher dosages of sedation medications, and an increase in adverse effects. Methods: This is a retrospective review from June 2012 to June 2013. Patients on chronic opioids (opioids use ≥12 weeks) were compared to randomly selected patients matched for age, race, and sex. Multivariate regression analysis was performed to identify factors that were independently predictive of longer procedure times. Results: Patients on chronic opioids required higher doses of fentanyl (122.0 ± 45.3 vs. 105.8 ± 47.2 µg; P < 0.0001) and midazolam (5.3 ± 5.3 vs. 4.4 ± 2 mg; P = 0.0037) and were more likely to receive diphenhydramine (42.8 vs. 22.6 %; P < 0.001). The induction period (11.3 ± 8.8 vs. 7.5 ± 4.0 min), duration of procedure (39.1 ± 17.5 vs. 33.4 ± 14.1 min), and recovery times (38.7 ± 15.3 vs. 33.8 ± 12.1 min) were significantly longer for patients on chronic opioids. In the multivariate regression analysis, opioid use was an independent predictor of longer procedure duration ( P < 0.05). Hypotensive episodes did not differ between groups (2.8 vs. 2.7 %; P = 0.8). However, patients on chronic opioids experienced more pain (13.4 vs. 5.9 %; P 0.001) and hypertensive episodes (8.1 vs. 2.8 %; P 0.002). Conclusion: Patients on chronic opioids represent a high-risk population with longer procedural times and more discomfort, despite higher dosages of sedative agents. Prospective studies are required to define the risks and benefits of more costly alternative sedation strategies for patients on chronic opioids. [ABSTRACT FROM AUTHOR]

Objectives: Biliary dyskinesia and gastroparesis are associated with upper abdominal discomfort and dyspeptic symptoms in the absence of structural abnormalities. We hypothesized that the similarity in symptoms would trigger testing and surgical treatment for biliary abnormalities in a significant number of patients, with refractory symptoms ultimately demonstrating impairment of gastric function. Methods: The study was designed as a retrospective review of patients seen between April 1, 2008 and December 31, 2009. Patients were identified using diagnosis code for gastroparesis {International Classification of Diseases, Ninth Revision code 536.3). Demographic information, duration, etiology and severity of disease, coexisting psychiatric illness, pain and functional gastrointestinal disorders, medication use, and abdominal surgery with a focus on cholecystectomy were abstracted from the medical records. Results: A total of 131 patients were identified. Women predominated (77.86%), and the idiopathic form of gastroparesis was the most common etiology. A total of 59 (45%) patients had undergone cholecystectomies. Although symptomatic cholelithiasis was the primary indication, more than one-third of these patients underwent surgery for biliary dyskinesia (n = 19) or chronic acalculous cholecystitis (n = 2). In this subgroup, improvement was either absent (n = 13) or transient only (n = 8), lasting for 1.0 ± 0.6 months. Patients who underwent cholecystectomy were younger compared with the rest of the group; all other variables did not show significant differences. Conclusions: Considering the overlap and correlation between gastric and gallbladder function, we should raise the threshold for biliary dyskinesia and reassess the appropriateness of surgical therapy, especially in patients with coexisting dyspeptic symptoms. [ABSTRACT FROM AUTHOR]

In present work, mechanical alloying (MA) is employed to produce composite powders of titanium (Ti) containing 0.25 wt% graphene nanoplatelets (GNPs). Four composite powder samples are prepared by carrying out high energy ball milling (HEBM) at different milling times. Subsequent cold compaction and pressureless sintering are performed to obtain sintered compacts. Influence of ball milling time on powder characteristics, crystallographic as well as morphological evolution, relative density, compressibility, corrosion rates and mechanism, sinterability and hardness of the composites have been investigated. The plastic deformation capacity and yield stress of the composite powders are analyzed using linear compaction equations. X-ray diffraction has confirmed the non-occurrence of titanium carbide (TiC) formation during MA. Scanning electron microscopy has not only revealed a transformation in morphology of Ti particle from bulk shape to flaky but also has shown a strong adherence of GNPs on Ti particles. Electrochemical characterization results indicate that exchange current density for 6 h ball milled sample is quite high that leads to a thicker TiO 2 resulting in pitting corrosion. Sinterability and micro hardness values are found to be highest for 2.5h ball milled composite in comparison to others. • Effect of milling times on structural and electrochemical properties are investigated. • TiC phase formation increases as milling duration is increased. • The corrosion rates are not much affected with the addition of 0.25 wt% graphene. • 6h ball milled composite reveals the presence of TiO 2 leading to pitting corrosion. • Sinterability and micro hardness are found highest for 2.5h ball milled composite. [ABSTRACT FROM AUTHOR]

Condensed tannin content of seven varieties of sorghum (White, Sandalbar, YS-98, JS-88, JS-263, JS-2002 and Hegari) found in Pakistan were determined and their effect on nutrient digestibility and absorption of minerals was investigated in White Leghorn Layers. For digestibility trial, 20 individually caged White Leghorn layers (30 weeks of age) were divided randomly into four experimental groups (5 birds/group) where each bird served as a replicate. Four isocaloric and isonitrogenous experimental diets i.e. control (C), low tannin (LT), medium tannin (MT) and high tannin (HT) were prepared. Diet C was without tannin; whereas, diet LT, MT and HT contained 1, 2 and 3 percent sorghum tannin, respectively. Among the seven varieties of sorghum grains the highest amount of tannin (5.34%) was observed in the variety Sandalbar; whereas, the lowest concentration of tannin was observed in white sorghum (0.02%). All tannin containing diets reduced the digestibility of nitrogen and starch but the effect was more severe with 3% tannin. However, ether extract digestibility remained unaffected. The mineral contents (calcium, phosphorus, sodium, potassium, magnesium and iron) in the feces of layers using sorghum tannins were significantly (P<0.05) more than those using diets without tannin. The results revealed that the effect of tannins on mineral absorption was more severe in birds fed high tannin diet (3%) than that of low tannin diets. [ABSTRACT FROM AUTHOR]

Effect of feeding management on production performance of broilers during summer was investigated. Three hundred day-old broiler chicks were reared in a group for one week (adaptation period). At day 8, all the birds were weighed individually and 180 chicks of middleweight range (μ±1σ) were selected to be used as experimental birds. The chicks were randomly divided into 18 experimental units (replicates) having 10 chicks each. These replicates were further allotted to six treatment groups (A, B, C, D, E and F) each having three replicates. Three feeding methods i.e., continuous feeding (CF, 24 h feeding), intermittent feeding (IF, 1 h feed and 3 h off) and feed withdrawal (FW, no feed from 9:00 am. to 5:00 pm.) were used. Under each feeding system, birds were fed a ration either without supplemented fat or with 3% supplemented fat. Birds kept under IF system showed significantly (P<0.05) lower weight gain, feed consumption and water consumption but better feed utilization than those of continuous fed birds; whereas, the birds kept under FW system showed no difference regarding feed utilization than those kept under CF system. Addition of fat in ration significantly reduced weight gain, feed intake and water consumption of the experimental birds than those fed ration without fat supplementation. However, fat supplemented ration did not show any difference regarding water consumption of the birds than those provided ration without fat supplementation, when they were kept under IF system. IF and FW systems significantly (P<0.05) reduced the leg abnormalities (hock burn) of the birds. No mortality was observed in the birds kept under IF system; whereas, 1.66 and 8.30% mortality was found in the birds kept under FW and CF systems, respectively. Mortality was found to be 2.22% in the birds fed fat supplemented ration and 4.44% in the birds fed ration without supplementation of fat. Birds kept under IF system fetched more profit than those kept under FW and CF feeding systems. [ABSTRACT FROM AUTHOR]

Congenital absence of the pericardium is a rare cardiac condition, which can be either isolated or associated with other cardiac and extracardiac anomalies. There are six different types, depending on the severity of the involvement. Most of the patients with this defect are asymptomatic, especially the ones with complete absence of the pericardium. However, some patients are symptomatic, reporting symptoms that include chest pain, palpitations, dyspnea, and syncope. Diagnosis is established by the characteristic features on chest X-ray, echocardiogram, chest computed tomography (CT), and/or cardiac magnetic resonance imaging (MRI). We present here a case of a 23 year-old-male, who presented to our hospital with complaints of pleuritic chest pain and exertional dyspnea, of a two-week duration. He was physically active and his past history was otherwise insignificant. His chest CT with contrast was interpreted as showing evidence of multiple emboli, predominantly in the left lung, and he was started on a heparin and warfarin therapy. A repeat chest CT with contrast three weeks later showed no significant change from the previous CT scan. Both scans showed that the heart was abnormally rotated to the left side of the chest. An echocardiogram raised the suspicion of congenital absence of the pericardium, with a posteriorly displaced heart. In retrospect, motion artifact on the left lung, attributed to cardiac pulsations and the lack of pericardium, resulted in a CT chest appearance, mimicking findings of pulmonary embolism. The misdiagnosis of pulmonary embolism was attributed to the artifact caused by excessive cardiac motion artifact on the chest CT scan. In non-gated CT angiograms, excessive motion causes an artifact that blurs the pulmonary vessels, reminiscent of a 'seagull' or a 'boomerang'. Physicians need to be aware of this phenomenon, as well as the characteristic radiological features of this congenital anomaly, to enable them to make a correct diagnosis. [ABSTRACT FROM AUTHOR]

A letter to the editor related to the impacts of inflammatory bowel disease (IBD) on the sexual functions of the IBD patients is presented.

This retrospective study, conducted using the U.S. National Inpatient Sample (NIS), examines the outcomes and management of nonvariceal upper gastrointestinal bleeding (NVUGIB) in COVID-19 patients and identifies predictive factors to enhance patient prognosis. We analyzed the 2020 U.S. NIS data involving adult patients (≥18 years) admitted with NVUGIB and categorized them based on the presence of COVID-19. Primary and secondary outcomes, NVUGIB-related procedures, and predictive factors were evaluated. Of 184,885 adult patients admitted with NVUGIB, 1.6% (2990) had COVID-19. Patients with NVUGIB and COVID-19 showed higher inpatient mortality, acute kidney injury, need for intensive care, and resource utilization metrics. Notably, there was a lower rate of early esophagogastroduodenoscopy (EGD). Multivariate logistic regression revealed conditions like peptic ulcer disease, mechanical ventilation, and alcohol abuse as significant positive predictors for NVUGIB in COVID-19 patients, whereas female gender and smoking were negative predictors. Our findings suggest that COVID-19 significantly increases the risk of mortality and complications in NVUGIB patients. The observed decrease in early EGD interventions, potentially contributing to higher mortality rates, calls for a review of treatment strategies. Further multicenter, prospective studies are needed to validate these results and improve patient care strategies. [ABSTRACT FROM AUTHOR]

Background: Resident physicians are frequently uncomfortable ordering enteral nutrition (EN) and are unaware of the variety of formulas and supplements available for different disease processes. Many depend on a clinical dietician to assist with recommending EN formulas and patient energy requirements that may not be readily available on patient admission. This creates a barrier to early initiation of EN and non-compliance with Society of Critical Care Medicine and American Society of Parenteral and Enteral Nutrition clinical guidelines. Objective: Internal medicine resident physicians were provided an iPod with a smart phone/device application (EN application) to assist them in choosing EN formulas for patients during their intensive care unit (ICU) rotation. The primary outcome was improved initiation of EN within 24 hours of admission. Secondary outcomes included the following: time to initiate EN, goal calories reached, infections rates, length of stay, mortality, and concordance with clinical guidelines. Design: The study is a quasi-experimental design to improve delivery of EN at an academic medical center in the medical ICU. Data were collected from a retrospective chart review to evaluate the impact of an EN application to assist resident physicians when ordering EN. Results: Use of the EN application reduced the percent of patients with delayed initiation of EN from 61.2% prior to 37.5% (P <.01). The mean time to initiate EN also improved 44.5 vs 31.9 hours (P <.01). Patients were also more likely to achieve their daily caloric goal (P <.01). Conclusion: The use of an EN application to assist internal medicine residents when ordering EN reduced delays in initiation of EN and improved overall delivery of EN to medical ICU patients. [ABSTRACT FROM AUTHOR]

Background: Resident physicians are frequently uncomfortable ordering enteral nutrition (EN) and are unaware of the variety of formulas and supplements available for different disease processes. Many depend on a clinical dietician to assist with recommending EN formulas and patient energy requirements that may not be readily available on patient admission. This creates a barrier to early initiation of EN and non-compliance with Society of Critical Care Medicine and American Society of Parenteral and Enteral Nutrition clinical guidelines. Objective: Internal medicine resident physicians were provided an iPod with a smart phone/device application (EN application) to assist them in choosing EN formulas for patients during their intensive care unit (ICU) rotation. The primary outcome was improved initiation of EN within 24 hours of admission. Secondary outcomes included the following: time to initiate EN, goal calories reached, infections rates, length of stay, mortality, and concordance with clinical guidelines. Design: The study is a quasi-experimental design to improve delivery of EN at an academic medical center in the medical ICU. Data were collected from a retrospective chart review to evaluate the impact of an EN application to assist resident physicians when ordering EN. Results: Use of the EN application reduced the percent of patients with delayed initiation of EN from 61.2% prior to 37.5% (P <.01). The mean time to initiate EN also improved 44.5 vs 31.9 hours (P <.01). Patients were also more likely to achieve their daily caloric goal (P <.01). Conclusion: The use of an EN application to assist internal medicine residents when ordering EN reduced delays in initiation of EN and improved overall delivery of EN to medical ICU patients. [ABSTRACT FROM AUTHOR]

Background: Bangladesh, one of the most densely populated countries in the world has been ranked 9th on the Climate Risk Index for 2017: the 10 most affected countries & 7th on the Long-Term Climate Risk Index: the 10 countries most affected from 1998 to 2017. Every year it is afflicted with various climatic disasters including floods, hurricanes and cyclones. Apart from the obvious devastation of lives and property, there is a huge increase in clinical diseases when these disasters occur. Mental health of affected persons after these disasters is a topic that is often neglected by local and national level. Methods: A qualitative case study was conducted on perceived need on mental health support & availability of such services in a cyclone affected area in rural Bangladesh. Ten (10) key informant interviews (KIIs) with different stakeholders and ten (10) in-depth interviews (IDIs) with affected people were taken. Findings: We found that cyclones had numerous psychosocial impacts on the population including acute stress disorder, sleep disorder, post-traumatic stress disorders (PTSDs), generalized anxiety disorders, suicidal ideation and depression. The survivors had specific needs for receiving support. Children, elderly and women were perceived to be more vulnerable. The government and NGOs had no specific action plans and initiatives to address these issues and support the mental health of affected population. There was a visible gap in finding effective ways to provide affected people with the required mental health & psycho-social services (MHPSS). Conclusion: Resilient, responsive and self-sustaining health systems for this vulnerable population are required. Implementation of effective mental health programs and strong mental health policies remain a challenge in Bangladesh where there is a cultural fatalistic acceptance of mental health issues. [ABSTRACT FROM AUTHOR]

Non-obstructive dysphagia (NOD) is defined as symptomatic dysphagia in patients with negative endoscopic and radiographic workup. The management of NOD remains controversial as there is a discrepancy between different guidelines and clinical practice. Despite the lack of high-quality studies, empiric dilation for NOD is a common clinical practice among endoscopists and the approach varies between different clinical centers. In this review, we summarize the published literature on empiric dilation for NOD and propose a management algorithm for offering empiric dilation to patients presenting with dysphagia. [ABSTRACT FROM AUTHOR]

Objectives: Adenomatous polyps are common, occurring in up to 25% of the population older than 50 years of age in the United States. Conflicting data are present in the literature about the impact of specific adenoma locations and the prediction on the number and advanced histology of adenomas elsewhere. With this study we aimed to review the association between cecal adenoma and the risk of discovering more and advanced adenomas in the remainder of the colon.Methods: We performed a retrospective study of 1880 patients who received outpatient colonoscopies between June 2012 and December 2014 at the Veterans Affairs Medical Center in Oklahoma City. The data collected included patient demographics, indications for colonoscopy, smoking history, alcohol use, family history of colon cancer, quality of bowel preparation, number of adenomas, location, size of adenomas, and the histology of adenomas and colon cancer.Results: The mean age of the study population was 61.6 ± 9.4 year, with 95% of the population being men. Cecal adenomas were found in 243 (12.9%) of patients. Patients with cecal adenoma tended to be older (65 ± 7 vs 61 ± 10, P < 0.0001), more likely to be men (97% vs 94%, P = 0.06) and less likely to have a colonoscopy done for screening indication (11% vs. 13%., P = 0.03). After adjusting for age, sex, indication, and quality of bowel preparation, patients with cecal adenoma were found to have a sixfold increase in finding ≥10 other adenomas elsewhere (4.5% vs 0.8% P = 0.0009) and a threefold increase in finding advanced adenomas (17.7% vs 9.9% P = 0.002) in the remainder of the colon. Stratifying by location, the increased risk was more pronounced in the right side (24.7% vs 8.9% P ≤ 0.0001) compared with the left side.Conclusions: Cecal adenoma is associated with an increased risk of finding more and advanced adenomas in the remainder of the colon, especially on the right side; therefore, the discovery of a cecal adenoma should prompt a more thorough evaluation of the entire colon, particularly the right colon. [ABSTRACT FROM AUTHOR]

Introduction: Some observational studies have demonstrated the benefit of famotidine in COVID-19-infected individuals. The preference of using an H2 receptor antagonist (H2RA) over proton pump inhibitors (PPI) during the COVID-19 pandemic has been questioned by clinicians. Aim: To compare the outcomes of hospitalized patients who were taking H2RA vs. PPI. Material and methods: We conducted a retrospective review of patients admitted for COVID-19 infection from 1 March until 31 July 2020. We included 396 patients admitted during the study period. Of the total, 39 (9.8%) received H2RA and 86 (21.7%) were taking PPI as home medications; 6 patients were taking both H2RA and PPI. Results: The baseline characteristics and comorbid conditions were similar in both groups. The mean age was 57.79 ±17.36 years, 43.2% were female, and 48.7% were Caucasian. The common comorbid conditions included HTN (56.8%), obesity (44.4%), diabetes mellitus (38.6%), and coronary artery disease (30.1%). Smoking was more prevalent in the PPI group (42.5% vs. 18.2%, p = 0.03). Gastrointestinal symptoms were seen on initial presentation in 31.1%, and 43.9% had elevated liver enzymes. The H2RA group had similar mortality (HR = 0.84, 95% CI: 0.35-2.05) to the non-H2B group. It remained non-significant as compared to PPI (HR = 0.34-3.19, 95% CI: 0.34-3.19). The secondary outcomes including readmission, ICU admission, and severe COVID infections (including ARDS and thromboembolism) were similar in these groups. Conclusions: The H2 receptor antagonist used as a home medication did not show benefit over the PPI in patients admitted for COVID-19 infections. [ABSTRACT FROM AUTHOR]

Electron-ion recombination rate coefficients for fluorine-like nickel ions have been measured by employing the merged-beam technique at the cooler storage ring CSRm at the Institute of Modern Physics in Lanzhou, China. The measured spectrum covers the energy range of 0–160 eV, including all the dielectronic recombination (DR) resonances associated with ΔN = 0 core excitations. The DR cross sections in this energy range were calculated by a relativistic configuration interaction method using the flexible atomic code (FAC). Radiative recombination (RR) cross sections were obtained from a modified version of the semi-classical Bethe & Salpeter (1957, Quantum Mechanics of One- and Two-Electron 56 Systems (Springer)) formula for hydrogenic ions. The comparison between the measurement and the calculation shows that the present theoretical model still needs to be improved at low collision energies. Temperature dependent plasma recombination rate coefficients were derived from the measured DR rate coefficients in the temperature range of 103–108 K and compared with the presently calculated result as well as previous available data in the literature. The experimentally derived data agree well with the theoretical calculations for temperatures where Ni19+ ions form in collisionally ionized plasmas. At lower temperatures typical for photo-ionized plasmas, discrepancies are found beyond the experimental uncertainty, which can be attributed to the disagreement between the measurement and the calculation of the low-lying DR resonances. The present experimental result benchmarks the plasma DR rate coefficients, in particular for temperatures below 105 K where the ΔN = 0 DR resonances dominate. [ABSTRACT FROM AUTHOR]

Invasive cervical cancer is the most prevalent cancer among women in Sub-Saharan Africa. In 2013, the World Health Organization (WHO) emitted recommendations to start Highly Active Antiretroviral Therapy (HAART) regardless of CD4 count. Although HAART has been shown to reduce the prevalence of high-risk human papillomavirus (HR-HPV) genotypes, it is unclear whether it confers a protective effect specifically for HPV 16. This review summarizes the existing evidence regarding the effect of HAART on HPV 16 infection, as this genotype may not be influenced by immunity level and explores its implications for Sub Saharan Africa. A comprehensive literature review was undertaken and quality assessment was carried out on the selected papers. Four cohort studies and three cross-sectional studies were identified for which the overall quality score assessment ranged from weak/moderate (Score of 1.8) to strong (Score of 3). The evidence yielded by our review was conflicting. Thus, the high heterogeneity between study populations and results did not allow us to draw any firm conclusions as to whether HAART has an impact on HPV 16 acquisition/prevalence. As only three studies were conducted in Africa, there are insufficient grounds for solid comparison between geographic regions. In light of inadequate data, HPV unvaccinated women on HAART should still receive more frequent follow-up. [ABSTRACT FROM AUTHOR]

The reduction of inequalities in access to quality care has been a central tenet of UK health policy. Ethnic minorities may experience additional inequalities because of language and other cultural barriers. This article reports interviewer reflections of conducting interviews with South Asian kidney patients about their experiences of end-of-life care. It explores themes which emerged from the analysis of a focus group held with eight bilingual research interviewers. The relevance of these themes to understanding inequalities and access to end-of-life care is discussed; together with the potential for the research process to contribute to service improvement. [ABSTRACT FROM AUTHOR]

Abstract: This study describes the effect of dietary levels of aflatoxin B1 (AFB1) and age of the birds upon the residue level in liver and muscles of broiler chicks. In three different experiments broiler chicks of 7, 14 and 28days of age were kept for 7days on contaminated rations having 1600, 3200 and 6400μg/kg AFB1. AFB1 residues were detected earlier in younger birds and those fed high AFB1 dietary levels. The highest residue levels in liver and muscles of young chicks fed 6400μg/kg AFB1 was 6.97±0.08 and 3.27±0.05ng/g, respectively. Maximum residue concentration was high in birds of young age and those kept on high AFB1 ration. After withdrawal of AF contaminated rations, residues clearance was slow and AFB1 was detectable in liver and muscles of birds for longer duration in younger birds and those fed high AFB1 dietary levels. AFB1 residues in poultry tissues may buildup to high levels in areas with no regulatory limits on AFB1 levels of poultry feed and may pose a risk to consumers health. [ABSTRACT FROM AUTHOR]