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Glycated hemoglobin has been a popular investigation to access the glycemic status. It is a marker for intracellular glycation, and hence, an investigation which can comply with both intracellular and extracellular glycation statuses is preferred. In this regard, fructosaminated HbA1c (FHbA1c), predicted HbA1c (PHbA1c) and glycation gap (GG) were evaluated in 57 cases of diabetes mellitus (DM) without complication and having a normal serum protein and albumin levels. Fifty controls were also evaluated. FHbA1c, PHbA1c and post-prandial predicted HbA1c (PPHbA1c) were plotted using population linear regression equation and calculated individually against each subject. The statistical calculation was evaluated using SPSS version 21. FHbA1c, PHbA1c, PPHbA1c and GG were found to be significantly elevated in cases (p value < 0.001). FHbA1c and GG show significant correlation with the glycemic indices in cases compared to controls. The correlation with FBS and PPBS increases as we move from controls to cases. Area under curve (AUC) in case of FHbA1c is 96.8%, and cut-off level of 5.85% can result in sensitivity of 88.2% and specificity of 90% for the diagnosis of DM. FHbA1c can be used as an additional investigation in cases of DM. Along with GG, it is increased in DM and correlates with the glycemic indices. It has a decent AUC on plotting ROC. Thus, FHbA1c and GG can be used as a part of glyco-metabolic profile and can provide insight into the individualised glycation tendency of the cell.

ObjectivesInforming research participants of the results of studies in which they took part is viewed as an ethical imperative. However, there is little guidance in the literature about how to do this. The Fluoxetine Or Control Under Supervision trial randomised 3127 patients with a recent acute stroke to 6 months of fluoxetine or placebo and was published in the Lancet on 5 December 2018. The trial team decided to inform the participants of the results at exactly the same time as the Lancet publication, and also whether they had been allocated fluoxetine or placebo. In this report, we describe how we informed participants of the results.DesignIn the 6-month and 12-month follow-up questionnaires, we invited participants to provide an email address if they wished to be informed of the results of the trial. We re-opened our trial telephone helpline between 5 December 2018 and 31 March 2019.SettingUK stroke services.Participants3127 participants were randomised. 2847 returned 6-month follow-up forms and 2703 returned 12-month follow-up forms; the remaining participants had died (380), withdrawn consent or did not respond.ResultsOf those returning follow-up questionnaires, a total of 1845 email addresses were provided and a further 50 people requested results to be sent by post. Results were sent to all email and postal addresses provided; 309 emails were returned unrecognised. Seventeen people replied, of whom three called the helpline and the rest responded by email.ConclusionIt is feasible to disseminate results of large trials to research participants, though only around 60% of those randomised wanted to receive the results. The system we developed was efficient and required very little resource, and could be replicated by trialists in the future.Trial registration numberISRCTN83290762; Post-results.

This work deals with the analysis and modification of operational parameters for meeting the emission standards, set by Central Pollution Control Board (CPCB)/State Pollution Control Board (SPCB) from time to time of electrostatic precipitator (ESP). The analysis is carried out by using standard chemical analysis supplemented by the relevant data collected from Korba East Phase (Ph)-III thermal power plant, under Chhattisgarh State Electricity Board (CSEB) operating at Korba, Chhattisgarh. Chemical analysis is used to predict the emission level for different parameters of ESP. The results reveal that for a constant outlet PM concentration and fly ash percentage, the total collection area decreases with the increase in migration velocity. For constant migration velocity and outlet PM concentration, the total collection area increases with the increase in the fly ash percent. For constant migration velocity and outlet e PM concentration, the total collection area increases with the ash content in the coal. i.e. from minimum ash to maximum ash. As far as the efficiency is concerned, it increases with the fly ash percent, ash content and the inlet dust concentration but decreases with the outlet PM concentration at constant migration velocity, fly ash and ash content.

The purpose of this article is to highlight the status and application of an automated cataloging system in central university libraries in north India. Data has been collected using questionnaires. Interview and observation techniques have also been used to bring objectivity in the present study. Results show that varying levels of progress have been made with respect to implementation of a cataloging system. Results also show that with the help of automation, libraries have satisfied user communities by way of easy retrieval. It has removed discrepancies and set a trend for standardization. Furthermore, staff morale has been boosted up in an automated environment.

Objective: Several studies indicate that serum adenosine deaminase (ADA) activity could be a potential marker for the diagnosis of patients with rheumatoid arthritis (RA). However, there has been no such study that could independently verify this finding in Nepali population. The present study therefore aims to measure the total ADA activity in the sera of Nepalese RA patients and verify its diagnostic potential. Materials and Methods: A total of 69 RA patients who visited Universal College of Medical Sciences Teaching Hospital (UCMSTH), Bhairahawa, Nepal for their medical treatment were enrolled for this study. An equal number of age and sex-matched healthy controls were also included in the study. Blood samples were collected from each study subjects and analyzed for serum total ADA, Creactive protein (CRP) and rheumatoid factor (RF). Results: Serum total ADA activity was found to be significantly (p0.05) in the ADA activity was found between the smokers and non-smoker RA patients. Out of total 69 RA patients, only 16 (23.1%) were positive for CRP and 11 (15.9%) were positive for RF. Conclusion: Measurement of serum total ADA activity could be a reliable marker for the diagnosis of RA in Nepali population with relevant clinical scenarios when there is absence of CRP and RF in the serum. DOI: http://dx.doi.org/10.3126/ajms.v4i2.6208 Asian Journal of Medical Sciences 4(2013) 30-35

Objective: The aim of this study was to determine the frequency of type 2 diabetes, impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) among patients visiting a tertiary level teaching hospital in south-western Nepal. Material & Methods: This is a retrospective study conducted among subjects (n=17082) who visited outpatient department of the Universal College of Medical Sciences Teaching Hospital (UCMSTH), Bhairahawa, Nepal for their medical checkup. Data related to age, sex, hospital number and blood glucose concentration of the study subjects were collected from hospital records and analyzed for the frequency study. Results: The average frequency of type 2 diabetes was found to be 6.1% over a period of five years and it was significantly (p=0.0232) higher in males (3.4%) than in females (2.8%). Frequency of IFG and IGT were found to be 2.31% and 2.70% respectively. The frequency of type 2 diabetes, IFG and IGT was significantly higher in males and age group of 51-60 years. Conclusion: The frequency of type 2 diabetes and impaired glycemia is increasing every year in south-western part of Nepal. We recommend that efforts be made by all the stakeholders to curb this emerging medical problem before it becomes epidemic in the general population. DOI: http://dx.doi.org/10.3126/ajms.v2i3.5485 Asian Journal of Medical Sciences 2 (2011) 202-206

Introduction Underwater Endoscopic Mucosal Resection (UEMR) is a relatively new technique, which has been developed for endoscopic resection of colonic lesions. In this technique submucosal injection is not required for many of the lesions. We present here the experience of two UK centres. Methods All of the UEMR procedures were performed by two experienced interventional endoscopists: NS performed 16 cases at St Mark’s hospital in London, and SI performed 18 cases at Russells Hall Hospital in Dudley. Patient data was collected prospectively. A Hybrid technique, i.e. injection of lifting solution or use of Argon Plasma Coagulation (APC) together with UEMR, was employed if the lesion was traversing a fold/removed in retroflexed position or if there was remnant tissue post resection, respectively. Results From May 2015 to February 2016, a total of 34 patients (mean age 64 years, range 35–85, males n = 21) have had UEMR of 35 lesions performed by the two operators. The lesions (mean size 33 mm, range 7–160 mm) were located in right colon (n = 5), transverse colon (n = 2), left colon (n = 9), and rectum (n = 19). Seven of the lesions (20%) were recurrence post previous traditional EMR. The morphology of the lesions were either flat (n = 21) or sessile (n = 14). Hybrid technique was employed as follows: Lifting (n = 14), APC (n = 4), and a combination of lifting and APC (n = 2). Histopathology of the lesions demonstrated low grade dysplasia (n = 29), high grade dysplasia (n = 4), and other (n = 2; One hyperplastic polyp, and one sessile serrated lesion). Complete endoscopic resection (at index procedure) was achieved in 34 out of the 35 lesions (97.1%); a large lesion (160 mm in size), which was crossing over two folds, was resected at two planned sessions. There was no immediate bleeding or perforation, but there was one case of delayed bleeding (2.8%). The procedures, which were performed either with no sedation or analgesia (n = 9), with light sedation and analgesia (n = 18), or with Entonox inhalation as required (n = 7), were well-tolerated with a pain score of zero or one (zero = no pain; one = minimal pain). Conclusion In our experience, underwater endoscopic mucosal resection seems to be a safe and a well-tolerated procedure. It can be an alternative to the traditional EMR, which requires either air or CO2 insufflation, and submucosal injection in all lesions. However, the air or CO2 insufflation significantly thins the bowel wall during the EMR, and submucosal injection does not only create a potential risk of seeding neoplastic cells into deeper wall layers,1 but it also prolongs the procedure time. Follow-up data is required to assess the short- and long-term recurrence rate associated with UEMR. Reference 1 Binmoeller, KF. J Interv Gastroenterol4:4:113–116. Disclosure of Interest None Declared

Introduction Home enteral tube feeding (HETF) has grown in the past 2 decades and there is now also a growing demand for post-pyloric HETF (PP-HETF) for selected cases. 1,2 The optimum route for delivering this is not established, with several options available including surgical jejunostomy (SJ), direct percutaneous endoscopic jejunostomy (DPEJ), and PEG with jejunal extension (PEG-J). We have reviewed our experience to help identify comparative outcomes. Methods Choice of feeding device was clinician-led according to indication, surgical and endoscopic risk. A 2 year review was done from Jan 2014 onwards. Patients were included if they were (1) already undergoing PP-HETF as of January 2014 or (2) had an interventional procedure to start PP-HETF at any time thereafter during the study period. Cases were identified from the community dietetic and electronic endoscopy databases. Case files were reviewed to identify outcome measures which were categorised as: Success of planned procedures; longevity of feeding device, premature removal (removal because of sepsis, migration, blockage or accidental), procedural complications or mortality Results 26 patients were identified (M:F 14:12, median age 55, range 22–83). Indications for PP-HETF were learning difficulties with Gastro-oesophgeal(GO) reflux (8), neurodegenerative or cerebrovascular disease with GO reflux (5), upper GI cancers(9) & others (4). Feeding interventions done successfully prior to or during the study period were SJ (10), DPEJ (14), PEG-J (14).Procedural success rates during study period were; SJ; 10/10 (100%), DPEJ;7/11 (64%), PEG-J; 12/13 (92%).Longevity of feeding devices at review census point (in months, median & range) was: SJ, 11 (3–23); DPEJ,18 (3–48); PEG-J, 6 (0.25–23). Tube premature removal rates (and reasons) were: SJ; 3/10 (30%; all fell out), DPEJ; 3/14(21%; 1 accidental, 2 infected), PEG-J; 6/14 (43%; 4 accidental, 2 blocked). There were no procedural complications recorded but one patient (DPEJ) died Conclusion In this case series which includes similar numbers of the common PP-HETF options, SJ had the highest, and DPEJ the lowest, procedure success rate.DPEJ had the highest longevity. Choice of feeding device for PP-HETF will depend on co-morbidity and surgical/ endoscopic risk but when DPEJ can be placed this may be the preferred option for long-term feeding. References 1 Ojo O. Managing patients on enteral feeding tubes in the community. Br J Community Nurs 2010; 15 :S6–S13. 2 Ojo O. The challenges of home enteral tube feeding: a global perspective. Nutrients 2015; 7 (4):2524–2538. doi:10.3390/nu7042524. Disclosure of Interest None Declared

The Frankfort horizontal is a useful compromise for studying skulls but not for orienting the natural head position (NHP) in the living because it is normally distributed around a true extracranial horizontal. Nonetheless, orthodontists dealing with living subjects, rather than inert crania, have used this Frankfort horizontal faithfully in cephalometry. Because the cant or inclination of all intracranial reference lines is subjected to biologic variation, they are unsuitable for meaningful cephalometric analysis. Registration of head posture in its natural position has the advantage that an extracranial vertical or a horizontal perpendicular to that vertical can be used as reference line for cephalometric analysis. Purpose of this paper is to provide an updated review of various methods to reproduce and record the NHP.

A circularly polarized antenna with square patches and slots has been proposed for radio frequency identification reader applications. The design of reader antenna is optimized to reduce the overall size of an antenna. A ground plane with an arrow type slot has been utilized for efficient coupling of RF power from the feed line to the antenna's square patches. On the square patches, square slots have been inserted to enable the antenna-reader to radiate a circular polarized wave. The test frequency of this antenna is 880 MHz at which it exhibits circularly polarized radiation patterns.

This report highlights a case of severe hyponatraemia secondary to excessive sweating and salt [corrected] poor fluid consumption and low salt diet in hot conditions. The case was complicated by the presence of marked hypokalaemia caused by secondary hyperaldosteronism confirmed, for the first time, by the presence of grossly elevated serum renin and aldosterone concentrations. With the rise in global temperature affecting even temperate climates doctors, especially in acute and general medicine, may be faced with this condition more often.

In our demonstration we present Trident, a scientific workflow workbench built on top of a commercial workflow system to leverage existing functionality to the extent possible. Trident is being developed in collaboration with the scientific computing community for use in a number of ongoing eScience projects that make use of scientific workflows, in particular the Pan-STARRS sky survey project and the Ocean Observatory Initiative. In our demonstration of Trident we will illustrate the ability to utilize both local and cloud resources for storage and execution, as well as services such as provenance, monitoring, logging and scheduling workflows over clusters. Our goal is to release Trident in early 2009 as an open source accelerator for others to use for eScience projects and to continue extending with support for new workflow features and services.

We introduce Trident, a scientific workflow workbench that is built on top of a commercial workflow system to leverage existing functionality. Trident is being developed in collaboration with the scientific community for oceanography, but the workbench itself can be used for any science project for scientific workflow.

Introduction Motor Neurone Disease is a fatal progressive neurodegenerative disorder of unknown aetiology. About 25 to 30% of all patients have bulbar symptoms as the presenting complaint. As dysphagia worsens, referral for Percutaneous Endoscopic Gastrostomy (PEG) feeding is increasingly common as an alternative or supplementary route for nutrition and hydration. There are concerns however regarding respiratory complications in this high risk group. The aim of this study was evaluate safety and efficacy of PEG placement using NIV cover in MND patients. Method We undertook a prospective study of MND patients who had PEG placement with NIV cover from January 2012 to April 2014. Our multi-disciplinary team comprised specialist nurses, respiratory consultants, gastroenterologists, neurologist, nutrition team, dietician and MND coordinator. All patients had initial respiratory assessment and were admitted to the ward a day prior to the procedure. NIV support was given using a nasal mask if needed. Patients stayed in overnight to facilitate instructions and care. Results 75 patients with motor neurone disease who had PEG inserted were included in the study. Median age at the time of PEG insertion was 67 years (range 38–88). Male to female ratio was 37:38. Mean FVC was 58% (range 22–89) and mean SNIP was -28 cm H 2 O (range 12–83). 47 of these 75 patients were ventilated only for the procedure, 3 only following the procedure. 11 patients were already on 24 h ventilation, 9 were on overnight ventilation, 2 were on >14 h ventilation and data was not available on 3 patients. Mean Charlson Co-morbidity index was 0.6. All PEG insertions were successful and none of the patients needed a RIG insertion. There was one patient who had bleeding post procedure which was conservatively managed. Another patient had a small bowel injury which needed a mini-laparotomy. This patient had an uneventful recovery. Hypoxia was a common occurrence but was corrected promptly with NIV. Intravenous sedation was appropriately titrated to avoid respiratory depression and to provide adequate sedation. Survival at 1 month was 97.3%. Conclusion PEG placement in high risk MND patients can be particularly challenging. It needs a multi-disciplinary approach. Our study has shown that high risk MND patients can have PEGs inserted safely with intensive support and monitoring. We do recognise however that there is a need for prospective studies in this field as well as need for studies comparing safety data between routine PEG insertion and PEG insertion with NIV support. Disclosure of interest None Declared.

Introduction Advances in endoscopy training and endoscopic resection techniques have facilitated the development of advanced EMR service in few regional centres. This should equate to a reduction in the number of surgery for benign colorectal polyps. Interestingly, a previous study of hospital episode statistics database for national trends in benign colorectal polyp surgery had showed no significant difference in the reduction of surgery over a 10 year period. 1 We aimed to assess the impact of a new advanced EMR service on the need for surgical intervention for benign polyps in a tertiary care centre. Method The advanced EMR service (including level 3 and 4 polyps) 2 was set up in May 2013. We retrospectively looked at the MDT outcomes 20 months prior and after setting up of the service to identify patients requiring external referral or surgery for benign polyps. Hospital electronic records were reviewed to ascertain details concerning polyp size, complications and bed days. Results In the period before the EMR service, 51 patients underwent surgery for benign polyps requiring 285 bed days. 8 complications were encountered. The average polyp size was 3.2 cms (Range 1–8 cms). 6 patients were referred externally for advanced EMR. Between May 2013 and Dec 2014, since the setting up of the service, 8 patients have had surgery requiring 46 bed days. During the same time, 180 polyps were encountered in 168 patients. The mean polyp size varied from 1.5 cms to 12 cms. Excluding patients who had surgery for invasive cancer, 91% of patients avoided surgery. Of 139 completely resected benign polyps, 66 (47%) polyps were level 4 and 89% polyps achieved complete endoscopic clearance with one procedure. 4 complications required 9 bed days. Conclusion An advanced EMR service decreases the need for surgical intervention, reduces the number of bed days and complications. Moreover, such a service also offers important savings for local healthcare economies. This study also emphasise the need for the development of regional benign polyp MDT. Disclosure of interest None Declared. References Almoudaris AM, et al . Surgery for benign colorectal polyps in England – trends and outcomes from 1997 to 2007. Gut 2011; 60 :A4 Gupta S, et al . The “SMSA” scoring system for determining the complexity of a polyp. Gut 2011; 60 :A129

Introduction Autoimmune hepatitis (AIH) is due to breakdown in immunological self-tolerance. Sustained remission in AIH is crucial to prevent the progression to end stage liver disease. 1 Around 9% of the patients are refractory/intolerant to the standard therapy with prednisolone (Pred) ± azathioprine (AZA). High levels of immunoglobulin are typical of AIH and plasma cells are frequently observed in liver histology. Rituximab is an anti-CD20 monoclonal antibody that depletes B-cells and has been used to treat other autoimmune conditions such as systemic lupus erythematosus. However, little has been reported on the role of B cells depletion and its outcome in AIH. The aim of the study was to evaluate the safety and efficacy of rituximab in the treatment of refractory AIH. Methods A retrospective case note review of well-defined and biopsy proven type-1 AIH (simplified scoring >6). 5 patients out of 200 who were intolerant/refractory to standard therapy were given Rituximab and the responses were followed up for 72 weeks. Efficacy was measured by biochemical and immunological parameters (bilirubin, AST, ALT and Immunoglobulin every 12 weeks. The dose of Prednisolone as well as UKELD/MELD score pre and post treatment was also evaluated. Results All 5 patients were female and mean age was 45 (range 35–66 yrs). The rituximab dose used was 1000 mg and the total number of doses received varied between 2 and 4 (Mean 3.2). Three patients had other concomitant autoimmune conditions (endocrine, rheumatological and renal related autoimmune diseases). The mean dose of prednisolone used pre-rituximab was 19mg (±SD 12.57) and this was reduced to 12.5mg (± SD 5.0) post treatment (statistically not significant=NS). There was a slight improvement of IgG pre and post Rituximab treatment (NS), with no improvement in UKELD score. There was an improvement in biochemical profile but this was not statistically significant throughout the observation period. All five patients were alive and rituximab was well tolerated without any serious adverse events. Conclusion Rituximab is well-tolerated and safe to use in resistant AIH. It can cause some biochemical and immunological improvement. Current evidence for its use in AIH patients is not well proven. The study numbers are too small to detect the actual outcome of the therapy. A multicenter larger cohort prospective study with longitudinal immunological, biochemical and histological profile assessment is warranted to assess its efficacy in resistant AIH patients. Reference Czaja AJ. Current and future treatments of AIH. Expert Rev Gastroenterology Hepatol 2009:3: 269–91 Disclosure of Interest None Declared.