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N-linked protein glycosylation is an essential co-and posttranslational protein modification that occurs in all three domains of life; the assembly of N-glycans follows a complex sequence of events spanning the (Endoplasmic Reticulum) ER and the Golgi apparatus. It has a significant impact on both physicochemical properties and biological functions. It plays a significant role in protein folding and quality control, glycoprotein interaction, signal transduction, viral attachment, and immune response to infection. Glycoengineering of protein employed for improving protein properties and plays a vital role in the production of recombinant glycoproteins and struggles to humanize recombinant therapeutic proteins. It considers an alternative platform for biopharmaceuticals production. Many immune proteins and antibodies are glycosylated. Pathogen's glycoproteins play vital roles during the infection cycle and their expression of specific oligosaccharides via the N-glycosylation pathway to evade detection by the host immune system. This review focuses on the aspects of N-glycosylation processing, glycoengineering approaches, their role in viral attachment, and immune responses to infection.

Background and Aims: The risk for infection in alcohol-related liver disease (ALD) has rarely been investigated at a population level, nor if the underlying liver histopathology is associated with infection risk. We examined the rate of hospital-based infections in a nationwide cohort of biopsy-proven ALD, and the subsequent risk of death. Methods: Population-based cohort study in Sweden comparing 4028 individuals with an international classification of disease (ICD) code for ALD and a liver biopsy from 1969 to 2017 with 19,296 matched general population individuals. Swedish national registers were used to ascertain incident infections in secondary or tertiary care and subsequent mortality until 2019. We used Cox regression, adjusted for sex, age, education, country of birth, diabetes, and number of hospitalizations in the year preceding liver biopsy date, to estimate hazard ratios (HRs) in ALD and histopathological subgroups compared to reference individuals. Results: Median age at ALD diagnosis was 59 years, 65% were men and 59% had cirrhosis at baseline. Infections were more common in patients with ALD (84 cases/1000 person-years [PY]) compared to reference individuals (29/1000 PYs; adjusted hazard ratio [aHR] 3.06, 95% CI = 2.85–3.29). This excess risk corresponded to one additional infection per 18 ALD patients each year. The rate of infections was particularly high in individuals with cirrhosis (aHR = 3.46) and in those with decompensation (aHR = 5.20). Restricting our data to those with an infection, ALD (aHR = 3.63, 95%CI = 3.36–3.93), and especially ALD cirrhosis (aHR = 4.31, 95%CI = 3.89–4.78) were linked to subsequent death. Conclusions: Individuals with biopsy-proven ALD have a three-fold increased rate of infections compared with the general population. The risk of death after an infection is also considerably higher in individuals with ALD.

BACKGROUND Previous studies investigating the prevalence of celiac disease (CD) in individuals with autoimmune hepatitis (AIH) have shown highly variable results. We therefore aimed to examine the prevalence of CD in individuals with AIH. METHODS Two professional librarians searched PubMed, EMBASE, Cochrane and Web of Science Core Collection up until 7 February 2020. The search terms included 'celiac disease', 'celiac', 'transglutaminases', 'gluten', 'gliadin', 'EMA', 'TTG' and 'villous' combined with 'autoimmune', 'hepatitis', 'ANA', 'SMA' and 'LKM'. This search yielded 2419 unique publications. A systematic review based on the PRISMA guidelines resulted in 31 articles eligible for full text review. Fifteen articles were deemed relevant, with 8 being included in our main analysis. A fixed-effect inverse variance-weighted model was used, and heterogeneity was calculated. RESULTS Our main analysis included 567 individuals with AIH from eight studies, where biopsy-verified CD (equivalent to Marsh III) was seen in 23 individuals (4.1%). The pooled prevalence of CD in AIH was 3.5% (95% CI = 1.6%-5.3%) (heterogeneity: P = .874; I2 = 0.0%), which is clearly higher than the 1% CD seen in most general populations. When also including studies where CD had been diagnosed through positive serology without biopsy (15 studies: n = 1817 individuals with AIH), the pooled prevalence of CD was 2.9% (95% CI = 2.1%-3.8%) (heterogeneity: P

We aimed to determine the risk of incident cancer in autoimmune hepatitis (AIH) compared with the general population and siblings. AIH was defined by the presence of a medical diagnosis of AIH and results of examination of a liver biopsy specimen in a nationwide Swedish population-based cohort study. We identified 5,268 adults with AIH diagnosed during 1969–2016 and 22,996 matched, general population, reference individuals and 4,170 sibling comparators. Using Cox regression, hazard ratios were determined for any incident cancer, and subtypes were determined from the Swedish Cancer Register. During follow-up, a cancer diagnosis was made in 1,119 individuals with AIH (17.2 per 1,000 person-years) and 4,450 reference individuals (12.0 per 1,000 person-years). This corresponded to a hazard ratio of 1.53 (95% confidence interval: 1.42, 1.66). Cancer risk was highest in those with cirrhosis. There was a 29.18-fold increased risk of hepatocellular carcinoma (HCC) (95% confidence interval: 17.52, 48.61). The annual incidence risk of HCC in individuals with AIH who had cirrhosis was 1.1% per year. AIH was also linked to nonmelanoma skin cancer (hazard ratio (HR) = 2.69) and lymphoma (HR = 1.89). Sibling analyses yielded similar risk estimates for any cancer (HR = 1.84) and HCC (HR = 23.10). AIH is associated with an increased risk of any cancer, in particular, HCC and extrahepatic malignancies. The highest risk for cancer, especially HCC, is in patients with cirrhosis.

COVID-19 is the current health challenge across the world. It originated in Wuhan, China, and has now spread to more than 180 countries. It is a zoonotic disease which spreads through droplets. The severity of disease is likely to end with the discovery of vaccines only. Researchers are repurposing drugs to fill the gap between COVID-19 and vaccine designing. Broad-spectrum antiviral drugs are preferred but they exhibit side effects. We have screened pentagalloylglucose present in Terminalia chebula which can prevent SARS-CoV-2 entry to the host cell. In this study, we have taken 8 active phytochemicals of Terminalia chebula which include gallic acid, chebulic acid, chebulanin, neochebulinic acid, ellagic acid, chebulagic acid, chebulinic acid, and pentagalloyglucose against spike proteins (S1 and S2), Replicase Polyprotein, 3C-like protease (3CL pro), Papain-like protease (PLpro), RNA dependent RNA polymerase (RdRp) of SARS-CoV-2. HADDOCK online server, Discovery Studio Visualizer and PyRx Vina tools were used to screen the potential component from T. chebula. It was analysed that pentagalloylglucose can be a better phytochemical against spike protein S1 similar to hemagglutinin of influenza virus. This phytochemical can be further used as a drug against SARS-CoV-2.

Patients with alcohol-related liver disease (ALD) frequently have risk factors for cardiovascular disease (CVD), but their long-term risk of CVD is not well-known, especially considering the competing risk of death from liver-related causes. It is further unknown if any excess risk varies across histological subgroups.We investigated the risk of CVD outcomes in 3488 persons with ALD and an available liver biopsy in Sweden between 1969 and 2016, compared with a matched reference population (n = 15,461). Administrative coding from national diagnostic and histopathology registers were used to define exposures and outcomes. Competing risk regression, taking non-CVD death into account and adjusting for potential confounders, was used to estimate subdistribution hazard ratios for incident CVD up until Dec 31, 2019.At baseline, patients with ALD had a median age of 58 years, 64% were men, and 2039 (58%) had cirrhosis on histology. The incidence rate of CVD was 35.6 per 1000 person-years in ALD compared with 19.0 per 1000 person-years in reference individuals. ALD was associated with a 2-fold increased short-term risk for CVD compared with matched reference individuals (subdistribution hazard ratio during the first year after diagnosis, 2.29; 95% confidence interval, 1.79-2.95), but this risk decreased with time. Incidence rates of CVD were comparable across histological subgroups (ranging from 27.4 CVD cases per 1000 person-years in those with normal histology to 39.2 cases per 1000 person-years in those with cirrhosis).Persons with biopsy-proven ALD have increased rates of CVD across histological subgroups compared with matched reference individuals, particularly just after ALD diagnosis. Active surveillance of modifiable CVD risk factors should be considered by clinicians treating patients with ALD.

In our previous study, we have isolated different genera of bacteria from gallstones and this intrigued us to study their role in gallstone formation. The isolates exhibited certain biliary activities like urease activity, slime production, and β-glucuronidase production. We aimed to investigate the role of these factors in the formation of gallstone in in vitro conditions at a supersaturated concentration of cholesterol. To mimic bile in in vitro state, Brilliant Green Bile Broth (BGBB) media having a composition similar to human bile was used. Four different experimental sets were prepared, each having nine flasks with varying concentrations of cholesterol and CaCO3 (calcium carbonate). Test sets I, II, III, and IV were inoculated with Salmonella, Enterococcus, Helicobacter, and Neisseria respectively, which were isolated from gallstone itself. Out of these four bacteria, only Helicobacter did not possess slime activity. A control set was also established which was devoid of bacteria. The control also had nine flasks with different concentrations of cholesterol and CaCO3. All the sets were incubated in the incubator shaker at 37 °C and 80 revolution per minutes (RPM) for 20 days. It was observed that the sets having bacteria had a less nucleation time as compared to the control (F = 5.274; p < 0.001). Solidification of gallstone was observed only in the set with bacteria having slime activity (sets I, II, and IV). The slime activity of bacteria leads to solidification of gallstones, whereas the other activities accelerate the nucleation of gallstone formation enhancing the severity of the disease.

Background: Autoimmune hepatitis (AIH) is a chronic inflammatory liver condition that predominantly affects women. However, pregnancy risks remain unclear in these women. Methods: A nationwide population-based cohort study (ESPRESSO) in Sweden 1992-2016 including 309 singleton births in women with AIH and 1,532 matched births in women from the general population was performed. AIH was diagnosed as a combination of administrative coding from medical diagnosis of AIH and liver biopsy data from Sweden’s 28 pathology departments. Using conditional logistic regression, odds ratios (ORs) for adverse pregnancy outcomes were determined. Findings: Among 306 live births to AIH women, 51 (16.7%) were preterm compared to 70 out of 1,524 (4.6%) reference births. This corresponded to an OR of 5.10 for preterm birth (95%CI=3.29-7.92), with similar odds seen when using sibling comparators. AIH women with and without cirrhosis had similar odds for preterm birth. The AIH association was particularly strong with medically indicated preterm birth (OR=13.01; 95%CI=5.50-30.79). In addition, AIH was associated with offspring low birth weight (OR=5.31; 95%CI=2.82-9.99) and low 5-min Apgar score (OR=3.46; 95%CI=1.14-10.49), but we found no association with congenital malformations (OR=1.14; 95%CI=0.68-1.91), small for gestational age (OR=1.04; 95%CI=0.38-2.85), stillbirth (OR=0.59; 95%CI=0.02-18.88), or neonatal death (OR=7.42; 95%CI=0.65-84.25). Maternal AIH was linked to an increased odds of cesarean section (OR=1.44; 5%CI=1.04-2.00) and preeclampsia (OR=3.65; 95%CI=2.01-6.64), but not to gestational diabetes. Interpretation: Maternal AIH was associated with a 5-fold higher odds of preterm birth, and future studies are needed to elucidate mechanisms and identify interventions that can reduce this risk. Funding: This project received funding through the Karolinska Institutet and Columbia University Irving Medical Center. Declaration of Interest: Jonas F Ludvigsson coordinates a study on behalf of the Swedish IBD quality register (SWIBREG). This study has received funding from Janssen corporation. Rajani Sharma is a speaker for Takeda on educational lectures, unrelated to this research. Hannes Hagstrom’s institution has received research funding from Intercept, Astra Zeneca and Gilead. Hannes Hagstrom has served as a scientific board advisor for BMS and Gilead. None of these are deemed relevant for the current study. Elizabeth C Verna is on the Gilead advisory board and receives Salix research support. Tracey G Simon reports grants to the institution from Amgen, and has previously served as a consultant to Aetion, for work unrelated to this manuscript. This study did not receive any support from these organizations and these organizations did not have a role in the design and conduct of the study. Authors not named here have disclosed no conflicts of interest. Ethical Approval: The ESPRESSO cohort was reviewed by the Stockholm Ethics Board (No. 2014/1287-31/4) approved on August 27, 2014.

Objective: To identify different Candida spp along with antifungal susceptibility pattern and risk factors associated with candidemia. Design, setting, and patients: This retrospective observational study was conducted in a tertiary-care academic hospital in Jaipur, Western India, for 3 years (July 2017–June 2020). Methods: Blood cultures were performed according to standard microbiological methods, and only 1 isolate per patient was included in the study. Isolates of Candida spp were identified using a VITEK-2 automated system and matrix-assisted laser desorption ionization-time of flight mass spectrometry. Antifungal susceptibility tests were performed using the broth microdilution assay according to the Clinical and Laboratory Standards Institute guidelines. Results: Of 3,443 blood cultures received from suspected sepsis cases, candidemia was identified in 95 (2.8%). In addition to Candida tropicalis (n = 36; 38%) and Candida parapsilosis (n = 17; 18%), 10 isolates of Candida auris comprised the fourth most common cause of candidemia. Presence of central venous catheter and diabetes were statistically significant risk factors for development of candidemia by NAC. Resistance to fluconazole was 36%, resistance to voriconazole was 20%, resistance to 5-flucytosine was 4%, and resistance to amphotericin-B was 7%. C. auris isolates were more resistant than other NAC spp. We detected no resistance among the echinocandins. Conclusions: The emergence of highly resistant isolates like C. auris emphasizes the need for constant monitoring of candidemia cases for species identification and routine antifungal susceptibility so that appropriate measures can be taken to reduce the related morbidity and mortality.

Background Low socioeconomic status has been linked with numerous poor health outcomes, but data are limited regarding the impact of insurance status on inflammatory bowel disease (IBD) outcomes. We aimed to characterize utilization of healthcare resources by IBD patients based on health insurance status, using Medicaid enrollment as a proxy for low socioeconomic status. Methods We retrospectively identified adult patients with IBD engaged in a colorectal cancer surveillance colonoscopy program from July 2007 to June 2017. Our primary outcomes included emergency department (ED) visits, inpatient hospitalizations, biologic infusions, and steroid exposure, stratified by insurance status. We compared patients who had ever been enrolled in Medicaid with all other patients. Results Of 947 patients with IBD, 221 (23%) had been enrolled in Medicaid. Compared with patients with other insurance types, patients with Medicaid had higher rates of ever being admitted to the hospital (77.6% vs 42.6%, P < 0.0001) or visiting the ED (90.5% vs 38.4%, P < 0.0001). When adjusted for sex, age at first colonoscopy, and ethnicity, patients with Medicaid had a higher rate of inpatient hospitalizations (Rate ratio [RR] 2.95; 95% CI 2.59–3.36) and ED visits (RR 4.24; 95% CI 3.82–4.70) compared to patients with other insurance. Patients with Medicaid had significantly higher prevalence of requiring steroids (62.4% vs 37.7%, P < 0.0001), and after adjusting for the same factors, the odds of requiring steroids in the patients with Medicaid was increased (OR 3.77; 95% CI 2.53–5.62). Conclusions Medicaid insurance was a significant predictor of IBD care and outcomes. Patients with Medicaid may have less engagement in IBD care and seek emergency care more often.

BACKGROUND AND AIMS Recent studies link NAFLD to an increased incidence of HCC and extrahepatic cancers. However, earlier studies were small or lacked liver histology, which remains the gold standard for staging NAFLD severity. APPROACH AND RESULTS We conducted a population-based cohort study of all adults with histologically defined NAFLD in Sweden from 1966 to 2016 (N = 8,892). NAFLD was defined from prospectively recorded liver histopathology submitted to all 28 Swedish pathology departments and categorized as simple steatosis, nonfibrotic NASH, noncirrhotic fibrosis, and cirrhosis. NAFLD patients were individually matched to ≤5 general population controls without NAFLD by age, sex, calendar year, and county (N = 39,907). Using Cox proportional hazards modeling, we calculated multivariable adjusted HRs (aHRs) and 95% CIs. Over a median of 13.8 years, we documented 1,691 incident cancers among NAFLD patients and 6,733 among controls. Compared with controls, NAFLD patients had significantly increased overall cancer incidence (10.9 vs. 13.8 per 1,000 person-years [PYs]; difference = 2.9 per 1,000 PYs; aHR, 1.27 [95% CI, 1.18-1.36]), driven primarily by HCC (difference = 1.1 per 1,000 PYs; aHR, 17.08 [95% CI, 11.56-25.25]). HCC incidence rates increased monotonically across categories of simple steatosis, nonfibrotic NASH, noncirrhotic fibrosis, and cirrhosis (0.8 per 1,000 PYs, 1.2 per 1,000 PYs, 2.3 per 1,000 PYs, and 6.2 per 1,000 PYs, respectively; Ptrend

Background and aims Some, but not all, prior studies have suggested that patients with chronic liver disease are at increased risk of contracting COVID-19 and developing more severe disease. However, nationwide data are lacking from well-phenotyped cohorts with liver histology and comparisons to matched general population controls. Methods We conducted a nationwide cohort study of all Swedish adults with chronic liver disease (CLD) confirmed by liver biopsy between 1966 and 2017 (n = 42,320), who were alive on February 1, 2020. CLD cases were matched to ≤ 5 population comparators by age, sex, calendar year and county (n = 182,147). Using Cox regression, we estimated multivariable-adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for COVID-19 hospitalization and severe COVID-19 (intensive care admission or death due to COVID-19). Results Between February 1 and July 31, 2020, 161 (0.38%) CLD patients and 435 (0.24%) general population controls were hospitalized with COVID-19 (aHR = 1.36, 95% CI = 1.11–1.66), while 65 (0.15%) CLD patients and 191 (0.10%) controls developed severe COVID-19 (aHR = 1.08, 95% CI = 0.79–1.48). Results were similar in patients with CLD due to alcohol use, nonalcoholic fatty liver disease, viral hepatitis, autoimmune hepatitis, and other etiologies. Among patients with cirrhosis (n = 2549), the aHRs for COVID-19 hospitalization and for severe COVID-19 were 1.08 (95% CI 0.48–2.40) and 1.23 (95% CI = 0.37–4.04), respectively, compared to controls. Moreover, among all patients diagnosed with COVID-19, the presence of underlying CLD was not associated with increased mortality (aHR = 0.85, 95% CI = 0.61–1.19). Conclusions In this nationwide cohort, patients with CLD had a higher risk of hospitalization for COVID-19 compared to the general population, but they did not have an increased risk of developing severe COVID-19.

In the present time, with the various advancement in science and technology, life has improved in many ways. Improvements in medicine and diagnostic techniques have played an important role in enhancing life span. This shows a direct impact on population size. To overcome these challenges, scientists have enhanced research to new heights. Although various biotechnological aspects have proven to be better in increasing crop productivity, the miniature size of nanoparticles makes them perfectly poised to minimize the use of chemicals and pesticides and lead to maximum availability of nutrients. In sustainable agriculture, soil composition, nutrient availability, and resistivity against diseases in plants are the major requirements and nanoparticle creations like nanoclays, nanozeolites, and hydrogels increase the water-holding capacity of the soil. Nanotubes and nanoparticles of silicon dioxide (SiO2), gold (Au), and titanium dioxide (TiO2) contribute to the uptake of nutrients. Nanofertilizers have the controlled mechanism to release nutrients in the soil. This minimizes the use of resources and maximizes the utility. In the present chapter, we will focus on various aspects of nanobiotechnology for crop quality and quantity improvement.

Background and Aims Autoimmune hepatitis (AIH) is a chronic inflammatory liver disease that may lead to cirrhosis and liver failure, but data on overall mortality in AIH are conflicting. Methods This was a nationwide population-based cohort study in Sweden from 1969-2017 of 6,016 adults with AIH and 28,146 matched general population reference individuals. AIH was defined by a combination of a medical diagnosis of AIH plus a liver biopsy from any of Sweden’s 28 pathology departments. Through Cox regression, we estimated hazard ratios (HRs) for overall and cause-specific death. Liver transplant was included in our main outcome of death. Results During follow-up, 3,185 individuals with AIH died (41.4/1000 person-years) compared with 10,477 reference individuals (21.9/1000 person-years). The 10-year cumulative incidence of death was 32.3% (95%CI = 31.1-33.6) for AIH individuals and 14.1% (95%CI = 13.7-14.5) for reference individuals. This corresponded to an adjusted HR of 2.29 (95%CI = 2.17-2.41), which remained elevated ≥ 20 years follow-up. AIH individuals with cirrhosis on biopsy had a high risk of death (HR = 4.55; 95%CI = 3.95-5.25), while mortality in patients with fibrosis, inflammation without fibrosis, or necrosis did not differ. Portal hypertension and overlap with cholestatic liver diseases were also associated with death. AIH was associated with an increased risk of death from cardiovascular disease (HR = 1.27; 95%CI = 1.15-1.40), liver disease (HR = 66.24; 95%CI = 48.19-91.03) and extrahepatic malignancy (HR = 1.69; 95%CI = 1.51-1.89). In a sibling comparison, AIH individuals remained at increased risk of death. Conclusion AIH is associated with a 2-fold increased risk of death. Risks were particularly high in individuals with cirrhosis, portal hypertension, and overlap with cholestatic liver disease.

The liver transplantation (LT) population is aging, with the need for transplant being driven by the growing prevalence of nonalcoholic steatohepatitis (NASH). Older LT recipients with NASH may be at an increased risk for adverse outcomes after LT. Our objective is to characterize outcomes in these recipients in a large multicenter cohort. All primary LT recipients ≥65 years from 2010 to 2016 at 13 centers in the Re-Evaluating Age Limits in Transplantation (REALT) consortium were included. Of 1023 LT recipients, 226 (22.1%) were over 70 years old, and 207 (20.2%) had NASH. Compared with other LT recipients, NASH recipients were older (68.0 versus 67.3 years), more likely to be female (47.3% versus 32.8%), White (78.3% versus 68.0%), Hispanic (12.1% versus 9.2%), and had higher Model for End-Stage Liver Disease–sodium (21 versus 18) at LT (P < 0.05 for all). Specific cardiac risk factors including diabetes with or without chronic complications (69.6%), hypertension (66.3%), hyperlipidemia (46.3%), coronary artery disease (36.7%), and moderate-to-severe renal disease (44.4%) were highly prevalent among NASH LT recipients. Graft survival among NASH patients was 90.3% at 1 year and 82.4% at 3 years compared with 88.9% at 1 year and 80.4% at 3 years for non-NASH patients (log-rank P = 0.58 and P = 0.59, respectively). Within 1 year after LT, the incidence of graft rejection (17.4%), biliary strictures (20.9%), and solid organ cancers (4.9%) were comparable. Rates of cardiovascular (CV) complications, renal failure, and infection were also similar in both groups. We observed similar posttransplant morbidity and mortality outcomes for NASH and non-NASH LT recipients. Certain CV risk factors were more prevalent in this population, although posttransplant outcomes within 1 year including CV events and renal failure were similar to non-NASH LT recipients.

BACKGROUND & AIMS: Persons with alcohol-related liver disease (ALD) are at an increased risk of death and liver-related endpoints, but the association with incident cancer is not well understood, and whether it differs across histopathological subgroups is undefined.METHODS: We investigated the risk of cancer in 3,410 persons with a diagnosis of ALD and an available liver biopsy in Sweden between 1969-2016, compared to a matched reference population. Administrative coding from national registers and liver biopsy data were used to define exposure and outcome status. Competing risk regression, adjusted for available confounders and using non-cancer mortality as the competing risk, was used to estimate subdistribution hazard ratios (sHRs) for incident cancer.RESULTS: At baseline, persons with ALD had a median age of 58.2 years, 67% were men, and 2,042 (60%) had cirrhosis. ALD was not associated with cancer in general (sHR=1.01, 95%CI=0.92-1.11), although the risk was increased in persons surviving ≥1 year (sHR=1.19, 95%CI=1.08-1.32). The risk of liver cancer was elevated sHR=12.80, 95%CI=9.38-17.45). HCC incidence among ALD persons with cirrhosis was 8.6 cases/1,000 person-years, corresponding to a cumulative incidence after 10 years of 5.0%.CONCLUSIONS: Persons with biopsy-proven ALD that survive the initial time after diagnosis are at an elevated risk for cancer, in particular HCC compared with the general population. Although the risk for HCC was elevated, data do not suggest that routine surveillance for HCC in ALD cirrhosis is cost-effective.

Background: Aspirin, when used with concurrent anticoagulation, increases the risk of gastrointestinal bleeding (GIB). Therefore, multisociety guidelines recommend prophylactic proton-pump inhibitors (PPIs) for patients receiving aspirin and anticoagulation. We aimed to determine rates and predictors of adherence to these recommendations. Methods: All adult inpatients discharged from the hospital on aspirin and anticoagulation from July 2009 to June 2014 were retrospectively evaluated for PPI prescription on discharge instructions. We used univariate and multivariate logistic regression to test for predictors of PPI prescription. Results: A total of 2422 patients were discharged on aspirin and anticoagulation; the mean age was 68 years and 53.2% were male; 42.2% were prescribed a PPI at discharge. On univariate analysis, factors associated with discharge PPI prescription included increased age (47.1% versus 37.9%), white race (47.3% versus 37.1–40.2%), higher aspirin dose (55.1% versus 39.4%), being married (46.2% versus 39.4%) and preadmission PPI use (96.6% versus 23.4%). On multivariate analysis, significant predictors of discharge PPI prescription were age 60–69 years [odds ratio (OR) 1.61] and 70–79 years (OR 1.48), and preadmission PPI use (OR 120.03). Lower odds of discharge PPI prescription included Medicaid (OR 0.55) or Medicare (OR 0.71) insurance, Spanish language (OR 0.63), and lower dose aspirin (81 mg) (OR 0.40). Conclusions: A total of 42.2% of patients discharged on aspirin and anticoagulation were prescribed PPIs. Older age and preadmission PPI use were predictive of PPI prescription, while Medicaid/Medicare insurance, Spanish language, and lower dose aspirin decreased the likelihood of discharge PPI prescription. This creates an opportunity to improve primary GIB prevention through quality improvement interventions.

Acute-on-chronic liver failure (ACLF) is a feared complication that can develop at any stage of chronic liver disease. The incidence of ACLF is increasing, leading to a significant burden to both the affected individual and health care systems. To date, our understanding of ACLF suggests that it may be initiated by precipitants such as systemic infection, alcohol use, or viral hepatitis. The prevalence of these vary significantly by geography and underlying liver disease, and these precipitants have a varying impact on patient prognosis. Herein, we present a review of our current understanding of the precipitants of ACLF, including gaps in current data and opportunities for meaningful intervention and areas of future research.

BACKGROUND: Insulin resistance and diabetes mellitus are common extrahepatic manifestations of chronic hepatitis C (HCV). Insulin resistance assessed by HOMA-IR is associated with low rates of sustained virological response, especially in HCV genotype 1 positive patients treated with peginterferon/ribavirin. The effect of insulin resistance on sustained virologic response in HCV genotype 3 positive patients who were treated with peginterferon/ribavirin still remains unclear. OBJECTIVE: To evaluate the impact of insulin resistance on sustained virological response in HCV genotype 3 patients treated with peginterferon/ribavirin. METHODS: A retrospective multicenter study was performed to evaluate the impact of insulin resistance on sustained virological response in non-diabetic HCV genotype 3 positive patients treated with peginterferon and ribavirin. A total of 200 HCV genotype 3 positive patients were enrolled in the study. All patients were non-diabetic. Each patient had a HOMA-IR value measured before the initiation of HCV treatment with peginterferon/ribavirin. The treatment duration was at least 24 weeks. The HOMA-IR cut-off was defined in the study as ≥2.5 due to the coefficient of correlation with sustained virological response of 0.202 (P=0.004). RESULTS: Univariate analysis showed that age, aspartate aminotransferase, platelets, stage of fibrosis and HOMA-IR were predictors of sustained virological response. However multivariate analysis showed advanced fibrosis [OR=2.01 (95%CI: 0.986-4.119) P=0.05] and age [OR=1.06 (95%CI: 1.022-1.110) P=0.002] as negative predictors of sustained virological response. CONCLUSION: In this retrospective multicenter study of non-diabetic HCV genotype 3 positive patients, insulin resistance was not associated with the sustained virological response in patients who were treated with peginterferon/ribavirin.

The present study summarizes the results of treatment in the form of disease-free survival and overall survival in bulky stage IB2 and locally advanced (stages II–IVA) squamous cell carcinoma of the uterine cervix. The treatment has been given in the form of NACT followed by CCRT in one arm and CCRT in the other arm. This retrospective study analyzed 713 cervical cancer patients who were treated at our center during 2007 and 2008; out of 713 patients, data of 612 patients have been compared. The patients' data were analyzed retrospectively. Patients had undergone PF 28.6 %, TPF 21.5 %, and only CCRT 49.9 %. Majority of patients were in the age group 41–50 years, while stage wise, mainly stage IIIb and IIb. Disease-free survival was observed on the basis of stage and NACT. The survival analyses were performed using the Kaplan–Meier method. All statistical calculations were done with SPSS Statistics version 20.0. For cancer cervix NACT versus CCRT, the DFS rate was at 5 years (58.3 vs. 41.8 % p = 0.001). NACT followed by CCRT demonstrated significantly superior DFS as compared to definitive CCRT, respectively, TPF (hazard ratio (HR) = 0.248, 95 % confidence interval (CI) 0.123–0.500; p

Introduction: Cirrhosis is associated with an increased risk of hemorrhagic stroke. We sought to determine whether liver transplantation is associated with a subsequently reduced risk of hemorrhagic stroke. Methods: We performed a retrospective cohort study using administrative claims data on hospitalizations and emergency department visits in CA, FL, and NY from 2005-2013. Patients with cirrhosis awaiting liver transplantation were identified by previously validated ICD-9-CM diagnosis codes for cirrhosis in combination with code V49.83 for “awaiting organ transplant” status. The exposure variable was liver transplantation, ascertained using CPT and ICD-9-CM procedure codes. The primary outcome was a composite of intracerebral hemorrhage and subarachnoid hemorrhage, identified using a previously validated algorithm. Patients were censored at the time of death or last available data. Hemorrhagic stroke incidence was calculated using survival statistics, and Cox proportional hazards modeling was used to examine the association between liver transplantation and hemorrhagic stroke. To minimize immortal time bias, we modeled liver transplantation as a time-varying covariate. We adjusted for demographics, established stroke risk factors, Elixhauser comorbidities, as well as hemodialysis and hepatocellular carcinoma, two factors which significantly increase patients’ priority status for liver transplantation. Results: We identified 11,250 patients with cirrhosis awaiting liver transplant, of whom 2,925 (26%) underwent transplantation. The mean age (54.7 years) did not differ between groups. Patients who underwent transplantation were more often male and less frequently had vascular comorbidities. Over a mean follow-up of 2.6 (±2.3) years, 154 hemorrhagic strokes were identified. The annual incidence of hemorrhagic stroke was 0.24% (95% CI, 0.15-0.36%) after liver transplantation compared with 0.66% (95% CI, 0.56-0.79%) among patients awaiting transplant. After adjustment for potential confounders, liver transplantation was associated with a lower risk of hemorrhagic stroke (HR, 0.6; 95% CI, 0.3-0.9). Conclusions: Liver transplantation was associated with a reduced risk of hemorrhagic stroke among patients with cirrhosis.

Background: Sterile body sites, if infected by micro-organisms than it can lead to severe morbidity and mortality. Therefore early diagnosis and prompt initiation of empiric treatment is necessary. Aim: This study was done to evaluate causative organisms of sterile body site infections and their antimicrobial sensitivity pattern in a tertiary care hospital, New Delhi. Settings and design: Prospective study over a period of one year from January 2015 to December 2015. Material and methods: Sterile body fluid specimens were processed for bacterial culture according to the standard procedures and antimicrobial susceptibility test for isolated organisms was done using agar disk diffusion method. Results: Amongst 405 samples, 122 fluids samples showed growth of organisms with an isolation rate of 30%. Isolates from different fluids were E. coli (28.6%), Acinetobacter spp. (27%), Klebseilla spp. (19.6%), Staphylococcus aureus (10.6%), Enterococcus spp. (7.3%), Pseudomonas spp. (4.9%) and Citrobacter spp. (1.6%). Gram negative isolates were mostly sensitive to carbepenems, colistin and polymyxin B (100%) and gram positive isolates were highly sensitive to vancomycin (100%), linezolid (100%) and ciprofloxacin (70%). Acinetobacter was the most resistant pathogens to many antibiotics. About 38.5% of S. aureus isolates in our study were MRSA. Conclusion: Therefore, knowledge of bacteriological and antimicrobial profile of sterile body fluids is important so that such life threatening infections can be treated effectively on an urgent basis.

The aim of this study was to analyze gallstones structurally and chemically as this may help to direct the measures for its treatment. On the basis of morphology, 459 gallstones were categorized into pigmented, cholesterol, and mixed gallstones and analyzed for their chemical structure and composition. Elementary analysis was done with the help of inductively coupled plasma, optical emission spectrophotometry. Fourier transform infrared spectroscopy was used for compound analysis. The effects of thermal stability were analyzed by thermal gravimetric analysis (TGA). Statistical analysis was done to correlate gallstone composition with their shape and number in gallbladder. Pigmented gallstones were predominant and generally occurred in multiple forms, cholesterol as solitaire and black pigmented as slug (χ 2 = 3.56; p

GPU acceleration of compute-intensive applications has emerged as a new research frontier with phenomenal success- rates. Such applications are characterized by large data-sets being processed by singular functional units (FUs) often described as SIMD (Single Instruction Multiple Data) computing. Moreover, with the proliferation of internet and its easy access on myriad devices, has resulted in huge amount of data generation. Initially, such data was considered disconnected and not related. But with the advent of semantic web, data has been found to be highly co- related and relevant. Organizing such huge amount of data and subsequently processing requires parallel processing framework that is both distributed and scalable. Graphical processing units (GPUs) are being actively probed in the domain of Big Data analysis, machine learning, and augmented reality since such applications are characterized by massive data spanned and generated over distributed network. GPUs provide a parallel programming framework using CUDA (Compute Unified Device Architecture) that can be utilized to efficiently collate and make inferences on these massive data-sets. Further, GPU multicores are available at commodity rates thus providing an option for cheap and low-power alternatives. The exponential growth of semantic web and the resultant generation of large-scale RDF (Resource Description Framework) triples pose new challenges in the domain of RDFstorage and retrieval. RDF data consist of triples which need to be efficiently indexed. Following are some of the many challenges related to efficient indexing of RDF triples

Cloud computing is a collective, optimized usage of IT resources which can be accessed from anywhere and performs the task of providing IT resources and services through various platforms as a service for users. Cloud users use different services of Cloud service providers and eventually end up keeping their data (in various forms) in cloud multi tenant environment. Multi-tenancy in cloud environment makes data vulnerable though with times different forms of threats and corresponding securities are already implemented in cloud environment. Although many of these services provide key functionality such as uploading and retrieving files by a precise user, more on going to the side of advanced services it offer features such as shared folders, real-time collaboration, and minimization of data transfers or unlimited storage space. As data is placed publically it require to search ways to protect the data from unauthorized access, files are uploaded publically and need to retrieve them securely with token ensuring possession proofs. In this paper we have presented a case of multilevel security application for ensuring data integrity (prevention and detection) in cloud environment. General Terms Algorithm, Programming Language, Secure Retrieval, [Cloud computing-Secure Data Retrieval]: Data Security.

in the field of information technology has enabled us to optimize the use of physical infrastructure with the help of virtualization, most of which is only used in specific applications like vitalizing a local area network on switch or vitalizing a compute resource to run more than one operating system on a desktop.The benefits of same has not been completely implemented and utilized in education and research environments where we require a large amount of IT resources. Cloud computing has emerged as one step further solution to deploy all virtualized IT resources as per need on self-service basis as a rental method for the users. Different cloud deployment methods have emerged according to the need of users, institutions and communities. This paper describes the framework of design and implementing a simple private cloud for education and research based on chip level virtualization with hypervisor to establish a simple model of Infrastructure as a service in cloud computing.

Cloud computing has grabbed the spotlight in the year 2013 at a conference in San Francisco, with vendors providing plenty of products and services that equip IT with controls to bring order to cloud chaos. Cloud computing trend is increasing rapidly so to make cloud computing more popular the very first step for the organization is to identify exact area where the cloud related threats lie. At an unusual pace, cloud computing has transformed business and government. And this created new security challenges. The development of the cloud service model provide business - supporting technology in a more efficient way than ever before .the shift from server to service based technology brought a drastic change in computing technology. However these developments have created new security vulnerabilities, including security issues w hose full impressions are still rising. This paper presents an overview and study of cloud computing, with several security threats, security issues, currently used cloud technologies and security solutions.