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Center of Plasma Physics-Institute for Plasma Research, Nazirakhat, Assam, has the neutron source based on Inertial Electrostatic Confinement of Fusion. In order to scale up the source, it is planned to build a neutron source facility. The facility needs the construction approval from AERB India for occupational radiation safety during the operation and after the operation. It will also assess the short-term and long-term radiological hazards due to the neutron source. In order to evaluate the post irradiation radiation hazards due the neutron source, the radioactivation analysis of laboratory is carried out and reported here. The radioactivity in the laboratory building and source components after short-term and long-term operation has been assessed. The tritium activity in the soil is also evaluated. The calculation is also done for the contact dose rate estimations after operation to assess the maintenance applicability inside the laboratory. The inhalation dose inside the laboratory after the operation has been also calculated to avoid any hazards after operation maintenance activities. The article provides the complete details of post operation hazards analysis for the Inertial Electrostatic Confinement Fusion neutron source facility.

Context and Aims: Effects of practicing yoga in diabetic mellitus (DM) patients have been identified to improve in control of blood glucose levels. The purpose of this work is to evaluate changes in blood flow of calf muscles after specific yoga postures for patients with DM using magnetic resonance imaging (MRI) techniques. Time of flight (TOF) magnetic resonance angiography maximum intensity projection (MIP), T1 maps, T2 maps, and diffusion-weighted Imaging are performed on volunteers and DM patients both pre- and post-exercise. Materials and Methods: TOF MIP, T1 maps with variable flip angles, and T2-weighted spin-echo imaging were performed on four volunteers (aged 30 ± 5) and DM patients (aged 32–68) preexercise, on a 1.5 T Siemens scanner. The total acquisition time was 6 min 20 s. Each volunteer and DM patient were then requested to perform yoga postures Supta Padangusthasana, Utkatasana, and Calf raise for 6 min 30 s at maximum effort, outside the scanner, and subsequently rescanned. To calculate significant signal increase, region of interests was drawn on TOF MIP coronal images in arteries of calf muscles. Student t-tests were performed to determine statistical significance. Results: Among volunteers, a significant signal increase in arteries of calf muscles was noticed, signal intensity graphs were plotted. In DM patients, signal increase in TOF MIP, T2-weighted images were seen in specific arteries (posterior, anterior tibial, and posterior tibial) of calf muscles postexercise. Discussion and Conclusions: The study indicates that yoga has a positive short-term effect on multiple DM-related foot complications. This study depicts that MRI provides potential insight into the benefits of yoga for DM patients through deriving biomarkers for preventive medicine relevant to yoga interception.

Introduction: Cerebral hemispheres are the two main parts of human brain. Though, the cerebral hemispheres may appear to be identical, one hemisphere is functionally dominant over the other. They also exhibit physical variations. The dominance may be due to lateralisation of cortical functions. In about 90% of the total population, the left hemisphere is dominant over the right where the speech and language areas are located. These areas are situated within the Pars Opercularis (PO) and Pars Triangularis (PT) in the dominant hemisphere of the Lateral Sulcus (Sylvian Fissure). The interhemispheric asymmetry of the Sylvian Fissure (SF) may be the basis of cerebral dominance for language, which is less studied in human beings. These asymmetries are relative and vary according to the functions concerned. Therefore, knowledge of the interhemispheric asymmetries is helpful in neurological diagnosis and management. Aim: To measure the length of the lateral sulcus and its rami on both hemispheres and to study their interhemispheric asymmetry. Materials and Methods: A cross-sectional pilot study was done on 30 whole brains of embalmed adult human cadavers irrespective of sexes taken from the Institute of Anatomy of Madras Medical College, Tamil Nadu, India, between the months of June to August, 2017. The lateral sulcus was measured on the superolateral surface of the brain. All measurements were taken with the help of a thin copper wire placed on the surface, its ends being held in position with artery forceps. The wire was then placed on a graduated metal scale and the lengths of the anterior ascending, anterior horizontal, posterior rami and total length of the lateral sulcus were noted. A data sheet was made using Microsoft excel software and the mean length of each ramus was calculated. Results: The mean total length of the SF was noted to be 8.4±0.51 cm on the right side and 8.8±0.56 cm on the left. The mean length of stem of lateral sulcus was 2.5±0.4 cm and 2.6±0.3 cm on the right and left side, respectively. The mean length of the anterior ascending ramus was found to be 2.7±0.3 cm on the right side and 3.13±0.3 cm on the left side. The mean length of the anterior horizontal ramus was found to be 2.34±0.37 cm on the right side and 2.55±0.4 cm on the left side. The mean length of the posterior ramus was found to be 5.6±0.65 cm on the right side and 6.1±0.63 cm on the left side. Conclusion: The SF and their rami of the left side were longer than of the right side in most specimens. This signifies the functional asymmetry between right and left cerebral hemispheres which may be related to language lateralisation of human brain. This interhemispheric difference has been implicated in various genetic syndromes and behavioural disorders in children particularly involving language milestone.

Objective: the primary correction of male epispadias consists of multiple surgical steps: isolation of the complex corpora-urethral plate, bladder neck plasty if incontinence is associated, tubularization of the urethral plate, correction of dorsal curvature, and skin coverage of the penile shaft. The present video demonstrates our center experience in managing incontinent male epispadias and addresses the above-mentioned technical details to achieve the best possible cosmetic and functional result. In particular, the bladder neck plasty through perineal approach, the correction of curvature by external rotation of the corpora and the penile shaft coverage with rotational skin flap Patient and surgical procedure: a 3-year-old boy was born with an isolated incontinent penopubic epispadias. The epispadias was repaired starting with the isolation of the corpora-urethral plate complex using disassembly technique and external rotation of both corpora to fix the dorsal chordee. In addition, the bladder neck was funneled to treat the incontinence. Dorsal skin coverage was achieved using penile skin rather than the redundant ventral prepuce. Result: the boy had an excellent outcome with no urethrocutaneous fistula or recurrence of dorsal chordee at one-year follow-up post-surgery. Conclusion: the described surgical steps allowed dorsal skin closure using the lateral rotation of ventral penile skin flap to improve cosmesis after epispadias repair and avoid the recurrence of chordee secondary to midline dorsal scarring

Objectives Despite the many proven advantages of a physically active lifestyle in patient populations, prescription of exercise is currently not widely implemented in routine clinical practice. The aims of this study were twofold: (1) to assess perceptions of clinicians on the current practice of exercise is medicine (E=M) prescription in two Dutch university medical centres and (2) to determine their perceived barriers and facilitators for the implementation of E=M in routine clinical care in Dutch university medical centres.Design A mixed methodologies study, using both online questionnaires and semi-structured interviews.Setting Dutch university medical centres.Participants Clinicians working within the departments of medical oncology, orthopaedics and rehabilitation medicine of two university medical centres.Results Forty-five clinicians (response rate of 51%) completed the questionnaire, and 19 clinicians were interviewed. The results showed that even though clinicians had a positive attitude towards prescribing E=M, only a few reported to regularly prescribe E=M to their patients. The 52 identified facilitators and barriers for implementation of E=M were categorised into four main themes: (1) beliefs toward the implementation of E=M (eg, clinicians knowledge and skills, and social support), (2) factors related to the patient perspective (eg, patient priorities or motivation), (3) factors related to the referral options (eg, knowledge of and trust in local referral options) and (4) practical considerations when implementing E=M (eg, time constraints).Conclusions Our study showed that even though many clinicians have a positive attitude toward an active lifestyle, many are not prescribing E=M on a regular basis. In order for clinicians to effectively implement E=M, strategies should focus on increasing clinicians E=M referral skills, improving clinicians knowledge of E=M referral options and develop a support system to ensure that E=M is high on the priority list of clinicians.

High quality daily testing for the presence of the SARS-CoV-2 in workplace settings has become part of the standard and mandatory protection measures implemented widely in response to the current pandemic. Such tests are often limited to a small fraction of the attending personnel due to cost considerations, limited availability and processing capabilities and the often cumbersome requirements of the test itself. A maximally efficient use of such an important and frequently scarce resource is clearly required. We here present an optimal testing strategy which minimises the presence of pre-symptomatic and asymptomatic infected members of the population in a workplace setting, derived under a series of simplifying statistical assumptions. These assumptions however, retain many of the generalities of the problem and yield robust results, as verified through a number of numerical simulations. We show that reduction in overall infected-person-days, IPD, by significant percentages can be achieved, for fixed numbers of tests per day of 5% and 10% of the population, of 30% and 50% in the IPD numbers, respectively.

This article is devoted to the effectiveness of postoperative pain relief in surgical hospitals in Ukraine. Multicenter study of the effectiveness of postoperative pain relief in Ukraine using paracetаmol in surgical hospitals – ROZUM is descibed. The effectiveness of multimodal analgesia and other analgesia in the postoperative period has been determined. Predictors of inadequate pain relief in surgical patients were identified, and the risks of pain syndrome development in a surgical hospital were assessed. The use of paracetamol in the schemes of multim

Introduction Preterm birth is one of the main problems in obstetrics, and the most important cause of neonatal mortality, morbidity and neurodevelopmental impairment. Multiple gestation is an important risk factor for preterm birth, with up to 50% delivering before 37 weeks. Progesterone has a role in maintaining pregnancy and is frequently prescribed to prevent (recurrent) preterm birth and improve pregnancy outcomes in high-risk patients. However, little is known about its long-term effects in multiple gestations. The objective of this follow-up study is to assess long-term benefits and harms of prenatal exposure to progesterone treatment in multiple gestations on child development.Methods and analysis This is a follow-up study of a multicentre, double-blind, placebo-controlled randomised trial (AMPHIA trial, ISRCTN40512715). Between 2006 and 2009 women with a multiple gestation were randomised at 16–20 weeks of gestation to weekly injections 250 mg 17α-hydroxyprogesterone caproate or placebo, until 36 weeks of gestation or delivery. The current long-term follow-up will assess all children (n=1355) born to mothers who participated in the AMPHIA trial, at 11–14 years of age, with internationally validated questionnaires, completed by themselves, their parents and their teachers.Main outcomes are child cognition and behaviour Additional outcomes are death (perinatal and up to age 14), gender identity, educational performance and health-related problems. We will use intention-to-treat analyses comparing experimental and placebo group. To adjust for the correlation between twins, general linear mixed-effects models will be used.Ethics and dissemination Amsterdam UMC MEC provided a waiver for the Medical Research Involving Human Subjects Act (W20_234#20.268). Results will be disseminated through peer-reviewed journals and summaries shared with stakeholders, patients and participants. This protocol is published before analysis of the results.Trial registration number NL8933.

Background: The role of saliva in the maintenance of oral health is unequivocal, and its composition influences the dynamics of dental caries by modifying the phases of demineralization and remineralization. Rationale: Dental caries is a dynamic disease characterized by phases of demineralization and remineralization. Remineralization is facilitated by saliva. In children-free from caries, remineralization is dominant, and in caries-active children, demineralization is predominant. Hence, this study has been planned to evaluate the levels of calcium and phosphorus in the saliva which play a significant role in the remineralization process. Objectives: This pilot study was carried out to evaluate the salivary calcium and phosphorus levels of children aged 3–6 years and their possible association with early childhood caries. Materials and Methods: Eighteen children aged 3–6 years were divided into two groups of nine children each – Group I is the caries-free group and children affected with early childhood caries comprising the Group II. Four milliliters of unstimulated whole saliva was collected. The salivary levels of calcium and phosphorus were evaluated using an emission spectrometer – inductively coupled plasma optical emission spectrometer ICP-OES available at Sophisticated Analytical Instrument Facility, Indian Institute of Technology Madras. Descriptive statistics were done. Results: The salivary levels of calcium and phosphorus in children-free from caries were found to be higher than in saliva of children with early childhood caries. Conclusion: More research is needed to elucidate the role of these elements in the prevention of caries.

Background and Objectives: Iran has long been considered to be one of the countries in the world with endemic brucellosis. The aim of this study was to review the surveillance system of brucellosis in Iran. Methods: Data of this study were obtained from the surveillance system of the Center for Communicable Disease Control, the review of records, documents, books and published articles and also interviews with process owners and experts of brucellosis surveillance in 2017-2019. Results: In the current surveillance system in Iran, all patients with brucellosis will undergo standard treatment for at least 2 months. The patient identified at each site, private or public sector, reports to the health center of the city. After reporting cases to higher levels, city health center carried out required epidemiologic investigation in the place of reported case in collaboration with its environmental levels. Finally, the individual assessment form, epidemiologic investigation form, for reported case is completed and registered in national surveillance database. Conclusion: Although integration of the brucellosis surveillance program into the health system of the country and reporting and treatment of human cases in accordance with the countrychr('39')s protocol in recent years is well executed, brucellosis control in Iran requires the one health approach. Accordingly, it can be concluded that despite the decrease in the number of brucellosis cases in recent years, the weakness in livestock surveillance has led to many fluctuations in the health systemchr('39')s success in providing surveillance for human cases of brucellosis.

Background and Objectives: The Family Physician (FP) plan was implemented in rural areas and cities with a population of less than 20000 in 2005. The purpose of this study was to explain the challenges and obstacles of¬ the Rural Family Physician Program in Kurdistan Province from the perspective of stakeholders. Methods: This qualitative study was conducted using 30 semi-structured interviews and 5 focused group discussions (FGD) with stakeholders of the FP plan from June 2017 to Jan 2018. The participants were selected through a purposive sampling method with maximum variation. The contents of the interviews and FGD were categorized by the content analysis method using MAXQDA10 software (V. 10). Results: The challenges and obstacles of the FP plan were categorized into 16 subcategories and 5 main categories. The main categories were stewardship challenges, service delivery challenges, cultural and educational challenges, human resource challenges, and infrastructure challenges. The most important subcategories of these challenges included weaknesses in policy-making, formation of laws and regulations, weaknesses in insurance performance, weaknesses in intra-sector coordination, weaknesses in the referral system, weaknesses in communicating the plan to the community, low survival of physicians, inadequate motivational mechanisms, and weaknesses in the information system. Conclusion: The rural FP plan faces many challenges that require multi-dimensional interventions. Identifying the challenges of the FP plan from the perspective of its stakeholders can help to gradually improve the plan.

Background and Objective: Traditional cheese has desirable organoleptic characteristics for Iranian consumers. Escherichia coli, Staphylococcus aureus and Salmonella are some of the most important microbial agents in food poisoning and gastrointestinal infections, which can contaminate this product and endanger the health of consumers. The aim of this study was to survey the contamination rate and determination of antibiotic resistance of Staphylococcus aureus, Escherichia coli and Salmonella strains isolated from traditional cheeses distributed in Mahabad, Iran. Materials and Methods: In a cross-sectional study, 100 samples of traditional cheese from the production and distribution centers in Mahabad city were randomly selected in 2016 to determine the bacterial contamination in accordance to national standard guidelines for the presence of Staphylococcus aureus, E.coli and Salmonella spp. Anti-biograms test was conducted using a standard disc diffusion method through the measurement of the inhibitory zone diameter on the Muller Hinton agar. Results: Among the 100 samples, 54, 45 and 0 samples were positive for Escherichia coli, Staphylococcus aureus and Salmonella, respectively. All E.coli (100%) were found to be resistant to Amoxicillin, while Staphylococcus aureus isolates (100%) were resistant to Amoxicillin-Clavulanic acid and Amoxicillin. However, 66.6% isolates of E.coli were susceptible to Ceftriaxone and 97.7% isolates of Staphylococcus aureus were susceptible to Trimethoprim – Sulfamethoxazole. Conclusion: The microbial quality of traditional cheeses distributed in Mahabad city was not evaluated as appropriate and the values did not meet the national standards. Thus, further monitoring and control are needed.

Background: Acidemia, is associated with reduced cardiac function in animals, but no studies showing an effect of acidemia on cardiac function in humans are reported. In the present study, we examined the effect of acidemia on cardiac function assessed with transpulmonary thermodilution technique with integrated pulse contour analysis (Pulse Contour Cardiac Output, PiCCO™) in a large cohort of critically ill patients. Methods: This was a prospective multicenter observational cross-sectional study of 297 patients from 6 intensive care units in London, England selected from all patients admitted consecutively between May 2018 and March 2019. Measurements of lowest plasma pH and concurrent assessment of cardiac function were obtained. Findings: There was a significant difference between two pH categories (pH ≤ 7.28 vs. pH > 7.28) for the following variables of cardiac function: SVI (difference in means 32.7; 95% CI: 21 to 45 mL/m2; p

The study was conducted to evaluate the effect of thermal conditioning on serum levels of Triiodothyronine (T3), thyroxine (T4) and corticosterone (CORT) in four different chicken strains namely Aseel, Naked Neck, Assel × Nandanam chicken-4 and Naked Neck × Nandanam Broiler-3. Chicks were divided into control (C; ambient temperature 28±1°C) and heat exposed groups (H; 39±1°C for 2 hours; 0-2 and 5-6 weeks of age). At 12th week, control group were divided into two groups, i.e. unexposed control (C) and exposed control (CE). Birds from H group (HE) and CE group were thermally challenged at 39±1°C for 4 hours daily on 12th week. On 42nd and 84th day, blood was withdrawn from each group, serum separated and processed for T3, T4 and CORT. The results indicated that the thermal conditioning had significantly decreased T3, T4 and increased CORT levels, irrespective of strains. At thermal challenge, a drastic drop in CORT level and improvement in thyroid hormone levels were noticed in the preconditioned birds. From present study, it was concluded that, the birds are able to withstand the heat stress effect which was indicated by drop in CORT level.

Introduction: Rickettsial disease in children has shown an increasing trend in several parts of India over recent years. The clinical features and seroprevalence vary in different geographic areas. Aim: To determine the seroprevalence and clinical features of Scrub typhus in paediatric patients. Materials and Methods: The prospective study was conducted for a period of six months included all paediatric patients

Objectives Informing 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.Design In 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.Setting UK stroke services.Participants 3127 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.Results Of 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.Conclusion It 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 number ISRCTN83290762; Post-results.

Introduction: The ever-growing number of COVID-19 patients stresses upon the need to identify effective yet readily available predictors of disease severity to ensure better clinical outcomes. D-dimer is a fibrin specific degradation product derived by enzymatic action of plasmin on factor XIIIa cross-linked fibrin. It serves as an ideal marker for activation of coagulation and fibrinolytic pathways. Identification of coagulopathy as an important complication in COVID-19 patients has brought to focus D-dimer as a possible predictor of clinical severity in patients. Aim: In this study, we analysed the role of D-dimer levels in assessing the clinical severity of the COVID-19 patients. Materials and Methods: We enrolled 217 in-patients of Tirunelveli Medical College in this single centre observational study and classified them into asymptomatic, mild, moderate and severe according to “Clinical Management Protocol: COVID 19”, by the Ministry of Health and Family Welfare and Director General of Health Services. D-dimer was estimated in the separated plasma, using latex based assay using semi-automated coagulation analyser. Data were presented as percentages for categorical variables and median±Inter Quartile Range (IQR) for continuous variables. Chi-square test was used to compare the D-dimer values between symptomatic and asymptomatic groups. A value of p

Introduction: Endoscopic Retrograde Cholangiopancreatography (ERCP) is a technically demanding procedure that requires considerable amount of training to be performed safely. Successful cannulation of the ducts depends on the expertise of the endoscopist. Conventionally, cannulation is facilitated with the help of smooth muscle relaxants like Hyoscine-N-butyl bromide or Drotaverine which impair duodenal contractions and facilitate sphincter of oddi relaxation. Aim: To compare the effect of Fatty meal versus Drotaverine hydrochloride versus Hyoscine-N-butyl bromide on duodenal contraction rate, ease of identification of the papillary orifice, time for cannulation, and adverse effects of agents used on haemodynamic parameters. Materials and Methods: The study was conducted at Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai,Tamil Nadu, India, where 60 patients admitted for ERCP with normal appearing ampulla, were taken-up for the study. Patients were subjected randomly into the three groups viz., Hyoscine group, Drotaverine group and Fatty meal group. In Fatty meal group, 200 mL of semi skimmed milk (1.7% fat) was given orally one hour prior to the procedure to allow for gastric emptying. A 20 mg of intravenous Hyoscine-N-butyl bromide and 40 mg of intravenous Drotaverine hydrochloride were administered 15 minutes before procedure in Hyoscine and Drotaverine group, respectively. Statistical analysis was done by Chi-square test and Analysis of Variance (ANOVA) test and using Statistical Package for the Social Sciences (SPSS) 16.0 version software. A p-value

Total chlorophyll content of sugarcane is an important indicator of plant health, directly correlated to the photosynthetic potential of the crop. With recent technological advancements, portable chlorophyll meters have largely replaced biochemical chlorophyll estimation, requiring laborious extraction procedure with solvents like acetone and dimethyl sulphoxide. Chlorophyll meters determine only ‘greenness’ index, which has to be converted into scientifically standard units in order to make the data comprehensive. Prediction models for inter-conversion of chlorophyll units are available for crops like rice, wheat, sorghum, barley, maize, etc., but not for sugarcane till date. In the present study, total chlorophyll content was recorded in diverse sugarcane germplasm and commercial hybrids using both non-destructive and destructive sampling methods. A strong positive correlation was observed between meter readings (SPAD and CCI) with total chlorophyll content estimated using 80% acetone (r = 0.800 and 0.793) and dimethyl sulphoxide (r = 0.915 and 0.868). Regression models for the best fit curve between meter reading and extracted chlorophyll values of the tested sugarcane germplasm and hybrids were non-linear, polynomial equations of the second order. The model developed was validated in an independent experiment wherein sugarcane variety Co 86032 was subjected to increasing nitrogen levels. Highly significant linear regression was found between observed and predicted values of all estimates of total chlorophyll content with almost negligible prediction error. Thus, the model calibrated and validated for sugarcane germplasm and commercial hybrids would be a small yet significant step towards aiding high-throughput phenotyping in sugarcane thereby accelerating crop improvement programmes.

Objectives: The objective of this study was to study the predictors of adverse drug reactions (ADRs) among geriatric patients in the Department of Medical Oncology. Methods: A hospital-based prospective observational study was carried out among 153 inpatients in the Department of Medical Oncology for 6 months. Patients above 60 years of age with a confirmed history of malignancy were included in the study. The potential risk factors for ADR were defined in relation to the patient and chemotherapeutic regimen and relationship between them was assessed by univariate and multivariate logistic regression analysis. Results: Among 153 patients, 94 (64.43%) experienced ADRs. The mean ADR per patient was 0.88 ± 1.2. The common ADRs found were alopecia (30.18%) and diarrhea (28.68%). Risk estimates revealed that there was a significant association between smokers (odds ratio [OR] = 10.326; 95% confidence interval [CI] 2.345–45.47, P = 0.001), alcoholics (OR = 10.897; 95% CI 2.479–47.902, P = 0.001), increasing age (OR = 2.22; 95% CI 1.698–2.909, P = 0.001), overweight (OR = 16.68; 95% CI 2.179–127.741, P = 0.001), and male participants (OR = 0.143; 95% CI 0.05–0.390 P = 0.001) with the development of ADRs. The risk of carboplatin (OR = 13.359; 95% CI 3.056–58.406 P = 0.001) and 5-fluorouracil (OR = 1.938 95% CI 1.266–2.935 P = 0.001) use and occurrence of ADRs were also found to be high. Conclusion: The study findings showed that smoking, alcohol consumption, age more than 70 years, and overweight had a high risk for developing ADRs in geriatric patients who underwent chemotherapy. The independent risk factors identified should be targeted for preventive measures to improve anticancer agent prescription and reduce the risk of ADRs.

Background. Colistin is an old antibiotic that has been reintroduced as salvage therapy in hospitalised patients because it is frequently the only agent active against Gram-negative bacteria. Various guidelines for colistin administration have led to confusion in establishing the appropriate dose, which has potential for adverse consequences including treatment failure or toxicity. The emergence and spread of colistin resistance has been documented in South Africa (SA), but no local information exists on how and why colistin is used in hospitals, and similarly, compliance with current dosing guidelines is unknown.Objectives. To evaluate the current utilisation of colistin in SA hospitals, in order to identify stewardship opportunities that could enhance the appropriate use of this antibiotic.Methods. Electronic patient records of adult patients on intravenous (IV) colistin therapy for >72 hours in four private hospitals were retrospectively audited over a 10-month period (1 September 2015 - 30 June 2016). The following data were recorded: patient demographics, culture and susceptibility profiles, diagnosis, and indication for use. Compliance with six colistin process measures was audited: obtaining a culture prior to initiation, administration of a loading dose, administration of the correct loading dose, adjustments to maintenance dose according to renal function, whether colistin was administered in combination with another antibiotic, and whether de-escalation following culture and sensitivity results occurred. Outcome measures included effects on renal function, overall hospital mortality, intensive care unit length of stay (LoS), and hospital LoS.Results. Records of 199 patients on IV colistin were reviewed. There was 99.0% compliance with obtaining a culture prior to antibiotic therapy, 93.5% compliance with prescription of a loading dose, and 98.5% compliance regarding prescription of colistin in combination with another agent. However, overall composite compliance with the six colistin stewardship process measures was 82.0%. Non-compliance related to inappropriate loading and maintenance doses, lack of adjustment according to renal function and lack of de-escalation following culture sensitivity was evident. Significantly shorter durations of treatment were noted in patients who received higher loading doses (p=0.040) and in those who received maintenance doses of 4.5 MU twice daily v. 3 MU three times daily (p=0.0027). In addition, compared with patients who survived, more patients who died received the 3 MU three times daily maintenance dose (p=0.0037; phi coefficient 0.26).Conclusions. The study identified multiple stewardship opportunities to optimise colistin therapy in hospitalised patients. Urgent implementation of a stewardship bundle to improve colistin utilisation is warranted.Â

A low cost high quality system for accessing quality of food samples by finding the presence of fungus is proposed. Most of the food items kept for long intervals will have fungal infection in them. The proposed system uses Histogram of Oriented Gradients algorithm along with Support Vector Machine classifier to detect the presence of fungus. The features of the food samples captured in real time using a webcam are extracted using Histogram of Oriented Gradients algorithm. The extracted features are given to SVM classifier which compares these features with the trained one and displays the quality of food samples. The algorithms are implemented using ARM Cortex A-53 processor. Experimental results indicate that very good sensitivity and specificity is obtained and the execution time of the algorithms implemented in ARM processor is much lesser compared to the results obtained using MATLAB software.

Abstract Background Despite substantial improvement in the control of malaria and decreased prevalence of malnutrition over the past two decades, both conditions remain heavy burdens that cause hundreds of thousands of deaths in children in resource-poor countries every year. Better understanding of the complex interactions between malaria and malnutrition is crucial for optimally targeting interventions where both conditions co-exist. This systematic review aimed to assess the evidence of the interplay between malaria and malnutrition. Methods Database searches were conducted in PubMed, Global Health and Cochrane Libraries and articles published in English, French or Spanish between Jan 1980 and Feb 2018 were accessed and screened. The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale and the risk of bias across studies was assessed using the GRADE approach. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guideline were followed. Results Of 2945 articles screened from databases, a total of 33 articles were identified looking at the association between malnutrition and risk of malaria and/or the impact of malnutrition in antimalarial treatment efficacy. Large methodological heterogeneity of studies precluded conducting meaningful aggregated data meta-analysis. Divergent results were reported on the effect of malnutrition on malaria risk. While no consistent association between risk of malaria and acute malnutrition was found, chronic malnutrition was relatively consistently associated with severity of malaria such as high-density parasitemia and anaemia. Furthermore, there is little information on the effect of malnutrition on therapeutic responses to artemisinin combination therapies (ACTs) and their pharmacokinetic properties in malnourished children in published literature. Conclusions The evidence on the effect of malnutrition on malaria risk remains inconclusive. Further analyses using individual patient data could provide an important opportunity to better understand the variability observed in publications by standardising both malaria and nutritional metrics. Our findings highlight the need to improve our understanding of the pharmacodynamics and pharmacokinetics of ACTs in malnourished children. Further clarification on malaria-malnutrition interactions would also serve as a basis for designing future trials and provide an opportunity to optimise antimalarial treatment for this large, vulnerable and neglected population. Trial registration PROSPERO CRD42017056934.

Background. Much has been published on whether newly graduated doctors are ready for practice, seeking to understand how to better prepare graduates for the workplace. Most studies focus on undergraduate education as preparation for internship by investigating knowledge and skills in relation to clinical proficiencies. The conversion from medical student to internship, however, is influenced not only by medical competencies, but also by personal characteristics and organisational skills. Most research focuses largely on the interns’ own perceptions of their preparation. Supervisors who work closely with interns could therefore present alternative perspectives.Objectives. To explore the views of medical intern supervisors on the internship training context, as well as their perspectives on attributes that would help an intern to function optimally in the public health sector in South Africa (SA). This article intends to extend our current understanding of what contributes to a successful internship by including the views of internship supervisors.Methods. Twenty-seven semi-structured interviews were held with medical intern supervisors in 7 of the 9 provinces of SA. The data were thematically analysed and reported using an existing framework, the Work Readiness Scale.Results. The intern supervisors indicated that interns were challenged by the transition from student to doctor, having to adapt to a new environment, work long hours and deal with a large workload. Clinical competencies, as well as attributes related to organisational acumen, social intelligence and personal characteristics, were identified as being important to prepare interns for the workplace. Diligence, reliability, self-discipline and a willingness to work (‘go the extra mile’) emerged as key for a ‘good’ intern. The importance of organisational skills such as triage, prioritisation and participation was foregrounded, as were social skills such as teamwork and adaptability.Conclusions. This article contributes to our understanding of what makes a successful medical internship by exploring the previously uncanvassed views of intern supervisors who are working at the coalface in the public health sector. It is envisaged that this work will stimulate debate among the medical fraternity on how best to prepare interns for the realities of the workplace. Educational institutions, health services and interns themselves need to take ownership of how to instil, develop and support these important attributes.

Bioactive glasses (BaGs) are widely utilised in bone tissue engineering (TE) but the molecular response of cells to BaGs is poorly understood. To elucidate the mechanisms of cell attachment to BaGs and BaG-induced early osteogenic differentiation, we cultured human adipose stem cells (hASCs) on discs of two silica-based BaGs S53P4 (23.0 Na2O - 20.0 CaO - 4.0 P2O5 - 53.0 SiO2 (wt-%)) and 1-06 (5.9 Na2O - 12.0 K2O - 5.3 MgO - 22.6 CaO - 4.0 P2O5 - 0.2 B2O3 - 50.0 SiO2) in the absence of osteogenic supplements. Both BaGs induced early osteogenic differentiation by increasing alkaline phosphatase activity (ALP) and the expression of osteogenic marker genes RUNX2a and OSTERIX. Based on ALP activity, the slower reacting 1-06 glass was a stronger osteoinducer. Regarding the cell attachment, cells cultured on BaGs had enhanced integrinβ1 and vinculin production, and mature focal adhesions were smaller but more dispersed than on cell culture plastic (polystyrene). Focal adhesion kinase (FAK), extracellular signal-regulated kinase (ERK1/2) and c-Jun N-terminal kinase (JNK)-induced c-Jun phosphorylations were upregulated by glass contact. Moreover, the BaG-stimulated osteoinduction was significantly reduced by FAK and mitogen-activated protein kinase (MAPK) inhibitors, indicating an important role for FAK and MAPKs in the BaG-induced early osteogenic commitment of hASCs. Upon indirect insert culture, the ions released from the BaG discs could not reproduce the observed cellular changes, which highlighted the role of direct cell-BaG interactions in the osteopotential of BaGs. These findings gave valuable insight into the mechanism of BaG-induced osteogenic differentiation and therefore provided knowledge to aid the future design of new functional biomaterials to meet the increasing demand for clinical bone TE treatments.

Axillary lymph node involvement is a very important poor prognostic factor in the clinical staging and management of breast cancer patients. Traditionally, axillary lymph node dissection (ALND) has been used for determining the status of the axillary lymph nodes. More recently the sentinel lymph node biopsy (SLNB) procedure has gained wider acceptance as the standard of care, having the advantage of being less invasivewhile providing good accuracy. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at these practical consensus recommendations in regards with the use of the two different procedures and other issues in patients with early breast cancer for the benefit of community oncologists.

Tulisan ini menyajikan percobaan dua teknologi fermentasi biogas dari eceng gondok (Eichhornia crassipes). Fermentasi cair dengan dua phase menghasilkan 1 volume biogas per volume reaktor per hari dengan volume beban 4 kg bobot kering per meter kubik reaktor per hari dan pemakaian waktu 12,5 hari. Sedangkan fermentasi padat menghasilkan lebih banyak biogas, yaitu 3-4 volume biogas pe volume reaktor per hari dengan volume beban 15 kg bobot kering per meter kubik reaktor per hari dan pemakaian waktu 22 hari. Kedua teknologi ini memberikan produksi biogas yang lebih tinggi daripada sistem konvensional seperti batch, Gobar dan semi-kontinu. Terutama fermentasi padat memberi harapan walaupun memerlukan praperlakuan eceng gondok secara intensif. Selain itu suhu merupakan factor penting. Pada suhu 350C (mesophilik); produksi gas lebih tinggi dibandingkan pada suhu ruang (22-280c). Fermentasi pada suhu mesophilik memungkinkan juga penambahan volume beban menjadi lebih tinggi.

Burn is one of the major causes of death and disability in the world. It can cause by heat, chemicals, electricity, sunlight or radiation. More burns caused by fires in buildings, contact with boiling water, steam, liquids and flammable gases. Accelerating the process of healing has always been of interest to practitioners because these injuries are usually takes long time to be healed. Therefore, proper treatment and care of this type of wound required to accelerate healing, prevent infection and chronicity. In traditional medicine, due to the high vegetation diversity and breadth of our country, the use of herbs for burns healing and lesions of various etiologies, has been intesified. Various studies on burn wound healing properties of medicinal plants have been performed. In this article, we refered to reliable sites for evaluating of 10 plants including Amebia euchroma, Green Tea, Hypericum perforatum, Centella asiatica, Scrophularia striata, Aloe vera, Cydonia Oblongae seeed, Malva sylvestris, Calendula officinalis and Myrtus to compare the restorative properties of a number of important medicinal plant flora of Iran on accelerating the process of wounds healing of burn in order to provide effective medicinal plant sources are addressed.

Penelitian ini bertujuan untuk melihat sejauh mana pengaruh pemberian jamur perusak kayu (white-rot fungus) terhadap perombakan ligno-selulosa yang terdapat pada limbah kehutanan untuk digunakan sebagai substrat pada fermentasi metan secara padat. Limbah kehutanan yang digunakan adalah serbuk gergaji kayu karet (Hevea brasiliensis) dan pinus (Pinus merkusii) serta daun kayu putih (Melaleuca leucodendron) sisa penyulingan. Jamur yang digunakan adalah Schizophyllum commune Fr. dengan lama waktu inokulasi sampai 5 minggu dan kemudian baru difermentasi. Karet merupakan substrat yang miskin untuk dapat menghasilkan metan. Produksi gas tidak meningkat secara nyata. Pinus sangat sukar dirombak, sedangkan pada limbah daun kayu putih terdapat inhibitor yang menjadi penghalang sewaktu proses berlangsung, namun inhibitor ini agak menjadi lunak untuk difermentasi setelah diberi pra-perlakuan terlebih dahulu dengan jamur perusak kayu. Pada masing-masing substrat terdapat hubungan spesiflk antara berat kering yang hilang selama berlangsungnya aktifltas jamur dengan perubahan produksi metan. Perubahan efisiensi metan berkisar antara 10%-25%. Praktisnva penerapan untuk "biogas generasi" masih diperlukan penelitian lebih lanjut untuk memperoleh produksi secara maksimal. Namun demikian untuk limbah ligno-selulosa lainnya seperti jerami pra-perlakuan ini sangat baik untuk dikembangkan.

Background. The delivery of aerosolised medication, as performed by nurses and physiotherapists in intensive care units (ICUs), forms an important component of patient care.Objectives. To determine the presence of contamination of nebulisers used within a ventilator circuit; to describe the protocol and clinical practice regarding decontamination and storage of these devices; and to identify micro-organisms colonising contaminated nebulisers and the surrounding air at patients’ bedsides.Methods. A cross-sectional multicentre observational study was conducted, including site and equipment sampling to determine contamination. ICU managers were interviewed to determine the decontamination and storage protocols used for nebulisers in their units. Swabs were taken from nebuliser chambers and streaked onto blood agar plates (BAPs). An air sampler was used to collect air samples from the surrounding bedside environment. The BAPs were incubated for bacterial and fungal contamination. Species of colonies observed in these samples were identified. Results. Sixty-one nebulisers from seven ICUs were sampled (Micro Mist n=37; Aeroneb n=24). Half of the nebulisers (Micro Mist (n=19, 51.4%));Aeroneb (n=12, 50%)) and most air samples (n=60, 98%)) presented with contamination. All participating ICUs reported decontamination and storage protocols, but visual inspection of nebulisers suggested that the protocols were not observed. Nebulisers rinsed with alcohol and left open to the environment to dry had the lowest contamination rates. Coagulase-negative Staphylococcus species (spp.) were mostly found in the surrounding air and Aeroneb samples, and Enterococcus spp. were mostly found in the Micro Mist nebulisers.Conclusion. Although decontamination and storage protocols for nebulisers were in place, nebuliser and air contamination was high, possibly due to poor staff adherenceÂ

BACKGROUND AND OBJECTIVE: Phenylketonuria (PKU) is the most prevalent inborn error of amino acid metabolism in the world and its incidence rate is increasing in Iran. The aim of the present study was to assess the efficiency of HRM technique as a fast and suitable method in identifying common mutations of phenylalanine hydroxylase gene including IVS10-11G>A and P281L in order to improve the early detection of the disease to prevent the occurrence of it. METHODS: In this case-control study, 20 DNA samples including one sample with IVS10-11G>A mutation , one sample with P281L mutation and 18 control samples were extracted from peripheral blood collected in Medical Genetic Center of Isfahan and were genotyped with HRM technique. To validate the mutations, the mutant samples were genotyped using sequencing. Bioinformatic analyses were used for determining structural and functional effects of P281L mutation on the of PAH protein. FINDINGS: HRM analysis identified IVS10-11G>A and P281L mutations with a sensitivity and specificity of 100% and the mutant and normal samples differentiated well in normalized and difference plots. Bioinformatic analyses demonstrated instability and pathological effects of PAH protein containing P281L mutation. CONCLUSION: HRM is a simple and fast technique detecting the two IVS10-11G>A and P281L mutations with 100% sensitivity and specificity.

Background. Problem-based learning (PBL) has been adopted across many health professions training institutions. Small-group student tutorials are a major component of PBL. Facilitator feedback during a tutorial is a key activity to promote self-regulated learning.Objective. To explore ways in which students use feedback to promote self-regulated learning in a PBL environment.Methods. This was an exploratory qualitative study in which individual interviews and focus group discussions were conducted with health science students who had experience of the tutorial process. Data were collected through audio recording and writing of field notes. Thematic analysis was employed to generate the reported themes.Results. Students used feedback in various ways that can lead to self-regulated learning. Their experiences were summarised into three themes, i.e. activation of prior knowledge; reflection; and formulation of a personal learning plan. From the findings, a conceptual model linking feedback and selfregulated learning in a PBL context was developed.Conclusion. In this study, we propose a conceptual model illustrating how feedback is a major activity in the critical pathway that leads to self-regulatedlearning.

Background. The concept of peer-assisted teaching or peer-assisted learning (PAL) has been receiving more attention in the teaching of medical and alliedhealth students. Many advantages have been described in the literature, but much more research is needed. Challenges with the academic platform at aspecific institution of higher learning necessitate investigation into the current literature on PAL, which can inform decisions in terms of teaching and learning of allied health professions students.Objective. To critically appraise evidence of the effectiveness and implementation of PAL during the professional clinical skills training of undergraduate students in allied health professions to make informed future decisions on teaching and learning.Methods. A literature search was conducted by an experienced librarian in the Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa and the researcher in multiple electronic databases (MEDLINE, CINAHL, Africa-Wide Information, ERIC and PubMed) published from 2000 to 2014.Results. One hundred and seventy-five articles on PAL in health professions training were identified. The selected articles (n=20) were independentlycritically appraised by two researchers by means of the standardised critical appraisal skills programme (CASP) and the Author Manuscript of theNational Institutes of Health on Appraising Quantitative Research in Health Education. Nine articles were identified to be reviewed (two by the same author).Conclusion. The findings with regard to the limited number of articles reviewed suggested that PAL may address some of the needs of the new generation of students and may be beneficial to the student tutor, student tutee and clinical supervisor. More evidence is needed in terms of the questions arising from the review, especially with regard to occupational therapy, dietetics and nutrition, and optometry, to fully implement PAL.

Bacterial blight (BB) and fungal blast diseases are the major biotic constraints that limit rice productivity. To sustain yield improvement in rice, it is necessary to developed yield potential of the rice varieties by incorporation of biotic stress resistance genes. Tellahamsa is a well-adapted popular high yielding rice variety in Telangana state, India. However, the variety is highly susceptible to BB and blast. In this study, simultaneous stepwise transfer of genes through marker-assisted backcross breeding (MABB) strategy was used to introgress two major BB (Xa21 and xa13) and two major blast resistance genes (Pi54 and Pi1) into Tellahamsa. In each generation (from F1 to ICF3) foreground selection was done using gene-specific markers viz., pTA248 (Xa21), xa13prom (xa13), Pi54MAS (Pi54) and RM224 (Pi1). Two independent BC2F1 lines of Tellahamsa/ISM (Cross-I) and Tellahamsa/NLR145 (Cross-II) possessing 92% and 94% recurrent parent genome (RPG) respectively were intercrossed to develop ICF1-ICF3 generations. These gene pyramided lines were evaluated for key agro-morphological traits, quality, and resistance against blast at three different hotspot locations as well as BB at two locations. Two ICF3 gene pyramided lines viz., TH-625-159 and TH-625-491 possessing four genes exhibited a high level of resistance to BB and blast. In the future, these improved Tellahamsa lines could be developed as mega varieties for different agro-climatic zones and also as potential donors for different pre-breeding rice research.

Tuberculosis and nutrition are intrinsically linked in a complex relationship. Altered metabolism and loss of appetite associated with tuberculosis may result in undernutrition, which in turn may worsen the disease or delay recovery. We highlight an updated Cochrane review assessing the effects of oral nutritional supplements in people with active tuberculosis who are receiving antituberculosis drug therapy. The review authors conducted a comprehensive search (February 2016) for all randomised controlled trials comparing any oral nutritional supplement, given for at least 4 weeks, with no nutritional intervention, placebo or dietary advice only in people receiving antituberculosis treatment. Of the 35 trials (N=8 283 participants) included, seven assessed the provision of free food or high-energy supplements, six assessed multi-micronutrient supplementation, and 21 assessed single- or dual-micronutrient supplementation. There is currently insufficient evidence to indicate whether routinely providing free food or high-energy supplements improves antituberculosis treatment outcomes (i.e. reduced death and increased cure rates at 6 and 12 months), but it probably improves weight gain in some settings. Plasma levels of zinc, vitamin D, vitamin E and selenium probably improve with supplementation, but currently no reliable evidence demonstrates that routine supplementation with multi-, single or dual micronutrients above the recommended daily intake has clinical benefits (i.e. reduced death, increased cure rate at 6 and 12 months, improved nutritional status) in patients receiving antituberculosis treatment. In South Africa, most provinces implement a supplementation protocol based on nutritional assessment and classification of individuals rather than on disease diagnosis or treatment status.Â

Objective The diagnosis of transient ischaemic attack (TIA) based on symptoms and signs can be challenging and would greatly benefit from a rapid serum biomarker of brain ischaemia. We aimed to quantify the added diagnostic value of serum biomarkers in patients suspected of TIA beyond symptoms and signs.Methods This is a cross-sectional diagnostic accuracy study with a 6-month follow-up period. Participants were patients suspected of TIA by the general practitioner (GP) in whom a blood sample could be collected within 72 hours from symptom onset. A research nurse visited the participant for the blood sample and a standardised interview. The GP referred participants to the regional TIA service. An expert panel of three neurologists classified cases as TIA, minor stroke or any other diagnosis, based on all available diagnostic information including the GP’s and neurologist’s correspondence and the follow-up period. We used multivariable logistic regression analyses to quantify the diagnostic accuracy of clinical predictors and the improvement of accuracy by seven biomarkers (NR2, NR2 antibodies, PARK7, NDKA, UFD1, B-FABP and H-FABP).Results 206 patients suspected of TIA participated, of whom 126 (61.2%) were diagnosed with TIA (n=104) or minor stroke (n=22) by the expert panel. The median time from symptom onset to the blood sample collection was 48.0 (IQR 28.3–56.8) hours. None of the seven biomarkers had discriminative value in the diagnosis of TIA, with C-statistics ranging from 0.45 to 0.58. The final multivariable model (C-statistic 0.83 (0.78–0.89)) consisted of eight clinical predictors of TIA/minor stroke: increasing age, a history of coronary artery disease, sudden onset of symptoms, occurrence of symptoms in full intensity, dysarthria, no history of migraine, absence of loss of consciousness and absence of headache. Addition of the individual biomarkers did not further increase the C-statistics.Conclusions Currently available blood biomarkers have no added diagnostic value in suspected TIA.Trial registration number NCT01954329

Sugarcane has been bred with a focus of obtaining high sugar varieties. Identifying associated traits assumes importance for genetic manipulation. Enzymes of sucrose metabolism were researched and reviewed over decades. In the present study sucrose content in individual internodes, and related enzymes viz., invertases (acid and neutral) and sucrose phosphate synthetase (SPS) were assessed. Sucrose content ranged from 119 mg/g to 432 mg/g, while acid invertase (AI) ranged from 1.35 μ mol g-1 h-1 to 52.3 μ mol g-1 h-1 Enzymes SPS did not show any specific trend among different internodes; however the SPS/AI ratio showed significant correlation with sucrose content. Significant differences were observed between high and low sugar varieties with regard to the parameters studied.