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Khalid A Binymin,1 Magda Nasher,2 Dipti Patel2 1Liverpool University, Medical School, England, UK; 2Southport and Ormskirk NHS Trust, Southport District General Hospital, Kew, UK Abstract: We are presenting a 72-year-old female who was admitted to hospital with deep vein thrombosis (DVT). She was known to have atrial fibrillation and was initiated on warfarin for stroke prophylaxis 3 days earlier. She was given warfarin therapy without low molecular weight heparin cover as per “slow-start regimen” protocol. The warfarin dose was increased after 3 days to achieve rapid anticoagulation, resulting in DVT in the left leg. We propose that the higher unopposed warfarin dose utilized in this case resulted in DVT. Warfarin loading doses may paradoxically result in a hypercoagulable state and potential clot formation because of significant reductions in protein C and protein S levels. Keywords: warfarin, deep vein thrombosis, slow-start regimen, protein C, protein S, warfarin-induced skin necrosis, stroke prophylaxis

The delivery of ophthalmic services at all levels is completely dependent on equipment: from the simple torch light to the highly sophisticated equipment used for diagnosis and treatment.In order to achieve the aims of VISON 2020: The Right to Sight and eliminate avoidable blindness by the year 2020, it is not enough to have the right equipment available at all levels of service delivery; there has to be a good maintenance and repair support service.The purpose of this equipment survey (commissioned by this journal) was to obtain an overview of the key issues and challenges faced by eye health providers with regard to their equipment.

Background: Diabetes is one of the major causes of cataract. Some drugs prescribed for the treatment of diabetes are the modulators of CYP450, which may alter the risk of cataract. Objective: To study the effect of CYP450 modulation in galactosemic cataract. Materials and Methods: Male Sprague-Dawley suckling rats were allotted to four groups (n = 6), as follows: Group 1: Normal control, Group 2: Galactose control, Group 3: CYP450 inhibitor pretreated and Group 4: CYP450 inducer pretreated. Cataract was induced in animals of all groups except group 1 by feeding them galactose (50%), 21 days after parturition. From the eighteenth day of life, CYP450 inhibitor (nifedipine; 8.1 mg/kg) and CYP450 inducer (pioglitazone; 3.8 mg/kg) were given orally to groups 3 and 4, respectively. The maturation pattern of the cataract was observed by an operating microscope, every third day. Biochemical changes in the lenses of all groups, for example, CYP450 activity expressed as ΅M NADPH oxidized / unit time, alterations in the levels of total proteins, soluble proteins, and reduced glutathione (GSH) following the induction of cataract, were estimated. Results: The microscopic examination of the lenses indicated that CYP450 inhibitor pre-treatment delayed (fourteenth day) the occurrence of cataract, while CYP450 inducer pretreatment demonstrated an early (ninth day) cataract as compared to galactose control rats (twelfth day). A significant decrease and increase in CYP450 activity was observed with the CYP450 inhibitor and inducer pre-treatment, respectively. There was no alteration in the GSH level, but a significant increase in total and soluble protein was found in groups 3 and 4 as compared to group 2. Conclusion: CYP450 may have a role in the initiation of cataract without any effect on the maturation pattern, as revealed by the delayed occurrence of cataract with the CYP450 inhibitor and an early onset of cataract with the CYP450 inducer.

Background: Surgeons are more interested in the techniques available, in recurrence rates, and in short term complications of hernia surgery. The present study was conducted with an objective to compare inguinal hernioplasty with the prolene hernia system verses Linchenstein repair. Methodology: The present comparative study was conducted on the patient admitted with the diagnosis of primary unilateral inguinal hernia. These patients were randomly placed in two groups, one group was subjected to open tension free Prolene hernia system mesh hernioplasty & other group Linchenstein repair. The patients were assessed for the severity of post operative pain using visual analogue scale, duration of surgery, technical difficulty and post-operative complications like wound infection, wound seroma. Results: Duration of surgery in case of Linchenstein mesh repair ranged from 40 -50 minutes and in PHS ranged from 60 - 80 minutes with mean of 70.4 minutes. For Linchenstein repair at the end of 7th day 24% cases have no pain, 60% cases have minimal pain, while 16% cases have moderate pain. For PHS at the end of 7th day 44% cases have no pain, 48% cases have minimal pain, while 8% cases have moderate pain. No patient has severe pain at the end of 7th and 15th day. Conclusion: There is no significant difference found in hospital stay, Complications, chronic pain and recurrence rate in either group. PHS is bit difficult for new surgeon, it requires expertise.

T4b oral cancer is a broad umbrella term for all advanced oral cancers, the prognosis of which varies drastically for disease of the same stage, according to the extent of the masticator space involvement. This was a retrospective observational study including all consecutive T4b oral squamous cell carcinoma patients treated surgically between January 2015 and January 2016 and followed up until January 2020. The disease was classified as upper disease or lower disease based on the anatomical location in relation to an imaginary plane passing through the base of the retromolar trigone. The prime objective was to evaluate overall survival and prognostic factors affecting overall survival. The projected 5-year overall and disease-free survival rates were 40.7% and 35.6%, respectively. The assessment of prognostic factors revealed that lower disease (lower anatomical subsites), bone invasion, and lymph nodal spread significantly affected survival. Patients with disease in an upper anatomical location without bone and nodal involvement can achieve fairly good survival (projected 5-year overall survival of 64.2%) when compared to the other subsets of patients. We propose a re-evaluation of the current staging system based on the prognostic features, so that all patients are not considered under a single stage, since their survival differs significantly. [ABSTRACT FROM AUTHOR]

The resilience of a bridge is computed using different quantitative and qualitative assessment methodologies. However, the resilience score obtained by these assessment approaches is insufficient for the decision-makers for setting a priority level for bridges in need of resilience improvement. To address this issue, the present study develops a methodology using the data envelopment analysis (DEA) approach. A total of 12 bridges are selected as the decisionmaking units in the DEA model. This study considers the variables such as age, area, design high flood level, and finish road level of the bridge as inputs, and bridge resilience index as the output variable. Based on these variables, three frameworks are developed to compute the efficiency of bridge resilience. A variable return to scale with the output-oriented formulation of DEA is selected to compute the efficiency of bridge resilience in all three frameworks. Thus, the proposed methodology enables bridge owners to set a priority level for bridges in need of resilience improvement based on the scores of the assessment methodology. [ABSTRACT FROM AUTHOR]

For designing of the breeding programme, analysis of genetic variability and character correlation is crucial in crop improvement. The aim of this experiment was to estimate genetic variability parameters and trait association for 13 quantitative traits which were measured in F2 segregating populations of six crosses containing nine parents. All the F2 populations showed significant GCV and PCV values for productive tillers per plant, grains per panicle, grain yield per plant and straw yield per plant, indicating that these traits may be improved through selection. Plant height, productive tillers per plant, grains per panicle, grain yield per plant and straw yield per plant showed high heritability coupled with high genetic advance, indicating that these traits were controlled by additive gene action and have a good chance of improvement through pure line selection. Grain yield per plant exhibited a strong positive correlation with plant height, panicle length, grains per panicle, straw yield per plant, productive tillers per plant and harvest index in all the six F2 segregating populations. The F2 population of the cross GR 17 × NVSR 2740 demonstrated that more GCV and PCV, high heritability with high genetic advance for the majority of the traits which can be improved by selection. [ABSTRACT FROM AUTHOR]

Low activation isotopic boron (11B) based magnesium diboride (Mg11B 2) superconductors doped with biomass-derived activated carbon were synthesized using 11B and magnesium powder via solid-state reaction. The effect of carbon doping on the lattice structure and superconducting properties of Mg11B 2 bulks were evaluated using X-ray powder diffraction, high resolution transmission electron microscopy, scanning electron microscopy and magnetization measurements. Precise refinement of structural parameters indicates successful substitution of carbon in Mg11B 2 bulks. The critical current density (J c) of carbon doped Mg11B 2 synthesized at 650 °C was enhanced more than two times compared with the pure Mg11B 2 bulk. Similar improvement was observed for the Mg11B 2 bulks heat-treated at 800 °C. This enhancement is due to successful substitution of biomass-derived carbon with high surface area into Mg11B 2 lattice. The flux pinning mechanism of pure and doped Mg11B 2 bulks were investigated using the Dew-Hughes model. This study provides information regarding enhancement of the J c of low activation Mg11B 2 superconductors suitable for next-generation fusion magnets. [ABSTRACT FROM AUTHOR]

The experiment was carried out to determine the genetic variability parameters and character associations for eleven quantitative traits in Indian bean genotypes. It revealed a significant amount of variability present among these genotypes. Seed yield per plant had high Genotypic coefficient of variation (GCV) and Phenotypic coefficient of variation (PCV) values, showing the potential for improvement by selection. Racemes per plant, pods per raceme, pods per plant, and pod weight had moderate GCV and PCV values. There was high heritability combined with a high genetic advance for pod weight and seed yield per plant. Plant height, pods per plant, and pod weight were significantly and positively associated with seed yield per plant. Pods per plant had the most positive direct effect on seed yield per plant, followed by racemes per plant, plant height, pod weight, pod length, and seeds per pod. Therefore, selection for such traits is advised to bring about improvement in Indian beans. [ABSTRACT FROM AUTHOR]

Neutrons produced by the carbon fusion reaction 12C(12C,n)23Mg play an important role in stellar nucleosynthesis. Past studies have shown large discrepancies between experimental data and theory, leading to an uncertain cross section extrapolation at astrophysical energies. We present the first direct measurement which extends deep into the astrophysical energy range along with a new and improved extrapolation technique based on experimental data from the mirror reaction 12C(12C,p)23Na. The new reaction rate has been determined with a well-defined uncertainty which exceeds the precision required by astrophysics models. Using our constrained rate, we find that 12C(12C,n)23Mg is crucial to the production of Na and Al in Pop-III Pair Instability Supernovae.