Piperacillin/tazobactam for surgical prophylaxis during pancreatoduodenectomy: meta-analysis.

BACKGROUND: Pancreatoduodenectomy is associated with an increased incidence of surgical-site infections, often leading to a significant rise in morbidity and mortality. This trend underlines the inadequacy of traditional antibiotic prophylaxis strategies. Hence, the aim of this meta-analysis was to assess the outcomes of antimicrobial prophylaxis, comparing piperacillin/tazobactam with traditional antibiotics. METHODS: Upon registering in PROSPERO, the international prospective register of systematic reviews (CRD42023479100), a systematic search of various databases was conducted over the interval 2000-2023. This inclusive search encompassed a wide range of study types, including prospective and retrospective cohorts and RCTs. The subsequent data analysis was carried out utilizing RevMan 5.4. RESULTS: A total of eight studies involving 2382 patients who underwent pancreatoduodenectomy and received either piperacillin/tazobactam (1196 patients) or traditional antibiotics (1186 patients) as antibiotic prophylaxis during surgery were included in the meta-analysis. Patients in the piperacillin/tazobactam group had significantly reduced incidences of surgical-site infections (OR 0.43 (95% c.i. 0.30 to 0.62); P < 0.00001) and major surgical complications (Clavien-Dindo grade greater than or equal to III) (OR 0.61 (95% c.i. 0.45 to 0.81); P = 0.0008). Subgroup analysis of surgical-site infections highlighted significantly reduced incidences of superficial surgical-site infections (OR 0.34 (95% c.i. 0.14 to 0.84); P = 0.02) and organ/space surgical-site infections (OR 0.47 (95% c.i. 0.28 to 0.78); P = 0.004) in the piperacillin/tazobactam group. Further, the analysis demonstrated significantly lower incidences of clinically relevant postoperative pancreatic fistulas (grades B and C) (OR 0.67 (95% c.i. 0.53 to 0.83); P = 0.0003) and mortality (OR 0.51 (95% c.i. 0.28 to 0.91); P = 0.02) in the piperacillin/tazobactam group. CONCLUSION: Piperacillin/tazobactam as antimicrobial prophylaxis significantly lowers the risk of postoperative surgical-site infections, major surgical complications (complications classified as Clavien-Dindo grade greater than or equal to III), clinically relevant postoperative pancreatic fistulas (grades B and C), and mortality, hence supporting the implementation of piperacillin/tazobactam for surgical prophylaxis in current practice.

Impact of Suaahara, an at-scale multisectoral nutrition programme, on health workers' maternal and child health, and nutrition knowledge and skills in Nepal.

Suaahara, an at-scale multisectoral nutrition programme in Nepal, aimed to advance knowledge and skills of frontline health workers to improve the quality of nutrition and health services at health facility and community levels. This study assessed the impact of Suaahara interventions on knowledge and skills of health facility workers and Female Community Health Volunteers (FCHVs). The study used a quasi-experimental design in which four Suaahara intervention districts were compared with pair-matched comparison districts. One health facility worker and three FCHVs from each survey cluster were included. Baseline survey consisted of 93 health facility workers (2015) and 118 FCHVs (2012), and endline survey (2022) consisted of 40 health facility workers and 120 FCHVs. Difference-in-differences regression models employing intent-to-treat analysis, accounting for clustering at the district level, assessed the impact of intervention. The intervention, relative to comparison, had no effect on health facility workers' knowledge. There was a positive effect, however, on FCHVs' knowledge in intervention relative to comparison areas on exclusive breastfeeding, timing of introduction of complementary feeding, sick child feeding and growth monitoring and promotion (GMP) for children under 2 years. Health facility workers and FCHVs in intervention versus comparison districts had higher endline scores for skills related to measuring the weight of children and pregnant women, measuring the height/length of children, conducting GMP for children under 2 years and identifying malnourished children. Suaahara interventions improved the capacity of health workers, particularly nutrition-related knowledge among FCHVs and GMP-related skills of both health facility workers and FCHVs.

Rationalizing polyp matching criteria in colon capsule endoscopy: an international expert consensus through RAND (modified DELPHI) process.

Background: Colon capsule endoscopy (CCE) has gained momentum as an alternative modality for the investigation of the lower gastrointestinal tract. Of the few challenges that remain, the comparison and - eventually - matching of polyps at different timestamps leads to the potential for double reporting and can contribute to false-positive findings and inaccuracies. With the impending artificial intelligence integration, the risk of double reporting the same polyp due to the lack of information on spatial orientation underscores the necessity for establishing criteria for polyp matching. Objectives: This RAND/University of California, Los Angeles (modified Delphi) process aims to identify the key factors or components used to match polyps within a CCE video. This involves exploring the attributes of each factor to create comprehensive polyp-matching criteria based on international expert consensus. Design: A systematic qualitative study using surveys. Methods: A panel of 11 international CCE experts convened to assess a survey comprised of 60 statements. Participants anonymously rated statement appropriateness on a 1-9 scale (1-3: inappropriate, 4-6: uncertain and 7-9: appropriate). Following a virtual group discussion of the Round 1 results, a Round 2 survey was developed and completed before the final analysis. Results: The factors that were agreed to be essential for polyp matching include (1) timestamp, (2) polyp localization, (3) polyp vascular pattern, (4) polyp size, (5) time interval of the polyp appearance between the green and yellow camera, (6) surrounding tissue, (7) polyp morphology and (8) polyp surface and contour. When five or more factors are satisfied, it was agreed that the comparing polyps are likely the same polyp. Conclusion: This study has established the first complete criteria for polyp matching in CCE. While it might not provide a definitive solution for matching difficult, small and common polyps, these criteria serve as a framework to guide and facilitate the process of polyp-matching.

Creating criteria and standards for matching polyps (abnormal growth in the bowels) on colon capsule video analysis: an international expert agreement using the RAND (modified Delphi process) process Background: Doctors often use colon capsule endoscopy (CCE), a high-tech capsule with two cameras, to record and check for diseases in the small and large bowels as the capsule travels through the intestines. One of the most common conditions in the large bowel is polyps, which are abnormal growths in the lining of the bowel. Comparing and matching polyps in the same video from the capsule can be tricky as they look very similar, leading to the possibility of incorrectly reporting the same polyp twice or more. This can lead to wrong results and inaccuracies. The literature did not have any criteria or standards for matching polyps in CCE before. Aim: Using the RAND/UCLA (modified Delphi) process, this study aims to identify the key factors or components used to match polyps within a CCE video. The goal is to explore each factor and create complete criteria for polyp matching based on the agreement from international experts. Method: A group of 11 international CCE experts came together to evaluate a survey with 60 statements. They anonymously rated each statement on a scale from 1 to 9 (1-3: inappropriate, 4-6: uncertain, and 7-9: appropriate). After discussing the Round 1 results virtually, a Round 2 survey with the same but revised questions was created and completed before the final analysis of their agreement. Results: The main factors for matching polyps are 1) the timing when the polyp was seen, 2) where it is in the bowel, 3) its blood vessel pattern, 4) size, 5) the timing of its appearance between cameras, 6) surrounding tissue features, 7) its shape, and 8) surface features. If five or more of these factors match, the compared polyps are likely the same. Conclusion: This study establishes the first complete criteria for matching polyps in CCE. While it may not provide a definitive solution for matching challenging and small polyps, these criteria serve as a guide to help and make the process of polyp matching easier.

Pectin/sodium alginate-based active film integrated with microcrystalline cellulose and geraniol for food packaging applications.

Biopolymer-based packaging films were prepared from pectin (PEC) and sodium alginate (SA), with the incorporation of 10 % MCC and different concentrations of geraniol (GER at 2.5, 5.0, 7.5, and 10.0 %). Rheological properties suggested that film-forming solutions and film-forming emulsions exhibited a shear-thinning or pseudo-plastic non-Newtonian behaviour. The dried films were crosslinked with 2.0 % CaCl2. The addition of MCC into PEC/SA film enhanced the TS but reduced it with the impregnation of GER without influencing the EAB and toughness of the film. The water solubility of the films significantly reduced with the rise in the GER levels but enhanced the water vapor and oxygen barrier attributes. TGA demonstrated that incorporating MCC reduced the film's thermal degradation (44.92 % to 28.81 %), but GER had an insignificant influence on the thermal stability. FTIR spectra revealed that hydrogen bond formation was positively linked with the GER addition in the film formulation. X-ray diffractograms showed that prepared films were predominantly amorphous. Antimicrobial studies showed a complete reduction of Escherichia coli and Bacillus cereus in 24 h. Overall, the composite film displayed excellent physical and active properties and PEC/SA/MCC/5.0 %GER/CaCl2 film was considered the best formulation for food packaging applications.

The Digital Era Heralds a Paradigm Shift in Dentistry: A Cross-Sectional Study.

Background The transformation of dental practice from conventional methods to digital technology has been widely discussed. This study aimed to examine the awareness, understanding, and attitudes towards the use of digital technology in dentistry, with a particular focus on computer-aided design/computer-aided manufacturing (CAD/CAM) technology. Methods A cross-sectional study was conducted, involving a questionnaire distributed to a diverse group of participants from the dental field. The questionnaire covered aspects of digital technology in dentistry, including awareness, perceived usefulness, understanding of CAD/CAM technology, perceived benefits and shortcomings, system awareness, and the impact on clinical decision-making. Results Almost all participants (99.3%) reported being aware of digital technology in dentistry. The perceived utility of digital technology varied widely, but it was considered particularly useful for specific dental procedures. Most of the respondents (948 out of 953) were aware of CAD/CAM technology, and many acknowledged its benefits, including fewer appointments, less chairside time, and greater precision. However, high cost, lack of knowledge, and preference for traditional methods were identified as barriers to adoption. Most participants believed that CAD/CAM would influence clinical decision-making and expressed interest in integrating it into their regular workflow. A majority had attended CAD/CAM training programs and believed there was a need to increase education on CAD/CAM during undergraduate and postgraduate courses. While a significant majority agreed that digital technology was the future of dentistry, a substantial number also expressed reservations. Conclusion The study concluded that there is a high level of awareness and readiness to adopt digital technology in dentistry. However, its perceived utility varied among participants, and several barriers to adoption were identified, indicating the need for expanded education and training. Despite some resistance, there is a growing recognition of the potential benefits of CAD/CAM technology and a trend towards integrating it into regular practice.

Declining groundwater and its impacts along Ganga riverfronts using combined Sentinel-1, GRACE, water levels, and rainfall data.

The Indo-Gangetic Plains (IGP) in northern India are vast alluvial tracts with huge shallow aquifers, densely populated and agriculturally productive regions. In the last few decades, IGP has been facing water scarcity driven by erratic monsoon dynamics, anthropogenic activity, and hydroclimatic variability. In urban centers, continuous groundwater withdrawal leads to high stress, affecting surface deformation and a threat to buildings and infrastructures. An attempt has been made to explore the possible linkage and coupling between groundwater level, hydroclimatic variables, and subsidence in the Central Ganga Plains (CGP), in Varanasi metropolis using the combined multisensory multitemporal data, Sentinel-1 (2017-2023), GRACE (2003-2023), groundwater levels (1998-2023), and precipitation (2002-2023). Long-term hydrological response in the CGP shows continuous depletion (14.6 ± 5.6 mm/yr) in response to precipitation variability. Results show spatiotemporal variations between GWS, and precipitation estimate with nonlinear trend response due to associated inter-annual/inter-seasonal climate variability and anthropogenic water withdrawal, specifically during the observed drought years. The significant storage response in the urban center compared to a regional extent suggests the potential impact of exponentially increasing urbanization and building hydrological stress in the cities. The implications of reducing storage capacity show measured land subsidence (∼2-8 mm/yr) patterns developed along the meandering stretch of the Ganga riverfronts in Varanasi. The groundwater level data from the piezometric supports the hydroclimatic variables and subsidence coupling. Considering the vital link between water storage, food security, and socioeconomic growth, the results of this study require systematic inclusion in water management strategies as climate change seriously impacts water resources in the future.

Results of a simple treatment protocol for aseptic femoral shaft nonunion in 330 patients.

INTRODUCTION: Our primary aim of the study was to assess the results of a treatment protocol for aseptic femoral shaft nonunion treated by three techniques - Exchange Nailing (EN), Plate Augmentation (PA), and Exchange Nailing combined with Plate augmentation (NP). The secondary objective was to assess the radiological outcome, duration of surgery (DOS) and need for blood transfusion (BT) in all the three groups. MATERIALS AND METHODS: We analyzed 330 patients treated for AFNU between Jan 2007 and Dec 2019. Using a simple treatment algorithm, EN, PA and NP were performed in 24,183 and 123 patients respectively. Patients in all the three groups were assessed for radiological-union (union rate and time to union), DOS and BT. RESULTS: Of these 330 patients, 327 (99 %) patients achieved radiological union at a mean duration of 6.07 months. Union rate is highest with NP followed by PA and EN. The union rate in patients with NP, PA and EN were 100 %, 99.5 % and 91.7 % respectively (p < 0.01). Time to union was lowest for NP followed by PA and EN (p < 0.001).The mean time to union for NP, PA and EN were 3.76, 7.2and 9.21 months respectively (p < 0.001). The mean DOS in minutes for NP, EN and PA was 107, 94 and 82 respectively (p < 0.01). The mean need for BT in the form of packed red blood cells for NP, PA and EN were 1.95, 1.87 and 1.38 units respectively (p < 0.01). CONCLUSION: Following a simple algorithm to decide treatment protocol on a case-to case basis helps to achieve good results in an optimal time period. When compared with EN and PA, NP is associated with 100 % union rate with least time to union making NP a reasonably effective procedure with a very high success rate. LEVEL OF EVIDENCE: IV.

Impact of Suaahara, an integrated nutrition programme, on maternal and child nutrition at scale in Nepal.

Suaahara was an innovative, complex, multi-sectoral, large-scale, nutrition programme in Nepal to increase exposure to nutrition-related information and services, improve nutrition-related knowledge and practices among pregnant women and mothers of infants and young children, and improve their nutrition. This study evaluated the effectiveness of Suaahara to improve nutrition and nutrition-related practices by comparing changes over 10 years between intervention and comparison districts. The samples of households at baseline in 2012 and endline in 2022 were 2040 and 2480, respectively, from 120 old wards. The impact was estimated using intent-to-treat regression models in which survey year, arm and their interaction were fixed effects, accounting for district clustering, with the interaction estimating differences between arms in changes over time. The intervention, relative to comparison, reduced maternal underweight by 8.43 percentage points (p < 0.001), consistent with improved maternal and fetal condition that was manifested as the greater length of 0.761 z-scores (p = 0.004) of infants 0-5.9 months. Complementary feeding practices with children between 6 and 23.9 months of age improved more in the intervention than comparison districts: child dietary diversity by 0.294 food groups (p = 0.072) and minimum dietary diversity by 9.51 percentage points (p = 0.028), feeding sick child more (p = 0.002) and administering oral rehydration solution and zinc for diarrhoea (p = 0.057) by about 17 percentage points each, and minimum meal frequency (p = 0.004) and minimum acceptable diet (p = 0.022) by about 15 percentage points each. Substantial impacts were demonstrated despite political restructuring, earthquakes, and other major challenges that Nepal and Suaahara faced and limitations in statistical power because of the reduced number of districts that then could be included in the study. Registered at clinicaltrials.gov with identifier NCT05448287.

Dynamics of land, ocean, and atmospheric parameters associated with Tauktae cyclone.

During the pre- and post-monsoon season, the eastern and western coasts are highly vulnerable to cyclones. The tropical cyclone "Tauktae" formed in the Arabian Sea on 14 May 2021 and moved along the west coast of India, and landfall occurred on 17 May 2021. During the cyclone, the maximum wind speed was 220 km/h with a pressure of 935 mb affecting meteorological, atmospheric parameters, and weather conditions of the northern and central parts of India causing devastating damage. Analysis of satellite, Argo, and ground data show pronounced changes in the oceanic, atmospheric, and meteorological parameters associated during the formation and landfall of the cyclone. During cyclone generation (before landfall), the air temperature (AT) was maximum (30.51 °C), and winds (220 km/h) were strong with negative omega values (0.3). The relative humidity (RH) and rainfall (RF) were observed to be higher at the location of the cyclone formation in the ocean and over the landfall location, with an average value of 81.28% and 21.45 mm/day, respectively. The concentration of total column ozone (TCO), CO volume mixing ratio (COVMR), H2O mass mixing ratio (H2O MMR), aerosol parameters (AOD, AE) and air quality parameter (PM) was increased over land and along the cyclone track, leading to a deterioration in the air quality. The strong wind mixes the air mass from the surroundings to the local anthropogenic emissions, and causing strong mixing of the aerosols. The detailed results show a pronounced change in the ocean, land, meteorological, and atmospheric parameters showing a strong land-ocean-atmosphere coupling associated with the cyclone.

The Diagnostic Utility of Volatile Organic Compounds in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis.

BACKGROUND: Volatile organic compounds [VOCs] show promise as potential biomarkers of for ulcerative colitis and Crohn's disease, two chronic, idiopathic, gastrointestinal disorders with diagnostic and management challenges. Non-invasive biomarkers aid early diagnosis and management. In this study we review studies of diagnostic accuracy of VOCs in inflammatory bowel disease. METHODS: A systematic search was carried out on the Pubmed and Scopus databases; with 16 studies reviewed and meta-analysis carried out on 10. RESULTS: Meta-analysis of 696 inflammatory bowel disease [IBD] cases against 605 controls revealed a pooled sensitivity and specificity of 87% (95% confidence interval [CI], 0.79 - 0.92) and 83% [95% CI, 0.73 - 0.90], respectively. Area under the curve [AUC] was 0.92. CONCLUSION: VOCs perform very well as non-invasive biomarkers of IBD, with much scope for future improvement and research.

Efficacy and Safety of Ustekinumab for Ulcerative Colitis Through 4 Years: Final Results of the UNIFI Long-Term Maintenance Study.

INTRODUCTION: Ulcerative colitis (UC) is a chronic condition that may require long-term treatment. We report the final efficacy and safety results of the UNIFI long-term extension study of ustekinumab in patients with UC through 4 years. METHODS: Ustekinumab induction responders who completed 44 weeks of maintenance treatment and agreed to enter the long-term extension continued their subcutaneous maintenance therapy (90 mg ustekinumab every 8 or 12 weeks [q8w or q12w] or placebo). Starting at week 56, randomized patients could receive dose adjustment to 90 mg q8w. Symptoms and adverse events were assessed through the study; endoscopic assessment was conducted at week 200. RESULTS: Of the 348 patients randomized to subcutaneous ustekinumab at maintenance baseline (q8w and q12w combined), 55.2% were in symptomatic remission at week 200. A greater proportion of biologic-naive patients (67.2% [117/174]) were in symptomatic remission than those with a history of biologic failure (41.6% [67/161]). Among patients in symptomatic remission at week 200, 96.4% were corticosteroid-free. Of the 171 patients with endoscopic evaluation at week 200, 81.6% (71/87) in the q12w group and 79.8% (67/84) in the q8w group had endoscopic improvement. From weeks 156 to the final safety visit (up to week 220), no deaths, major adverse cardiovascular events, or tuberculosis occurred in patients receiving ustekinumab. Nasopharyngitis, UC worsening, and upper respiratory tract infections were the most frequently reported adverse events. DISCUSSION: The long-term efficacy of ustekinumab maintenance in patients with UC was confirmed through 4 years. No new safety signals were observed. ClinicalTrials.gov number NCT02407236.

Gut microbiota signatures in inflammatory bowel disease.

BACKGROUND: Inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), affect millions of people worldwide with increasing incidence. OBJECTIVES: Several studies have shown a link between gut microbiota composition and IBD, but results are often limited by small sample sizes. We aimed to re-analyze publicly available fecal microbiota data from IBD patients. METHODS: We extracted original fecal 16S rRNA amplicon sequencing data from 45 cohorts of IBD patients and healthy individuals using the BioProject database at the National Center for Biotechnology Information. Unlike previous meta-analyses, we merged all study cohorts into a single dataset, including sex, age, geography, and disease information, based on which microbiota signatures were analyzed, while accounting for varying technical platforms. RESULTS: Among 2518 individuals in the combined dataset, we discovered a hitherto unseen number of genera associated with IBD. A total of 77 genera associated with CD, of which 38 were novel associations, and a total of 64 genera associated with UC, of which 28 represented novel associations. Signatures were robust across different technical platforms and geographic locations. Reduced alpha diversity in IBD compared to healthy individuals, in CD compared to UC, and altered microbiota composition (beta diversity) in UC and especially in CD as compared to healthy individuals were found. CONCLUSIONS: Combining original microbiota data from 45 cohorts, we identified a hitherto unseen large number of genera associated with IBD. Identification of microbiota features robustly associated with CD and UC may pave the way for the identification of new treatment targets.

Human gut microbiota and endocrinology: paradigm shift from genome to its regulation.

Over the last two decades, it has become clear that the human gut microbiota, a complex community of bacteria, archaea, fungi and viruses, are a critical determinant of human health and disease. Microbiota-derived metabolites provide the host with energy, protect against pathogens, modulate immune and endocrine systems as well as the level of reactive oxygen species in the gut. It has come with no surprise that the human gut microbiota is also linked to the production, utilisation and regulation of host hormones. This implies that the gut microbiota is capable of influencing human behaviour, appetite regulation and metabolism as well as development and immunity. Many of the advances in the field of crosstalk between the gut microbiota and host health, disease and behaviours are generally based on DNA analyses of microbial populations and transplantation of monocultured commensal species to germ-free animals. Recent reports on the activity of the gut microbiota in gastrointestinal diseases such as inflammatory bowel disease and colorectal cancer have highlighted two important points. First, microbial DNA-based abundance does not always correlate with their level of activity and secondly, that metabolism of the complex gut microbiota is regulated by host health status, including the production and metabolism of several human hormones. In this review, we will discuss the lessons learnt from studying the activity and metabolism of the human gut microbiota in health and across gastrointestinal diseases, and how these findings can shape future research on the microbiome-gut-endocrine axis.

Clinical utility of colon capsule endoscopy: a moving target?

The purpose of this article is to provide an overview of white light colon capsule endoscopy's current clinical application, concentrating on its most recent developments. Second-generation colon capsule endoscopy (CCE2) is approved by the FDA for use as an adjunctive test in patients with incomplete colonoscopy and within Europe in patients at average risk, those with incomplete colonoscopies or those unwilling to undergo conventional colonoscopies. Since the publication of European Society of GI Endoscopy guidelines on the use of CCE, there has been a significant increase in comparative studies on the diagnostic yield of CCE. This paper discusses CCE2 in further detail. It explains newly developed colon capsule system and the current status on the use of CCE, it also provides a comprehensive summary of systematic reviews on the implementation of CCE in colorectal cancer screening from a methodological perspective. Patients with ulcerative colitis can benefit from CCE2 in terms of assessing mucosal inflammation. As part of this review, performance of CCE2 for assessing disease severity in ulcerative colitis is compared with colonoscopy. Finally, an assessment if CCE can become a cost-effective clinical service overall.

Comparing High- and Low-Model for End-Stage Liver Disease Living-Donor Liver Transplantation to Determine Clinical Efficacy: A Systematic Review and Meta-Analysis (CHALICE Study).

INTRODUCTION: Various studies have demonstrated that low-Model for End-Stage Liver Disease (MELD) living-donor liver transplant (LDLT) recipients have better outcomes with improved patient survival than deceased-donor liver transplantation (DDLT) recipients. LDLT recipients gain the most from being transplanted at MELD <25-30; however, some existing data have outlined that LDLT may provide equivalent outcomes in high-MELD and low-MELD patients, although the term "high" MELD is arbitrarily defined in the literature and various cut-off scores are outlined between 20 and 30, although most commonly, the dividing threshold is 25. The aim of this meta-analysis was to compare LDLT in high-MELD with that in low-MELD recipients to determine patient survival and graft survival, as well as perioperative and postoperative complications. METHODS: Following PROSPERO registration CRD-42021261501, a systematic database search was conducted for the published literature between 1990 and 2021 and yielded a total of 10 studies with 2183 LT recipients; 490 were HM-LDLT recipients and 1693 were LM-LDLT recipients. RESULTS: Both groups had comparable mortality at 1, 3 and 5 years post-transplant (5-year HR 1.19; 95% CI 0.79-1.79; p-value 0.40) and graft survival (HR 1.08; 95% CI 0.72, 1.63; p-value 0.71). No differences were observed in the rates of major morbidity, hepatic artery thrombosis, biliary complications, intra-abdominal bleeding, wound infection and rejection; however, the HM-LDLT group had higher risk for pulmonary infection, abdominal fluid collection and prolonged ICU stay. CONCLUSIONS: The high-MELD LDLT group had similar patient and graft survival and morbidities to the low-MELD LDLT group, despite being at higher risk for pulmonary infection, abdominal fluid collection and prolonged ICU stay. The data, primarily sourced from high-volume Asian centers, underscore the feasibility of living donations for liver allografts in high-MELD patients. Given the rising demand for liver allografts, it is sensible to incorporate these insights into U.S. transplant practices.

Spatio-temporal evolution of groundwater quality and its health risk assessment in Punjab (India) during 2000-2020.

The state known as the bread basket of India has now been defamed as the cancer capital of the country. The toxicity of groundwater associated with the declining water level is reported in recent years. However, an extensive temporal and spatial analysis is required to identify hotspots. In this study, spatial tools are utilized to understand the evolution of groundwater in Punjab (> 315 sites) for the last two decades (2000-2020) for drinking purposes using the water quality index (WQI). The data for pH, electric conductivity (EC), bicarbonate (HCO3¯), chloride (Cl¯), sulfate (SO42¯), nitrate (NO3¯), fluoride (F¯), calcium (Ca2+), magnesium (Mg2+), sodium (Na+), and potassium (K+) collected from the Central Groundwater Board (CGWB) were analyzed. The results show that the average cation abundance is in declining order of Na > Mg > Ca > K, and anion abundance is in order of HCO3¯ > SO42¯ > Cl¯ > NO3 > F. The ions are compared with water quality standards defined by BIS and WHO. The study shows that in the year 2000, 69.52% of locations are above the acceptable limit for EC, 68.89% for Mg2, 84.76% for Na+, 51.75% for HCO3¯, 38.41% for NO3¯, and 17.20% for F¯. While in the year 2020, 48.89% exceed the acceptable limit for EC, 57.78% for Mg2+, 68.25% for Na+, 34.92% for HCO3¯, 27.30% for NO3¯, and 8.88% for F¯. WQI shows that in the year 2000, 13.01% of sampling locations are categorized as very poor and 20% as unsuitable for drinking. Meanwhile, in 2020, 6.35% of locations are categorized as very poor and 12.38% as unsuitable for drinking in the study area. In addition to the effect on plant growth, consumption of contaminated water can adversely affect human health. The health hazards for F¯ (HQF) and NO3¯ (HQN) and their total health index (THI) are also evaluated that depicts 244 groundwater sampling sites in the year 2000, and 152 sampling sites in the year 2020 show high non-carcinogenic effects on adults, children, and infants. Southwestern Punjab is found to be the worst affected, while north-eastern regions drained by the Himalayan rivers show better quality water. Shifting in agricultural practices in the last two decades and declining water levels due to excess pumping of water from deeper water tables deteriorated the quality of water in the Southern region as observed from the geospatial analysis.

Impact of Seasonal Variations on Semen Parameters: A Retrospective Analysis of Data from Subjects Attending a Tertiary Care Fertility Centre.

Background: Seasonal variations in semen parameters have been detected in many previous studies, mostly conducted in the West and Mediterranean countries. Located in a tropical region, we have only three seasons - summer, winter and rainy season. Literature search did not reveal studies from Indian subcontinent. Aims: Our objective was to find if our climate produced seasonal variations in semen parameters such as sperm concentration (SC), total motile SC, morphology and vitality, which may have implications in fertility management. Settings and Design: This is a descriptive study, conducted at a tertiary level hospital. Semen analysis reports of male partners of all infertile couples during the 4-year period from 2019 to 2022 were analysed. Materials Methods: The data were collected from records of all infertile couples registered for the treatment in the department during the study period. Semen analysis reports of male partners of all infertile couples attending outpatient department of the Reproductive Medicine Department during the 4-year period from January 2019 to December 2022 were collected. The data of azoospermic and severe oligospermic (<5 million/mL) men and those receiving hormone treatment were excluded. Statistical Analysis Used: Data were analysed using SPSS 23 and variables expressed as mean and standard deviation. Changes in mean values over years and over seasons were evaluated using F-test. Post hoc analysis was done using Sidak method. P < 5% was considered statistically significant. Results: The data of 2326 patients were analysed. SC was lowest during summer but was not statistically significant. Sluggishly motile sperm per cent was maximum in rainy season (P = 0.002). Post hoc analysis showed significant variations in summer samples compared to both rainy and winter seasons. Head defect (HD) and tail defects showed a significant seasonal variation (P = 0.011 and P = 0.024, respectively), lowest HD seen in rainy season. Conclusion: Semen parameters showed seasonal variations, with favourable features in colder climates, and may need to be considered in infertility management, especially if the male is oligospermic.