Where does capsule endoscopy fit in the diagnostic algorithm of small bowel intussusception?

INTRODUCTION: The investigation of small bowel (SB) intussusception is variable, reflecting the lack of existing standards. The aim of this study was to understand the role of small bowel capsule endoscopy (SBCE) to investigate this pathology. METHODOLOGY: This was a retrospective multi-centre study. Patients with intussusception on SBCE and those where SBCE was carried out due to findings of intussusception on radiological investigations were included. Relevant information was collected. RESULTS: Ninety-five patients (median age 39+/-SD19.1 years, IQR 30) were included. Radiological investigations were carried out in 71 patients (74.7%) prior to SBCE with intussusception being present in 60 patients on radiological investigations (84.5%). Thirty patients (42.2%) had intussusception on radiological investigations followed by a normal SBCE. Ten patients (14.1%) had findings of intussusception on radiological investigations, a normal SBCE and repeat radiological investigations that were also normal. Abnormal findings were noted on SBCE that could explain intussusception on imaging in (16 patients) 22.5% of patients. Five patients (5.3%) underwent radiological investigations and SBCE to investigate coeliac disease and intussusception. None had associated malignancy. Four patients (4.2%) underwent SBCE to investigate familial polyposis syndromes and went on to SB enteroscopy and surgery accordingly. Most patients (n = 14; 14.8%) with intussusception on initial SBCE (without prior radiological imaging) had suspected SB bleeding (n = 10, 10.5%). Four patients (4.2%) had additional findings of a mass on CT scan and went on to have surgery. CONCLUSION: SBCE should be used to complement radiology when investigating intussusception. It is a safe non-invasive test that will minimise unnecessary surgery. Additional radiological investigations following a negative SBCE in cases of intussusception noted on initial radiological investigations are unlikely to yield positive findings. Radiological investigations following intussusception noted on SBCE in case of patients presenting with obscure gastrointestinal bleeding, may yield additional findings.

Outcome of Malnourished Children Admitted in the Nutritional Rehabilitation Home.

BACKGROUND: Globally, the burden of malnutrition, especially undernutrition, as well as the consequences of malnutrition is of the rise which is especially of significant concern for underdeveloped countries. Countries like Nepal are also facing a similar problem of malnutrition. In Madhesh province, among the under 5 children the incidence of chronic malnutrition is 29.3%. Our aim is to assess the malnourishment in the children of Madhesh province in Nepal. METHODS: This cross-sectional quantitative study was carried out among 409 malnourished children who were admitted from July 17, 2018 to July 16, 2022 at NRH in Gajendra Narayan Singh Hospital. Collected data were fed into Microsoft-excel and analyzed using SPSS software, version-2016. As data were normally distributed, frequency, percentage, mean and standard deviation were calculated for descriptive analysis. To find out the association of categorical variables, the Chi-square test or Fisher's Exact test was used where appropriate. P-value <0.05 was significant. RESULTS: Out of 409 malnourished cases, 145 cases were SAM (SD<-3) and 264 cases were MAM (-2 to -3SD) at the time of admission. The mean increment in the weight was 1.14±0.44  kg.  The average length of stay was 19.82±8.73 days. There is a significant difference (p<0.001) in the length of stay among the SAM and MAM cases of our study and a difference in the increment of weight in comparison to mean weight gain (1.14±0.44  kg) with respect to the length of stay of the malnourished child who stayed for more than 28 days and less. CONCLUSIONS: There is significant weight gain in malnourished children after management at the Nutritional Rehabilitation Center.

Keggin Cluster Modulated Photocatalytic Activity of Aryl Sulfonium Polyoxometalate Hybrids toward Dichromate Reduction.

Dichromate (Cr2O72-) ion having chromium in its +6 oxidation state is a carcinogen and a potential threat to humans and aquatic life. The photocatalytic reduction of toxic Cr(VI) species into less toxic Cr(III) is an important target in heterogeneous catalysis. In this work, the catalytic activities of a series of Keggin cluster-based aryl sulfonium polyoxometalate hybrids, (FPDS)3[PMo12O40] (1), (FPDS)3[PW12O40] (2), (FPDS)4[SiMo12O40] (3), and (FPDS)4[SiW12O40] (4), toward the photocatalytic reduction of Cr(VI) have been analyzed and compared. Here, we used the aryl sulfonium counterions to modulate the POM cluster's solubility in water and stabilize the photogenerated e--h+ pair on the cluster. All of the hybrids 1-4 catalyzed the reduction of Cr(VI) to Cr(III) under ultraviolet (UV) irradiation, and their photocatalytic efficiencies followed the order hybrid 1 > hybrid 3 > hybrid 2 > hybrid 4, with the rate-constant values of 0.048, 0.0056, 0.0035, and 0.0028 min-1, respectively. Hybrid 1 with [PMo12O40]3- Keggin cluster exhibited the best photocatalytic activity in the series yielding a 99% reduction in 120 min. The reasons behind the best photocatalytic activity of hybrid 1 are identified as its low band gap, less charge recombination, and fast photoresponse. The electron-trapping analyses performed using AgNO3 revealed electrons as the main reactive species responsible for the photocatalytic reduction of Cr(VI). A plausible photocatalytic mechanism has also been proposed based on electron-trapping experiments. The present study shows that aryl sulfonium Keggin hybrids can function as efficient photocatalysts for Cr(VI) reduction, and their catalytic efficiency varies with the nature of the Keggin cluster.

Predictors of Postoperative ICU Admission in Patients With COVID-19-Associated Mucormycosis.

BACKGROUND: Studies exploring factors predicting postoperative ICU requirement in patients with coronavirus disease 2019 (COVID-19)-associated mucormycosis (CAM) were not found in the literature. The aim was to evaluate the demographic profile, comorbidities, pattern of steroid received, airway assessment, and intraoperative hemodynamic perturbations associated with ICU requirement amongst patients scheduled for sinonasal debridement. METHODS: This is a retrospective cohort study. All CAM patients of ≥18 years were included. The patients' characteristics, comorbidities, pattern of steroid received, airway assessment, intraoperative hemodynamic perturbations, and outcome data were retrieved. RESULTS: A total of 130 patients were included. Thirty got admitted to ICU, out of which 26 expired. Amongst the various comorbidities, diabetes was the most common (93.85%) and was associated with higher chances of ICU requirement. Of patients with a history of steroid intake, 71% had a significantly higher risk of ICU admission. Out of 30 patients admitted to ICU, 87% (n=26) received invasive ventilation, and the rest were admitted for observation only. CONCLUSION: Middle age, uncontrolled diabetes, history of steroid intake, increased levels of serum creatinine with low potassium, and increased total leucocyte count are the independent risk factors predicting postoperative ICU admission amongst patients with CAM scheduled for sinonasal debridement.

Determination of elastic constants of functionalized graphene-based epoxy nanocomposites: a molecular modeling and MD simulation study.

Functionalization of graphene is the best way to create a high degree of dispersion and bonding to polymer matrix in order to obtain high performance composites. The effects of carboxyl (-COOH) functionalized graphene (FG) on the mechanical properties of its epoxy-based nanocomposites have been examined by molecular dynamics (MD) simulations. Simulations cells of nanocomposites with varying wt% of FG (1, 2, and 3 wt%) were constructed using Material Studio 6.0. The MD simulation findings of nanocomposites reveal that they have better mechanical properties such as elastic modulus, bulk modulus, shear modulus, and the Poisson's ratio than pure epoxy. Furthermore, the computational results of nanocomposites have been effectively confirmed with available experimental data. Therefore, the current MD simulation shows a decent computational sign for the existing experimental and simulation outcomes on mechanical properties of FG/epoxy nanocomposites.

Professorial Advancement Initiative: A Cross-Institutional Collaboration to Increase Faculty Diversity in STEM.

In this paper, we describe the model for faculty diversity developed as part of the Professorial Advancement Initiative (PAI) funded under the NSF AGEP program. The PAI, consisting of 12 of the 14 Big Ten Academic Alliance universities, had the goal of doubling the rate at which the universities hired tenure-track minoritized faculty, defined by National Science Foundation as African Americans, Hispanic/Latinx, Native Americans, and Pacific Islanders. This paper reviews the key programmatic elements of the PAI and discusses lessons learned and the practices developed that helped the Alliance achieve its faculty diversity goal.

Integration of tobacco control in Masters of Public Health curricula of India.

CONTEXT: Tobacco is the single largest cause of preventable death among adults globally, as it is in India. Despite this alarming situation, there is very minimal inclusion of tobacco in formal education systems, including the medical discipline, in India. AIMS: The present study analyzed the extent of integration of tobacco control related content in Masters of Public Health (MPH) curricula of various institutes in India. MATERIALS AND METHODS: This cross-sectional study was conducted during January 2011 to May 2011 in all colleges of the country offering a MPH course. The colleges were enlisted using various internet search engines (Google Scholar, Pubmed, Medline), other published literature and snowball technique. A 50 items semi-structured questionnaire was designed, posted and e-mailed (followed by hard copy) to the Person-In-Charge of the MPH program. STATISTICAL ANALYSIS: Descriptive statistics were used to profile the tobacco control content in respective institutions. All data entry and analysis was conducted using SPSS (version 16) for windows. RESULTS: The duration of the MPH course was two years in all institutes and had accreditation with some affiliated body. Tobacco related diseases were covered under 'non communicable diseases' section by every institute. However, a mere 41.4% of institute's had faculty who had received specialized training in tobacco control. More coverage was given to health risks and effects of smoking as compared to cessation interventions (5 A's), symptoms of withdrawal and pharmacological treatments. Only 25% of institutes were in process of introducing tobacco courses into their curricula. Lack of expertise and administrative barriers were cited as perceived major problems in inclusion of tobacco control in MPH curricula. CONCLUSIONS: It can be concluded that tobacco control is not receiving adequate attention in public health curricula in India. There is a need for coordinated efforts in the area of tobacco control so as to reduce morbidity and mortality from tobacco induced diseases.