Comparison of Rifaximin Alone and With Quinolones in the Primary Prevention of Spontaneous Bacterial Peritonitis in Patients With Decompensated Chronic Liver Disease.

Background In cirrhotic patients with ascites, primary prevention of spontaneous bacterial peritonitis (SBP) is a key strategy to lower morbidity and death. Rifaximin and fluoroquinolone used alternately as main prophylaxis are as effective as reported. This study aimed to compare the frequency of occurrence of SBP in patients with decompensated chronic liver disease treated with rifaximin alone and in combination with fluoroquinolone. Methodology A total of 76 patients with hepatitis C virus-related decompensated chronic liver disease and ascites were divided into two groups based on matching age, sex, and Child-Pugh class. Group A (38 patients) received rifaximin 1,100 mg/day in two divided doses with daily fluoroquinolone 400 mg/day, whereas group B (38 patients) received rifaximin 1,100 mg/day alone as a two dosage. The patients were monitored for up to three months. The study's endpoints were SBP, hepatocellular carcinoma, compliance failure, death, or liver transplantation. Results In this comparative study involving 76 patients, the demographic and clinical characteristics were assessed across two treatment groups: rifaximin alone (n = 38) and rifaximin with fluoroquinolone (n = 38). The combination therapy demonstrated a statistically significant reduction in SBP compared to rifaximin alone. Additionally, the overall survival rate was higher in the combination group. These findings suggest potential benefits of the combined approach in managing hepatic encephalopathy-related complications. Conclusions When compared to rifaximin alone for primary SBP prophylaxis, the combination of rifaximin with fluoroquinolone exhibited greater effectiveness with the same safety profile.

Comparative Analysis of Outcomes in Acute Organophosphate Poisoning With and Without N-acetyl Cysteine Intervention.

INTRODUCTION: Organophosphorus poisoning (OPP) stands as a significant health concern in numerous regions, especially in developing nations. Despite the rising complexities and case fatalities associated with exposure, the treatment approach has remained unchanged for many years. Based on clinical insights, certain pharmacologic agents have demonstrated utility in enhancing outcomes and reducing complications arising from this type of exposure. OBJECTIVES: The objective of this study is to compare the outcome of N-acetyl cysteine in the treatment of acute organophosphate poisoning cases. In terms of a) its impact on the requirement of atropine, b) Length of hospital stay, and mortality. METHODS: The study was conducted in the intensive care unit (ICU) of the General Hospital Lahore. Thirty patients with a history and clinical presentation indicative of acute organophosphorus poisoning were randomly divided into two groups in a 1:1 ratio. The treatment group received parenteral administration of atropine, pralidoxime, and N-acetylcysteine (NAC) as an adjuvant, and the control group received standard treatment for acute organophosphate (OP) toxicity. RESULT: Throughout the study duration, 30 patients suffering acute organophosphate (OP) toxicity (14 men, 16 women) were examined, with an age mean of (25.83±11.59) years. In the interventional group, only four patients required ICU admission, but in the control group, eight patients were admitted to ICU. The correlation result between the dose of atropine and length of hospital stays was not statistically significant between both study groups (<0.005). Plasma Cholinesterase (PChE) level (KU L-1) and total dose of Pralidoxime (g) were statistically significant in the length of hospital stay. The data was not normally distributed, so the non-parametric tests were applied. The Wilcoxon ranked test showed significant improvement in both the controlled and interventional groups because the p-value was (<0.005). Intergroup comparison analyzed by using the Mann-Whitney U test showed a significant reduction in the severity and other associated symptoms in the interventional group because the p-value was (0.001). CONCLUSION: The outcome demonstrated that the NAC group had a decreased demand for atropine rather than Pralidoxime. In the NAC group, the length of hospital stay and mortality was decreased. The administration of NAC to the present study procedure for acute organophosphate (OP) poisoning is suggested.

Unraveling the impact of human perturbation on nitrogen cycling in terrestrial ecosystems of lower Himalaya, Pakistan.

Terrestrial ecosystems are under the enormous pressure of land use management regimes through human disturbances, resulting in the disruption of biogeochemical cycles and associated ecosystem services. Nitrogen (N) in soil ecosystems is of vital importance for primary productivity, hence estimating the extent of these human interventions on N-cycling processes becomes imperative from economic and environmental perspectives. This work investigated the impacts of variable anthropogenic activities on N cycling in three different terrestrial ecosystems (arable, grassland, and forest) in three regions of lower Himalaya, Pakistan. Potential nitrification (PNA) and denitrification (DEA) enzyme activities, relative distribution of inorganic N species (NH4, NO3), and the role of inherent edaphic factors were assessed. Results revealed high nitrification potentials and increased nitrous oxide (N2O) emissions in the incubated soil microcosms, in the order as arable > grassland > forest ecosystems. Notably, higher rates of both studied processes (~ 30-50%) and elevated soil mineral nitrogen pool were observed in arable ecosystems. Forest soils, assumed as pristine ecosystems relying mainly on natural N fixation, produced (de)nitrification rates relatively lower than grasslands, followed by arable soils which were moderately disturbed through long-term fertilization and intensive land-use regimes. Linear regression modeling revealed that the inorganic N species (particularly NO3), and inherent edaphic factors were the key determinants of high (de)nitrification rates, hence warn of accelerated N losses in these ecosystems. The study highlights that elevated PNA and DEA being proxies for the altered N cycling in the studied terrestrial ecosystems are of great ecological relevance in view of predicted N2O budget in the lower Himalaya.

Examining computationally the structural, elastic, optical, and electronic properties of CaQCl3 (Q = Li and K) chloroperovskites using DFT framework.

This study presents the investigations of structural, elastic, optical, and electronic properties of CaQCl3 (Q = Li and K) chloroperovskites for the first time using the DFT framework. The WIEN2K and IRelast packages are used in which the exchange-correlation potential of the modified Becke-Johnson potential (TB-mBJ) is used for obtaining better results. The optimized crystal structural parameters comprising the lattice constant, optimum volume, ground state energy, bulk modulus, and the pressure derivative of bulk modulus are computed by fitting the primitive unit cell energy versus primitive unit cell volume using the Birch-Murnaghan equation of state. The elastic properties which consist of cubic elastic constants, Poisson's ratio, elastic moduli, anisotropy factor, and the Pugh ratio are computed using the very precise IRelast package incorporated inside WIEN2K. The electronic properties are analyzed from the computation of electronic bands structure and density of states (DOS), and it is concluded that an indirect band gap of 4.6 eV exists for CaLiCl3 and a direct band gap of 3.3 eV for CaKCl3 which confirms that CaLiCl3 is an insulator while CaKCl3 is a wide band gap semiconductor. The analysis of DOS shows that the greater contribution to the conduction band (CB) occurs because of the "Ca" element whereas in the valence band the major contribution is from the "Cl" element. The spectral curves of various parameters of optical properties from 0 eV up to 42 eV incident photon energies are observed and it is found that the CaQCl3 (Q = Li and K) chloroperovskites are optically active having a high absorption coefficient, optical conductivity, optical reflectivity, and energy loss function from 25 eV to 35 eV incident photon energies. The applications of these materials can be deemed to alter or control electromagnetic radiation in the ultraviolet (UV) spectral regions. In summary, the results for selected CaQCl3 (Q = Li and K) chloroperovskites depict that these are important compounds and can be used as scintillators, and energy storage devices, and in many modern electronic gadgets.

Extension of Tablo TrEatmeNt Duration (XTEND) study: successful 24 h prolonged therapy with Tablo in critical patients.

BACKGROUND: The Tablo® Hemodialysis System (Tablo) is an all in one, easy-to-learn device featuring integrated water purification, on demand dialysate production and two-way wireless data transmission and is approved for use in the acute, chronic, and home settings. Prior reports have demonstrated Tablo's ability to achieve clinical goals, seamlessly integrate into hospitals and reduce cost across a wide range of treatment times. Extension of the Tablo cartridge to 24 h allows prolonged therapy and even greater flexibility for prescribers in the acute setting. The objective is to report on the first ever experience with Tablo prolonged therapy between 12 and 24 h in critically ill patients treated at a single-center ICU. METHODS: Nursing staff were trained during a single training session on Tablo prolonged therapy. After a run-in period of five treatments, Tablo data were collected via real-time transmission to a cloud-based, HIPAA compliant platform and reviewed by site staff. Dialysis treatment delivery, clinically significant alarms, and clotting events were recorded. Sub-group analysis between COVID-19 positive and negative patients were reported. RESULTS: One hundred (100) consecutive Tablo prolonged treatments had a median prescribed treatment time of 24 h and a median achieved treatment time of 21.3 h. Median cartridge usage was 1.3 per treatment. The dialysis treatment time was delivered in 91% of treatments, with 6% ending early due to an alarm, and 3% ending due to clotting. Clinically significant alarms occurred at a median rate of 0.5 per treatment hour with a resolution time of 18 s. Median blood pump stoppage time related to these alarms was 2.3 min per treatment. Blood pump stoppage time was higher in the COVID-19 subgroup when compared to the non-COVID-19 subgroup. CONCLUSION: Tablo successfully achieves prescribed treatment time with minimal therapy interruptions from alarms or cartridge changes. This data demonstrates the effectiveness of Tablo in achieving personalization of treatments necessary for unstable patients and enabling successful delivery of extended therapy with minimal clotting. Tablo's prolonged therapy meets the needs of critically patients, including COVID-19 positive patients, requiring renal replacement therapy for greater than 12 h.

Preparation and Characterization of Agar Based Magnetic Nanocomposite for Potential Biomedical Applications.

PURPOSE: The purpose of the present study was to make a biocompatible agar based composite material via incorporation of appropriate additives within the agar matrix for potential applications in drug delivery and biomedical fields. METHODOLOGY: Agar based composites were prepared by the incorporation of magnetic iron oxide nano particles, graphite and sodium aluminum as additives in different proportions within the agar matrix by a simple thermophysico- mechanical method. The as prepared agar based composites were then characterized by different techniques i.e. FTIR, SEM, TGA, XRD and EDX analyses. The FTIR peaks confirmed the presence of each component in the agar composite. SEM images showed the uniform distribution of each component in the agar composite. TGA study showed the thermal stability range of different composite sheets. XRD pattern revealed the crystallinity and EDX analysis confirmed the elemental composition of the prepared composites. The prepared agar based composites were evaluated for antimicrobial activities against three pathogenic bacterial strains Escherichia coli, Staphylococcus aureus and Klebsiella pneumonia and the result indicated efficient antimicrobial activities for all composites. CONCLUSION: From the overall study, it was concluded that due to the non-toxic nature, thermal stability and excellent antibacterial properties, the prepared agar based composites can receive potential biomedical applications.

Implications and importance of skeletal muscle mass in estimating glomerular filtration rate at dialysis initiation.

There is a trend toward "early" initiation of dialysis for renal replacement therapy. However, several observational studies showed an association of increased mortality at higher estimated glomerular filtration rate (eGFR) at dialysis initiation. This surprising result is due to errors in estimation of glomerular filtration rate (GFR). In malnourished patients with low muscle mass, serum-creatinine-based equations overestimate GFR. In patients with higher muscle mass, these equations underestimate GFR. This spurious association of higher prevalence of malnutrition in patients with higher eGFR compared with those with lower eGFR ultimately leads to the appearance of increased mortality with early initiation of dialysis. Therefore, reliable equations that properly account for creatinine production are warranted to estimate GFR at initiation of dialysis. Until then, in those with extremes of nutrition, mean of measured urea and creatinine clearances might provide more accurate GFR estimation for initiation of dialysis than the currently available equations.

Jockeying for position in the humanitarian field: Iraqi refugees and faith-based organisations in Damascus.

The rise in the number of interventions by faith-based organisations in the humanitarian field has reignited debate about the role of religion in the public sphere. This paper presents a nuanced examination of the part played by religious institutions and networks in the strategies of forced migrants in urban contexts. Furthermore, it considers how such organisations work to integrate displaced populations into their new surroundings. Drawing on two case studies and ethnographic fieldwork and in-depth interviews with Iraqi refugees and refugee service providers in Damascus, Syria, carried out between March 2010 and March 2011, it evaluates how Iraqi refugees, as active social agents, utilise religious institutions and networks in conjunction with established international humanitarian organisations to produce a distinctive geography of exile. In addition, it draws attention to how the Syrian state exerts influence over religious actors and how ultimately this affects the decision-making of forced migrants.