Experimental Investigation on Geopolymer Concrete with Various Sustainable Mineral Ashes

The aim of this research was to find the best alternative for river sand in concrete. In both geopolymer concrete (GPC) and cement concrete (CC), the fine aggregates are replaced with various sustainable mineral ashes, and mechanical and durability tests are conducted. Specimens for tests were made of M₄₀ grade GPC and CC, with five different soil types as river sand substitute. The materials chosen to replace the river sand are manufactured sand (M-sand), sea sand, copper slag, quarry dust, and limestone sand as 25%, 50%, 75%, and 100%, respectively by weight. GPF50 and CC50 were kept as control mixes for GPC and CC, respectively. The test results of respective concretes are compared with the control mix results. From compressive strength results, M-sand as a fine aggregate had an increase in strength in every replacement level of GPC and CC. Additionally, copper slag is identified with a significant strength reduction in GPC and CC after 25% replacement. Copper slag, quarry dust, and limestone sand in GPC and CC resulted in considerable loss of strength in all replacement levels except for 25% replacement. The cost of GPC and CC is mixed with the selected fine aggregate replacement materials which arrived. Durability and cost analyses are performed for the advisable mixes and control mixes to have a comparison. Durability tests, namely, water absorption and acid tests and water permeability and thermal tests are conducted and discussed. Durability results also indicate a positive signal to mixes with M-sand. The advisable replacement of river sand with each alternative is discussed.     

Relationship between diabetic retinopathy and diabetic peripheral neuropathy - Neurodegenerative and microvascular changes

Purpose:To determine the relationship between diabetic retinopathy (DR) and diabetic peripheral neuropathy (DPN), and their associated risk factors.Methods:We conducted a cross-sectional analysis on 500 patients who attended the Endocrinology department at a quaternary health care center in Kerala between November 2017 and April 2018. Patients above the age of 30 years with type 2 diabetes mellitus (DM) were included. They underwent a detailed medical history, dilated fundus examination for DR, assessment and grading of DPN, and blood investigations. Among these, 49 randomly selected patients without DR had peripapillary retinal nerve fiber layer (RNFL) and ganglion cell inner plexiform layer (GCIPL) assessed by optical coherence tomogram. RNFL and GCIPL changes in different grades of neuropathy were evaluated.Results:Out of 500 patients, 303 (60.6%) were males and 197 (39.4%) were females. Prevalence of DR was 48% and DPN 71.8%. Risk factors for the development of DR included duration of DM >15 years, HbA1c (glycated hemoglobin) greater than 6.5%, serum creatinine more than 1.5 mg/dl, and the presence of DPN. There was a statistically significant association between DR and DPN. There was significant thinning of GCIPL in patients with moderate to severe neuropathy without DR.Conclusion:There is a significant association between DR and DPN and their severities. There are early changes in inner retinal layers of diabetic patients without microvascular changes of DR. These neurodegenerative changes parallel DPN in the course of DM. Our study stresses the importance of multidisciplinary approach in the management of diabetes and its complications.     

Glycemic Effect of Oat and Barley Beta-glucan When Incorporated into a Snack Bar: A Dose Escalation Study

Background: The blood glucose-lowering effects of β-glucan from oats and barley depend on the amounts consumed and their rheological properties. This has been recently challenged with growing evidence that the food matrix may also be an important factor in predicting its physiological response.

Objective: The objective of this study was to examine the effects of varying doses of β-glucan from oats and barley and added to a snack bar on postprandial glycemia.

Design: In a randomized crossover study, 12 healthy males and females consumed one of 8 snack bars containing 0 (control), 1.5, 3, and 6 g of β-glucan derived from oats or barley or 3 white bread controls. All treatments contained 50 g of available carbohydrate. Blood glucose concentrations were measured after ingestion of the treatments over 2 hours.

Results: Incorporation of 1.5 to 6 g of β-glucan into snack bars had no additional glucose-lowering benefits irrespective of dose and source compared to the control bars (0 g β-glucan), suggesting that both the solid food matrix and composition of the bars may play a role in their effects on glycemic response. All bars reduced blood glucose area under the curve (AUC) by an average of 25% (p < 0.05) compared to the mean of the 3 white bread controls.

Conclusion: Adding β-glucan from oats and barley to the snack bar formulation used in this study did not yield any additional benefits beyond the glucose-lowering effects of the snack bars themselves.     

Effect of Oat β-Glucan on Affective and Physical Feeling States in Healthy Adults: Evidence for Reduced Headache,Fatigue, Anxiety and Limb/Joint Pains

The gastrointestinal (GI) side-effects of dietary fibers are recognized, but less is known about their effects on non-GI symptoms. We assessed non-GI symptoms in a trial of the LDL-cholesterol lowering effect of oat β-glucan (OBG). Participants (n = 207) with borderline high LDL-cholesterol were randomized to an OBG (1 g OBG, n = 104, n = 96 analyzed) or Control (n = 103, n = 95 analyzed) beverage 3-times daily for 4 weeks. At screening, baseline, 2 weeks and 4 weeks participants rated the severity of 16 non-GI symptoms as none, mild, moderate or severe. The occurrence and severity (more or less severe than pre-treatment) were compared using chi-squared and Fisher’s exact test, respectively. During OBG treatment, the occurrence of exhaustion and fatigue decreased versus baseline (p < 0.05). The severity of headache (2 weeks, p = 0.032), anxiety (2 weeks p = 0.059) and feeling cold (4 weeks, p = 0.040) were less on OBG than Control. The severity of fatigue and hot flashes at 4 weeks, limb/joint pain at 2 weeks and difficulty concentrating at both times decreased on OBG versus baseline. High serum c-reactive-protein and changes in c-reactive-protein, oxidized-LDL, and GI-symptom severity were associated with the occurrence and severity of several non-GI symptoms. These data provide preliminary, hypothesis-generating evidence that OBG may reduce several non-GI symptoms in healthy adults.     

Virus containment box for retinopathy of prematurity screening and laser

Purpose:Health care workers are susceptible to contracting infection with COVID-19 by aerosol transmission. This is a risk while examining and/or treating an un-sedated neonate in retinopathy of prematurity (ROP) screening and treatment. But screening for neonates for ROP and treating with laser, when required, should not be delayed to avoid the blindness. We describe a cost-effective method of containing aerosols generated during such a procedure in an un-sedated baby.Methods:An acrylic transparent containment box was prepared to accommodate an average-sized infant. The box had four walls and a roof. The floor was open to place the container box over the baby. The walls have two types of openings, large ones to allow passage of hands to examine the baby, small ones to enable passage of oxygen tubing when required. A simulation was created to examine the impact of aerosol spray on examining healthcare personnel.Results:The cost of the acrylic box was negligible. It could be assembled locally with available acrylic sheets and craftsmen. It was not difficult to examine the baby inside the box, and the simulation demonstrated that it protected the health personnel from the aerosol contamination.Conclusion:The described method is likely to increase healthcare personnel''s confidence not to delay or deny ROP screening and laser treatment and save the babies from blindness.     

Management of Complex Upper Extremity Trauma with Associated Vascular Injury

Introduction  Combined soft tissue and vascular injuries of the upper extremity pose several challenges at once to the plastic surgeon. Many decisions have to be taken urgently that will influence the salvage or amputation of the affected extremity. The aim of this article was to provide an evidence-based outline for the management of such injuries. Learning objectives of this article are as follows: (1) approach to a patient with upper extremity composite tissue and vascular injury presenting to the emergency, (2) decision-making as to when to salvage and when to go for amputation of the traumatized upper extremity, (3) role of imaging in emergency situation, (4) role of fasciotomy, (5) intraoperative sequencing of steps, and (6) options for vascular reconstruction and the flaps used for coverage. After reading this article, the reader should have a clear understanding of the management of vascular injury in a patient with composite defects of upper extremity.     

When a placebo is not a 'placebo': a placebo effect on postprandial glycaemia

AIMS: Placebo effects in clinical trials remain uncertain. To investigate a placebo effect on acute postprandial plasma glucose, we conducted a follow-up investigation on a previous study. METHODS: The effect of placebo (9 g encapsulated cornstarch +500 ml water, taken at -40 min) on the plasma glucose response to a 75-g oral glucose tolerance test (OGTT) was assessed in a previous study in 12 healthy subjects (gender, five male, seven female; age 27 +/- 6 years; body mass index 24 +/- 3.4 kg m(-2)). This was compared with the effect of a water control (500 ml water taken alone at -40 min) on the same outcome in the same subjects in a follow-up study. RESULTS: Cornstarch placebo decreased plasma glucose area under the curve during the 75-g OGTT by 28% [Delta (95% confidence interval) -63.3 min mmol(-1) l(-1) (-218.33, 91.66), P < 0.02] compared with the water control (P < 0.05). CONCLUSIONS: Postprandial plasma glucose outcomes may be vulnerable to placebo effects.     

Radiographic stool quantification: an equivalence study of 484 symptomatic and asymptomatic subjects

Purpose

To determine if symptomatic patients referred for radiographic stool quantification have equivalent stool burden to asymptomatic patients.

Method

This was an IRB-approved HIPAA-compliant retrospective equivalence cohort study. An a priori equivalence power calculation was performed. Consecutive abdominal radiographs performed in adult outpatients with bloating, constipation, diarrhea, or abdominal pain to assess “fecal loading” [n = 242 (fecal cohort)] were compared to those performed in asymptomatic adult outpatients to assess “renal stones” [n = 242 (renal cohort)]. Radiographs were randomized and reviewed by two blinded independent abdominal radiologists. Exclusion criteria, designed to avoid unblinding, included urinary tract calculi ≥ 0.5 cm, multiple urinary tract calculi, and ureteral stent(s). Readers scored all radiographs (n = 484) for stool burden using validated Leech criteria [scale: 0 (none) to 15 (extreme diffuse)]. Mean Leech scores and 95% confidence intervals were calculated. Multivariable generalized linear modeling was performed to adjust for baseline medication use, age, and gender. The adjusted parameter estimate was used to test for equivalence in the mean difference between cohorts using Schuirmann’s method of two one-sided t-tests. Inter-reader agreement was assessed with intraclass correlation coefficients.

Results

Overall mean Leech scores for fecal [6.9 (95% CI 6.7, 7.2)] and renal [7.3 (95% CI 7.1, 7.5)] cohorts were equivalent within a margin of 0.75 (adjusted mean difference: − 0.4 [90% CI − 0.7, − 0.04]; p value = 0.02). Inter-reader agreement was good [ICC: 0.62 (95% CI 0.56, 0.68)].

Conclusion

Radiographic stool quantification produces equivalent results in symptomatic and asymptomatic adults and is of uncertain value.

     

Intra-osseous lipoma of the talus: a case report

Intra-osseous lipomas are rare benign tumours. We report one such case in the talus of a 60-year-old man. The patient underwent curettage and bone grafting. At the 22-month follow-up, radiographs of the talus showed dense sclerosis with multiple cortical breaks in the anterior process and no evidence of local recurrence or avascular necrosis. The patient had a painless ankle joint with normal range of movement.