Laboratory Investigations Research Articles

Role of Endoscopic Ultrasound in Diagnosis of Submucosal Lesions of Gastrointestinal Tract

The study aimed to understand the magnitude of submucosal lesions as part of the referral to the endoscopic ultrasound (EUS) unit in one year and know the percent of the different types and sites of submucosal lesions of GIT in Theodore Bilharz Research Institute as tertiary referral center draining Egyptian community. Within one year, all patients referred to the EUS unit at Theodore Bilharz Research Institute (TBRI) for assessment to assess the percent of submucosal lesions cases as part of the total referral and know the different types seen and their common sites as compared to the international literature. Patients diagnosed to have submucosal lesion will be subjected to; full clinical history, thorough physical examination, laboratory investigations, BUS for more characterization (site, size, location, echo pattern, etc.) and BUS-guided fine-needle aspiration (FNA) for histopathological examination. The work comprised 36 patients; 16 females and 20 males. Their ages ranged from 21 to 75 years. All patients had preliminary upper endoscopy or colonoscopy. According to the indication of upper preliminary endoscopy or colonoscopy, 12 (33.3%) were complaining of melena, 5 (13.8%) hematemesis, 1 (2.7%) bleeding per rectum, 7 (19.4%) upper abdominal pain, 2 (5.5%) dysphagia, finally, 8 (22.2%) vomiting. According to the site of the submucosal lesion, 24 (66.6%) were gastric, 6 (16.6%) esophageal, 4 (11.1%) duodenal, 1 gastro-esophageal (2.8%), and 1 (2.8%) rectal. 34 cases (94%) were covered by normal overlying mucosa while 2 cases (6%) had superficial ulcerations. It was concluded that EUS criteria, can be used without FNA and histopathologic examination to reduce the cost of differentiation between malignant and benign lesions. All homogenous lesions were benign. Lesion size of 4.5 cm is a cut off; > 4.5 cm were malignant whereas < 4.5 cm were benign. All submucosal lesions without areas of breakdown were benign. Those infiltrating all layers are malignant. EUS guided fine needle aspiration (FNA) and histopathological examination should be done for some submucosal masses to put a definite diagnosis. EUS with colored Doppler is necessary in differentiating cystic from vascular lesions.

Mavacamten: a novel avenue towards hypertrophic obstructive cardiomyopathy

Hypertrophic obstructive cardiomyopathy (HCM) is the most common heterogeneous genetic cardiovascular disorder. Its pathophysiology involves left ventricular hypertrophy, increased fibrosis, hypercontractility, and reduced compliance. The symptomatic obstructive HCM presents as dyspnoea, syncope, chest pain, palpitations, arrhythmias, or sudden death, usually after provocative manoeuvres like exercise. Until April 2022, treatment options were disease non-specific like Beta blockers, Cardio-selective Calcium Channel Blockers, Dipyridamole, and Ranolazine. Mavacamten is a first-in-class, FDA-approved drug molecule for HCM. It works by selective and reversible inhibition of the cardiac myosin ATPase thereby decreasing the formation of actin- myosin cross- bridges in systole and diastole. The excessive actin-myosin cross-bridging is the hallmark of disease and is responsible for the compromised functioning of the heart in both the systole and diastole phase due to left ventricular outflow tract (LVOT) obstruction and increased ventricular filling pressure respectively. Mavacamten acts by producing super-relaxed state of heart which is then translated into decreased LVOT obstruction and improved cardiac filling pressures thereby improving the functional capacity and symptoms in patients with New York Heart Association (NYHA) stage II, and III symptomatic or obstructive heart failure. Mavacamten is administered orally 2.5-15 mg per day with titration guided by lab investigations and clinical symptoms. Its bioavailability is 85%, undergoes metabolism by CYP2C19 and CYP3A4 and is excreted mainly in urine. It is also an enzyme inducer and shows considerable drug interactions. Common adverse effects are dizziness and syncope. Sometimes the drug may worsen heart failure or completely block ventricular function. Mavacamten has raised hopes for the possibility of managing this potentially lethal intrigue disorder with medicines alone.

The process of sonocatalytic degradation via γ-Fe2O3 to eliminate the antibiotic Co-Amoxiclav/ the effect of diverse parameters/ kinetics study/ using response surface methodology

In this work, the elimination of co-amoxiclav antibiotic from the water environment was optimized via the ultrasonic process coupled with γ Fe2O3 nanoparticles through the response surface methodology (RSM). In a laboratory investigation, parameters such as pH value (3–10), nanoparticle dose (0.1–0.3) g/L, reaction time (15–90) min, initial antibiotic concentration (20–75) mg/L and the frequencies of ultrasound waves (35–130) kHz were studied to assess the effect. The chemical oxygen demand (COD) was determined to track the elimination of Co-amoxiclav. The consequences of the data analysis showed that the catalyst dose and time contact had the greatest influence on the elimination rate of Co-Amoxiclav. The optimum condition in the performed runs were pH 3, ultrasound wave frequency 37 kHz, initial antibiotic concentration 10 mg/L, catalyst dose 0.2 g/L and reaction time 90 min. A COD removal efficiency of 97.09 was obtained with Co-Amoxiclav. The outcomes of this study illustrate that sonocatalytic elimination method has a high efficiency in eliminating Co-amoxiclav antibiotics from aqueous media.

The seasonal variation of Asian dust, anthropogenic PM, and their sources in Dushanbe, Tajikistan

Central Asia's arid climate and growing population make it susceptible to air pollution from mineral dust and anthropogenic sources. To assess the impact of these pollution sources on local air quality, the chemical composition of PM10 aerosol particles was collected within a year at Dushanbe, Tajikistan. Primary sources of the pollutants, their impact on PM10 composition, and their seasonal trends were assessed. The measurement approach employed analysis of trace metals, ions, organic compounds, laboratory investigations, diagnostic ratio calculations, all complemented by positive matrix factor analysis. The results reveal that for about 70% of the year, PM10 levels (80 ± 55 μg m−3 as the annual average) in Dushanbe were higher than the WHO limits, with varying levels during the seasons. Summer concentrations peaked up to 434 μg m−3 due to a combined mineral and road dust influence. Interestingly, winter concentrations reached 152 μg m−3 due to strong contributions (about 64%) from residential heating and fossil fuel combustion, often triggered during sub-10 °C temperatures. Mineral dust events were associated with elevated concentrations of trace metals, including Zn and Pb, alongside organic carbon and high-chain n - alkanes. During such events, Ca/Fe, Ca/Al ratios exceeded those of Saharan dust, suggesting a high salt content in Asian dust, potentially influenced by dried-off lake emissions. It was striking to observe that winter periods exhibited concerning levels of carcinogenic PAHs, such as benzo(b)fluoranthene (<25 ng m−3) and benzo[a]pyrene (<12 ng m−3, BaP), with average values of 4.1 ± 5.9 ng m−3 (BaP) that significantly exceed WHO recommendations. The high PM10 and PAH exposure could pose severe health risks, necessitating collective attention from the local authorities in developing new mitigation strategies concerning the reduction of emissions from residential heating of coal and wood in winter to curb combustion emissions and reduce exposure.

Mechanics of Rainfall-Induced Landslides after a Prolonged Dry Period Based on Laboratory Tests and Numerical Models Incorporating Soil-Water Characteristic Curves

In India, particularly within its Northeastern territories, landslides triggered by rainfall following dry periods are a major concern, consistently causing extensive damage to both life and infrastructure. This study focuses on mitigating their impact through preemptive measures, with an emphasis on analyzing slope stability to determine critical intervention points. The investigation includes experimental tests on soil samples to assess key parameters, such as soil matric suction and unconfined compressive strength, alongside an analysis of slope failures during the 2017 monsoon in Mizoram’s Lunglei district. Employing Soil-Water Characteristic Curves (SWCC) derived from ASTM D5298-10 standards and a microwave drying technique for preparing soil samples, the research evaluates the condition of the slopes before and after monsoonal rains. This study utilizes a blend of numerical modeling and empirical laboratory investigations to explore the factors contributing to slope instability. The findings underscore the necessity of advanced landslide warning systems, suggesting that a deeper understanding of rainfall-induced slope failures could significantly enhance disaster preparedness and reduce potential damages.

Approach to fever in children

BackgroundFever in children is one of the most common reasons for outpatient visits as well as in-patient evaluation, often causing anxiety among parents and caregivers. Fever can be a standalone feature or be associated with other localising symptoms and signs like rash, lymphadenopathy, or any other organ system involvement with or without a focus of infection. The etiologies of fever vary depending on the clinical setting and epidemiology. India being a tropical country, sees a distinct spectrum of tropical infections. Physicians need to stay updated on the prevalent diseases in their region and the unique factors that may influence the clinical presentations and course of fever in the cohort of children they manage. The challenge lies in balancing the benefit of early treatment for severe diseases versus the harms of unnecessary investigations and treatment for self-resolving illnesses. ObjectivesThis review aims to provide a comprehensive overview of fever in children, covering its etiology, clinical features, and management strategies. This review offers an algorithmic approach to fever tailored to the Indian setting to guide physicians in identifying the disease based on clinical symptoms and signs, ordering essential laboratory investigations, and initiating appropriate management promptly. ContentThe review categorises fever into various segments like fever with localising signs like rash, lymphadenopathy, fever due to infection localised to a particular organ system, and fever without a focus including fever of unknown origin. It delves into the diverse etiological factors contributing to fever in each of these categories, encompassing infectious and non-infectious origins. It gives pointers to identify the etiology from history, examination, and confirm them with judicious use of diagnostic investigations with emphasis on identifying the red flag signs that require immediate attention, especially in vulnerable groups like neonates and young infants.

Clinical Profile and Short-Term Outcomes of Acute Kidney Injury in Elderly Patients in a Tertiary Care Center.

Background Acute kidney injury (AKI) is a common and serious condition affecting elderly patients. Despite its significance, comprehensive research focusing specifically on the clinical profile and short-term outcomes of AKI in this vulnerable population is lacking. Objective This study aimed to evaluate the clinical profile and short-term outcomes of AKI in elderly patients admitted to a tertiary care center. Methods A prospective observational study was conducted from December 2023 to March 2024, involving 75 elderly patients (aged ≥65 years) diagnosed with AKI. Baseline demographic data, clinical profiles, laboratory investigations, mortality rate among elderly patients diagnosed with AKI within 30 days of diagnosis, and short-term outcomes were recorded and analyzed. Descriptive statistics and appropriate statistical tests were used for the data analysis. Results The study cohort had a mean age of 72.6 years. Hypertension was present in 55 patients (73.3%), and diabetes mellitus was observed in 30 patients (40.0%). Prerenal causes of AKI were identified in 40 patients (53.3%), while acute tubular necrosis was found in 25 patients (33.3%). Stage 2 AKI was the most common, affecting 35 patients (46.7%). Out of the 75 patients, 15 patients (20.0%) succumbed to AKI within the study period. Deceased patients had longer hospital stays, with a median of 16 days compared to 10 days for survivors. ICU admission was required for 13 of the deceased patients (86.7%), compared to 32 of the surviving patients (53.3%). The need for renal replacement therapy was higher among the deceased patients, with 11 out of 15 patients (73.3%) requiring it, compared to 19 out of 60 surviving patients (31.7%). Renal function recovery was notably lower in the deceased patients. Conclusion AKI in elderly patients was associated with significant morbidity and mortality, highlighting the need for early recognition, appropriate management, and preventive strategies. A comprehensive evaluation of the clinical profile and short-term outcomes of AKI in the elderly population provides valuable insights for optimizing patient care and improving outcomes.

Urticaria Pigmentosa – A Case Report with a Review of the Literature

Mastocytosis encompasses a rare group of diseases characterized by the accumulation of mast cells, primarily in the skin or internal organs. In the 2016 revised WHO classification, mastocytosis is divided into cutaneous mastocytosis (CM), systemic mastocytosis (CM), and localized mast cell tumor. Cutaneous mastocytosis (CM) includes maculo-papular CM/urticaria pigmentosa (UP), diffuse CM and cutaneous mastocytoma. Urticaria pigmentosa is the most common skin variant. It presents with erythematous brownish macules or papules, often accompanied by pruritus. A case of a 48-year-old woman with disseminated, mildly pruritic, sharply demarcated, livid-brownish macules on the skin of the trunk and extremities is presented. A positive Darier symptom was established. Laboratory tests revealed granulocytosis (73%) and lymphocytosis (19.8%). Serum tryptase and 24-hour urine 5-hydroxyindoleacetic acid were not elevated. The diagnosis of urticaria pigmentosa was confirmed by the histopathological examination revealing perivascular infiltrates of mast cells, mainly in the deep dermis. Screening performed did not detect systemic involvement. Symptomatic treatment with H1 and H2 blockers and topical corticosteroid was carried out. Avoidance of triggers is recommended. The patient&amp;apos;s condition has improved. Both a historical review of mastocytosis and a revised classification, as well as the epidemiology, etiology with triggering factors, clinical presentation, laboratory investigations, and management of urticaria pigmentosa are presented.

Comparative Analysis of Antihypertensive and Anticonvulsant Regimens in Managing Pre-eclampsia and Eclampsia: Insights from a Sudanese Retrospective Study.

BACKGROUND Preeclampsia presents with gestational proteinuria, usually after 20 weeks of gestation, and can be complicated by generalized tonic-clonic seizures of eclampsia. Particularly in countries with limited healthcare resources, preeclampsia and eclampsia are major causes of maternal morbidity and mortality. This retrospective study aimed to evaluate the presentation, management, and outcomes of 185 women with preeclampsia and eclampsia in 2 maternity hospitals in Omdurman, Sudan, between January and December 2020. MATERIAL AND METHODS An analytical retrospective study was conducted in 2 main maternity hospitals in Omdurman, Sudan, between January and December 2020. The study included 185 pregnant women with preeclampsia or eclampsia. Data on clinical and obstetric characteristics (history of the illness, comorbid diseases, parity, gravida, multifetal pregnancy, and laboratory investigations), medications used, and maternal and neonatal outcomes were obtained for the diagnosis. The data were analyzed using the SPSS version 27. RESULTS Results: The mean age was 27.2±6.3 years, with 42.7% primigravida, 30% had a triple-drug regimen, nifedipine was the most common antihypertensive (60.5%), and 17.3% of patients underwent observation only. The seizure rate was 20%, with 92.73% controlled with magnesium sulfate. The antihypertensive regimen before delivery was significantly associated with the mode of delivery (P=0.001) and maternal outcomes (P=0.047); the regimen used after delivery significantly achieved blood pressure control (P=0.043) and improved maternal outcomes (P=0.007), but not fetal outcomes. CONCLUSIONS Maternal outcomes were markedly affected by the antihypertensive drug regimens used and the patient's seizure control status, and use of anti-convulsants successfully controlled all seizures.

Clinical Approach to Advanced Mantle Cell Lymphoma: A Detailed Case Analysis

Mantle cell lymphoma (MCL) is a rare and aggressive subtype of non-Hodgkin lymphoma (NHL) originating from cells in the mantle zone. Herein, we present a case report of a 49-year-old male patient diagnosed with stage VI MCL, illustrating various diagnostic methods and procedures utilized in his evaluation. The patient presented with progressively enlarging cervical lymph nodes, fatigue, weight loss, anorexia, chronic diarrhea, abdominal pain, and rectal bleeding. Clinical examination revealed cutaneomucosal pallor, tachycardia, expiratory polypnea, bilateral jugulocarotid adenopathies, and splenomegaly. Laboratory investigations showed normocytic normochromic anemia, hyperleukocytosis, lymphocytic predominance, and thrombocytopenia. Peripheral blood smear analysis indicated a lymphoproliferative disorder, confirmed by flow cytometry revealing monotypic lymphoid cells. Bone marrow biopsy showed hypoplastic marrow with atypical cells. Immunohistochemistry confirmed mantle cell lymphoma localization. Subsequent thoraco-abdomino-pelvic CT scan revealed mediastinal and abdominal adenopathy with splenomegaly, leading to a diagnosis of stage IV MCL. The case highlights the importance of early and comprehensive diagnostic approaches in MCL management.

Advancing the Use of Suction Lysimeters to Inform Soil Leaching and Remediation of PFAS Source Zones

AbstractPorewater in soil vadose zones is an integrator of the fundamental processes governing the transport and partitioning of per and poly‐fluoroalkyl substances (PFAS) as they move from source zones to groundwater. Suction lysimeters are being advanced as a method to provide reliable and representative PFAS porewater samples, to inform PFAS leaching and for monitoring remedial approaches. We report outcomes of lysimeter investigations across 3 sites and 18 lysimeters within fine‐textured soil profiles. Soil cores were recovered from the same locations, and PFAS concentrations in soils and lysimeter porewater were compared and compared with prior laboratory investigations. Variable concentration distributions with depth of PFAS in soils were found with a maximum sum of PFAS of ~56 mg/kg dominated by perfluorooctane sulfonic acid (PFOS). The maximum sum of PFAS in porewater was 13.5 mg/L. Comparison across all collocated soil and porewater concentrations did not provide consistent trends. PFAS mass fractions within lysimeter porewater samples were much higher for most PFAS than mass fractions determined from laboratory investigations, but the fraction was lower for PFOS. The results indicate preferential recovery of individual shorter chain PFAS via leaching at lower liquid: soil ratios such as those experienced under suction during recovery of porewater by lysimeters. Suggestions are offered to advance the use of suction lysimeters in promoting porewater PFAS concentrations as an alternative for regulatory compliance, and in closing the gap between field and laboratory approaches. There is merit in using lysimeters at PFAS field sites with improvements and considerations embraced.

NFS-16. NOVEL AUSTRIAN CARE AND PREVENTION GUIDE FOR CHILDREN AND ADOLESCENTS WITH NF1

Abstract BACKGROUND Unified strategies for the care of children and adolescents affected by Neurofibromatosis type 1 (NF1) are lacking in Europe. While ERN GENTURIS developed guidelines for the tumour surveillance and management in NF1, these recommendations do not cover all other aspects of the disease. This holds not only true on an international level, but also on the national level in Austria. Despite being a small country with a uniform health and social security system, approaches to patient care may be comparable but not identical. AIM In order to standardise and improve patient care for children with NF1 in Austria, a care and prevention sheet was developed. METHODS In close cooperation with the Austrian patient organisation NF Kinder the Austrian NF network was established. This network is composed of dedicated health-care providers (medical as well as psychosocial) involved in the care of patients with NF1 in ten Austrian centres as well as patient representatives, some of whom were also involved in drafting the novel ERN GENTURIS recommendations. This network undertook the task of reviewing existing guidelines and incorporate the national healthcare structure and best practice guidelines into a consensus document. RESULTS The recommendations were condensed into a single sheet that is divided in four sections: clinical examination, lab investigations, imaging, additional consultations. For each parameter, the document advises on the age specific intervals for screening. Furthermore, it indicates the appropriate time points during follow-up (e.g. at initial presentation, at transition, if clinically indicated, …). The recommendations thereby focus not only on the inherent tumour risk but address the broad spectrum of possible symptoms (such as orthopaedic or surgical), specifically emphasising also psychosocial and neurocognitive issues. CONCLUSION The novel Austrian care and prevention guide for children and adolescents with NF1 will facilitate uniform best practice care for affected kids on a national level

Development of a universal atomistic cement model incorporating nanomaterials: From laboratory investigation to molecular simulation

Hydrated cement is considered one of the most complex binder systems. The development of models that suitably represent hydrated cement is still far from established due to the complexity of the hydration process, as well as the multiscale phase and different morphological properties. Therefore, this study attempts to develop a hydrated cement model using molecular-level simulation and laboratory testing. This model aimed to predict the mechanical properties of cement paste between 0.25 and 0.65 w/c ratios. In this regard, five cement paste mixtures with various w/c ratios were prepared and tested to evaluate their mechanical properties and micro-structures. Then, a novel modeling methodology using molecular dynamics (MD) simulation was carried out to develop an ingredient-based atomistic cement model. In this regard, the Dreiding force field (DFF) was used in all the simulation processes, starting from the cement clinker phases to the hydrated cement. The experimental results of cement paste mixtures revealed some useful data that was supportive of the simulations. Radial distribution function (RDF) and fractional free volume (FFV) were utilized to investigate the local atomic structure of the cement paste models. The calcium-silicate-hydrated (C–S–H) of the developed model was characterized through RDF and benchmarked to a well-known mineral analog, namely tobermorite. The developed model was computationally tested under different w/c ratios, and reliable results in terms of micro-structural matrix as well as mechanical properties were obtained. Then, the cement models incorporating different ratios of nano-silica were developed, and a good estimation of the mechanical properties was obtained. Because of the universal nature of the reported model in this research, it could be utilized to further predict the mechanical behavior and durability performance of the cement paste.

The novel 2024 WHO Neisseria gonorrhoeae reference strains for global quality assurance of laboratory investigations and superseded WHO N. gonorrhoeae reference strains-phenotypic, genetic and reference genome characterization.

MDR and XDR Neisseria gonorrhoeae strains remain major public health concerns internationally, and quality-assured global gonococcal antimicrobial resistance (AMR) surveillance is imperative. The WHO global Gonococcal Antimicrobial Surveillance Programme (GASP) and WHO Enhanced GASP (EGASP), including metadata and WGS, are expanding internationally. We present the phenotypic, genetic and reference genome characteristics of the 2024 WHO gonococcal reference strains (n = 15) for quality assurance worldwide. All superseded WHO gonococcal reference strains (n = 14) were identically characterized. The 2024 WHO reference strains include 11 of the 2016 WHO reference strains, which were further characterized, and four novel strains. The superseded WHO reference strains include 11 WHO reference strains previously unpublished. All strains were characterized phenotypically and genomically (single-molecule PacBio or Oxford Nanopore and Illumina sequencing). The 2024 WHO reference strains represent all available susceptible and resistant phenotypes and genotypes for antimicrobials currently and previously used (n = 22), or considered for future use (n = 3) in gonorrhoea treatment. The novel WHO strains include internationally spreading ceftriaxone resistance, ceftriaxone resistance due to new penA mutations, ceftriaxone plus high-level azithromycin resistance and azithromycin resistance due to mosaic MtrRCDE efflux pump. AMR, serogroup, prolyliminopeptidase, genetic AMR determinants, plasmid types, molecular epidemiological types and reference genome characteristics are presented for all strains. The 2024 WHO gonococcal reference strains are recommended for internal and external quality assurance in laboratory examinations, especially in the WHO GASP, EGASP and other GASPs, but also in phenotypic and molecular diagnostics, AMR prediction, pharmacodynamics, epidemiology, research and as complete reference genomes in WGS analysis.

Intracerebral haemorrhage in a child with isolated levocardia, transposition of great arteries and common atrium. Rare Case Report

Background: Pediatric hemorrhagic stroke is rare and frequently associated with vascular lesions. Children with congenital heart diseases commonly present with ischemic stroke and rarely presenting with hemorrhagic stroke. Case presentation: We present a 9 years old girl with one day history of right sided weakness (hemiplegia) preceded by headache for two days. Radiological investigations were helpful in confirming left cerebral haemorrhage, transposition of great arteries, common atrium and situs inversus with levocardia in this patient. Laboratory investigations indicated high haemoglobin level and high red blood cell counts. We report a rare case of intracerebral haemorrhagic stroke in a child with multiple congenital malformations Conclusion: We concluded that high haemoglobin and red blood cell counts due to the recurrent hypoxia from deoxygenated blood and strenuous activities can occasionally cause spontaneous bleeding in visceral organs including the brain.

Determinants of Mortality in COVID-19–Associated Opportunistic Fungal Infections

Abstract Background COVID-19–associated mucormycosis (CAM) affected over 50,000 people during the second wave of the pandemic in India. Epidemiological aspects of CAM were reported, but there is a lack of published literature on mortality and its determinants in CAM and other fungal infections. The present study investigated patterns and determinants of mortality in these patients. Methods The retrospective study reviewed case records of 390 patients, with at least 1 year of follow-up, for information related to demographics, epidemiology, clinical features, laboratory investigations, and treatment. The association between categorical variables was studied using the chi-square test of independence and logistic regression between 2 groups of those who survived and those who died during hospitalization or after discharge. Results A total of 157 (40%) patients did not survive; of these, 112 (29%) died during hospitalization and 45 (11%) had postdischarge mortality. The risk of mortality was associated with higher age, use of corticosteroids (odds ratio, 1.38; 95% confidence interval, 0.87–2.16), visual acuity &lt;3/60 at presentation, palate involvement, and abnormal levels of white blood cells and red blood cells. Conclusions The demographic, clinical, laboratory, and microbiological parameters may be predictors of mortality in patients of rhino-orbital-cerebral mucormycosis.

Durability Assessment of Eco-Friendly Bricks Containing Lime Kiln Dust and Tire Rubber Waste Using Mercury Intrusion Porosimetry

The global challenge faced due to the impact of the construction industry on climate change, along with the issues surrounding sustainable waste disposal, has necessitated various research on using waste products as eco-friendly alternatives in construction. In this study, the avoidance of waste disposal through landfills in Australia was encouraged by incorporating lime kiln dust (LKD) and tire rubber waste (TRW) into masonry mixes to manufacture green bricks. Furthermore, the investigations in this article highlight the use of mercury intrusion porosimetry (MIP) to determine the durability of the LKD-TRW bricks when exposed to freeze–thaw (F-T) cycles by examining the pore size distribution within the bricks. The LKD waste was blended with ground granulated blast furnace slag (GGBFS) at a 70:30 blending ratio and combined with the TRW in stepped increments of 5% from 0 to 20% to produce these eco-friendly bricks. The compressive strength (CS), flexural strength (FS), frost resistance (FR), pore size distribution according to mercury intrusion porosimetry (MIP), and the water absorption (WA) properties of the bricks were assessed. The CS and FS values at 28 days of curing were recorded as 6.17, 5.25, and 3.09 MPa and 2.52, 2, and 1.55 MPa for 0, 5, and 10% TRW contents, respectively. Durability assessments using the F-T test showed that the bricks produced with 0% TRW passed as frost-resistant bricks. Furthermore, the results from the MIP test showed a total pore volume of 0.033 mL/g at 3 µm pore size for the 0% TRW content, further confirming its durability. Hence, the 0% LKD-TRW bricks can be utilized in cold regions where temperatures can be as low as −43 °C without deteriorating. Lastly, WA values of 7.25, 11.76, and 14.96% were recorded for the bricks with 0, 5, and 10% TRW, respectively, after the 28-day curing period. From all of the results obtained from the laboratory investigations, the LKD-TRW bricks produced with up to 10% TRW were within the satisfactory engineering requirements for masonry units.

Platelet Indices as Novel Surrogate Markers for the Prognosis of COVID-19 Infection: An Observational Study.

Background The new severe acute respiratory syndromecoronavirus 2 (SARS-CoV-2) causes severe acute respiratory illness accountable for causing the coronavirus disease 2019 (COVID-19) illness. Thrombotic issues, acute respiratory distress syndrome (ARDS), and cytokine storm are significant contributors to morbidity and mortality in patients with COVID-19. Elevated D-dimer levels and prothrombin times are further indicators of abnormal coagulation parameters in COVID-19 patients. This study aimed to study the platelet indices as prognostic markers in COVID-19 infection. Methods In this prospective observational study, 150 real-time reverse transcription-polymerase chain reaction (RT-PCR)-positive COVID-19 patients were enrolled between October 2020 and September 2021. All the subjects were screened and explained the study procedure in their native language. Following enrolment, a detailed history and physical examination were performed. Subsequently, laboratory investigations were performed, and patients were subjected to high-resolution computed tomography (HRCT) examination to classify patients into mild, moderate, and severe according to the severity of the illness. The platelet indices taken into account were plateletcrit (PCT) in percentage, platelet count (PLT) in lakh per microlitre, mean platelet volume (MPV) in femtolitres, and platelet distribution width (PDW) in femtolitres. Results The mean PLT was significantly greater among survivors than non-survivors (2.03 ± 0.72 versus 1.76 ± 0.47; p-value = 0.018). The mean MPV (10.42 ± 0.53 versus 9.22 ± 0.64; p-value <0.0001) and PDW (17.99 ± 1.53 versus 16.54 ± 0.91 fl; p-value <0.0001) were significantly greater among non-survivors than survivors. However, the mean PCT was significantly greater among survivors than non-survivors (0.22 ± 0.03% versus 0.18 ± 0.33%; p-value <0.0001).At a cut-off of 0.213, the sensitivity and specificity of PCT in predicting death were found to be 79.2% and 74.5%, respectively. At a cut-off of 16.75, the sensitivity and specificity of PDW in predicting death were found to be 68.8% and 59.8%, respectively. The findings demonstrated a relationship between elevated MPV and PDW and mortality and severe COVID-19 infection. Increased PCT was connected to higher survival, with a specificity and sensitivity of 87.5% and 75.5%, respectively, and MPV >9.75 may predict death. PDW >16.75 exhibited a specificity and sensitivity of 68.8% and 59.8%, respectively, in predicting death. With comparable sensitivity and specificity of 79.2% and 74.5%, PCT >0.213 may predict death. Conclusion In severely sick COVID-19 patients, platelet indices should be routinely calculated and can be utilized as simple, low-cost prognostic indicators.

Aerosol‐Cloud Interactions From Aviation Soot Emissions

AbstractCurrent models estimate global aviation contributes approximately 5% to the total anthropogenic climate forcing, with aerosol‐cloud interactions having the greatest effect. However, radiative forcing estimates from aviation aerosol‐cloud interactions remain undetermined. There is an expected significant increase in aircraft emissions with aviation demand expected to rise by over 4% per year. Soot may play an important role in the ice nucleation of aircraft‐induced cirrus formation due to a high emission rate, but the ice nucleating properties are poorly constrained. Understanding the microphysical processes leading to atmospheric ice crystal formation is crucial for the reliable parameterization of aerosol‐cloud interactions in climate models due to their impact on precipitation and cloud radiative properties. Ice nucleation of aircraft‐emitted soot is potentially affected by particle morphology with condensation of supercooled water occurring in pores followed by ice nucleation. However, soot has heterogeneous properties and undergoes atmospheric aging and oxidation that could change surface properties and contribute to complex ice nucleation processes. This review synthesizes current knowledge of ice nucleation catalyzed by aviation in the cirrus regime and its effects on global radiative forcing. Further research is required to determine the ice nucleation and microphysical processes of cirrus cloud formation from aviation emissions in both controlled laboratory and field investigations to inform models for more accurate climate predictions and to provide efficient mitigation strategies.

Case Report: A Case Report on an 18-Year-Old Female with Cerebral Vasculitis in Systemic Lupus Erythematosus (SLE).

Cerebral vasculitis is a rare but severe complication of Systemic Lupus Erythematosus (SLE), presenting significant challenges in management due to its potential for devastating neurological consequences and poor prognosis. We present a case of an 18-year-old female with known SLE who presented with seizures, declining cognitive function, and unresponsiveness. Neurological examination, laboratory investigations, and radiological imaging supported the diagnosis of cerebral vasculitis secondary to SLE. Despite aggressive immunosuppressive therapy, the patient’s neurological status continued to deteriorate, leading to respiratory failure and multiorgan dysfunction. Ultimately, the patient succumbed to multiorgan failure attributed to severe CNS vasculitis and its complications. This case underscores the importance of early recognition and aggressive management of cerebral vasculitis in SLE while highlighting the need for further research into more effective therapeutic strategies to improve patient outcomes.