Wednesday, 19 January 2022

Lupine Publishers| Numerical Solution of Boundary Layer Flow of Viscous Fluid Via Successive Linearization Method

Lupine Publishers| Journal of Computer Sciences & Applications



Abstract

The aim of this work is to obtain the numerical solutions for the boundary layer flow of heat transfer of incompressible viscous fluid. The governing partial differential equations are converted into ordinary differential equation by using a similarity transformation. The nonlinear equation governing the flow problem is modeled and then solved numerically by means of a successive linearization method (SLM). The numerical results are derived in tables for comparisons. The important result of this comparison is to show the high precision of the SLM in solving system of nonlinear differential equations. Graphical outcomes of various parameters such as Prandtl number (Pr) and Eckert number (Ec) on the flow, field are discussed and analyzed. Besides this the present results have been tested and compared with the available published results in a limiting manner and an excellent agreement is found.

Keywords: Viscous fluid; Successive linearization; Boundary layer

Introduction

In the recent years, a great deal of interest has been gained to fluids applications. Some fluids not easy to expressed by particular constitutive relationship between shear rates and stress and which is totally different than the viscous fluids [1,2]. These fluids including many home items namely, toiletries, paints, cosmetics certain oils, shampoo, jams, soups etc. have different features and are denoted by non-Newtonian fluids. In general, the categorization of non-Newtonian fluid models is given under three class which are named the integral, differential, and rate types [3-6]. In the present study, the main interest is to discuss the heat transfer flow of hydrodynamic viscous fluid over a flat plate in a uniform stream of fluid with dissipation effect. The most phenomena in the field of engineering and science that occur is nonlinear. With this nonlinearity the equations become more difficult to handle and solve. Some of these nonlinear equations can be solved by using approximate analytical methods such as Homotopy analysis method (HAM) proposed by liao S [7,8], Homotopy Perturbation method (HPM) it was found by Ji-Huan [9] and Adomain decomposition method (ADM) Q Esmaili et al. [10], Makinde OD et al. [11] and Makinde OD [12].

However, some of these equations are solved via traditional numerical techniques such as finite difference method,shooting method and Keller box method, Runge-Kutta. Recently some studies have presented a new method called Successive Linearization Method (SLM). This method has been applied successfully in many nonlinear problems in sciences and engineering, such as the MHD flows of non- Newtonian fluids and heat transfer over a stretching sheet [13], viscoelastic squeezing flow between two parallel plates [14], two dimensional laminar flow between two moving porous walls [15] and convective heat transfer for boundary layer with pressure gradient [16,17]. Therefore, the effectiveness, validity, accuracy and flexibility of the SLM are verified among of all these successful applications. Presently a new investigation on the heat transfer flow of hydrodynamic viscous fluid over a flat plate in a uniform stream of fluid with dissipation effect is discussed. The numerical solution to the resulting nonlinear problem is computed by using the SLM approach. The embedded flow parameters are discussed and illustrated graphically.

Mathematical formulation of the problem

The governing equations are

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where (u,v ) are the components of velocity in (x , y) directions, the kinematic viscosity T is temperature of fluid, the thermal diffusivity

k the fluid thermal conductivity, ρc the fluid capacity heat and cp the specific heat. The relevant boundary conditions are defined as

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Where , Tw T are constants. Introducing the following dimensionless variables

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Utilizing equation (6), equation (1) is satisfied automatically and equations (2) and (3) characterize to the following problems statement

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The related boundary conditions

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Solution of the problem

Here successive linearization method (SLM) [14-16] is implemented to obtain the numerical solutions for nonlinear system (8) and (10) corresponding to the boundary condition Eq. (11) – (13) (Table 1). The convergence for numerical values of f "(0) and −θ '(0) for different order of approximation when Ec = 0.01, Pr =1 and n =1.00 (Table 1).

Table 1: The convergence for numerical values of f "(0) and −θ '(0) for different order of approximation when Ec=0.01, Pr 1 and 1.00 Ec n=1.00.

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The numerical values of f (η ) and f '(η )when, n =1, Pr =1 for Ec= 0.01. (Table 2).

Table 2: The numerical values of f (η ) and f '(η ) when, n =1, Pr =1 for Ec = 0.01.

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The numerical values of θ (η ) and −θ '(η )when, n =1, Pr =1 for Ec =0.01 (Table 3).

Table 3: The numerical values of θ (η ) and −θ '(η ) when, n =1, Pr =1 for Ec =0.01.

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Comparison of numerical values of f (η ) with Ref: [16] when, n= Ec = 0, Pr =1 (Table 4).

Table 4: Comparison of numerical values of f (η ) with Ref: [16] when, n= Ec = 0, Pr =1.

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This section concerns with the graphical illustrations obtained by using successive linearization method for velocity, temperature profiles. These profiles show the variations of embedded flow parameters in the solution expressions for heat transfer analysis for an incompressible viscous fluid. The physical interpretation of the problem has been discussed in Figures 1 – 4. These figures are plotted in order to illustrate such variations. Here the graphs have been determined for the heat transfer flow of steady Newtonian fluid. Figures 1 & 2 shows the effects of the parameter on the velocity profile for f '(η ) and θ (η ) when Ec, Pr are fixed. It is worth noticing that by increasing the parameter η reveals that buoyancy because of augments of gravity which boosts on the velocity. Figure 3 is sketched for the variation of Prandtl number Pr on θ (η ) . It is noted that for lager Pr ,the thermal field is lower and then this reduce the temperature. In fact law Prandtl number Pr assist fluid with higher thermal conductivity and this create thicker thermal boundary layer than that for lager Pr. Finally, Figure 4 shows the effect of Ec on velocity and temperature profiles over the plate, and we note that by increasing in Ec parameter is seen that the effect is very big for the temperature.

Figure 1: Effects of n and f '(η ) .

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Figure 2: Effects of n and θ (η ) .

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Figure 3: Effects of Ec for θ (η ) .

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Figure 4: Effects of Pr for θ (η ) .

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Conclusion

In this research, the problem of heat transfer of an incompressible viscous fluid over flat pate is solved numerically. The numerical solutions are well established by SLM. The influence of various parameters is shown through different graphs. The present results have been tested and compared with the available published results in [16], in a limiting situation shown in tables v and an excellent agreement is found [17].

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Monday, 17 January 2022

Lupine Publishers| Degradation of Malachite Green by Green Synthesized Copper Nanoparticles by Using Aloe Barbadensis Leaf Extracts

 Lupine Publishers| Journal of Nanomedicine



Abstract

The present study was aimed to account a green synthesis of copper nanoparticle is by interaction of leaf extract and copper salt. The bio-synthesis of nanoparticles put forward a cost free and eco-friendly method of nanoparticle synthesis. Copper nanoparticles were synthesized by using aqueous solution of copper sulphate and extract of Aloe barbadensis. The prepared leaf extract was observed when 1mM copper sulphate solution is added in it. Color change of the reaction mixture was observed from deep blue to colorless and then to brick red and dark red indicating the formation of copper nanoparticles. The synthesized CuO NPs was characterized by using different technique such as UV, IR, XRD, and SEM. ward a cost-free and environmentally suitable method of nanoparticle synthesis. Synthesized CuO nanoparticles with average particle size of 60n. Shape of copper nanoparticles was spherical and cubic and their range was 80-120nm Different functional group in synthesized nanoparticles are examined by FTIR. UV spectrophotometer confirm peak of copper nanoparticle experiments Copper oxide nanoparticles shows maximum absorbance at 272nm. Catalytic activity of synthesized nano particles is also examined on the degradation of malachite green. This catalytic effect of copper oxide nanoparticles can be contributed to its small size.

Keywords: Aloe Barbadensis, SEM, Copper Oxide Nanoparticles, Green Synthesis, XRD, Green Synthesis, Highly Stabilized Nanoparticles , Ecofriendly, Phenolic Content, Degradation of Malachite Green

Introduction

Nanotechnology deals with manipulation of matter at low size normally lesser then that of the 100nm. Metallic nanoparticles can be prepared by chemical and physical method. These methods have certain flaws like toxic chemicals and also dangerous to environment [1]. Developing research in green chemistry employed prominent part in nanotechnology to attain benefit to society surface area and mass ratios increase adsorption property [2]. Green synthesis has been concerned in synthesis of highly stabilized nanoparticles. Synthesis of nanoparticles taking assistance of ecofriendly methods has achieved huge attention in the modern era. The particles produced by green synthesis differ from those using physio–chemical approaches. [3] Green synthesis, a bottom up approach, is similar to chemical reduction where an expensive chemical reducing agent is replaced by extract of a natural product such as leaves of trees/crops or fruits for the synthesis of metal or metal oxide NPs. Biological entities possess a huge potential for the production of NPs. Biogenic reduction of metal precursors to corresponding NPs is eco-friendly [4] (Figure 1). Copper nanoparticles were synthesized by leaf extract of Aloe barbadensis plant. The plant is also known as “Aloe vera”. The green synthesis of copper nanoparticle by Aloe vera plant extract is fast, easy and (Figure 2). environmentally suitable method [5].

Figure 1: Green synthesis of NPs.

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Phenolic content in plant extract dissolved in water, degradable and catalyzed synthesis of nanoparticle as capping and reducing agent [6]. This old plant is well known for deeper healing effects. It is majorly present in cosmetics and skin creams. It has the ability to clean skin and anti-aging effects of it is also famous [7]. Aloe vera contains antioxidant vitamins A, C, and plus vitamin B12, folic acid, and choline [8]. Its gel juice is taken as power drink. Minerals such as calcium, copper, selenium, chromium, manganese, magnesium, potassium and zinc are present in aloe vera. Leaves of aloe vera provide anthraquinones [9]. Copper nanoparticles synthesis by using electron microscopy represented that their range is upto 50 to 130nm [10]. Copper nanoparticles important as compares to other nanoparticles due to their properties that are found at less cost than that of expensive metal such as gold and silver such as examination of catalytic activity of copper nanoparticles by degradation of malachite green [11]. Copper oxide particles show effective catalytic removal of organic dyes such as malachite green, when particles were added into it [12]. The use 0fgreen method increased so much because of its easy preparation and low manufacturing cost. Moreover, less to toxic starting materials and ease of handling make it more favorable [13]. Malachite green is extensively used in many industries as a dye for leather, textiles and also in aquaculture industry to control fish parasites and disease [14]. Malachite green is classified as a class II health hazard and they pose toxicity (mutagenicity, genotoxicity) to the aquatic organisms like fish, algae, bacteria etc. and it’s proved to be highly carcinogenic and is banned by many countries [15] (Figure 3). The removal of organic pollutants and dyes from industries remain as a challenge as these dye molecules are difficult to decompose. Varieties of organic and heavy metal pollutants were removed by nano adsorbents by various research groups [16].

Figure 2: Aloe veraplant.

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Figure 3: Malachite Green

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Materials and Methods

Material

Copper sulphate, Aloe barbadensis leaves, sodium borohydride (NaBH4), organic dyes such as Malachite green

Preparation of Plant Leaf Extract

50g of the Aloe vera is taken from the nearby garden. The leaves of aloe vera are first separated from the gel part o0f aloe vera. The leaves are then washed thoroughly with distilled water to remove soil and dust particles. After washing leaves were dried and finely chopped. These finely chopped leaves were allowed to boil for 15min at 100 °C with 100mL of de-ionized water in a250-mL flask and then allow to cooled down to come at least at room temperature. The resulting solution is passed through a filter paper to remove any solid particles and then again filtered throughaWhatmanfilterpaperofporesize0.2μm.Thefiltrate is stored at 6 °C as a stock for the synthesis of CuO NPs.

Green Synthesis of Cuo NPs: A copper sulphate solution of fifty milliliters was added to 15ml aloe vera leaves extract. The solution was stirred on a magnetic stirrer at 120degrees. The color change was observed. The color changes from deeply blue to colorless and then dark red at saturation. Brick red color confirms the nanoparticles formation. The resultant solution was centrifuged for ten mints at speed of 50,000rpm. After discarding supernatant copper oxide nanoparticles were dried in a watch glass. After drying, black color particles (Figure 4). were assemble for further characterization.

Figure 4: copper NPs synthesis.

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Characterization of Green Synthesis Copper Nanoparticles

The morphological, structural and chemical composition of CuO NPs were analysed by using SEM (jsm-6480) and XRD (XPERTPRO) equipment. Optical properties of synthesized particles are investigated by UV spectrophotometer (DB-20). Size and shape of copper oxide nanoparticles were observed by SEM (jsm-6480). The crystal structure of synthesized nanoparticle is examined by XRD (XPERT-PRO), FTIR analysis is performed for the collection of the functional groups, present in this synthesis of CuONps.

Colour change observation: Color changes indicate the formation of nanoparticles of copper oxide. Blue color solution was turned into red or brick red indicated for formation of copper nanoparticles synthesis.

Result

X-Rays Diffraction Studies

Copper oxide nanoparticles were examined by X-ray diffractometer (XPERT-PRO). Copper oxide powder was put in cubes of XRD for calculation of intensity. The resultant pattern of synthesized nanoparticles was analyzed. The peaks at 2θ correspond to intensity as the peaks at28, 29.8, 32.1, 35.8, 36, 43.3, 47.5, 51.1, and have 112, 200, 103, 202, 004, 111, 301 and 200, pattern which is compare to JCPDS card no (049-1832). The pattern of Cu nanoparticles compared to JCPDS card no (01-085-1326), the peaks at 2θ. XRD pattern confirmed that CuO nanoparticles are highly crystalline with cubic crystal structure. The average size of the particle calculated by Scherrer equation was 60-100nm (Figure 5).

Figure 5: XRD pattern of Cuo NPs.

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FTIR Analysis

In this analysis, FTIR (IPRrestige-21) spectrum was analyzed. The analyzation confirms the presence of copper nanoparticles. Different peaks were observed at 1100cm-1 confirm formation of Copper oxide nano particle speaks was observe in range of 400-4000cm-1. The FTIR spectrum of Copper oxide nanoparticle exhibits that the broad absorption band at 32cm-1 corresponds to the hydroxyl (OH) functional group in alcohols and phenolic compounds. The peak at 1601.2cm-1 is due C=C aromatic bendindg. Absorption peak at 1038.0 cm-1 stretching vibration of C–O group of primary and secondary alcohols (C–O), while smaller peaks at 900- 700cm-1 were also (Figure 6). Assigned to the aromatic bending vibration of C–H group (Table 1).

Table 1: Absorption peak at 1038.0cm−1 stretching vibration of C–O group of primary and secondary alcohols (C–O), while smaller peaks at 900–700 cm−1 were also assigned to the aromatic bending vibration of C–H group.

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Figure 6: FTIR spectra of copper oxide nanoparticles.

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Ultra violet spectroscopy: The presence of copper oxide nanoparticles is confirmed at the range of 200-1100nm. The ecofriendly method for the synthesis of copper oxide nanoparticles using Aloe vera leaves extract proved feasible, coast free and successful method. UV-Vis spectra analysis has apparently shown the formation of copper oxide nanoparticles. Nanoparticles synthesized have variety of application in the different field. The maximum absorption peak is between 265-285nm.The peak at about 280nm was achieved (Figure 7).This peak confirmed formation of the copper oxide nanoparticles.

Figure 7: Nanoparticles synthesized have variety of application in the different field.

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SEM Analysis

The average particle size of copper nanoparticle was analyzed by SEM model (JSM-6480). The range of grain of copper oxide nanoparticle was calculated about 50.5-130nm by SEM micrograph. It was observed that particles were smooth with a spherical shape (Figure 8). The catalytic activity of the CuO NPs analyzed by the degradation of malachite green dye. The catalytic activity of the CuO NPs analyzed by the degradation of malachite green dye. Preparation of 1000mg/l dye S.S. 1000ppm solution of Malachite green dye was prepared by dissolving dye in 1-liter distilled water.

Different concentration of dyes was prepared from stock solution. 100ppm solution was prepared from 1000ppm solution after dilution. After that 150,200,250-ppm solution was prepared. 18g of NaBH4 is made up to 10mL and kept aside. Different concentrations of NaBH4 and catalyst are tested on the methylene blue dye. The catalytic degradation of organic dyes was observed by measuring UV-Visible spectra at regular time intervals.

Figure 8: SEM micrograph.

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Malachite Green: Malachite green is extensively used in many industries as a dye for leather, textiles and also in aquaculture industry to control fish parasites and disease. The use has increased so much because of its easy preparation and low manufacturing cost (Table 2) (Figure 9).

Figure 9: Stucture of dye (malachite green).

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Table 2: The use has increased so much because of its easy preparation and low manufacturing cost.

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Structure

Dye Degradation: The degradation of malachite green in the absence and presence of CuO NPs were studied spectrotometrically by using DB-20 UV-Vis spectrophotometer determining the decrease in the absorbance at 631nm.The reaction was study spectrophotometrically at room temperature (25 0C). The colour of the reaction mixtures faded, indicating that degradation had occurred. The same procedure was followed for uncatalyzed reactions, in absence of CuO NPs.

1-Time Effect on Dye Removal: Decolorization of dye Malachite Green at room temperature was analyzed. Initially 20ml dye solution was taken and 1mg of greenly synthesized copper nanoparticles using aloe vera leaves extract dissolved in it. 0.1mg of NaBH4 was dissolved as a reducing agent. The solution was heated for 10- 20 mint at 100 degrees. The time interval was taken in consider gradually during reaction. The removal percentage of decolorization was calculated and draws graphically. The maximum time was 120 mints with70% color removal. This confirms the rapid reaction of copper oxide nanoparticles (CuO NPS) (Figure 10).

Figure 10: The time interval was taken in consider gradually during reaction.

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Figure 11: Aloe vera synthesized copper oxide nanoparticles showed maximum percentage decolorization as pH was increased at a certain limit after more increase has a negative effect.

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2-pH effect on dye removal: pH of the solution also majorly affected the de-colorization of dye. pH effect on the decolorization of copper oxide nanoparticles was analyzed in this research. Aloe vera synthesized copper oxide nanoparticles showed maximum percentage de-colorization as pH was increased at a certain limit after more increase has a negative effect. This may be happened due to the formation of more positive ion competition. Maximum de-colorization 70% was at pH 5 (Figure 11).

3-Concentration of dye effect on decolorization of dye: The increase or decrease in the concentration of Malachite green MG dye is also considerable in decolorization efficiency. The graph was obtained after experimenting various concentration of dyes. The maximum amount of dye taken was 20mg/l. After increasing concentration no effect on 70 decolorizatioof dye was observed (Figure 12).

Figure 12: After increasing concentration no effect on70 decolorizatioof dye was observed.

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4-Effect of Copper Oxide Nanoparticles Amount on Dye Removal: The number of copper oxide nanoparticles exhibits positive results on decolorization. The number of nanoparticles 1 gram was taken showed maximum de-colorization power. This confirmed from the experiments that increasing of nanoparticle showed no effect on de-colorization. This concentration of nanoparticles was used in further experimentation of research (Figure 13).

Figure 13: This concentration of nanoparticles was used in further experimentation of research.

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Conclusion

Here in conclusion, we concluded a method of green synthesis of Cu nanoparticles by leaf extract of Aloverabarbadensis plant. This eco-friendly way of synthesis of nanoparticles is more recommended over other methods as green synthesized CuO NPs are cost-effective, biogenic molecules with the capability to serve as dye absorbent. From vast of analyzation on nanotechnology for synthesis of nanoparticles it is declared that it is safer and best by using natural plants. With the huge plant variety much more plants are still not known for the synthesis of nanoparticles. Nanoparticles synthesized can be applicable in the different field of biochemistry, Pharma, agriculture and industry. Copper oxide nanoparticles have the ability to remove carcinogenic dyes. In the present study, Malachite green dye was removed by nanoparticles and its time, pH, contact time was observed. The maximum contact time was 120min, pH was observed 5, nanoparticle amount 1mg which proved green synthesized copper nanoparticles, as best removal of carcinogenic dye like Malachite green.

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Lupine Publishers| D-Dimer; A Potential Clinical Marker for Predicting Metastasis & Stages in Lung Cancer

 Lupine Publishers| Journal of  Pharmacology & Clinical Research



Abstract

The relationship between plasma D-dimer level and the prognosis of advanced lung cancer is close to each other. This study investigated the role of plasma D-dimer as a prognostic factor in advanced lung cancer: a) The aim of the current study was to investigate the association of D dimer plasma level with the development of stages in lung cancer. b) D-dimers levels as predictor of fibrinolysis and Disseminated Intravascular Coagulation (DIC). The subjects were selected from oncology department, Ghulab Devi Hospital and Mayo Hospital, Lahore. Total 45 subjects were included in the present study. The selected subjects were divided into two groups. Group A included 15 normal, healthy, age and sex matched controls and group B included 30 patients, histologically diagnosed cases of lung cancer. The patients had no history of coagulation disorders or on anti-coagulant therapy. The plasma D-dimer was measured in normal, heathy Controls and 30 histologically diagnosed cases of lung cancer by enzyme-linked immunosorbent assay. The median age of the patients (18 males and 12 females ) was 39.433± 5.11 and 13.3% had stage lb, 20% had llb, 6.7 % llla, 36.11 lllb, 23.3 % had lV disease. Histologic sub-type was Non-small cell lung carcinoma (NSCLC) 30 %, Small cell lung carcinoma (SCLC) were 10 %, Squamous cell carcinoma were 10 %, adenocarcinoma 16.7 % and large cells carcinoma were 10%.In the present study. The Mean ± SD value of D-dimer level of the patients was 1068.70±441.86ng/dl, which was significantly higher than that of the control group. The plasma levels of D-dimer were significantly higher in patients with bronchogenic carcinoma as compared with healthy controls. Plasma D-dimer level was significantly higher in metastatic disease (P <0.01). D dimer levels were positively associated with clinical cancer stage (P<0.05) and metastasis (P<0.05). These findings suggested that the plasma D dimer level may be use as marker for predicting cancer metastasis and staging in lung cancer

Keywords:Lung Cancer; Malignancies; Haemostatic System; Coagulation; Tumor Cells; Hyper coagulopathy; D Dimer

Introduction

Lung cancer is one of the most prevalent malignancies in the world [1,2]. This cancer is currently the most common malignant disease and the leading cause of cancer related-deaths in all age groups and in both sexes [3]. The association between cancer and haemostatic system has been known since Trousseau’s study from the 19th century [4]. Coagulation or fibrinolytic system activation is present in lung cancer patients at clinical or subclinical level. There is a complex interaction, which has an important role in the course of the disease, between pathogenetic mechanisms of thrombosis, tumor cells, homeostatic systems, and patient characteristics. Patients with deep venous thrombosis (DVT) or subclinical hypercoagulopathy usually have worse prognosis. D-dimer is the cleavage product of cross linked fibrin that is formed by activation of the coagulation system, which signals hyperfibrinolysis in response to clot activation and fibrin formation [5]. Elevated levels of D-dimer have been detected in patients exhibiting diffuse intravascular coagulation [6], thromboembolic events, [7] D-dimer is a widely used biomarker for indicating the activation of coagulation and fibrinolysis [8,9]. Coagulation disorders are among the most common complications in cancer patients [8,10]. D-dimer is a degradation product of cross-linked fibrin that appears in the blood after a blood clot is degraded by fibrinolysis [11]. D-dimer is produced by fibrin degradation, and measurement of D-dimer levels can help in the diagnosis of thrombosis [12]. D-dimer levels have been found to be significantly higher in lung cancer with poor prognosis[13,14]. D-dimer is a plasmin-mediated degradation product of cross-linked fibrin clot, which is formed by the activation of the coagulation system for any reason [15]. Several studies suggested that serum D-dimer level may be an important parameter in assessing prognosis of disease and response to treatment in patients with lung cancer[14,16]. As D-dimer is a sensitive marker of fibrinolysis so, it is recommended measuring the plasma level of D-dimer in all new lung carcinoma patients [17]. The results suggested that the plasma level of D-dimer was notably associated with the extent of tumor metastasis and tumor stage in lung cancer patients.

Material and Methods

Total 45 subjects were included in the present study. 30 patients histologically diagnosed cases of bronchogenic carcinoma from oncology department, Ghulab Devi Hospital and Mayo Hospital Lahore, who were admitted between July 2017 to August 2018. The control group consisted of 15 healthy individual without co-morbidity. Lung cancer staging was performed for all patients according to the 7th TNM classification. The inclusion criteria were as following histological diagnosed cases of bronchogenic carcinoma pretreatment were selected. Patients with a history of venous thrombosis or anticoagulation therapy, hypertension, cardiovascular and cerebrovascular disease, diabetes, acute or chronic inflammatory disease, or previous malignancy were excluded from the current study. Written informed consent was obtained from each subjects before the sample collection. 3ml of venous blood was collected in the disposable syringe and put in to vacutainer tubes containing anticoagulant citrate buffer (1:9, buffer blood for D-dimers assay. History and clinical features were recorded in all subjects on performa. The principals of different tests and their procedures were adopted accordingly. Blood samples were centrifuged and the plasma was separated. D-dimer level was measured in the plasma, via enzyme-linked fluorescent immunoassay method using a PC-Vidas device (BioMerieux Fr). A D-dimer level <500 ng/dl was considered normal.

Results and Observations

Thirty patients with histological confirmed lung cancer were enrolled in the study. Mean age was 39.433 ± 5.11 years within the, range of 26-52 years, and there were 18 males (60.0%) and 12 females (40.0%). There were 05 (16.7%) adenocarcinomas, 10 (33.3%) squamous cell carcinomas, 03 (10.0%) small cell carcinomas and 09 (30%) non small cell carcinomas. 04 (13.3%) patients were classified as stage Ib, 06 (20%) patients as stage IIb, 02 (6.7%) patients as stage IIIa, 11 (36.7%) patients as stage IIIb and 07 (23.3%) patients as stage IV. The general characteristics of the lung cancer patients are shown in Table 1.

Discussion

The quotation “Qi is the commander of Blood and Blood acts as the mother of Qi” highlights the collaboration of Blood and Qi. Blood is seen as Yin and Qi can be classified into Yang, which can result in diseases when the imbalance of Yin-Yang occurs. Blood, produced with food qi (gu qi) by Spleen, circulates in the veins governed by Heart to nourish the organs and the systems. Blood, in addition to food qi, is also generated by the mother of Liver based on the Generating sequence Kidney, which stores prenatal Jing and produces marrow that generates to manufacture Blood. Qi circulates in the traditional twelve meridians to support the life, interacting with Blood for the Zang-Fu organs to function normally in harmony [20,21]. The studies on the relation between Qi in the twelve meridians and the oxygen metabolism highlight that one may be short of breath and experience wheezing or coughing when the normal level of blood oxygen is below, presenting the high similarity of physiological functions and pathological reactions between Qi and oxygen [22]. In other words, this suggested that oxygen, to some extent, is equivalent to Qi [23]. The Generating Sequence of the Five Elements theory shows Kidney is the mother of Liver, which suggests that Kidney’s problems can affect its child Liver. The maximum oxygen is delivered with the normal value of 45% of hematocrit [24]. Kidney produces Erythropoietin to promote the number of red blood cells to increase the capacity of the blood to carry more oxygen. In addition, the circulation of oxygen in the Kidney is closely associated with the production of Erythropoietin determined by tissue oxygen pressure [25]. In other words, stagnated Liver qi can be dispersed as long as Kidney can function normally with the delivery of the healthy Qi to Liver. In a word, the inflammation resulted from the infection can be reduced with much more oxygen delivered upwards with the blood to Lung.

Table 1: Characteristics of the patients (n=30).

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D-dimer levels in patients with lung cancer were higher than those of the control group, and the difference was statistically significant P 0.05 (Table 2). D-dimer levels according to disease stage are shown in Table 3. When the D-dimer levels were compared according to disease stage in patients with lung cancer, a significant difference was observed between the D-dimer levels of patients with stage lb, llb and those with stage IV disease (P = 0.025). There was no significant difference between the other stage groups in terms of D-dimer levels. D-dimer levels were significantly higher in lung cancer patients than in the control group (P<0.01; Table 3). These data suggested that the plasma level of D dimer may be used as a marker of metastasis and staging in lung cancer.

Table 2: D-dimer in patients of lung cancer and control group.

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Table 3: D-dimer levels according to stages in lung cancer (ng/ dl).

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Discussion

There is some evidence that the activation of coagulation and fibrinolytic system by neoplastic cells facilitates invasiveness and metastases [18]. Thus, the extent of such activation has been associated with tumor stage and prognosis in some malignancies such as breast, colorectal and lung cancer [19,20]. D-dimer is a product of cross-linked fibrin degradation by plasmin-induced fibrinolytic activity, and D-dimer levels are a biomarker of global hemostasis and fibrinolysis [21]. High D-dimer levels were associated with poor prognoses in patients with breast, [22,23] colon and rectum, [24,19] and lung [25,26] cancers. In the present study, it was demonstrated that elevated plasma levels of D dimer were associated with clinical cancer stages and metastasis in lung cancer patients. D-Dimers: In this study, D-dimers were found to be significantly increased (p < 0.01) in patients with lung cancer when compared with controls (Table 2). The D-dimer level was more in SCLC as compared to NSCLC. The increased D-dimer was more in Patients having DIC and in patients of metastatic disease. These increased levels of D-dimers may be due to enhanced fibrinolysis [27] in their study Showed increased levels of D-dimers in patients having malignancy. These findings are consistent with the results of [27,18,28,29]. Several studies have reported that plasma D-dimer levels were elevated and associated with the stage and mortality in lung cancer [28,29]. They also observed similar increase of D-dimers in lung cancer (2.0). Our study has some limitations. This is a retrospective observational study with small sample size. Therefore, the findings of this study need to be validated by prospective and multicentre studies. The present study thus provides more reference values for patients with later-stage tumors and poorer overall condition. SCLC is a highly invasive tumor with a poor prognosis, with different biological characteristics from NSCLC. Valid biomarkers are therefore needed to determine the prognosis of SCLC. In the present study, pretreatment plasma D-dimer levels were independently in patients with SCLC. This conclusion is supported by previous studies of lung cancer in general

Conclusion

The present study demonstrated that D-dimer plasma level was significantly higher in lung cancer patients and associated with clinical stages and metastasis. The current study was limited in that it only identified the association of D-dimer with tumor stage and metastasis.

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Friday, 14 January 2022

Lupine Publishers | Effect of Tyrosine Kinase Inhibitors on Renal Functions

 Lupine Publishers | Journal of Urology & Nephrology


Abstract

Background: We aim to document if any difference exists for renal functions between metastatic and non-metastatic patients.

Methods: The study population included 12 metastatic and 15 non-metastatic patients. Metastatic renal cancer patients using the TKIs were compared to non- metastatic patients.

Results:Preoperative estimated glomerular filtration rate (e-GFR) was significantly low in metastatic patients than nonmetastatic patients (p: 0.048). A trend toward increased acute kidney injury during hospital stay in the non-metastatic group was observed, but this fell just short of statistical significance (p: 0.109). Two groups did not differ significantly in terms of postoperative e-GFR (p: 0.256). No statistically significant differences were observed in actual e- GFR between two groups (p: 0.638). No statistically significant differences were found in pre-TKIs and post-TKIs e-GFR values (p: 0.735). Proteinuria was statistically more common in metastatic patients than non-metastatic patients (p<0.001). No statistically significant difference in age, sex, follow-up period, NSAIDs use, antihypertensive and ARBs/ACEIs use were documented between the two groups.

Conclusion: Increased risk for proteinuria was documented in metastatic patients with TKIs use. However, use of the TKIs had no effect on e- GFR. No statistically significant differences were observed in actual e- GFR between two groups.

keywords: Hypertension, Glomerular Filtration Rate, Proteinuria, Tyrosine- Kinase Inhibitors

Abbrevations: RCC: Renal cell carcinoma , TKIs: Tyrosine-Kinase Inhibitors, AKI: Acute Kidney Injury, NSAIDs: Non-Steroidal Anti-Inflammatory Drugs, ARBs: Angiotensin Receptor Blockers, ACEIs: Angiotensin Converting Enzyme Inhibitors, ARBs: Angiotensin Receptor Blockers, CCBs: Calcium Channel Blockers, e- GFR: Estimated Glomerular Filtration Rate

Introduction

Renal cell carcinoma (RCC) accounts for approximately 3% of adult malignancies [1]. Treatment options for the RCC include surgery, radiotherapy and immunotherapy [2]. Besides these options, molecular-targeted therapies in the form of tyrosinekinase inhibitors (TKIs) are commonly used. These agents are well tolerated compared to previously used options (interleukin 2 or interferon-α) and the use of these agents results in longer progression-free survival and increased response rates [3-5]. Despite the advances achieved with these agents, use of the TKIs results in side effects such as fatigue, nausea, diarrhea, gastrointestinal hemorrhage, dysphonia, and palmar-plantar erythrodysaesthesia [6]. Hypertension and proteinuria are also usually encountered after the start of these agents [7-9]. In this study, we compared clinical features between patients with renal cell carcinoma with and without the TKIs treatment and aim to document if any difference exists for renal functions between metastatic and non-metastatic patients during their follow up period.

Materials and Methods

The patients diagnosed with the RCC and followed up at Istanbul Health Sciences University Haydarpaşa Numune Education and Research Hospital oncology polyclinics between 2009 and 2016 were evaluated. Eligible 12 metastatic patients who received a nephrectomy and were treated with the TKIs were included in the metastatic group. Fifteen non-metastatic RCC patients who only received a nephrectomy formed the non-metastatic group. Metastatic patients who did not receive a nephrectomy, patients on dialysis, and patients with insufficient data were excluded. Patients’ demographics and laboratory data were collected from the hospital records and via telephone. The clinical, demographic, and laboratory parameters were compared between the two groups. The data collected included patient age, sex, follow-up time, nephrology follow-up, mortality, history of perioperative acute kidney injury(AKI), use of non-steroidal anti-inflammatory drugs (NSAIDs), use of antihypertensive medications including angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), calcium channel blockers(CCBs), and alpha and beta blockers. The data also included laboratory parameters such as estimated glomerular filtration rate (e-GFR) (calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation 2) and proteinuria (assessed using dipstick and 24-hour urine collection). Creatinine levels before the operations were used to calculate postoperative e-GFR, and postoperative creatinine levels taken just before hospital discharge were used to calculate postoperative e-GFR. Actual e-GFR was calculated using creatinine levels measured at the last hospital visit. Perioperative AKI was defined using the acute kidney injury network classification system. Increase in serum creatinine of 0.3 mg/dl or more within 48 hours or ≥ 1.5 times baseline within 7 days was used in order to define perioperative AKI. Urine volume was not used as a criterion because data for urine volume were not available.

The TKIs used as targeted therapy for our patients were sunitinib, pazopanib, and axitinib. Available creatinine measurements before and after the TKIs treatment were used to present the effect of the TKIs on renal function. Statistical analyses were performed using the MedCalc Statistical Software version 12.7.7 (MedCalc Software bvba, Ostend, Belgium; http://www. medcalc.org; 2013). The normality of continuous variables was investigated using the Shapiro-Wilk test. Descriptive statistics are presented using the mean and standard deviation for normally distributed variables and median (and minimum–maximum) for the non-normally distributed variables. Student’s t-test was used to compare two normally distributed groups. Non-parametric statistical methods were used for values with skewed distributions. The Mann-Whitney U test was used to compare two non-normally distributed groups. The χ² test was used for categorical variables and expressed as observation counts (and percentages). Statistical significance was accepted when the two-sided p value was lower than 0.05.

Results

The study population consisted of 22 males and 5 female patients. The mean age of study population was 59.2±11.3 years. Clinical and laboratory parameters of metastatic and nonmetastatic patients are listed in Table 1. Preoperative e-GFR was significantly lower in metastatic patients when compared to nonmetastatic patients (p: 0.048). When two groups were compared, a trend toward the increased AKI during hospital stay in the nonmetastatic group was observed, but this fell just short of statistical significance (p: 0.109). There was no statistically significant result between two groups when two groups were compared for postoperative e-GFR (p: 0.256). The statistically nonsignificant result for postoperative e-GFR between two groups was also observed for actual e-GFR (p: 0.638) and no statistically significant differences were found between pre-TKI and post-TKI e-GFR values (p: 0.735). Proteinuria was more common in metastatic patients than non-metastatic patients (p<0.001). In metastatic group 8 patients had proteinuria. Four patients out of these 8 patients had 24-hour proteinuria measurements. One patient had nephrotic range proteinuria and the other three patients had non-nephrotic range proteinuria. No biopsies were performed on these patients with proteinuria. Two metastatic patients had negative results for proteinuria. Data for dipstick proteinuria were unavailable for the other two patients. Only one patient in the non-metastatic group had proteinuria and it was at a level of less than 1 gr/day. There was no statistically significant differences in age, sex, follow-up period, NSAIDs use, antihypertensive and ARBs/ACEIs use, and follow-up time between metastatic and non- metastatic patients. Follow-up times for metastatic and non-metastatic patients were 29.9±19.6 and 25.2±9.4 months; respectively. Three patients died during the follow-up period and all were in the metastatic group.

Table 1: Clinical and laboratory parameters.

lupinepublishers-openaccess-journal-urology-nephrology

e-GFR: Estimated glomerular filtration rate; NSAİDs: Non-steroidal anti-inflammatory drugs; ARBs/ACEIs: angiotension receptor blockers/ angiotension converting enzyme inhibitors; * antihypertensive use rather than ARBs/ACEIs

Discussion

Nearly all patients taking the TKIs experience a rise in blood pressure. Systemic vasoconstriction and volume overload are parts of the mechanisms responsible for systemic hypertension caused by TKIs [7]. Despite the risk of hypertension occurrence, the development of hypertension is mostly a good prognostic sign because it is associated with longer progression free and overall survival and can be used as a biomarker for tumor responsiveness [10]. Regarding our study, there was no statistically significant results between groups for ACEIs/ARBs and other antihypertensive use. Proteinuria is another important side effect that can be encountered after the start of targeted agents. In the kidney, the vascular endothelial growth factor pathway is known to be responsible for proteinuria after the start of TKIs [11]. In the study of Baek et al. [12] initiation of sunitinib therapy was related to proteinuria and aggravation of preexisting proteinuria in 17.6% and 23.1% of patients; respectively [12]. Again in the COMPARZ study, discontinuation of treatment because of proteinuria was observed in 3% and 1% the of patients treated with pazopanib and sunitinib; respectively [13]. In our study, most of the patients treated with the TKIs had proteinuria. However, only one patient had nephroticrange proteinuria. We did not perform a renal biopsy on this patient but important data can be obtained through this procedure. Biopsyproven acute interstitial nephritis, thrombotic microangiopathy and acute tubular necrosis have also been encountered after the TKIs use [14-16]. In our study, there was no statistically significant difference between pre-TKIs and pre-TKIs e-GFR values. However, patients can develop renal insufficiency during treatment with targeted agents. A study by Zhu et al. [17] showed the development of renal insufficiency in the RCC patients receiving sunitinib [17]. In our study, despite the statistically significant result for preoperative e- GFR in favor of non- metastatic patients, there was no statistically significant results for postoperative e-GFR between two groups which may be due to the high percentage of patients with AKI in the non-metastatic group. Despite the tumor burden and use of the TKIs in metastatic patients, the non-significant result for postoperative e-GFR between two groups did not change at last hospital visit. The small sample size and retrospective nature of the study are important limitations that should be considered. However, renal side effects encountered after use of the TKIs were emphasized in this study with comparing metastatic and non-metastatic RCC patients. In conclusion, increased risk for proteinuria was documented in metastatic patients with TKIs use. However, use of the TKIs had no effect on e- GFR. There was also no statistically significant difference for the actual e-GFR between the two groups despite the higher preoperative e-GFR observed for non- metastatic patients.

Compliance with Ethical Standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Institutional approval has been obtained.

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Lupine Publishers | Tips for Grandparents

 Lupine Publishers |Journal of Complementary & Alternative Medicine


Opinion

The lives of traditional Malays are always circled with various incidents that can cause a person to experience various diseases. A disease can be cured through medical methods. Since disease can be avoided, Malay credentials believe there are several ways in which the disease can be avoided. Hence, there are some tips that allow the Malay community to practice the tips to achieve a better life. In traditional Malay medicine, the use of many tips is practiced. Tips are not only used for treating ailments but have many other functions. Tips are often used for the purpose of maintaining a personal beauty, a taste of cuisine and so on. The tips used by ordinary Malaysians use the many herbs that grow in the area of the home. Knowledge of this herbaceous plant can be used as a cure for illness. Therefore, the use of herbs in the tips is widespread. Tips are derived from one generation to one generation. Practical delivery is often done to facilitate a new generation of practicing the tips. Hence, one does not need a detailed study on the use of herbs but is sufficiently illustrated by the previous generation either in the village community or in the city. In everyday life, there are just new tips.

The history of the practice of hints is still unknown because there is no clear evidence of the fact that since humans have practiced hints. But what can be said, tips have been around since people began to know the importance of tips. In the past man was exposed to all dangers. Animism and Hindu influence have led the local community to believe every place they want to explore has certain powers such as a waiter or a ghost. These powers if not presented with a presentation will cause a person to get the spread of the disease. Therefore, the community has already created a tip that is used to protect themselves from harm. Then after people are attacked by a variety of diseases, they are trying to maintain their health. Because they are susceptible to various diseases, preventive measures have been implemented. Hence, many herbs have been used as a cure for diseases. The effectiveness of tips in life has led people to create some tips on how to look after their own beauty. These tips are widely practiced by women to look always beautiful and interesting. In addition, the tips can also make a person healthy. Tips keep on changing and not only focusing on body care but covers all aspects of everyday life.

Before the Malay community embraced Islam, the influence of animism and Hinduism was so thick. The influence of this belief enabled some of the beliefs that led the Malays to fear and want protection. The beliefs of animism believe that every place they want to explore has many external elements such as waiter, pod or ghost. They also believe these elements will cause a striker to attack someone. Therefore, the Malay community has been looking for a way to avoid the illness that may be present. Hence, they have found some tips that intend to give the waiter. Among the tips that are still practiced today are to tear down homes or dwellings so that family members living there will not get any harm or illness. After the advent of Islam, the belief in such elements is diminishing. The Malay community began to believe that every illness was the result of an unhealthy body that either did not care for our own health or there were external elements such as weather or infection. Therefore, the Malay community has begun to create some tips to keep yourself healthy. Then the use of tips continues to be expanded and not just a matter of health.

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Thursday, 13 January 2022

Lupine Publishers | A Critical Review of Publications related to Al-Hijama Therapy

 Lupine Publishers | Journal of Clinical & Community Medicine


Short Communication

Evidence-based clinical practice emphasizes the use of information from well designed and conducted research in healthcare decision-making. It largely depends upon the outcomes from prospective randomized clinical trials in which the number of patients are sufficiently high to ensure that the results are robust. Such trials need to be adequately powered and to define from the beginning what magnitude of difference between treatments is being sought. The classical approach when assessing the value of new medications has been the use of blind assessments in which both patients and assessors do not know which drug or placebo they are receiving. The application of such an approach in Al-Hijama is either impractical or even unethical as it would require use of sham wet cupping. A recent review from Iran Bamfarahnak et al. [1] suggested Al-Hijama is currently prescribed for up to 120 diseases that are difficult to treat, including cutaneous (21.7%), musculoskeletal (15%), and central nervous system (13.3%) disorders. However, the number of such treatments subjected to rigorous assessment is relatively limited. In this review those studies which have dealt with pain will be considered first. Subsequently studies dealing with hypertension and cardiovascular risk factors will be assessed. In addition, its potential benefit in management of shingles will be considered. Al-Hijama and wet cupping are used in many other conditions, but research papers published in peer reviewed journals during the last twenty years are mainly restricted to the above fields. Of note few of the reported studies draw attention to the religious distinction between the technique of Al-Hijama and simple wet cupping, the recipients and the practitioners. However, in 2014 the Taibah theory was put forward as the basis for a physiological explanation of how Al-Hijama works and its distinction from simple wet cupping [2].

Spinal and related pain has been treated in controlled trials on several occasions. (Table 1) In only two studies were patients randomized to one of two interventions. The alternative treatment was with heat pads. In the other studies patients either received standard care or no active intervention. The numbers involved in these studies were small with the largest being of 98 patients with low back pain. Outcome measures were mainly pain rating scores. However, in all studies, patients who received Al-Hijama or wet cupping did significantly better than those who were controls. Future studies need to be larger and conducted over longer periods with independent blinded assessors of the efficacy of the treatments using well-recognized validated tools.

Table 1: Summary of Recent Studies on the use of Al-Hijama in the treatment of painful conditions.

Lupinepublishers-clinical-community-medicine

Similar approaches need to be adopted in assessing the role of cupping in the management of hypertension. Lee et al identified two studies after a systematic search of 15 different data bases. Lee et al. [8] One assessed the effectiveness of dry cupping on changes in cerebral vascular function compared with drug therapy. There was a significant effect in favor of cupping on vascular compliance and degree of vascular filling. An uncontrolled observational study tested wet cupping for acute hypertension and found that a one-time treatment reduced blood pressure. Such evidence is not convincing, but it is tantalizing and there is an urgent need for more rigorous assessments especially of wet cupping.

Other areas in which cupping has been investigated includes its role in the management of infection. Cao et al. [9] presented a systematic review of eight randomized controlled trials involving 651 patients who had infection with Herpes zoster which had resulted in shingles. The methodological quality was considered generally fair in terms of randomization, blinding, and intention-totreat analysis [9]. Meta-analyses showed wet cupping was superior to medication in the number of cured patients (Relative Risk 2.49, 95% Confidence Interval 1.91 to 3.24, p < .00001), the number of patients with improved symptoms (RR 1.15, 95% CI 1.05 to 1.26, p = .003), and reducing the incidence rate of post-herpetic neuralgia (RR 0.06, 95% CI 0.02 to 0.25, p = .0001).

In addition to considering whether and how effective cupping can be researchers have looked into its mechanism of action. Tagil et al. [10] investigated 31 healthy volunteers in whom they measured serum nitric oxide, malondialdehyde levels and the activity of superoxide dismutase and myeloperoxidase in venous blood. Levels fell consistent with the removal of oxidants and decreased oxidative stress. However, the study was flawed because of the absence of a control group [10]. This contrasts with a randomized controlled trial of 47 healthy young men in whom wet cupping led to a substantial decrease in LDL cholesterol (p < 0.0001) and in the LDL/HDL ratio (p < 0.0001). (10) In 2014 El Sayed [11] attempted to give an integrated physiological explanation as to how Al-Hijama works. His Taibah theory suggests that Al-Hijama works through a “surgical excretory procedure.” During the first cupping step a fluid mixture is collected inside the uplifted skin due to the negative pressure inside the sucking cups [11]. This fluid mixture contains collected interstitial fluid, iron, ferritin and haemolyzed red cells, filtered fluids from blood capillaries, haemolysed white cells and platelets. This fluid mixture does not contain intact blood cells as they are too big to pass through the pores of skin capillaries and cannot be filtered. Puncturing the skin up liftings and applying a second cupping creates a pressure gradient and a traction force across skin and capillaries and increases filtration at the arterial end of capillaries at net pressure of -163 to -433mmHg and at venous end of capillaries at net pressure of -143 to -413mmHg resulting in a clearance from the blood of iron, ferritin and haemolyzed cells [12]. However, this theory needs independent confirmation and does not have the “solid scientific and medical base” claimed by the authors-yet!

In conclusion Al-Hijama continues to show clinical benefit in a range of conditions. Unfortunately, there have been few robust clinical trials which would convince a sceptic of its value. It is important that Muslim practitioners and patients are open to such studies. If this attitude is adopted it will ensure that practitioners deliver Al-Hijama to the highest standards and will reassure new patients and indeed attract more people for therapy. Once its value in clinical conditions has been demonstrated to the wider medical audience then the preventive benefit of Al-Hijama could be more easily investigated.

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Wednesday, 12 January 2022

Lupine Publishers| Bariatric Surgery and Pregnancy

 Lupine Publishers| Journal of Gastroenterology and Hepatology


Short Communication

Obesity represents a dangerous public health concern all over the universe. The World Health Organization suggests that, by 2015, approximately 2.3 billion adults will be overweight and more than 700 million will be obese [1]. Prevalence of obesity continues to rise and obesity has become the second leading cause of death in the West [2]. Obesity is associated with numerous comorbidities affecting virtually every organ system, including hypertension, type II diabetes mellitus, coronary artery disease, dyslipidemia, certain cancers, and ultimately increased mortality [3]. Obese women of reproductive age are a specific group at risk for a host of obesityrelated reproductive and obstetric complications, such as infertility, early miscarriage, gestational hypertension and diabetes mellitus, pre-eclampsia, preterm birth, and intrauterine fetal demise [4].

Bariatric surgery has been recently proven to decrease mortality in postoperative patients when compared to obese controls and is, thus, a promising weapon in the fight against obesity [5]. Over 80 %of bariatric surgical patients are women with obesity in their reproductive years [6]. Obesity adversely affects fertility; the rapid weight loss following bariatric surgery can increase fecundity. To combat reproductive complications of obesity, the American College of Obstetrics and Gynecology advocates weight loss prior to conception and acknowledges bariatric surgery as preliminarily promising in prepregnancy obesity treatment [7]. Bariatric surgery has become a cornerstone in the management of morbid obesity and is safely recommended for obese women of childbearing age [8].

Figure 1: Procedures of Bariatric Surgery.

lupinepublishers-openaccess-journal-gastroenterology-hepatology

Procedures for bariatric surgery are traditionally categorized into three groups (Figure 1). The aim of the first group of procedures is to restrict energy intake by reducing gastric capacity. This includes the laparoscopic adjustable gastric band (LAGB). The Roux-en-Y gastric bypass (RYGB) is another type, which combines food restriction with a certain degree of malabsorption by shortening the length of the intestinal tract. The third group includes vertical sleeve gastrectomy (VSG). The Laparoscopic Sleeve Gastrectomy is performed by removing approximately 80 percent of the stomach. The remaining stomach is a tubular pouch that resembles a banana and the fourth type is biliopancreatic diversion. The most performed procedures today are the LAGB and the RYGB [9].

Restrictive approaches like vertical banded gastroplasty and laparoscopic adjustable gastric banding are designed to restrict caloric intake, whereas primarily malabsorptive procedures such as Biliopancreatic diversion with or without duodenal switch promote weight loss by decreasing nutrient absorption [10]. Reports of pregnancy after bariatric surgery demonstrated concerning complications related to poor maternal nutritional status, including anemia, neural tube defects, and intrauterine growth retardation [11]. In addition, a case of gastrointestinal bleeding after vertical banded gastroplasty and reports of fatal bowel obstruction secondary to internal intestinal herniation after Roux-en-Y gastric bypass caused further alarm among both bariatric surgeons and obstetricians alike [12].

Reproductive Management after Bariatric Surgery

a) Operation-to-birth intervals of less than 2 years were associated with higher risks for prematurity [13] because women after bariatric surgery suffer from nutritional deficiencies may be rather grave and may involve the developing foetus [14].

b) Reliable contraception after the operation. During this period there is a need for the use of reliable contraception. As there is a risk for malabsorption of hormones taken orally, the combined and progestogen-only pills are contraindicated, and displaced by non-oral hormonal contraception or non-hormonal methods, including intrauterine devices and condoms [15].

c) Nutritional monitoring and supplementation tailored to the type of bariatric operation performed with a specific focus on keying out and treating deficiencies in iron, folic acid, B12, calcium, and vitamin D both pre- and post-conception.

d) Recommendations during pregnancy: one standard prenatal vitamin daily, which may include or should be supplemented with the following 400 μg folate daily for all reproductive-aged women 50-100 mg elemental iron daily for menstruating and pregnant women 1,000 mg calcium daily for all postoperative patients, 60 g of dietary protein daily for pregnant patients.

e) Low threshold for suspicion of intestinal obstruction during pregnancy. Image via CT scan and surgical exploration as needed.

f) Close follow up of weight changes during gestation and postpartum cooperation with high-risk obstetrical colleagues in patient management.

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Monday, 10 January 2022

Lupine Publishers| Use of Latest Robots for Autism Spectrum Disorder

 Lupine Publishers| Journal of Robotics & Mechanical Engineering


Abstract

One of the prominent applications of robots is in assistive therapy using humanoids. Robots are now playing a vital role in our lives as assistants, therapist, companions and much more. Autism Spectrum Disorder (ASD) affects the communication skills and social cues of a person considerably. Recently efforts have been made in the development of communicational, behavioral, motor movements, joint attention and physical behavior of the children suffering from ASD using the humanoid robots. The therapies based on interactive interventions using robots for ASD have proved to be a favorable tool for improving the behavior of children with ASD. There are different ways to identify and improve the behavior in ASD child e.g. psychologists’ sessions, computer vision based bio markers like joint attention measurement and gait analysis, and robot assisted therapies using Autism Observation Scale for Infants (AOSI). In particular the area of robotics is helping a lot in the treatment of ASD as the robot acts as a mediator as well as measures the response of an autistic child.

Keywords: Autism; Joint Attention; Therapy; Bio Markers

Introduction

for the treatment of Autism spectrum disorder. The SAR aims at improving the social response and communication skills of an individual suffering with social disabilities. One of the most commonly addressed disabilities by the humanoid robots is Autism Spectrum Disorder (ASD) [1]. Impairment in social interactions and communication skills caused by a complex developmental brain disorder refers to the definition of Autism Spectrum Disorder [2]. Children under ASD lack verbal, non-verbal and communication skills such as joint attention, imitation, gait, motor skills, facial expressions etc. With the advancement in recent years, robots are now replacing human tasks with a lot of accuracy, reliability, different aesthetic and functional characteristics. Robots have now been interacting with ASD children under specially designed interactive interventions for improving the social cues and behavior of ASD child. There are several robots that have been made to develop social development skills or physical impairments. Research shows that robots helps to improve the attention span and develop the spontaneous skills of a child with ASD [3,4]. Examples of such robots are Paro [5-7], robotic doll Robot [8-11]. These robots help people with physical, emotional and behavioral disorders to improve their social interaction and cues.

Robots Utilized in ASD Interventions

Table 1: Commonly used robots in autism spectrum disorder therapies.

Lupinepublishers-openaccess-robotics-mechanical-engineering-journal

There are multiple robots which have been developed and utilized in Autism Spectrum Disorder curing. Few of them are given in Table 1, which are listed along with their specifications. Among all, NAO is more famous and it’s being utilized in different applications along with Autism Spectrum Disorder.

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Lupine Publishers| Two Trajectorieess a Promise of Reform and Ashaaram Pattern what are we Missing?

 Lupine Publishers| Journal of Orthopedics and Sports Medicine


Abstract

The working of social and economic institutions, inequality is also a product of the way political institutions work. Government has known to serve the interest of economics elites and this most often works to the detriment of common people. This refers to the article ‘’Two trajectorieess’’ A Promise of reform and Ashaaram Pattern, what others do. A molar leadership deficit, our political leaders choose not to speak on certain issues. But they are forgetting that they have a molar responsibility towards domestic violence testing among divorced women begins privately manage pharmaceutical intuition associated to slums occupied area in Pune University, India. The horrific incidence in kathua and unnao has shown.com the ugliest side of the country’s politician. The right procedure is not followed for the enquiry of the domestic violence and his contention by government police. The term intimate partner violence is often used synonymously with domestic abuse or domestic violence, but it specifically refers to violence occurring within a couple relationships (i.e., marriage, non-cohabitating intimate partners). To these, the World Health Organization (WHO) adds controlling behaviours as a form of abuse. Intimate partner violence has been observed in opposite and same-sex relationships, and in the former instance by both men against women and women against men.

The high risk of experiencing domestic violence among divorced women in pharmacy institution in India who associated in slum occupied underscores the need for effective, instructional-based and standard behaviour culturally primary prevention. To inform such domestic violence primary prevention strategies for this population, author herein aimed to identify correlates of domestic violence testing in divorce women. Utilizing a cross-sectional design, potential correlates of domestic violence experience were explored among a geographically-clustered random sample of speak up few known women recently-divorce women residing in private pharmacy institution in slums in Pune, India. In domestic violence testing was associated with less educational attainment by the participant’s, less satisfaction of the job with the respect they earn, if not given’’ at the time of college hours, poorer living of life style, unhealthy food and conflict skills, and greater acknowledgement of domestic violence occurrence in college and friends. These connection suggest strategies that could be incorporated into future domestic violence early prevention interventions for this vulnerable population (i.e. promoting completion of formal education of men alongside women, migration causes of institution harassment, abuse language, more personal, skills, and challenging norms surrounding domestic violence add or before inspect the pharmacy institution.

Introduction

Women who have experienced intimate violence disease are at greater risk for physical and mental health problems including posttraumatic stress disorder (PTSD) and dependency. Most women get a severe stroke and the impact of all may compound these costs. Researchers have reported that women with these experiences are more difficult to treat; many do not access treatment and those who do, frequently do not stay because of difficulty maintaining helping relationships. However, these women’s perspective has not been previously studied in close monitoring in privately manage pharmaceutical institution [1,2].The purpose of this study is to describe the experience of seeking help for divorcées women dependency by Indian pharmaceutical institution to avoid the present violence. Women with dependency with a history of depression want help however the health and social services do not always recognize their calls for help or their symptoms of distress. Dependency thickens and stiffens walls, which can inhibit quality of life and will power, confidence.

Perception of alcohol use among well–Educated employees of pharmacy institution before and after the office hour in slums Pune Suburban has conflict. Little is known about how the overall employment conditions in a country impact the likelihood of employment of privately running out pharmacy institution in Pune University India [3,4]. Correlation of intimate domestic violence has aware of physical, sexual, psychological abuse, and control perpetrated against an intimate condition, is reported and prevalent globally accepted. Approximately one third of divorcee women reporting physical and/or *abuse by their head of the department during their office hour. Not only is an abuse word a violation of human rights that often results in physical injury. Divorcee women who experience domestic violence have higher odds of depression (measure face reading , body sacred, appearance, lower standards of dress, anxiety and other mental health disorders [5,6] true principal health, burn out stages and gynaecologic morbidity, rashes, sores, or lesions in the mouth or nose, or under the skin among other chronic disease states which is not known. Additionally, their children suffer from greater morbidity and mortality. In India, although national estimates suggest decreasing frequency, one in three women still report having been abused by their head of the department during their lifetime. Further, this figure is likely an underestimate of the abuse women suffer post-marriage with little hesitation, as it did not survey violence perpetration by the in-law or other members who believes traditional cultural draws. Divorcee women who reside in privately manage pharmacy institution in pune university India’s slums are among those at greatest risk of domestic violence.

While the disparate figures between slum- and non-slum occupied communities may be in sum art factual due to shameinduced underreporting in higher income communities, factors that drive increased domestic violence perpetration and compel women to remain in abusive relationships are likely disproportionately greater in slum communities. Women in slum communities may be more likely to experience domestic violence because their reporting officers and related to inadequate finances, crowding, and poor sanitation, discrimination, and subordination, reside in communities where normalization and acceptance of Domestic violence is greater, alcohol use is greater, perception has not known, have weakened support systems that do not allow them to develop and exercise positive coping mechanisms, no longer yoga knowledge, weaken immunity profile [7]. Further, in Pune slum communities, at the time of appointment, many women transition from unclear to join the intuitions (no appointment letter produce to employee) and newly enter the slums from surrounding rural areas; thus, the differences in upbringing within the couple may also influence illegal expectations and prompt conflict. Further, divorcee women residing in slums may be more likely to stay in abusive relationships because of poorer knowledge, skill and physiological and mental unawareness to support services, NGO’s, organisation head dependency systems, stronger perceptions of hopelessness and surrender, and residence in environments where domestic violence and other forms of violence occurs with frequency and acceptance. The risk imposed by these factors is compounded by local sanctions that encourage divorcee women to weaken ties with natal family members and their community post-marriage, that limit the time the couple spends together alone to develop their relationship both pre- and post-marriage, and external pressure on the couple (i.e. fertility].

Thus, domestic violence prevention for women residing in slum communities requires a culturally-educated, communityeducated approach that recognizes the structural factors of slum environments pharmaceutical institutions that shape domestic violence risk. Further, given the high domestic violence burden and limited and saturated support resources, focus in resourcelimited sittings should be on primary prevention. National evidence suggests that almost two-thirds of divorcee women who report domestic violence, state the abuse had begun within the first two years of job, underscoring the need for such prevention efforts to occur pre- or immediately post-marriage. To date, few studies have examined drisk factors for domestic violence experience among women residing in slum communities in India. T hose who have, identified the following risk factors: age, low educational attainment of self and spouse, young age of marriage, having a legal versus illegal, additional dowry request from marital family, employment, employment status, residence in a joint family, renting versus owning one’s residence, fewer class rooms in the institution and shared rooms, accepting attitudes toward women beating, shorter duration of marriage, and women alcohol dependency cannot ignore. And although causal directionality could not be established, one cross-sectional study among slum-dwelling women found participation in social groups and vocational training to be associated with domestic violence experience, perhaps because participation challenges social norms. Of note, none of these studies specifically examined correlates of violence in early stage, critical for primary domestic violence prevention. As part of formative work that led to the development of an intervention for the primary prevention of domestic violence for newly-wed couples residing in Pune slums, we aimed to explore correlates of domestic violence experience among recently-married women.

Methods

This study was considering it is fundamental characteristics and importance of present situation and instruction at all levels of our educational systems, from pre-primary to graduate.

Study Design

The study was conducted in Pune university pharmacy institutions, the second largest city in the western state of Maharashtra, India. According to most recent data from world university ranking. The study employed a cross-sectional design, wherein semi-structured interviews were conducted during the academic year 2016-2018. Interviews were conducted one-on-one in privately by trained female study staff in Marathi. Participant recruitment and enrolment. To be eligible for the study, participants had to be: a divorcee woman over 18 years of age; recently divorce; in a first marriage; in a second marriage.

Data Collection

Sample has collected to speak up methodology and data was selected using a muster name and item semi-structured questionnaire administered one-on-one in private by a trained female study team member.

Participant and study team safety

The study protocol was developed using the guidance of the AICTE and safety recommendations for research on violence against women.

Discussion

This study is the first to report correlates of domestic violence experience in early marriage among women residing in slums linkage private pharmaceutical institutions in pune university, India. We identified nine key potential domestic violence correlates: Teachers are not allowed to give physical punishment to the students. If seen strict action will be taken. During assembly nobody will be allowed to enter the school, the teacher should stand behind the respective classes. No P.F will be deducted from teacher salary i-e compulsory. Defence of unqualified pharmaceutical confidentiality that must be stop. Mobile phone should be kept in the office while signing the attendance register and collect it while leaving the school. Performed such other duties as may be not prescribed. No personal work is allowed during school time. Fourth Saturday of the month is holiday. Poor transportation facility.

Acknowledgment

This study has been guided by under supervision and guidance of Renowned Laboratory Scientist Respected Dr. Ramesh Paranjape’ Retd. Director and Scientist ‘G’ National AIDS Research Institute India. I express my sincere gratitude towards Respected Sir’ for motivation and being great knowledge source for this research. This work was supported by Award Number R.S.S.M./447/2017 Rastriya Samta Swatantra Manch. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Rastriya Samta Swatantra Manch. Thanks go to grammar teacher who reviewed the manuscript grammar.

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