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"Patel, Sunil"
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Utilization of sugarcane bagasse ash as green adsorbent for Fuchsin basic dye removal
Sugarcane bagasse is generated in huge quantities worldwide which can be converted into high-end valuable products. A major portion of bagasse is converted into Sugarcane Bagasse Ash (SCBA) by burning it at a high temperature in industries. Proper utilization of SCBA instead of landfilling can reduce the harmful environmental effects. In this paper, application of bagasse ash as a green adsorbent for the removal of Fuchsin Basic (FB) dye was investigated. SCBA was characterized using XRD, FTIR, SEM-EDS, BET for insights into its properties. Parameters like contact time, pH, temperature, initial concentration and adsorbent dosage were varied and their impact on dye removal was studied. A maximum removal around 78% (for 10 mg/L dye concentration, 3 g/L adsorbent dosage, 7 pH, 60 min and 25 °C) was achieved using SCBA. Adsorption equilibrium was investigated and Langmuir model fitted best (q
max
= 9.1706 mg/g and k
l
= 0.1690 L/mg, R
2
= 0.9939) as compared to Freundlich and Temkin models. Additionally, kinetics studies revealed that Pseudo second order (R
2
= 0.9998) was superior over other kinetic models. Thermodynamic study confirmed the endothermic adsorption of FB on SCBA and FB removal of 50% was observed even after four cycles indicating reusability of adsorbent after regeneration. Use of SCBA directly as adsorbent without excessive pretreatment promises to be an attractive option.
Journal Article
سر الثراء = The secret to wealth : دراسات
في هذا الكتاب المذهل سر الثراء الجزء الثالث قام كلا من سونيل تولسياني وبراين تريسي بجمع قادة اليوم القادمين من جميع أنحاء العالم للكشف عن إستراتيجياتهم المتطورة لمساعدتك على أن تصبح ثريا بشكل كبير. داخل هذه الصفحات، ستجد تقنيات وأدوات لتغيير الحياة لتحقيق أحلامك. سواء كنت تريد أن تصبح رائد أعمال ومليونير فائق الثروة، أو تشتري العقارات دون استخدام أموالك الخاصة، أو تتقاعد ثريا في سن أصغر، أو تقوم بجذب عملائك ذوي الدخل المرتفع، أو إعداد نفسك لتربح مبالغ ضخمة من الدخل السلبي، فهذا الكتاب مناسب لك تماما.
Book
The impact of robotic surgery on a tertiary care colorectal surgery program, an assessment of costs and short term outcomes: A Canadian perspective
BackgroundRobotic surgery for colorectal pathology has gained interest as it can overcome technical challenges and limitations of traditional laparoscopic surgery. A lack of training and costs have been cited as reasons for limiting its use in Canada. The objective of this paper was to assess the impact of robotic surgery on outcomes and costs in a Canadian setting.MethodsThis is a retrospective study of consecutive patients undergoing left sided colorectal surgery (“Pre-Robotic Phase” n = 145 vs. “Post Robotic Phase” n = 150) and a single tertiary care centre in Ontario, Canada. Utilization and success of minimally invasive surgery (MIS), length of stay, complications and hospital costs were compared. Univariate and Multivariate analysis was used for these comparisons.ResultsCharacteristics, diagnosis and type of resection were similar between groups. Robotic Implementation resulted in higher rates of successful MIS (i.e. attempt at MIS without conversion) (85% vs. 47%, P < 0.001), shorter mean length of stay (4.7 days vs. 8.4 days, P < 0.001), and similar mean operative times (3.9 h vs. 3.9 h, P = 0.93). Emergency Department visits were fewer in the Robotic Phase (24% vs. 34%, P = 0.04), with no difference in readmission, anastomotic leak or unplanned reoperation. After robotic implementation, the mean total hospital costs decreased, but this was not statistically significant (− $1453, 95% CI −$ 3974 to + $1068, P = 0.25). Regression analysis, adjusting for age, gender, obesity, ASA and procedure showed similar findings (Robotic Phase −$ 657, 95% CI − $3038 to +$ 1724, vs Pre Robotic Phase [Reference], P = 0.59).InterpretationImplementation of a robotic colorectal surgery program in a Canadian tertiary care centre showed improved clinical outcomes, without a significant increase in the cost of care. Although this study is from a single institution, we have demonstrated that robotic colorectal surgery is feasible and can be cost effective in the right setting.
Journal Article
The Effect of Antibiotic-Coated Sutures on the Incidence of Surgical Site Infections in Abdominal Closures: a Meta-Analysis
Objective
This meta-analysis aims to determine if antibiotic-impregnated sutures for abdominal fascial closure prevent postoperative surgical site infections (SSIs), hernias, and/or dehiscence.
Methods
MEDLINE and EMBASE databases (1946–2016) were searched. Randomized controlled trials comparing antibiotic-impregnated sutures to standard sutures for abdominal closure were eligible. Risk of bias was evaluated using the Cochrane Handbooks definitions.
Results
Four-hundred fifty articles were reviewed; five eligible studies (
N
= 3117) were identified. All studies routinely used prophylactic antibiotics. Overall risk of SSI in the antibiotic-impregnated suture group was 10.4 vs. 13.0% in the control group. Pooled data showed no difference in SSI between suture types (odds ratio 0.79, 95% CI 0.57–1.09,
P
= 0.15,
I
2
= 44%). There was no evidence of subgroup effect by suture material (polydioxanone vs. polyglactin 910;
P
= 0.19) or by comparing colorectal surgery studies to others (
P
= 0.67). There was a high risk of bias in two studies, one for high loss to follow-up and one for not using an intent-to-treat analysis.
Conclusion
Our meta-analysis is the most comprehensive review on the utility of antibiotic-impregnated sutures in abdominal surgery to prevent SSI. We found no evidence to support routine use of these sutures.
Journal Article
A Snapshot of the International Views of the Treatment of Rectal Cancer Patients, a Multi-regional Survey: International Tendencies in Rectal Cancer
Background
Management of rectal cancer has a number of potentially appropriate alternatives for each patient. Despite acceptance of standards, practices may vary among regions. There is significant paucity of data in this area. The objective was to create a snapshot of the regional differences.
Design
This online survey included 10 questions. Enquiries focused on controversial topics, on surgeon and hospital volume, surgical margins, appropriateness of surgical approaches and techniques, watch-and-wait strategies, and total neoadjuvant therapy. Major colorectal surgery societies around the world were asked to invite their members to complete the survey.
Outcome Measures
Frequency of responses across regions within each question was compared by Fisher’s exact test.
Results
Seven hundred and fifty-three participants from 60 countries responded. Eight regions were identified, and four had sufficient representation for comparisons. Similarities and differences in the therapies among these regions were identified. Robotic surgery penetrance is higher in North America, and watch and wait is more accepted in South America. Patients in Oceania are more likely to be diverted; Europe has more usage of taTME.
Discussion
This online survey was practical as a mean to provide a rapid assessment of the international picture on consistency and variability of rectal cancer patients’ care, and to potentially identify opportunities to standardized care to patients. Medical surveys have inherent limitations; pertinence to our study is selection bias.
Conclusions
The management of rectal cancer varies among different regions. Identification of differences is important when considering global efforts to improve management and interpret data.
Journal Article
Income differences in time to colon cancer diagnosis
Introduction People with low income have worse outcomes throughout the cancer care continuum; however, little is known about income and the diagnostic interval. We described diagnostic pathways by neighborhood income and investigated the association between income and the diagnostic interval. Methods This was a retrospective cohort study of colon cancer patients diagnosed 2007–2019 in Ontario using routinely collected data. The diagnostic interval was defined as the number of days from the first colon cancer encounter to diagnosis. Asymptomatic pathways were defined as first encounter with a colonoscopy or guaiac fecal occult blood test not occurring in the emergency department and were examined separately from symptomatic pathways. Quantile regression was used to determine the association between neighborhood income quintile and the conditional 50th and 90th percentile diagnostic interval controlling for age, sex, rural residence, and year of diagnosis. Results A total of 64,303 colon cancer patients were included. Patients residing in the lowest income neighborhoods were more likely to be diagnosed through symptomatic pathways and in the emergency department. Living in low‐income neighborhoods was associated with longer 50th and 90th‐percentile symptomatic diagnostic intervals compared to patients living in the highest income neighborhoods. For example, the 90th percentile diagnostic interval was 15 days (95% CI 6–23) longer in patients living in the lowest income neighborhoods compared to the highest. Conclusion These findings reveal income inequities during the diagnostic phase of colon cancer. Future work should determine pathways to reducing inequalities along the diagnostic interval and evaluate screening and diagnostic assessment programs from an equity perspective.
Journal Article
ERAS for Ambulatory TURBT: Enhancing Bladder Cancer Care (EMBRACE) randomised controlled trial protocol
IntroductionTransurethral resection of bladder tumour (TURBT) is one of the more common procedures performed by urologists. It is often described as an ‘incision-free’ and ‘well-tolerated’ operation. However, many patients experience distress and discomfort with the procedure. Substantial opportunity exists to improve the TURBT experience. An enhanced recovery after surgery (ERAS) protocol designed by patients with bladder cancer and their providers has been developed.Methods and analysisThis is a single-centre, randomised controlled trial to investigate the effectiveness of an ERAS protocol compared with usual care in patients with bladder cancer undergoing ambulatory TURBT. The ERAS protocol is composed of preoperative, intraoperative and postoperative components designed to optimise each phase of perioperative care. 100 patients with suspected or known bladder cancer aged ≥18 years undergoing initial or repeat ambulatory TURBT will be enrolled. The change in Quality of Recovery 15 score, a measure of the quality of recovery, between the day of surgery and postoperative day 1 will be compared between the ERAS and control groups.Ethics and disseminationThe trial has been approved by the Johns Hopkins Institutional Review Board #00392063. Participants will provide informed consent to participate before taking part in the study. Results will be reported in a separate publication.Trial registration number NCT05905276
Journal Article
Emergency Colorectal Surgery in Those with Cirrhosis: A Population-based Study Assessing Practice Patterns, Outcomes and Predictors of Mortality
Background
Those with cirrhosis who require emergency colorectal surgery are at risk for poor outcomes. Although risk predictions models exists, these tools are not specific to colorectal surgery, nor were they developed in a contemporary setting. Thus, the objective of this study was to assess the outcomes in this population and determine whether cirrhosis etiology and/or the Model for End Stage Liver Disease (MELD-Na) is associated with mortality.
Methods
This population-based study included those with cirrhosis undergoing emergent colorectal surgery between 2009 and 2017. All eligible individuals in Ontario were identified using administrative databases. The primary outcome was 90-day mortality.
Results
Nine hundred and twenty-seven individuals (57%) (male) were included. The most common cirrhosis etiology was non-alcoholic fatty liver disease (NAFLD) (50%) and alcohol related (32%). Overall 90-day mortality was 32%. Multivariable survival analysis demonstrated those with alcohol-related disease were at increased risk of 90-day mortality (hazards ratio [HR] 1.53, 95% confidence interval [CI] 1.2–2.0 vs. NAFLD [ref]). Surgery for colorectal cancer was associated with better survival (HR 0.27, 95%CI 0.16–0.47). In the subgroup analysis of those with an available MELD-Na score (n = 348/927, 38%), there was a strong association between increasing MELD-Na and mortality (score 20+ HR 6.6, 95%CI 3.9–10.9; score 10–19 HR 1.8, 95%CI 1.1–3.0; score <10 [ref]).
Conclusion
Individuals with cirrhosis who require emergent colorectal surgery have a high risk of postoperative complications, including mortality. Increasing MELD-Na score is associated with mortality and can be used to risk stratify individuals.
Lay Summary
Patients who have advanced liver disease (i.e., cirrhosis) are at higher risk for surgical complications. Limited research is available on how this affects patients who need to have emergency bowel surgery. This study looked at 927 patients with liver cirrhosis who had emergency bowel surgery to see how they did. One third of them died within 90 days after surgery. The patients who had liver disease because of alcohol had a higher risk of dying. The more severe the liver disease, the higher the risk of complications. This study can help clinicians understand how to care for and counsel patients with liver cirrhosis who need bowel surgery.
Journal Article
Avacincaptad pegol for geographic atrophy secondary to age-related macular degeneration: 18-month findings from the GATHER1 trial
Background/Objectives
To assess the safety and efficacy of avacincaptad pegol (ACP), a C5 inhibitor, for geographic atrophy (GA) secondary to age-related macular degeneration (AMD) over an 18-month treatment course.
Subjects/Methods
This study was an international, prospective, randomized, double-masked, sham-controlled, phase 2/3 clinical trial that consisted of 2 parts. In part 1, 77 participants were randomized 1:1:1 to receive monthly intravitreal injections of ACP 1 mg, ACP 2 mg, or sham. In part 2, 209 participants were randomized 1:2:2 to receive monthly ACP 2 mg, ACP 4 mg, or sham. The mean rate of change of GA over 18 months was measured by fundus autofluorescence.
Results
Compared with their respective sham cohorts, monthly ACP treatment reduced the mean GA growth (square root transformation) over 18 months by 28.1% (0.168 mm, 95% CI [0.066, 0.271]) for the 2 mg cohort and 30.0% (0.167 mm, 95% CI [0.062, 0.273]) for the 4 mg cohort. ACP treatment was generally well tolerated over 18 months, with most ocular adverse events (AEs) related to the injection procedure. Macular neovascularization (MNV) was more frequent in both 2 mg (11.9%) and 4 mg (15.7%) cohorts than their respective sham control groups (2.7% and 2.4%).
Conclusions
Over this 18-month study, ACP 2 mg and 4 mg showed continued reductions in the progression of GA growth compared to sham and continued to be generally well tolerated. A pivotal phase 3 GATHER2 trial is currently underway to support the efficacy and safety of ACP as a potential treatment for GA.
Journal Article