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Heme Iron Polypeptide in Iron Deficiency Anemia of Pregnancy: Current Evidence

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Open Journal of Obstetrics and Gynecology 2017年第4期7卷 420-431页

作者： Bhaskar Pal Hemant Deshpande Tripura Sundari parag Biniwale kamlesh shah Sugandh Goel Amandeep Singh khurana Amit Qamra Salman Motlekar Hanmant Barkate Department of Obstetrics & Gynecology Apollo Gleneagles Hospital Ltd. Kolkata India Department of Obstetrics & Gynecology Dr D.Y. Patil Medical College & Hospital Pune India Department of Obstetrics & Gynecology Krishna Institute of Medical Sciences Secunderabad India Department of Obstetrics & Gynecology Biniwale Clinic Pune India Department of Obstetrics & Gynecology Sahyadri Hospital Karad India Department of Medical Affairs Wockhardt Limited Mumbai India

Iron deficiency is the most common nutritional deficiency leading to anemia in pregnancy. Conventionally, non-heme form of iron salts has been the mainstay of treatment. However, patient compliance is an important concern with existing oral iron therapy due to gastrointestinal side effects. Heme iron, a better bioavailable and tolerable form of iron can be suitable form of iron for supplementation in pregnancy. Evidence suggests its utility in pregnancy for treatment of iron deficiency anemia with benefits extending to postpartum period. Effective transfer across placenta to fetus further supports its utility in pregnancy. This review discusses in details the absorption kinetics along with clinical evidence on efficacy, safety, and tolerability of heme-iron supplementation in iron deficiency anemia of pregnancy.

关键词： Heme Iron Pregnancy Iron Absorption Iron Deficiency Anemia

Bitter Bottle Gourd Toxicity

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Open Journal of Emergency Medicine 2023年第4期11卷 192-197页

作者： Farzin Vajifdar Renaldo Pavrey parag Badki Department of Emergency Medicine Holy Family Hospital Mumbai India Centre for Accident & Emergency Medicine Nanavati Max Super Specialty Hospital Mumbai India Intensive Care Holy Family Hospital Mumbai India

Bottle gourd (Lagenaria siceraria), colloquially known as “lauki” or “doodhi” in India, is an edible plant in the Cucurbitaceae family. Consumption of raw bottle gourd juice is common practice in India. However, little known is the fact that ingestion of raw bottle gourd juice that is extremely bitter tasting is associated with cucurbitacin toxicity. Cucurbitacin is a pheromone produced by the plant as a defense mechanism against insects and herbivores. It is responsible for imparting the bitter taste, and the associated toxicity. The exact mechanism of cucurbitacin toxicity is not well understood, however it is suspected to result in gastric erosions and increased capillary permeability, resulting in rapid onset of vomiting, diarrhea, gastrointestinal bleeding, hypotension and shock. As serum and urine concentration measurements of cucurbitacin are not readily available, bottle gourd toxicity remains a clinical diagnosis based largely on the temporal association of ingestion of unusually bitter tasting vegetable or its juice with rapid onset of symptoms. Physician awareness is therefore of paramount importance in the diagnosis of this unusual entity. We present the case of a 78-year-old woman, with no comorbid conditions, who presented to the Emergency Department (ED) with three episodes of vomiting and multiple episodes of watery loose stools soon after ingestion of extremely bitter tasting, fresh bottle gourd juice. A prompt diagnosis of cucurbitacin toxicity was made in the ED and fluid resuscitation was commenced expeditiously. However, it was noted that most physicians were unfamiliar with this entity, and therefore skeptical of the diagnosis. Our rationale in presenting this clinical case report is three-fold: 1) To create physician awareness regarding this unique clinical entity, especially among emergency physicians, as they are the first point of contact for a critically ill patient. 2) To highlight the rapid onset and progression of symptoms in cucurbitac

关键词： Bottle Gourd Cucurbitacin Tetracyclic Triterpenoid Compounds

Developing Strong and Hybrid Formulation for the Single Stage Single Period Multi Commodity Warehouse Location Problem: Theoretical Framework and Empirical Investigation

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American Journal of Operations Research 2015年第3期5卷 112-128页

作者： R. R. k. Sharma parag Tyagi Vimal kumar Ajay Jha Department of Industrial & Management Engineering IIT Kanpur India

We note that the Single Stage Single Period Multi Commodity Warehouse Location Problem (SSSPMCWLP) has been first attempted by Geoffrion and Graves [1], and that they use the weak formulation (in context of contribution of this paper). We give for the first time “strong” formulation of SSSPMCWLP. We notice advantages of strong formulation over weak formulation in terms of better bounds for yielding efficient Branch and Bound solutions. However, the computation time of “strong” formulation was discovered to be higher than that of the “weak” formulation, which was a major drawback in solving large size problems. To overcome this, we develop the hybrid strong formulation by adding only a few most promising demand and supply side strong constraints to the weak formulation of SSSPMCWLP. So, the formulations developed were put to test on various large size problems. Hybrid formulation is able to give better bound than the weak and takes much less CPU time than the strong formulation. So, a kind of trade off is achieved allowing efficiently solving large sized SSSPMCWLP in real times using hybrid formulation.

关键词： SSUWLP SSSPMCWLP Strong and Weak Constraints Hybrid Formulation RMIP

Pesticide residue elimination for fruits and vegetables:the mechanisms,applications,and future trends of thermal and non-thermal technologies

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Journal of Future Foods 2022年第3期2卷 223-240页

作者： An-An Zhang parag Prakash Sutar Qiang Bian Xiao-Ming Fang Jia-Bao Ni Hong-Wei Xiao College of Engineering China Agricultural UniversityBeijing 100083China Department of Food Process Engineering National Institute of Technology RourkelaOdisha 769008India National Pesticide Engineering Research Center Nankai UniversityTianjin 300071China Institute of Agicultural Research Chinese Academy of Agricultural SciencesBeijing 100093China

Pesticide residues on food are threatening human health and wellbeing,ecological *** processing is one of the necessary ways to eliminate residues to guarantee the safety and sustainable development of the *** review outlines the mechanisms,applications,and factors influencing the efficiency as well as their limitations of pesticide residue elimination *** thermal processing technologies like drying,blanching,baking,and roasting have been proved to reduce pesticides extensively whereas sometimes concentration effects occur,and more toxic metabolites or by-products are ***,the negative effects on quality attributes of fruits and vegetables(F&V)should be *** innovative non-thermal processing technologies like ultrasound,cold plasma,high-pressure processing,and pulsed electric fields have flourished currently,which show great ability to eliminate pesticide residues significantly with minimal impact on the quality of F&*** particular,heat-sensitive nutrients like ascorbic acid,phenolics,and carotenoids would retain to a great ***,these technologies have their ***,there is much information about combined processing technology affecting the pesticide behaviors of F&***,the future developments for pesticide elimination of these technologies are identified and discussed.

关键词： Fruits Vegetables Pesticide residues Thermal technologies Non-thermal technologies

Multistep-ahead River Flow Prediction using LS-SVR at Daily Scale

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Journal of Water Resource and Protection 2012年第7期4卷 528-539页

作者： parag P. Bhagwat Rajib Maity Department of Civil Engineering Indian Institute of Technology Kharagpur Kharagpur India

In this study, potential of Least Square-Support Vector Regression (LS-SVR) approach is utilized to model the daily variation of river flow. Inherent complexity, unavailability of reasonably long data set and heterogeneous catchment response are the couple of issues that hinder the generalization of relationship between previous and forthcoming river flow magnitudes. The problem complexity may get enhanced with the influence of upstream dam releases. These issues are investigated by exploiting the capability of LS-SVR–an approach that considers Structural Risk Minimization (SRM) against the Empirical Risk Minimization (ERM)–used by other learning approaches, such as, Artificial Neural Network (ANN). This study is conducted in upper Narmada river basin in India having Bargi dam in its catchment, constructed in 1989. The river gauging station–Sandia is located few hundred kilometer downstream of Bargi dam. The model development is carried out with pre-construction flow regime and its performance is checked for both pre- and post-construction of the dam for any perceivable difference. It is found that the performances are similar for both the flow regimes, which indicates that the releases from the dam at daily scale for this gauging site may be ignored. In order to investigate the temporal horizon over which the prediction performance may be relied upon, a multistep-ahead prediction is carried out and the model performance is found to be reasonably good up to 5-day-ahead predictions though the performance is decreasing with the increase in lead-time. Skills of both LS-SVR and ANN are reported and it is found that the former performs better than the latter for all the lead-times in general, and shorter lead times in particular.

关键词： Multistep-ahead Prediction kernel-based Learning Least Square-Support Vector Regression (LS-SVR) Daily River Flow Narmada River

Predictors for perioperative blood transfusion in elderly patients with extra capsular hip fractures treated with cephalo-medullary nailing

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Chinese Journal of Traumatology 2018年第1期21卷 16-19页

作者： M, All Fazal Caroline Bagley parag Garg Royal Free NHS Foundation Trust The Ridgeway Enfield EN2 8JL United Kingdom

The aim of our study was to determine predictive factors and requirement for perioperative blood transfusion in elderly patients with extra capsular hip fractures treated with cephalo-medullary device. Methods： Seventy-nine patients with extra capsular hip fractures treated with cephalo-medullary nailing were included in the study. Age, sex, ASA grade, timing of surgery, preoperative and postoperative haemoglobin, length of hospital stay, fracture type, number of units transfused and 30-day mortality were recorded. Results： The mean age was 82.3 years. Forty-seven patients underwent a short nail and 32 patients a long nail; 53.4% patients required blood transfusion postoperatively. Transfusion was required in 71,8% of the long nails （p 〈 0.05）, 65.8% patients above the age of 80 （p 〈 0.05）, 100% of the patients with hemoglobin below 90 g/L and 20 patients with a ASA grade of 3 （p 〈 0.05）. 78.5% patients with A2 fracture and 75% of A3 fractures needed blood transfusion （p 〉 0.05）. Length of hospital stay in non-transfusion group was 13 days and in transfusion group was 19 days （p 〈 0.05）. 55.1% operated within 36 h and 47,B% operated after 3B h of admission needed transfusion （p 〉 0.05）. Thirty-day mortality in patients needing blood transfusion was 5% and in non-transfusion group was 3.7% （p 〉 0.05）, Conclusion： Patient age, ASA grade, preoperative haemoglobin and length of nail are reliable predictors for perioperative blood transfusion in extra capsular hip fractures in elderly patients treated with cephalo-medullary nailing and reinforce a selective transfusion policy.

关键词： Hip fractures Fracture fixation Cephalo-medullary nailing Blood transfusion

One-year survival in recipients older than 50 bridged to heart transplant with Impella 5.5 via axillary approach

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Journal of Geriatric Cardiology 2023年第5期20卷 319-329页

作者： Smit Paghdar Smruti Desai Ji-Min Jang Jose Ruiz Sharan Malkani parag Patel Daniel S Yip Juan C Leoni Jose Nativi Basar Sareyyupoglu kevin Landolfo Si Pham Rohan M Goswami Division of Heart Failure and Transplant Mayo Clinic in FloridaUSA Department of Cardiothoracic Surgery Mayo Clinic in FloridaUSA

BACkGROUND Optimizing patients with advanced heart failure before orthotopic heart transplantation(OHT), especially in patients greater than 50 years old, is imperative to achieving successful post-transplant outcomes. Complications are well-described for patients bridged to transplant(BTT) with durable left ventricular assist device(LVAD) support. Given the lack of data available in older recipients after the recent increase in mechanical support use, we felt it crucial to report our center’s one-year outcomes in older recipients after heart transplantation with percutaneously placed Impella 5.5 as a *** Forty-nine OHT patients were supported with the Impella 5.5 intended as a bridge between December 2019 and October 2022 at Mayo Clinic in Florida. Data were extracted from the electronic health record at baseline and during their transplant episode of care after Institutional Review Boards approval as exempt for retrospective data *** Thirty-eight patients aged 50 or older were supported with Impella 5.5 as BTT. Ten patients underwent heart and kidney transplantation within this cohort. The median age at OHT was 63(58–68) years, with 32 male(84%) and six female patients(16%). Etiology was divided into ischemic(63%) and non-ischemic cardiomyopathy(37%). The baseline median ejection fraction was 19%(15–24). Most patients were in blood group O(60%), and 50% were diabetic. The average duration of support was 27 days(range 6–94). The median duration of follow-up is 488 days(185–693). For patients that have reached the 1-year follow-up timeframe(22 of 38, 58%), the 1-year post-transplant survival is 95%.CONCLUSION Our single-center data provides awareness for using the Impella 5.5 percutaneously placed axillary support device in older heart failure patients in cardiogenic shock as a bridge to transplantation. One-year survival outcomes after heart transplantation are excellent despite the older recipient’s age and prolonged pre-transplant support.

关键词： One approval transplant

Predicting short-term adverse outcomes in the geriatric population presenting with syncope:a comparison of existing syncope rules and beyond

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Journal of Geriatric Cardiology 2023年第1期20卷 11-22页

作者： Suud A.kiradoh Timothy E.Craven Maria O.Rangel Lillian M.Nosow Erfan Zarrinkhoo Suma Menon parag A.Chevli Tareq M.Islam Luqman A.Thazhatuveetil-kunhahamed Department of Internal Medicine Atrium Health Wake Forest Baptist Medical CenterWinston-SalemUSA Biostatistics EpidemiologyResearchand Design(BERD)Atrium Health Wake Forest Baptist Medical CenterWinston-SalemUSA Department of Cardiology Atrium Health Wake Forest Baptist Medical CenterUSA

OBJECTIVES Syncope at age 65+is associated with increased mortality,irrespective of *** rules were designed to aid in risk-stratification but were only validated in the general adult *** objective was to determine if they can be applied to a geriatric population in predicting short-term adverse *** In this single-center retrospective study,we evaluated 350 patients aged 65+presenting with *** criteria included confirmed non-syncope,active medical condition,drug or alcohol-related *** were stratified into high or low risk based on Canadian Syncope Risk Score(CSRS),Evaluation of Guidelines in Syncope Study(EGSYS),San Francisco Syncope Rule(SFSR),and Risk Stratification of Syncope in the Emergency Department(ROSE).Composite adverse outcomes at 48-hour and 30-day included all-cause mortality,major adverse cardiac and cerebrovascular events(MACCE),return emergency department visit,hospitalization,or medical *** assessed each score's ability to predict the outcomes using logistic-regression and compared performances using receiver-operator *** analyses were performed to study the associations between recorded parameters and *** CSRS outperformed with AUC of 0.732(95%CI:0.653-0.812)and 0.749(95%CI:0.688-0.809)for 48-h and 30-day outcomes,*** for CSRS,EGSYS,SFSR,and ROSE for 48-hour outcomes were 48%,65%,42% and 19%;and for 30-day outcomes were 72%,65%,30% and 55%,*** fibrillation/flutter on EkG,congestive heart failure,antiarrhythmics,systolic blood-pressurekG abnormality,heart disease history,severe pulmonary hypertension,BNP>300,vasovagal predisposition,and antidepressants highly correlated with 30-day *** Performance and accuracy of four prominent syncope rules were suboptimal in identifying high-risk geriatric patients with short-term

关键词： syncope mortality return

A Fault-Tolerant FPGA Architecture

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Computer Technology and Application 2011年第4期2卷 311-318页

作者： parag kumar Lala Mohammed Tanveer Anwar James Patrick Parkerson Department of Electrical Engineering Texas A＆M University Texarkana 75505 USA Department of Computer Science and Computer Engineering University of Arkansas Fayetteville 72701 USA

SRAM （Static RAM）-based FPGAs （Field Programmable Gate Arrays （FPGAs） have gained wide acceptance due to their on-line reconfigurable features. The growing demand for FPGAs has motivated semiconductor chip manufacturers to build more densely packed FPGAs with higher logic capacity. The downside of high density devices is that the probability of errors in such devices tends to increase. This paper proposes an FPGA architecture that is composed of an array of cells with built in error correction capability. Collectively a group of such cells can implement any logic function that is either registered or combinational. A cell is composed of three units： a logic block, a fault-tolerant address generator and a director unit. The logic block uses a look-up table to implement logic functions. The fault-tolerant address generator corrects any single bit error in the incoming data to the functional cell. The director block can transmit output data from the logic block to another cell located at its South, North, East or West, or to cells in all four directions. Thus a functional cell can also be used to route signals to other functional cells, thus avoiding any intricate network of interconnects, switching boxes, or routers commonly found in commercially available FPGAs.

关键词： Soft error fault tolerant address generator configuration register director unit similarity circuit.