Purpose Lower gastrointestinal bleeding (LGIB) is common and risk stratification scores can guide clinical decision-making. There is no robust risk stratification tool specific for LGIB, with existing tools not routinely adopted. We aimed to develop and validate a risk stratification tool for LGIB. Methods Retrospective review of LGIB admissions to three centres between 2010 and 2018 formed the derivation cohort. Using regressional analysis within a machine learning technique, risk factors for adverse outcomes were identified, forming a simple risk stratification score-The Birmingham Score. Retrospective review of an additional centre, not included in the derivation cohort, was performed to validate the score. Results Data from 469 patients were included in the derivation cohort and 180 in the validation cohort. Admission haemoglobin OR 1.07(95% CI 1.06-1.08) and male gender OR 2.29(95% CI 1.40-3.77) predicted adverse outcomes in the derivation cohort AUC 0.86(95% CI 0.82-0.90) which outperformed the Blatchford 0.81(95% CI 0.77-0.85), Rockall 0.60(95% CI 0.55-0.65) and AIM65 0.55(0.50-0.60) scores and in the validation cohort AUC 0.80(95% CI 0.73-0.87) which outperformed the Blatchford 0.77(95% CI 0.70-0.85), Rockall 0.67(95% CI 0.59-0.75) and AIM 65 scores 0.61(95% CI 0.53-0.69). The Birmingham Score also performs well at predicting adverse outcomes from diverticular bleeding AUC 0.87 (95% CI 0.75-0.98). A score of 7 predicts a 94% probability of adverse outcome. Conclusion The Birmingham Score represents a simple risk stratification score that can be used promptly on patients admitted with LGIB.

IntroductionHerein, two cases of a rare, self resolving condition are described. Vascular surgeons are often called to see patients with spontaneous discolouration of extremities and digits. Often after extensive investigations no diagnosis can be ascertained and the condition resolves spontaneously.ReportTwo cases are described here, which presented with spontaneous onset of this condition and after extensive testing no cause was ascertained. The condition resolved spontaneously.DiscussionAchenbach's syndrome is a benign, self-limiting condition of unknown aetiology and clinicians should be aware of it to avoid unnecessary time consuming and expensive investigations.

A worldwide shortage of molecular biology consumables is in surge. This includes filter tips, nucleic acid purification kits, polymerases, reverse-transcriptase, and different types of reagents which are included in viral diagnostic kits. In developing countries, the problem is even worse, since there is few capital enterprise to adopt this kind of industry. So, our aim is to develop a suitable, functional, comparable to commercial ones, and affordable in-house protocol to purify viral RNA. We sought some published and commercial RNA purification solutions to set-up an in-house protocol for viral RNA extraction. Solution was prepared accordingly. Also, LPA (linearized polyacrylamide) carrier was evaluated. The whole setting of in-house solutions with addition of LPA carrier was compared to QIAamp viral RNA minikit solutions. Our results showed that linearized polyacrylamide (LPA) carrier in homemade solutions is comparable to poly A carrier which is used in the most commercial kit. In addition, the whole setting of RNA purification solutions did achieve the purpose of viral RNA purification. Also, the result was confirmed using sputum of a Sars-Cov2 infected patient. Our experiments did end up with an affordable homemade solutions for viral RNA purification.

Background The current advancement and increasing use of diagnostic imaging has led to increased detection of abdominal aortic aneurysms (AAA). Many of these patients are unfit for elective AAA surgery. Aim To investigate the outcome of conservative management of unfit patients with large AAA (>5.5 cm) who are turned down for elective surgical intervention. Patients and methods Between January 2006 and April 2017, 457 patients presented with AAA >5.5 cm. Seventy-six patients (M: F 54:22) were deemed unfit for elective repair. Mean age was 79.8 years (range 64–96). Mean AAA size was 60.22 mm (55–83). Results Forty-nine of the 76 patients (64%) had died by April 2017. Fifteen (19.7%) patients died directly because of their aneurysm rupture. A further 34 (44.7%) patients died from non-aneurysm-related causes. Conclusion Patients with large AAA deemed unfit for elective surgery have an overall poor prognosis and die mainly from other causes than AAA. Surgical intervention when rupture occurs results in poor survival.

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As a consequence of Covid-19 pandemic, the basic lab consumables are in shortage, especially in the low-income countries. Thus, the main objective of the present study is to develop and evaluate homemade solution to isolate plasmid. To pursue this objective, RNase A was overexpressed in Bl21 DE3 cells (E. coli strain) and prepared as crude refolding reaction with proper activity. Also, lysis buffers, neutralization buffer, and washing buffers were prepared. The homemade miniprep kit showed successful isolation of the px48SpCas9 plasmid. The prepared plasmid purity was enough to be used successfully in PCR amplification. In addition, to get extra benefits from this study, seven primers were designed to match the plasmid backbone to produce DNA ladder (100–1500 bp). In conclusion, we were able to have attainable working solutions for plasmid miniprep and DNA ladder.

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complications were reported. Following LTAD, 15 patients (5/ 15 had pre-LTAD diagnosis) developed SBP at median 60(20-425) days. Post-LTAD SBP was treated with antibiotics but 5 died. In 10 patients LTAD was removed after median 10 days of antibiotics and only 4 were replaced. For those who had replacement, 2 of 3 patients given prophylaxis suffered recurrent SBP. Other indications for removal were (leak 2; blockage 2). Patients needed hospitalization for median 19 (2-40) days in the 6 months prior to LTAD, and 12(0-34) days in the following 6 months. In 11 of 20 patients with MELD score less than 21 (figure 1), the drain remained for 90 or more days while the median lifespan of LTAD in the whole cohort was 67(6-465). Conclusions In some patients, LTAD achieved long term palliation without hospital admission but many developed SBP postinsertion. Nevertheless, there was still a reduction in hospital stay. It was not possible to identify factors which might predict a successful outcome from this small cohort. Further research should focus on the impact of LTAD on quality of life measures, the role of antibiotic prophylaxis and better defining when LTAD is best employed in the natural history of patient's with ascites.