Search results for: audit hours

Authors: Jibran Abbasy, Rizwan Sultan, Ammar Humayun, Tabish Chawla

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Background: Hydatid disease caused by Echinococcus Granulosus affects liver in 70-90% of cases. Dogs are the definitive host while humans are the accidental host. Modalities used for its treatment are especially important for our population as the disease is endemic in many Asian countries. The aim of the study was to perform an audit of the various modalities used for treatment of hydatid disease of liver and the response to each modality in tertiary care center of Pakistan. Materials and Methods: Retrospective audit of patients diagnosed and treated for Hydatid disease of the liver at Aga Khan University Hospital from 1st January 2007 to 31st December 2014 was completed. All patients aged 16 and above were included. Patients who had extra hepatic disease and missing records were excluded. Outcome measures were morbidity, mortality and recurrence of the disease. Results: During the study period 56 patients were treated for isolated hepatic hydatid disease and were included. Mean age was 39 years with 48% being females and 52% males. Most common presenting complaint was abdominal pain seen in 53% of patients(n=41). Duration of symptoms was less than 6 months in 74% (n=38). Mostly right lobe was involved in 69% (n=38).Most common treatment modality used was surgery in 34 patients followed by PAIR in 14 patients while 8 patients were treated medically. At a median follow up of 34 months recurrence was seen in 2 patients treated with PAIR while no patient treated with surgery had recurrence with the median follow up of 20 months. While no morbidity and mortality were observed in PAIR, but in surgery 5 patients had morbidity while 1 patient had mortality. Conclusion: Our data is comparative to other studies in terms of morbidity, mortality, and recurrence. We had adequate follow up. In our study PAIR and surgery both are effective and have less complications and recurrence rate. Surgery is still the gold standard in terms of recurrence.

Keywords: echinococcous granulosus, puncture aspiration irrigation reaspiration (PAIR), surgery, hydatid disease

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Authors: Andrew White, Abigail Lowe, Kory Watkins, Hamed Akhlaghi, Nicole Winter

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The timing and appropriateness of diagnostic imaging are critical to the evaluation and management of traumatic injuries. Within the subclass of trauma patients, the prevalence of c-spine injury is less than 4%. However, the incidence of delayed diagnosis within this cohort has been documented as up to 20%, with inadequate radiological examination most cited issue. In order to assess those in which c-spine injury cannot be fully excluded based on clinical examination alone and, therefore, should undergo diagnostic imaging, a set of criteria is used to provide clinical guidance. The NEXUS (National Emergency X-Radiography Utilisation Study) criteria is a validated clinical decision-making tool used to facilitate selective c-spine radiography. The criteria allow clinicians to determine whether cervical spine imaging can be safely avoided in appropriate patients. The NEXUS criteria are widely used within the Emergency Department setting given their ease of use and relatively straightforward application and are used in the Victorian State Trauma System’s guidelines. This audit utilized retrospective data collection to examine the concordance of c-spine imaging in trauma patients to that of the NEXUS criteria and assess compliance with state guidance on diagnostic imaging in trauma. Of the 183 patients that presented with trauma to the head, neck, or face (244 excluded due to incorrect triage), 98 did not undergo imaging of the c-spine. Out of those 98, 44% fulfilled at least one of the NEXUS criteria, meaning the c-spine could not be clinically cleared as per the current guidelines. The criterion most met was intoxication, comprising 42% (18 of 43), with midline spinal tenderness (or absence of documentation of this) the second most common with 23% (10 of 43). Intoxication being the most met criteria is significant but not unexpected given the cohort of patients seen at St Vincent’s and within many emergency departments in general. Given these patients will always meet NEXUS criteria, an element of clinical judgment is likely needed, or concurrent use of the Canadian C-Spine Rules to exclude the need for imaging. Midline tenderness as a met criterion was often in the context of poor or absent documentation relating to this, emphasizing the importance of clear and accurate assessments. The distracting injury was identified in 7 out of the 43 patients; however, only one of these patients exhibited a thoracic injury (T11 compression fracture), with the remainder comprising injuries to the extremities – some studies suggest that C-spine imaging may not be required in the evaluable blunt trauma patient despite distracting injuries in any body regions that do not involve the upper chest. This emphasises the need for standardised definitions for distracting injury, at least at a departmental/regional level. The data highlights the currently poor application of the NEXUS guidelines, with likely common themes throughout emergency departments, highlighting the need for further education regarding implementation and potential refinement/clarification of criteria. Of note, there appeared to be no significant differences between levels of experience with respect to inappropriately clearing the c-spine clinically with respect to the guidelines.

Keywords: imaging, guidelines, emergency medicine, audit

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Authors: Morteza Gharibi, Abdolghader Pakniat, Somayeh Bahrampouri

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Introduction: Emergency department (E.R.) crowding is a serious widespread problem in hospitals that leads to irregularities, a slower rate of delivery of services to patients, and a long-term stay. In addition, the long-term stay in the E.D. reduces the possibility of providing services with appropriate quality to other patients who are undergoing medical emergencies, which leads to dissatisfaction among patients. This study aimed to determine the relationship between ED-crowding and the mortality rate of the patients referred to the E.D. In a retrospective cohort study, all patients who expired in first 24 hours of admission were enrolled in the study. Crowding index at the moment of admission was calculated using Edwin Score. The data including history and physical examination, time of arrival in the E.D., diagnosis (using ICD 10 code), time of death, cause of death, demographic information was recoded based on triage forms on admission and patients’ medical files. Data analysis was performed by using descriptive statistics and chi square test, ANOVA tests using SPSS ver. 19. The time of arrival in E.D. to death in crowded E.D. conditions, with an average of five hours and 25 minutes, was significantly higher than the average admission Time of arrival in E.D. to death in active and crowded E.D. conditions. More physicians and nurses can be employed during crowded times to reduce staff fatigue and improve their performance during these hours.

Keywords: mortality, emergency, department, crowding

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Authors: Hiroshi Ikeda

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In this research, a questionnaire survey was conducted to measure nap, drowsiness and fatigue of drivers who work long shifts, to discuss about the work environment and health conditions for taxi and bus drivers who work at night time. The questionnaire sheet used for this research was organized into the following categories: tension/tiredness, drowsiness while driving, and the nap situation during night-time work. The number of taxi drivers was 127 and the number of bus drivers was 40. Concerning the results of a comparison of nap hours of taxi and bus drivers, the taxi drivers’ nap hours are overwhelmingly shorter, and also the frequency of drivers who feel drowsiness is higher. The burden on bus drivers does not change because of the system of a two-driver rotation shift. In particular, the working environment of the taxi driver may lead to greater fatigue accumulation than the bus driver’s environment.

Keywords: bus and taxi, drowsiness, fatigue, nap

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Authors: J. Fenianos, C. Khater, D. Brouillet

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Ecological projects are often faced with reluctance from local communities hosting the project, especially when this project involves variation from preset ideas or classical practices. This paper aims at appreciating the contribution of environmental psychology through cognitive flexibility exercises to improve the acceptability of local communities in adopting more ecological rehabilitation scenarios. The study is based on a quarry site located in Bekaa- Lebanon. Four groups were considered with different levels of involvement, as follows: Group 1 is Training (T) – 50 hours of on-site training over 8 months, Group 2 is Awareness (A) – 2 hours of awareness raising session, Group 3 is Flexibility (F) – 2 hours of flexibility exercises and Group 4 is the Control (C). The results show that individuals in Group 3 (F) who followed flexibility sessions accept comparably the ecological rehabilitation option over the more classical one. This is also the case for the people in Group 1 (T) who followed a more time-demanding “on-site training”. Another experience was conducted on a second quarry site combining flexibility with awareness-raising. This research confirms that it is possible to reduce resistance to change thanks to a limited in-time intervention using cognitive flexibility. This methodological approach could be transferable to other environmental problems involving local communities and changes in preset perceptions.

Keywords: acceptability, ecological restoration, environmental psychology, Lebanon, local communities, resistance to change

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Authors: Aarti M. Shetty, Estela Davoodi, Subrata Gangooly, Anita Rao-Coppisetty

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Background: Testing Patency of Fallopian Tubes is among one of the several protocols for investigating Subfertile Couples. Both, Hysterosalpingogram (HSG) and Laparoscopy and dye test have been used as Tubal patency test for several years, with well-known limitation. Hysterosalpingo Contrast Sonography (HyCoSy) can be used as an alternative tool to HSG, to screen patency of Fallopian tubes, with an advantage of being non-ionising, and also, use of transvaginal scan to diagnose pelvic pathology. Aim: To determine the indication and analyse the performance of transvaginal scan and HyCoSy in Broomfield Hospital. Methods: We retrospectively analysed fertility workup of 282 women, who attended HyCoSy clinic at our institution from January 2015 to June 2016. An Audit proforma was designed, to aid data collection. Data was collected from patient notes and electronic records, which included patient demographics; age, parity, type of subfertility (primary or secondary), duration of subfertility, past medical history and base line investigation (hormone profile and semen analysis). Findings of the transvaginal scan, HyCoSy and Laparoscopy were also noted. Results: The most common indication for referral were as a part of primary fertility workup on couples who had failure to conceive despite intercourse for a year, other indication for referral were recurrent miscarriage, history of ectopic pregnancy, post reversal of sterilization(vasectomy and tuboplasty), Post Gynaecology surgery(Loop excision, cone biopsy) and amenorrhea. Basic Fertility workup showed 34% men had abnormal semen analysis. HyCoSy was successfully completed in 270 (95%) women using ExEm foam and Transvaginal Scan. Of the 270 patients, 535 tubes were examined in total. 495/535 (93%) tubes were reported as patent, 40/535 (7.5%) tubes were reported as blocked. A total of 17 (6.3%) patients required laparoscopy and dye test after HyCoSy. In these 17 patients, 32 tubes were examined under laparoscopy, and 21 tubes had findings similar to HyCoSy, with a concordance rate of 65%. In addition to this, 41 patients had some form of pelvic pathology (endometrial polyp, fibroid, cervical polyp, fibroid, bicornuate uterus) detected during transvaginal scan, who referred to corrective surgeries after attending HyCoSy Clinic. Conclusion: Our audit shows that HyCoSy and Transvaginal scan can be a reliable screening test for low risk women. Furthermore, it has competitive diagnostic accuracy to HSG in identifying tubal patency, with an additional advantage of screening for pelvic pathology. With addition of 3D Scan, pulse Doppler and other non-invasive imaging modality, HyCoSy may potentially replace Laparoscopy and chromopertubation in near future.

Keywords: hysterosalpingo contrast sonography (HyCoSy), transvaginal scan, tubal infertility, tubal patency test

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Authors: Ciaran Smiddy, Fergus Nugent, Karen Fitzmaurice

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A measure of prescribing and administration of Antimicrobial Prophylaxis before and during Covid-19(2019 vs. 2021) was desired to assess how these were affected by Covid-19. Antimicrobial Prophylaxis was assessed for 60 patients, under 3 Orthopaedic Consultants, against local guidelines. The study found that compliance with guidelines improved significantly, from 60% to 83%, but Appropriate use of Vancomycin reduced from 37% to 29%.

Keywords: antimicrobial stewardship, prescribing, spinal surgery, vancomycin

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Authors: Autumporn Buranapongphan, Ketsirin Meethong, Phukan Pahaphom

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The objectives of this research is aim to study the standard formula of choux cream recipe. Formulation of choux cream were used gluten free as a replacer with flour in choux dough, quinoa milk in cream and shelf life on product. The results showed the acceptance test using 30 target consumers revealed that liking of choux dough with water 34%, egg 30% flour 19% butter 16% baking powder 1% and cream with milk 68% sugar 13% butter 6.8% egg 4.5% and vanilla 0.9%. The gluten free exhibited the formulation of dough is rice flour 12% potato starch 26% tapioca 7.7% and quinoa flour 4.3%. The ratio of corn flour at 40% had significant effects on liking of viscosity for quinoa cream. During storage by Total viable count (TVA) were kept in room temperature for 8 hours and chilled for 18 hours.

Keywords: choux cream, gluten free, quinoa, dough

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Authors: F. Christie, M. Staber

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Malnutrition is a predictor of poor clinical outcome in the elderly. Up to 60% of hip fracture patients are clinically malnourished on admission. This study assessed the perioperative nutritional state of patients admitted with a proximal femoral fracture and examined if adequate nutritional support was achieved. Methods: Prospective, the observational audit of 30 patients, admitted with a proximal femoral fracture, over a one-month period. We recorded: patient demographics; surgical delay; nutritional state on admission; documentation of Malnutrition Universal Screening Tool (MUST) score; dietician input and daily calorie intake through food charts. The nutritional state was re-assessed weekly and at discharge. The outcome was measured by the length of hospital stay and thirty-day mortality. Results: Mean age 87, M:F 1:2 and all patients were ASA three or four. Five patients (17%) had a prolonged ( >24 hours) fasting period. All patients had a MUST score completed on admission, 27% were underweight and 30% were high risk for malnutrition. Twenty-six patients (87%) were appropriately assessed for dietician referral. Thirteen patients had food charts; on average, hospital meals provided 1500kcal daily. No patient achieved > 75% of the provided calories with 69% of patients achieving 50% or less. Only three patients were started on nutritional supplements. Twenty-three patients (77%) lost weight, averaging 6% weight loss during admission. Mean length of stay (LOS) was 23 days and 30-day mortality 9%. Four patients (13%) gained weight, their mean LOS was 17 days and 30-day mortality 0%. Discussion: Malnutrition in the elderly originates in the community. Following major trauma it’s difficult to reverse nutritional deficits in hospitals. It’s therefore concerning that no high-risk patient achieved their recommended calorie intake. Perioperative optimisation needs to include early nutritional intervention, early anaesthetic review and adjusted anaesthetic techniques to support feeding.

Keywords: trauma, nutrition, neck of femur fracture

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Authors: Gbenga F. Akomolafe, Joseph Omojola, Ezekiel S. Joshua, Seyi C. Adediwura, Elijah T. Adesuji, Michael O. Odey, Oyinade A. Dedeke, Ayo H. Labulo

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Microgravity is known to be a major abiotic stress in space which affects plants depending on the duration of exposure. In this work, tomatoes seeds were exposed to long hours of simulated microgravity condition using a one-axis clinostat. The seeds were sown on a 1.5% combination of plant nutrient and agar-agar solidified medium in three Petri dishes. One of the Petri dishes was mounted on the clinostat and allowed to rotate at the speed of 20 rpm for 72 hours, while the others were subjected to the normal gravity vector. The anatomical sections of both clinorotated and normal gravity plants were made after 72 hours and observed using a Phase-contrast digital microscope. The percentage germination, as well as the growth rate of the normal gravity seeds, was higher than the clinorotated ones. The germinated clinorotated roots followed different directions unlike the normal gravity ones which grew towards the direction of gravity vector. The clinostat was able to switch off gravistimulation. Distinct cellular arrangement was observed for tomatoes under normal gravity condition, unlike those of clinorotated ones. The root epidermis and cortex of normal gravity are thicker than the clinorotated ones. This implied that under long-term microgravity influence, plants do alter their anatomical features as a way of adapting to the stress condition.

Keywords: anatomy, clinostat, germination, lycopersicon esculentum, microgravity

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Authors: Srijitra Khanpakdee, Teera Butburee, Jung-Ho Yun, Miaoqiang Lyu, Supphasin Thaweesak, Piangjai Peerakiatkhajohn

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The synthesis of titanium dioxide (TiO₂) nanorods (NRs) on fluorine-doped tin oxide (FTO) glass via hydrothermal methods was investigated to determine the optimal reaction time for enhanced photocatalytic and optical performance. Reaction times of 4, 6, and 8 hours were studied. Characterization through SEM, UV-vis, XRD, FTIR, Raman spectroscopy and photoelectrochemical (PEC) techniques revealed significant differences in the properties of the TiO₂ NRs based on the reaction duration. XRD and Raman spectroscopy analysis confirmed the formation of the rutile phase of TiO₂. As photoanodes in PEC cells, TiO₂ NRs synthesized for 4 hours exhibited the best photocatalytic activity, with the highest photocurrent density and superior charge transport properties, attributed to their densely packed vertical structure. Longer reaction times resulted in less optimal morphological and photoelectrochemical characteristics. The bandgap of the TiO₂ NRs remained consistent around 3.06 eV, with only slight variations observed. This study highlights the critical role of reaction time in hydrothermal synthesis, identifying 4 hours as the optimal duration for producing TiO₂ NRs with superior photoelectrochemical performance. These findings provide valuable insights for optimizing TiO₂-based materials for solar energy conversion and renewable energy applications.

Keywords: titanium dioxide, nanorods, hydrothermal, photocatalytic, photoelectrochemical

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Authors: Hindar Panguji, Nichlah Rifqiyah, Irkham Widiono, Pudji Astuti

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Many transportations of livestock in Indonesia is still managed traditionally. Transportation involves several things that may cause stress, from a certain treatment or other factors, either externally or internally, that act as stressors. This study aimed to determine the profile of cortisol and IL-6 in female Bali breeding cattle transported for 120 hours using 100 GT traditional vessels with two floors and a capacity of 300-400 heads. Before transportation, all of the animals have got the vaccination. Blood samples from thirty cows were taken before transportation, during loading, during docking, and after transportation. ELISA method was used to analyze the concentration of cortisol and IL6. The averages of cortisol concentration before transportation, during loading, docking, and after transportation were 78.21±27.96 ng/mL, 90.78±30.91 ng/mL, 69.90±53.92 ng/mL and 69.34±32.03 ng/mL respectively. The average concentration of IL-6 before, during, docking and after transportation were 259.86±70.16 pg/mL, 315.41±64.21 pg/mL, 410.13±247.43 pg/mL dan 424.81±98.86 pg/mL. It was concluded there were no differences in cortisol concentrations and level of IL6 of each cow at different stages of transportation (p > 0.05) It would be possible that vaccination could reduce the fluctuation of cortisol.

Keywords: shipping, Bali's breed cows, vessel, cortisol, IL6

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Authors: Chang-Liang Shih, Kuei-Min Liao, Ya-Yuan Wang, Wu-Chun Tu

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Forcipomyia taiwana, an important vexing pest, influences the development of the industry of Taiwan tourism and the quality of country life. Using human-attractant method to investigate the blood-sucking behavior of Forcipomyia taiwana in three districts in Taichung, it revealed that female F. taiwana only exhibits blood-sucking behavior in daytime, not in nighttime. The blooding-sucking behavior of female F. taiwana was affected by some factors, i.e., season and atmospheric factors. During 2008 to 2010, our study revealed that blood-sucking behavior commenced from 7:00 to 8:00 in the spring equinox, the summer solstice and the autumnal equinox, but from 8:00 to 9:00 in the winter solstice. However, regardless of any seasons, it revealed that blood-sucking behavior reached the acme between 13:00 and 15:00, and then descending. In those four seasons, the summer solstice had longer lighting and higher temperature, the average sucking activity was around 12 hours, on the contrary, the winter solstice had shorter lighting and lower temperature, the average sucking activity bridled to around 8 hours whilst it retrenched to 11 hours in the spring equinox and the autumnal equinox. To analyze the correlation between blood-sucking behavior and atmospheric factors, it revealed that female blood-sucking behavior was correlated positively to temperature and lighting but negatively to humidity. In addition, our study also showed that there is no blood-sucking behavior under 18ºC.

Keywords: Forcipomyia taiwana, circadian rhythm, blood-sucking behavior, season

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Authors: Norul Hisham Hamid, Amir Affan, Ummi Hani Abdullah, Paridah Md. Tahir, Khairul Akmal Azhar, Rahmat Nawai, W. B. H. Wan Sulwani Izzati

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The dimensional stability and static bending properties of epoxy composite reinforced with amorphous and crystalline silica were investigated. The amorphous and crystalline silica was obtained by the precipitation method from carbonisation process of the rice husk at a temperature of 600 °C and 1000 °C for 7 hours respectively. The epoxy resin was mixed with 5%, 10% and 15% concentrations of amorphous and crystalline silica. The mixture was stirred for 10 minutes and cured at 28 °C for 72 hours and oven dried at 80 °C for 72 hours. The scanning electron microscope image showed the silica sized of 10-30nm was obtained. The water absorption and thickness swelling of epoxy/amorphous silica composite was not significantly different with silica concentration ranged from 0.08% to 0.09% and 0.17% to 0.20% respectively. The maximum modulus of rupture (85 MPa) and modulus of elasticity (3284 MPa) were achieved for 10% silica concentration. For epoxy/crystalline silica composite; the water absorption and thickness swelling were also not significantly different with silica concentration, ranged from 0.08% to 0.11% and 0.16% to 0.18% respectively. The maximum modulus of rupture (47.9 MPa) and modulus of elasticity (2760 MPa) were achieved for 10% silica concentration. Overall, the water absorption and thickness swelling were almost identical for epoxy composite made from either amorphous or crystalline silica. The epoxy composite made from amorphous silica was stronger than crystalline silica.

Keywords: epoxy, composite, dimensional stability, static bending, silica

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Authors: A. M. Raseona, D. M. Barry, T. L. Nedambale

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Preservation of semen is an important process to ensure that semen quality is sufficient for assisted reproductive technology. This study evaluated the effectiveness of different extenders to preserve Nguni bull semen stored at controlled room temperature 24 °C for three days, as an alternative to frozen-thawed semen straws used for artificial insemination. Semen samples were collected from two Nguni bulls using an electro-ejaculator and transported to the laboratory for evaluation. Pooled semen was aliquot into three extenders Triladyl, Ham’s F10 and M199 at a dilution ratio of 1:4 then stored at controlled room temperature 24 °C. Sperm motility was analysed after 0, 24, 48 and 72 hours. Morphology and viability were analysed after 72 hours. The study was replicated four times and data was analysed by analysis of variance (ANOVA). Triladyl showed higher viability percentage and consistent total motility for three days. Ham’s F10 showed higher progressive motility compared to the other extenders. There was no significant difference in viability between Ham’s F10 and M199. No significant difference was also observed in total abnormality between the two Nguni bulls. In conclusion, Nguni semen can be preserved in Triladyl or Ham’s F10 and M199 culture media stored at 24 °C and stay alive for three days. Triladyl proved to be the best extender showing high viability and consistency in total motility as compared to Ham’s F10 and M199.

Keywords: bull semen, artificial insemination, Triladyl, Ham’s F10, M199, viability

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Authors: Krupali Mukeshkumar, Jinesh Shah

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Background: Bilateral Sagittal Split Osteotomy (BSSO), used for the correction of mandibular deformities, is a common oral and maxillofacial surgical procedure. Inferior alveolar nerve dysfunction is commonly reported post-operatively by patients as paresthesia or anesthesia. The current literature lacks a consensus on the incidence of inferior alveolar nerve dysfunction as patients are not routinely assessed pre and post-operatively with an objective assessment. The range of incidence varies from 9% to 85% of patients, with some authors arguing that 100% of patients experience nerve dysfunction immediately post-surgery. Systematic reviews have shown a difference between incidence rates at different follow-up periods using objective and subjective methods. Aim: To identify the incidence of inferior alveolar nerve dysfunction following BSSO. Gold standard: Nerve dysfunction incidence rates similar or lower than current literature of 83% day one post-operatively and 18.4% at one year follow up. Setting: A retrospective cross-sectional audit of patients treated between 2017-2019 at the Royal Stoke University Hospital, Maxillofacial and Orthodontic departments. Sample: All patients who underwent a BSSO (with or without le fort one osteotomy) between 2017–2019 were identified from the database. Patients with pre-existing neurosensory disturbance, those who had a genioplasty at the same time and those with no follow-up were excluded. The sample consisted of 121 patients, 37 males and 84 females between the ages of 17-50 years at the time of surgery. Methods: Clinical records of 121 cases were reviewed to assess the age, sex, type of mandibular osteotomy, status of the nerve during the surgical procedure, type of bony split and incidence of nerve dysfunction at follow-up appointments. The surgical procedure was carried out by three Maxillo-facial surgeons and follow-up appointments were carried out in the Orthodontic and Oral and Maxillo-facial departments. Results: 120 patients were treated to correct the mandibular facial deformity and 1 patient was treated for sleep apnoea. Seventeen patients had a mandibular setback and 104 patients had mandibular advancement. 68 patients reported inferior alveolar nerve dysfunction at one week following their surgery. Seventy-six patients had temporary paresthesia present between 2 weeks and 12 months post-surgery. 13 patients had persistent nerve dysfunction at 12 months, of which 1 had a bad bony split during the BSSO. The incidence of nerve dysfunction postoperatively was 6.6% after 1 day, 56.1% at 1 week, 62.8% at 2 weeks, 59.5% between 3-6 weeks, 43.0% between 8-16 weeks and 10.7% at 1 year. Conclusions: The results of this audit show a similar incidence rate to the research gold standard at the one-year follow-up. Future Recommendations: No changes to surgical procedure or technique are indicated, but a need for improved documentation and a standardized approach for assessment of post-operative nerve dysfunction would be beneficial.

Keywords: bilateral sagittal split osteotomy, inferior alveolar nerve, mandible, nerve dysfunction

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Authors: Mazita Mohd Diah, Anton V. Dolzhenko, Tin Wui Wong

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Nanoparticles, being small with a large specific surface area, increase solubility, enhance bioavailability, improve controlled release and enable precision targeting of the entrapped compounds. In this study, chitosan as polymeric permeation enhancer was conjugated to a polar pro-drug, carboxymethyl-5-fluorouracil (CMFU) to increase the skin drug permeation. Chitosan-CMFU conjugate was synthesized using chemical conjugation process through succinate linker. It was then transformed into nanoparticles via spray drying method. The conjugation was elucidated using Fourier Transform Infrared and Proton Nuclear Magnetic Resonance techniques. The nanoparticle size, size distribution, zeta potential, drug content, skin permeation and retention profiles were characterized. The conjugation was denoted using 1H NMR by new peaks at signal δ = 4.184 ppm (singlet, 2H for CH2) and 7.676-7.688 ppm (doublet, 1H for C6) attributed to CMFU in chitosan-CMFU NMR spectrum. The nanoparticles had profiles of particle size: 93.97 ±35.11 nm, polydispersity index: 0.40 ± 0.14, zeta potential: +18.25 ±2.95 mV and drug content: 6.20 ± 1.98 % w/w. Almost 80 % w/w CMFU in the form of nanoparticles permeated through the skin in 24 hours and close to 50 % w/w permeation occurred in first 1-2 hours. Without conjugation to chitosan and nanoparticulation, less than 40 % w/w CMFU permeated through the skin in 24 hours. The skin drug retention likewise was higher with chitosan-CMFU nanoparticles (15.34 ± 5.82 % w/w) than CMFU (2.24 ± 0.57 % w/w). CMFU, through conjugation with chitosan permeation enhancer and processed in nanogeometry, had its skin permeation and retention degree promoted.

Keywords: carboxymethyl-5-fluorouracil, chitosan, conjugate, skin permeation, skin retention

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Authors: Ohabuiro John Uwabunkeonye

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Source of green energy is becoming a concern in developing countries where most energy source in use emits high level of carbon (IV) oxide which contributes to global warming. More so, even with the generation of energy from fossil fuel, the electricity supply is still very inadequate. Therefore, this paper examines different ways of designing and installing photovoltaic (PV) system in terms of optimal sizing of PV array and battery storage in an area of very low peak sunlight hours (PSH) and inadequate supply of electricity from utility companies. Different sample of Peak sunlight hour for selected areas in Nigeria are considered and the lowest of it all is taken. Some means of ensuring that the available solar energy is harnessed properly and converted into electrical energy are discussed for usage in such areas as mentioned above.

Keywords: green energy, fossil fuel, peak sunlight hour, photovoltaic

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Authors: Mairaj Ahmad, L. Paglia, F. Marra, V. Genova, G. Pulci

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This study employed Rene N4 and FSX 414 superalloys, which are used in numerous turbine engine components due of their high strength, outstanding fatigue, creep, thermal, and corrosion-resistant properties. An in-depth examination of corrosion mechanisms with vapor present at high temperature is necessary given the industrial trend toward introducing increasing amounts of hydrogen into combustion chambers in order to boost power generation and minimize pollution in contrast to conventional fuels. These superalloys were oxidized in recent tests for 500, 1000, 2000, 3000 and 4000 hours at 982±5°C temperatures with a steady airflow at a flow rate of 10L/min and 1.5 bar pressure. These superalloys were also examined for wet corrosion for 500, 1000, 2000, 3000, and 4000 hours in a combination of air and water vapor flowing at a 10L/min rate. Weight gain, X-ray diffraction (XRD), scanning electron microscopy (SEM), and energy dispersive x-ray spectroscopy (EDS) were used to assess the oxidation and heat corrosion resistance capabilities of these alloys before and after 500, 1000, and 2000 hours. The oxidation/corrosion processes that accompany the formation of these oxide scales are shown in the graph of mass gain vs time. In both dry and wet oxidation, oxides like Al2O3, TiO2, NiCo2O4, Ni3Al, Ni3Ti, Cr2O3, MnCr2O4, CoCr2O4, and certain volatile compounds notably CrO2(OH)2, Cr(OH)3, Fe(OH)2, and Si(OH)4 are formed.

Keywords: hot corrosion, oxidation, turbine materials, high temperature corrosion, super alloys

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Authors: Sherif Sabri, Suzy Fawzi, Sanaa Abdelshafy, Ayman Nagah

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Introduction: Static derangements in lactate homeostasis during ICU stay have become established as a clinically useful marker of increased risk of hospital and ICU mortality. Lactate indices or kinetic alteration of the anaerobic metabolism make it a potential parameter to evaluate disease severity and intervention adequacy. This is an inexpensive and simple clinical parameter that can be obtained by a minimally invasive means. Aim of work: Comparing the predictive value of dynamic indices of hyperlactatemia in the first twenty four hours of intensive care unit (ICU) admission with other static values are more commonly used. Patients and Methods: This study included 40 critically ill patients above 18 years old of both sexes with Hyperlactamia (≥ 2 m mol/L). Patients were divided into septic group (n=20) and low oxygen transport group (n=20), which include all causes of low-O2. Six lactate indices specifically relating to the first 24 hours of ICU admission were considered, three static indices and three dynamic indices. Results: There were no statistically significant differences among the two groups regarding age, most of the laboratory results including ABG and the need for mechanical ventilation. Admission lactate was significantly higher in low-oxygen transport group than the septic group [37.5±11.4 versus 30.6±7.8 P-value 0.034]. Maximum lactate was significantly higher in low-oxygen transport group than the septic group P-value (0.044). On the other hand absolute lactate (mg) was higher in septic group P-value (< 0.001). Percentage change of lactate was higher in the septic group (47.8±11.3) than the low-oxygen transport group (26.1±12.6) with highly significant P-value (< 0.001). Lastly, time weighted lactate was higher in the low-oxygen transport group (1.72±0.81) than the septic group (1.05±0.8) with significant P-value (0.012). There were statistically significant differences regarding lactate indices in survivors and non survivors, whether in septic or low-oxygen transport group. Conclusion: In critically ill patients, time weighted lactate and percent in lactate change in the first 24 hours can be an independent predictive factor in ICU mortality. Also, a rising compared to a falling blood lactate concentration over the first 24 hours can be associated with significant increase in the risk of mortality.

Keywords: critically ill patients, lactate indices, mortality in intensive care, anaerobic metabolism

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Authors: Peter O. Osifo, Hein W. J. P. Neomagus, Hein V. D. Merwe

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Chitosan materials from different sources of raw materials were characterized in order to determine optimal preparation conditions and parameters for membrane production. The membrane parameters such as molecular weight, viscosity, and degree of deacetylation were used to evaluate the membrane performance for zinc ion adsorption. The molecular weight of the chitosan was found to influence the viscosity of the chitosan/acetic acid solution. An increase in molecular weight (60000-400000 kg.kmol-1) of the chitosan resulted in a higher viscosity (0.05-0.65 Pa.s) of the chitosan/acetic acid solution. The effect of the degree of deacetylation on the viscosity is not significant. The effect of the membrane production parameters (chitosan- and acetic acid concentration) on the viscosity is mainly determined by the chitosan concentration. For higher chitosan concentrations, a membrane with a better adsorption capacity was obtained. The membrane adsorption capacity increases from 20-130 mg Zn per gram of wet membrane for an increase in chitosan concentration from 2-7 mass %. Chitosan concentrations below 2 and above 7.5 mass % produced membranes that lack good mechanical properties. The optimum manufacturing conditions including chitosan concentration, acetic acid concentration, sodium hydroxide concentration and crosslinking for chitosan membranes within the workable range were defined by the criteria of adsorption capacity and flux. The adsorption increases (50-120 mg.g-1) as the acetic acid concentration increases (1-7 mass %). The sodium hydroxide concentration seems not to have a large effect on the adsorption characteristics of the membrane however, a maximum was reached at a concentration of 5 mass %. The adsorption capacity per gram of wet membrane strongly increases with the chitosan concentration in the acetic acid solution but remains constant per gram of dry chitosan. The optimum solution for membrane production consists of 7 mass % chitosan and 4 mass % acetic acid in de-ionised water. The sodium hydroxide concentration for phase inversion is at optimum at 5 mass %. The optimum cross-linking time was determined to be 6 hours (Percentage crosslinking of 18%). As the cross-linking time increases the adsorption of the zinc decreases (150-50 mg.g-1) in the time range of 0 to 12 hours. After a crosslinking time of 12 hours, the adsorption capacity remains constant. This trend is comparable to the effect on flux through the membrane. The flux decreases (10-3 L.m-2.hr-1) with an increase in crosslinking time range of 0 to 12 hours and reaches a constant minimum after 12 hours.

Keywords: chitosan, membrane, waste water, heavy metal ions, adsorption

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Authors: Klazina T. Havinga, Hilde R. H. de Geus

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Introduction: Pre-operative coagulation management of Apixaban prescribed patients, a new oral anticoagulant (a factor Xa inhibitor), is difficult, especially when chronic kidney disease (CKD) causes drug overdose. Apixaban is not dialyzable due to its high level of protein binding. An antidote, Andexanet α, is available but expensive and has an unfavorable short half-life. We report the successful extracorporeal removal of Apixaban prior to emergency surgery with the CytoSorb® Hemoadsorption device. Methods: A 89-year-old woman with CKD, with an Apixaban prescription for atrial fibrillation, was presented at the ER with traumatic rib fractures, a flail chest, and an unstable spinal fracture (T12) for which emergency surgery was indicated. However, due to very high Apixaban levels, this surgery had to be postponed. Based on the Apixaban-specific anti-factor Xa activity (AFXaA) measurements at admission and 10 hours later, complete clearance was expected after 48 hours. In order to enhance the Apixaban removal and reduce the time to operation, and therefore reduce pulmonary complications, CRRT with CytoSorb® cartridge was initiated. Apixaban-specific anti-factor Xa activity (AFXaA) was measured frequently as a substitute for Apixaban drug concentrations, pre- and post adsorber, in order to calculate the adsorber-related clearance. Results: The admission AFXaA concentration, as a substitute for Apixaban drug levels, was 218 ng/ml, which decreased to 157 ng/ml after ten hours. Due to sustained anticoagulation effects, surgery was again postponed. However, the AFXaA levels decreased quickly to sub-therapeutic levels after CRRT (Multifiltrate Pro, Fresenius Medical Care, Blood flow 200 ml/min, Dialysate Flow 4000 ml/h, Prescribed renal dose 51 ml-kg-h) with Cytosorb® connected in series into the circuit was initiated (within 5 hours). The adsorber-related (indirect) Apixaban clearance was calculated every half hour (Cl=Qe * (AFXaA pre- AFXaA post/ AFXaA pre) with Qe=plasma flow rate calculated with Ht=0.38 and system blood flow rate 200 ml-min): 100 ml/min, 72 ml/min and 57 ml/min. Although, as expected, the adsorber-related clearance decreased quickly due to saturation of the beads, still the reduction rate achieved resulted in a very rapid decrease in AFXaA levels. Surgery was ordered and possible within 5 hours after Cytosorb initiation. Conclusion: The CytoSorb® Hemoadsorption device enabled rapid correction of Apixaban associated anticoagulation.

Keywords: Apixaban, CytoSorb, emergency surgery, Hemoadsorption

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Authors: Malinee Pongsavee

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Sodium formate is the chemical substance used for food additive. Catalase is the important antioxidative enzyme in protecting the cell from oxidative damage by reactive oxygen species (ROS). The resultant level of oxidative stress in sodium formatetreated lymphocytes was investigated. The sodium formate concentrations of 0.05, 0.1, 0.2, 0.4 and 0.6 mg/mL were treated in human lymphocytes for 12 hours. After 12 treated hours, catalase activity change was measured in sodium formate-treated lymphocytes. The results showed that the sodium formate concentrations of 0.4 and 0.6 mg/mL significantly decreased catalase activities in lymphocytes (P < 0.05). The change of catalase activity in sodium formate-treated lymphocytes may be the oxidative damage marker for detect sodium formate exposure in human.

Keywords: sodium formate, catalase activity, oxidative damage marker, toxicity

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Authors: Abhichet Nobhiwong, Jiraporn Rojtinnakorn, Udomluk Sompong

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Six probiotic strains isolated from Chiang Mai and Chiang Rai province, Thailand; CR1-2, CM3-4, CM5-2, CR7-8, CM10-5 and CM10-8 were used to study their morphology and inhibition activity on three pathogenic bacteria; Aeromonas sp., Streptococcus sp. and Flavobacterium sp. that isolated from infected Nile tilapia. The agar well diffusion technique was applied for 24 and 48 hours incubation. Interestingly, some probiotics showed good inhibition activity both 24 and 48 hours on each 3 bacterial pathogens. The capable inhibiting Aeromonas sp. were CR1-2 and CR5-2 with inhibition diameters of 13.0 mm and 11.2 mm, respectively. For Streptococcus sp., effective probiotics were CR10-2 with inhibition diameters of 10.7 mm. Whereas for Flavobacterium sp., effective probiotics were CR5-2 with inhibition diameter of 9.7 mm. It can be concluded that these probiotics have potentiality to develop as the pathogens biocontrol products. These will be support for safety and organic aquaculture that which the most worthy for people health.

Keywords: probiotics, Aeromanas sp., Streptococcus sp., Flavobacterium sp.

Procedia PDF Downloads 254

Authors: T. C. Ng, R. Radzi, T. K. Ng, H. C. Chen

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The analgesic effects of lidocaine-bupivacaine block in cats undergoing routine orchiectomy were determined in this controlled, randomized, and blinded study. Twelve cats were randomly assigned to two groups. Cats in local block group received subcutaneous infiltration of 1 mg/kg of 2% lidocaine and 1 mg/kg of 0.5% bupivacaine into the scrotal sac. Cats in control group received equivolume of saline. Both groups were induced with mixture of ketamine (15 mg/kg) and acepromazine (0.1 mg/kg) intramuscularly and maintained on sevoflurane via facemask. Non-invasive blood pressures (BP), heart (HR), and respiratory rate (RR) were measured intra-operatively at specific events. Post-operatively, all cats received meloxicam, 0.2 mg/kg subcutaneously. Pain scores were determined at 4, 8, and 24 hours postoperatively. Mechanical pressure thresholds (MPT) at the perineum and metatarsus were determined at 2, 4, 8, and 24 hours postoperatively. Intra-operatively, the BP and HR tended to be higher in the control group. The increment in HR peaked during traction and autoligation of the spermatic cord in the control group. There was no treatment difference in RR. Post-operatively, pain scores in the group given local blocks were lower than the control group at 4 hour post-operation. There was no treatment difference in the post-operative HR, RR, BP and MPT values. In conclusion, subcutaneous infiltration of lidocaine-bupivacaine into the scrotal sac before orchiectomy improved intra-operative hemodynamic stability and provided better analgesia up to 4 hours post-surgery.

Keywords: analgesia, bupivacaine, cat, lidocaine, local block, orchiectomy

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Authors: Muhammad Sufyan, Muhammad D. Gogi, Muhammad Arshad, Ahmad Nawaz, Muhammad Usman

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Cotton (Gossypium hirsutum) universally known as silver fiber and is one of the most important cash crop of Pakistan. A wide array of pests constraints cotton production among which sucking insect pests cause serious losses. Mostly new chemistry insecticides used to control a wide variety of insect pests including sucking insect pests. In the present study efficacy of different neonicotinoids was evaluated against sucking insect pests of cotton in the field and in laboratory for red and dusky cotton bug. The experiment was conducted at Entomology Research Station, University of Agriculture Faisalabad, in a Randomized Complete Block Design (RCBD). Field trial was conducted to evaluate the efficacy of Confidence Ultra (Imidacloprid) 70% SL, Confidor (Imidacloprid) 20% SL, Kendo (Lambda cyhalothrin) 24.7 SC, Actara (Thiamethoxam) 25% WG, Forcast (Tebufenozide+ Emamectin benzoate) 8.8 EW and Timer (Emamectin benzoate) 1.9 EC at their recommended doses. The data was collected on per leaf basis of thrips, aphid, jassid and whitefly before 24 hours of spray. The post treatment data was recorded after 24, 48 and 72 hours. The fresh, non-infested and untreated cotton leaves was collected from the field and brought to the laboratory to assess the efficacy of neonicotinoids against red and dusky cotton bug. After data analysis all the insecticides were found effective against sucking pests. Confidence Ultra was highly effective against the aphid, jassid, and whitefly and gave maximum mortality, while showed non-significant results against thrips. In case of aphid plot which was treated with Kando 24.7 SC showed significant mortality after 72 hours of pesticide application. Similar trends were found in laboratory conditions with all these treatments by making different concentrations and had significant impact on dusky cotton bug and red cotton bug population after 24, 48 and 72 hours after application.

Keywords: cotton, laboratory and field conditions, neonicotinoids, sucking insect pests

Procedia PDF Downloads 217

Authors: Eric Lee G. Escobedo-Wu, Nidhi Rohatgi, Fouzel Dhebar

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It is challenging for patients to navigate through healthcare systems after-hours. This leads to delays in care, patient/provider dissatisfaction, inappropriate resource utilization, readmissions, and higher costs. It is important to provide patients and providers with effective clinical decision-making tools to allow seamless connectivity and coordinated care. In August 2015, patient-centric Stanford Health Care established Clinical Advice Services (CAS) to provide clinical decision support after-hours. CAS is founded on key Lean principles: Value stream mapping, empathy mapping, waste walk, takt time calculations, standard work, plan-do-check-act cycles, and active daily management. At CAS, Clinical Assistants take the initial call and manage all non-clinical calls (e.g., appointments, directions, general information). If the patient has a clinical symptom, the CAS nurses take the call and utilize standardized clinical algorithms to triage the patient to home, clinic, urgent care, emergency department, or 911. Nurses may also contact the on-call physician based on the clinical algorithm for further direction and consultation. Since August 2015, CAS has managed 228,990 calls from 26 clinical specialties. Reporting is built into the electronic health record for analysis and data collection. 65.3% of the after-hours calls are clinically related. Average clinical algorithm adherence rate has been 92%. An average of 9% of calls was escalated by CAS nurses to the physician on call. An average of 5% of patients was triaged to the Emergency Department by CAS. Key learnings indicate that a seamless connectivity vision, cascading, multidisciplinary ownership of the problem, and synergistic enterprise improvements have contributed to this success while striving for continuous improvement.

Keywords: after hours phone calls, clinical advice services, nurse triage, Stanford Health Care

Procedia PDF Downloads 156

Authors: Jalal M. Abdallah

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There is a great problem in testing and investigations the reliability of different type of transformers insulation materials. It summarized in how to create and simulate the real conditions of working transformer and testing its insulation materials for Partial Discharge PD, typically as in the working mode. A lot of tests may give untrue results as the physical behavior of the insulation material differs under tests from its working condition. In this work, the real working conditions were simulated, and a large number of specimens have been tested. The investigations first stage, begin with choosing samples of different types of insulation materials (papers, pressboards, etc.). The second stage, the samples were dried in ovens at 105 C⁰and 0.01bar for 48 hours, and then impregnated with dried and gasless oil (the water content less than 6 ppm.) at 105 C⁰and 0.01bar for 48 hours, after so specimen cooling at room pressure and temperature for 24 hours. The third stage is investigating PD for the samples using ICM PD measuring device. After that, a continuous test on oil-impregnated insulation materials (paper, pressboards) was developed, and the phase resolved partial discharge pattern of PD signals was measured. The important of this work in providing the industrial sector with trusted high accurate measuring results based on real simulated working conditions. All the PD patterns (results) associated with a discharge produced in well-controlled laboratory condition. They compared with other previous and other laboratory results. In addition, the influence of different temperatures condition on the partial discharge activities was studied.

Keywords: transformers, insulation materials, voids, partial discharge

Procedia PDF Downloads 291

Authors: Roberto Cassino, Valeria Dissette, Carlo Alberto Bignozzi, Daniele Pazzi

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Background and Aims: The aim of this work was to investigate, both ‘in vitro’ and ‘in vivo’, if the new SCX technology (SiO2-Ag+Chlorex) can easily defeat infections and it is really more effective than SSD (SilverSulfaDiazine). ‘In vitro’ methods: we tested ‘in vitro’ the effectiveness of both silver materials using a pool of 5 strains: Pseudomonas Aeruginosa, Staphylococcus aureus, Escherichia Coli, Enterococcus hirae and Candida Albicans. 100 µl of this pool have been seeded on Petri dishes and kept for 24 hours in incubation at 37 C°. ‘In vivo’ methods: we enrolled patients with multiple infectious chronic wounds (according with cutting & harding criteria for infection); after a qualitative evaluation of the wounds bacterial population, taking a sample by plug, we included in the study 6 patients for a total of 10 wounds, infected by one or more of the microorganisms used for the ‘in vitro’ test. The protocol consisted of a treatment with a spray powder of SSD every 48 hours for 14 days; in case of worsening we should have to start a new treatment with a spray powder containing silicon dioxide, ionic silver and chlorexidine (SiO2-Ag+Chlorex) every 48 hours for 14 days. We evaluated the number of clinical signs of infection and the disappearance or not of the wound edge erithema. ‘In vitro’ results: SSD demonstrated a wide zone of inhibition within 24 hours, but after 5 days there was no more signs of inhibition; on the contrary SCX had a good inhibition ring that lasted more than 5 days. ‘In vivo’ results: all wounds treated with SSD got worse; the signs of infection increased and the wound edge erithema did not disappear. According with the protocol, we treated then all wounds with SCX and they all improved within the period of observation with complete disappearance of clinical signs of infection and no more wound edge erithema. Conclusions: the study demonstrated the effectiveness of SiO2-Ag+Chlorex, especially in terms of long lasting antimicrobial action. We had the same results ‘in vitro’, so that there has been a perfect correspondence between the laboratory outcomes and the clinical ones.

Keywords: chronic wounds, infections, ionic silver, SSD

Procedia PDF Downloads 305

Authors: Langhit Kurar, Loren Charles

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Introduction: In light of recent BOAST 12 (August 2016) published guidance on management of ankle fractures, the project aimed to highlight key discrepancies throughout the care trajectory from admission to point of discharge at a district general hospital. Wide breadth of data covering three key domains: accident and emergency, radiology, and orthopaedic surgery were subsequently stratified and recommendations on note documentation, and outpatient follow up were made. Methods: A retrospective twelve month audit was conducted reviewing results of ankle fracture management in 37 patients. Inclusion criterion involved all patients seen at Darent Valley Hospital (DVH) emergency department with radiographic evidence of an ankle fracture. Exclusion criterion involved all patients managed solely by nursing staff or having sustained purely ligamentous injury. Medical notes, including discharge summaries and the PACS online radiographic tool were used for data extraction. Results: Cross-examination of the A & E domain revealed limited awareness of the BOAST 12 recent publication including requirements to document skin integrity and neurovascular assessment. This had direct implications as this would have changed the surgical plan for acutely compromised patients. The majority of results obtained from the radiographic domain were satisfactory with appropriate X-rays taken in over 95% of cases. However, due to time pressures within A & E, patients were often left without a post manipulation XRAY in a backslab. Poorly reduced fractures were subsequently left for a long period resulting in swollen ankles and a time-dependent lag to surgical intervention. This had knocked on implications for prolonged inpatient stay resulting in hospital-acquired co-morbidity including pressure sores. Discussion: The audit has highlighted several areas of improvement throughout the disease trajectory from review in the emergency department to follow up as an outpatient. This has prompted the creation of an algorithm to ensure patients with significant fractures presenting to the emergency department are seen promptly and treatment expedited as per recent guidance. This includes timing for X-rays taken in A & E. Re-audit has shown significant improvement in both documentation at time of presentation and appropriate follow-up strategies. Within the orthopedic domain, we are in the process of creating an ankle fracture pathway to ensure imaging and weight bearing status are made clear to the consulting clinicians in an outpatient setting. Significance/Clinical Relevance: As a result of the ankle fracture algorithm we have adapted the BOAST 12 guidance to shape an intrinsic pathway to not only improve patient management within the emergency department but also create a standardised format for follow up.

Keywords: ankle, fracture, BOAST, radiology

Procedia PDF Downloads 162