Search results for: hypercapnic respiratory failure

Authors: In Kyong Yi, Yun Jeong Chae, Jihoon Hwang, Sook-Young Lee, Jong-Yeop Kim

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Background: Pentax airway scope (AWS) is a recently developed video laryngoscope for use in both normal and difficult airways, providing a good laryngeal view. The purpose of this randomized noninferior study was to evaluate the efficacy of the Pentax-AWS regarding intubation time, laryngeal view and ease of intubation in pediatric patients with normal airway, compared to Macintosh laryngoscope. Method: A total of 136 pediatric patients aged 1 to 10 with American Society of Anesthesiologists physical status I or II undergoing general anesthesia required orotracheal intubation were randomly allocated into two groups: Macintosh laryngoscope (n =68) and Pentax AWS (n=68). Anesthesia was induced with propofol, rocuronium, and sevoflurane. The primary outcome was intubation time. Cormack-Lehane laryngeal view grade, application of optimal laryngeal external manipulation (OELM), intubation difficulty scale (IDS), intubation failure rate and adverse events were also measured. Result: No significant difference was observed between the two groups regarding intubation time (Macintosh; 23[22-26] sec vs. Pentax; 23.5[22-27.75] sec, p=0.713). As for the laryngeal view grade, the Pentax group showed less number of grade 2a or higher grade cases compared to the Macintosh group (1/2a/2b/3; 52.9%/41.2%/4.4%/1.5% vs. 98.5%/1.5%/0%/0%, p=0.000). No optimal laryngeal external manipulation application was required in the Pentax group (38.2% vs. 0%, p=0.000). Intubation difficulty scale resulted in lower values for Pentax group (0 [0-2] vs. 0 [0-0.55], p=0.001). Failure rate was not different between the two groups (1.5% vs. 4.4%, p=0.619). Adverse event-wise, slightly higher incidence of bleeding (1.5% vs. 5.9%, p=0.172) and teeth injury (0% vs. 5.9%, p=0.042) occurred in the Pentax group. Conclusion: In conclusion, Pentax-AWS provided better laryngeal view, similar intubation time and similar success rate compared with Macintosh laryngoscope in children with normal airway. However, the risk of teeth injury might increase and warrant special attention.

Keywords: Pentax-AWS, pediatric, video laryngoscope, intubation

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Authors: Gulcan Sahal, Nermin Hande Avcioglu, Isil Seyis Bilkay

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Klebsiella species which are natural colonizers of human upper respiratory and human gastrointestinal tracts are also responsible for every reoccurring nosocomial infections by means of having ability to form slimy layers known as biofilm on many surfaces. Therefore, in this study, investigation of biofilm formation in K. pneumoniae and K. rhinoscleromatis and examination of each Klebsiella strains’ clinical information in the light of their biofilm formation results were aimed. In this respect, biofilm formation of Klebsiella strains was analyzed via crystal violet binding assay. According to our results, biofilm formation levels of K. pneumoniae and K. rhinoscleromatis strains were different from each other. Additionally, in comparison to K. rhinoscleromatis strains, K. pneumoniae was observed to include higher amounts of strong biofilm forming strains. Besides, it was also seen that clinical information of patients from which strong biofilm forming Klebsiella strains were isolated were similar to each other. Our results indicate that there should be more precautions against K. pneumoniae which includes higher amount of strong biofilm forming strains.

Keywords: biofilm formation, Klebsiella pneumoniae, Klebsiella rhinoscleromatis, biosystems engineering

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Authors: Destin Kurniawati

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Asthma is one of the deadly diseases in the world. According to the World Health Organization in 2012, 300 million people suffer from asthma of different races and classes. An estimated 250,000 people die because of asthma annually.As well as more than 57% of children and 51% of adults with asthma. There two risk factors for asthma. That risk factors are the host and environmental. One of the environmental factors that can bring asthma is allergens. When an allergen enters the body, the allergen binds to IgE and cause cell granulat- issued several mediators such as histamine, leukotrienes, bradykinin or something like that. This will cause localized edema effect on bronchial walls of small, thick mucous secretions in the bronchioles, and bronchial smooth muscle spasm. Then there will be inflammation of the airways. Methodology this research is by literature. Therefore, to anticipate and cope with asthma is to control environmental factors that serve to minimize allergens and controlling one's intake in the form of antioxidant-rich foods. Foods rich in antioxidants serve to improve lung function and decrease symptoms of the disease of the respiratory tract.

Keywords: asthma, deadly disease, allergen, environmental and food control

Procedia PDF Downloads 261

Authors: Xie Xiaobin, Zhang Yan, Shi Yipeng, Sun Wenying, Chen Shuang, Cai Zhipeng, Zhang Hong, Zhang Lixia, Xie Like

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Objective: The objective of this research is to compare the efficacy of the late in-situ surgical revision augmented with continuous infusion and needle revision on failed trabeculectomy blebs. Methods From December 2018 to December 2021, a prospective randomized controlled trial was performed on 44 glaucoma patients with failed bleb ≥ 6months with medically uncontrolled in Eye Hospital, China Academy of Chinese Medical Sciences. They were randomly divided into two groups. 22 eyes of 22 patients underwent the late in-situ surgical revision with continuous anterior chamber infusion in the study group, and 22 of 22 patients were treated with needle revision in the control group. Main outcome measures include preoperative and postoperative intraocular pressure (IOP), the number of anti-glaucoma medicines, the operation success rate, and the postoperative complications. Results The postoperative IOP values decreased significantly from the baseline in both groups (both P<0.05). IOP was significantly lower in the study group than in the control group at one week, 1, and 3 months postoperatively (all P<0.05). IOP reductions in the study group were substantially more prominent than in the control group at all postoperative time points (all P<0.05). The complete success rate in the study group was significantly higher than in the control group (71.4% vs. 33.3%, P<0.05), while the complete failure rate was significantly lower in the study group (0% vs. 28.5%, P<0.05). According to Cox’s proportional hazards regression analysis, high IOP at baseline was independently associated with increased risks of complete failure (adjusted hazard ratio=1.141, 95% confidence interval=1.021-1.276, P<0.05). There was no significant difference in the incidence of postoperative complications between the two groups (P>0.05). Conclusion: Both in-situ surgical and needle revision have acceptable success rates and safety for the late failed trabeculectomy blebs, while the former is likely to have a higher level of efficacy over the latter. Needle revision may be insufficient for eyes with low target IOP.

Keywords: glaucoma, trabeculectomy blebs, in-situ surgical revision, needle revision

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Authors: Pranay Mathur, Carlo Michelassi, Simi Karatha, Gilda Pedoto

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Industrial plant uptime is top most importance for reliable, profitable & sustainable operation. Trip and failed start has major impact on plant reliability and all plant operators focussed on efforts required to minimise the trips & failed starts. The performance of these CTQs are measured with 2 metrics, MTBT(Mean time between trips) and SR (Starting reliability). These metrics helps to identify top failure modes and identify units need more effort to improve plant reliability. Baker Hughes Trip reduction program structured to reduce these unwanted trip 1. Real time machine operational parameters remotely available and capturing the signature of malfunction including related boundary condition. 2. Real time alerting system based on analytics available remotely. 3. Remote access to trip logs and alarms from control system to identify the cause of events. 4. Continuous support to field engineers by remotely connecting with subject matter expert. 5. Live tracking of key CTQs 6. Benchmark against fleet 7. Break down to the cause of failure to component level 8. Investigate top contributor, identify design and operational root cause 9. Implement corrective and preventive action 10. Assessing effectiveness of implemented solution using reliability growth models. 11. Develop analytics for predictive maintenance With this approach , Baker Hughes team is able to support customer in achieving their Reliability Key performance Indicators for monitored units, huge cost savings for plant operators. This Presentation explains these approach while providing successful case studies, in particular where 12nos. of LNG and Pipeline operators with about 140 gas compressing line-ups has adopted these techniques and significantly reduce the number of trips and improved MTBT

Keywords: reliability, availability, sustainability, digital infrastructure, weibull, effectiveness, automation, trips, fail start

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Authors: Dileep Kumar, Janhavi Ramchandra Rao Kumar, Rao

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COVID-19 has ravaged the globe, and it is spreading its Spectre day by day. In the absence of established drugs, this disease has created havoc. Some of the infected persons are symptomatic or asymptomatic. The respiratory system, cardiac system, digestive system, etc. in human beings are affected by this virus. In our present investigation, we have undertaken a study of the Indian Ayurvedic herb, Ocimum sanctum against SARS-CoV-2 using molecular docking and dynamics studies. The docking analysis was performed on the Glide module of Schrödinger suite on two different proteins from SARS-CoV-2 viz. NSP15 Endoribonuclease and spike receptor-binding domain. MM-GBSA based binding free energy calculations also suggest the most favorable binding affinities of carvacrol, β elemene, and β caryophyllene with binding energies of −61.61, 58.23, and −54.19 Kcal/mol respectively with spike receptor-binding domain and NSP15 Endoribonuclease. It rekindles our hope for the design and development of new drug candidates for the treatment of COVID19.

Keywords: molecular docking, COVID-19, ocimum sanctum, binding energy

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Authors: Anupama Singh, Papia Raj

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Though Municipal Solid Waste (MSW) is a worldwide problem, yet its implications are enormous in developing countries, as they are unable to provide proper Municipal Solid Waste Management (MSWM) for the large volume of MSW. As a result, the collected wastes are dumped in open dumping at landfilling sites while the uncollected wastes remain strewn on the roadside, many-a-time clogging drainage. Such unsafe and inadequate management of MSW causes various public health hazards. For example, MSW directly on contact or by leachate contaminate the soil, surface water, and ground water; open burning causes air pollution; anaerobic digestion between the piles of MSW enhance the greenhouse gases i.e., carbon dioxide and methane (CO2 and CH4) into the atmosphere. Moreover, open dumping can cause spread of vector borne disease like cholera, typhoid, dysentery, and so on. Patna, the capital city of Bihar, one of the most underdeveloped provinces in India, is a unique representation of this situation. Patna has been identified as the ‘garbage city’. Over the last decade there has been an exponential increase in the quantity of MSW generation in Patna. Though a large proportion of such MSW is recyclable in nature, only a negligible portion is recycled. Plastic constitutes the major chunk of the recyclable waste. The chemical composition of plastic is versatile consisting of toxic compounds, such as, plasticizers, like adipates and phthalates. Pigmented plastic is highly toxic and it contains harmful metals such as copper, lead, chromium, cobalt, selenium, and cadmium. Human population becomes vulnerable to an array of health problems as they are exposed to these toxic chemicals multiple times a day through air, water, dust, and food. Based on analysis of health data it can be emphasized that in Patna there has been an increase in the incidence of specific diseases, such as, diarrhoea, dysentry, acute respiratory infection (ARI), asthma, and other chronic respiratory diseases (CRD). This trend can be attributed to improper MSWM. The results were reiterated through a survey (N=127) conducted during 2014-15 in selected areas of Patna. Random sampling method of data collection was used to better understand the relationship between different variables affecting public health due to exposure to MSW and lack of MSWM. The results derived through bivariate and logistic regression analysis of the survey data indicate that segregation of wastes at source, segregation behavior, collection bins in the area, distance of collection bins from residential area, and transportation of MSW are the major determinants of public health issues. Sustainable recycling is a robust method for MSWM with its pioneer concerns being environment, society, and economy. It thus ensures minimal threat to environment and ecology consequently improving public health conditions. Hence, this paper concludes that sustainable recycling would be the most viable approach to manage MSW in Patna and would eventually reduce public health hazards.

Keywords: municipal solid waste, Patna, public health, sustainable recycling

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Authors: Louis Ngai Yuen Wong, Varun Maruvanchery

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The Bukit Timah Granite, which is a major rock formation in Singapore, encompasses different rock types such as granite, adamellite, and granodiorite with various hybrid rocks. The present study focuses on the Central Singapore Granite found in the Mandai area. Even within this small aerial extent, lithological variations with respect to the composition, texture as well as the grain size have been recognized in this igneous body. Over the years, the research effort on the Bukit Timah Granite has been focused on achieving a better understanding of its engineering properties in association with civil engineering projects. To our best understanding, a few types of research attempted to systematically investigate the influence of grain size, mineral composition, texture etc. on the strength of Bukit Timah Granite rocks in a comprehensive manner. In typical local industry practices, the different lithological varieties are not differentiated, but all are grouped under Bukit Timah Granite during core logging and the subsequent determination of engineering properties. To address such a major gap in the local engineering geological practice, a preliminary study is conducted on the variations of uniaxial compressive strength (UCS) in seven distinctly different lithological varieties found in the Bukit Timah Granite. Other physical properties including Young’s modulus, P-wave velocity and dry density determined from laboratory testing will also be discussed. The study is supplemented by a petrographical thin section examination. In addition, the specimen failure mode is classified and further correlated with the lithological varieties by carefully observing the details of crack initiation, propagation and coalescence processes in the specimens undergoing loading tests using a high-speed camera. The outcome of this research, which is the first of its type in Singapore, will have a direct implication on the sampling and design practices in the field of civil engineering and particularly underground space development in Singapore.

Keywords: Bukit Timah Granite, lithological variety, thin section study, high speed video, failure mode

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Authors: Ali Baker, Russel Krawitz

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This paper describes a rare occurrence where a potentially fatal complication of COVID-19 infection (MIS-A) was misdiagnosed as an acute abdomen. As most patients with this syndrome present with fever and gastrointestinal symptoms, they may inadvertently fall under the care of the surgical unit. However, unusual imaging findings and a poor response to anti-microbial therapy should prompt clinicians to suspect a non-surgical etiology. More than half of MIS-A patients require ICU admission and vasopressor support. Prompt referral to a physician is key, as the cornerstone of treatment is IVIG and corticosteroid therapy. A 32 year old woman presented with right sided abdominal pain and fevers. She had also contracted COVID-19 two months earlier. Abdominal examination revealed generalised right sided tenderness. The patient had raised inflammatory markers, but other blood tests were unremarkable. CT scan revealed extensive lymphadenopathy along the ileocolic chain. The patient proved to be a diagnostic dilemma. She was reviewed by several surgical consultants and discussed with several inpatient teams. Although IV antibiotics were commenced, the right sided abdominal pain, and fevers persisted. Pan-culture returned negative. A mild cholestatic derangement developed. On day 5, the patient underwent preparation for colonoscopy to assess for a potential intraluminal etiology. The following day, the patient developed sinus tachycardia and hypotension that was refractory to fluid resuscitation. That patient was transferred to ICU and required vasopressor support. Repeat CT showed peri-portal edema and a thickened gallbladder wall. On re-examination, the patient was Murphy’s sign positive. Biliary ultrasound was equivocal for cholecystitis. The patient was planned for diagnostic laparoscopy. The following morning, a marked rise in cardiac troponin was discovered, and a follow-up echocardiogram revealed moderate to severe global systolic dysfunction. The impression was post-COVID MIS with myocardial involvement. IVIG and Methylprednisolone infusions were commenced. The patient had a great response. Vasopressor support was weaned, and the patient was discharged from ICU. The patient continued to improve clinically with oral prednisolone, and was discharged on day 17. Although MIS following COVID-19 infection is well-described syndrome in children, only recently has it come to light that it can occur in adults. The exact incidence is unknown, but it is thought to be rare. A recent systematic review found only 221 cases of MIS-A, which could be included for analysis. Symptoms vary, but the most frequent include fever, gastrointestinal, and mucocutaneous. Many patients progress to multi-organ failure and require vasopressor support. 7% succumb to the illness. The pathophysiology of MIS is only partly understood. It shares similarities with Kawasaki disease, macrophage activation syndrome, and cytokine release syndrome. Importantly, by definition, the patient must have an absence of severe respiratory symptoms. It is thought to be due to a dysregulated immune response to the virus. Potential mechanisms include reduced levels of neutralising antibodies and autoreactive antibodies that promote inflammation. Further research into MIS-A is needed. Although rare, this potentially fatal syndrome should be considered in the unwell surgical patient who has recently contracted COVID-19 and poses a diagnostic dilemma.

Keywords: acute-abdomen, MIS, COVID-19, ICU

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Authors: Gautam, Gurcharan Singh, Mandeep Kaur, Yogesh Aggarwal, Sanjeev Naval

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The present ground reality scenario of suffering of humanity shows the evidence of failure to take wrong decisions to shape the civilization with Irresponsibilities in the history. A strong positive will of right responsibilities make the right civilization structure which affects itself and the whole world. Present suffering of humanity shows and reflect the failure of past decisions taken to shape the true culture with right social structure of society, due to unplanned system of Indian civilization and its rapid disaster of population make the failure to face all kind of problems which make the society sufferer. Our India is still suffering from disaster like earthquake, floods, droughts, tsunamis etc. and we face the uncountable disaster of deaths from the beginning of humanity at the present time. In this research paper our focus is to make a Disaster Resistance Structure having the solution of dense populated urban cities area by high vertical expansion HYBRID STRUCTURE. Our efforts are to analyse the Reinforced Concrete Hybrid Structure at different seismic zones, these concrete frames were analyzed using the response spectrum method to calculate and compare the different seismic displacement and drift. Seismic analysis by this method generally is based on dynamic analysis of building. Analysis results shows that the Reinforced Concrete Building at seismic Zone V having maximum peak story shear, base shear, drift and node displacement as compare to the analytical results of Reinforced Concrete Building at seismic Zone III and Zone IV. This analysis results indicating to focus on structural drawings strictly at construction site to make a HYBRID STRUCTURE. The study case is deal with the 10 story height of a vertical expansion Hybrid frame structure at different zones i.e. zone III, zone IV and zone V having the column 0.45x0.36mt and beam 0.6x0.36mt. with total height of 30mt, to make the structure more stable bracing techniques shell be applied like mage bracing and V shape bracing. If this kind of efforts or structure drawings are followed by the builders and contractors then we save the lives during earthquake disaster at Bhuj (Gujarat State, India) on 26th January, 2001 which resulted in more than 19,000 deaths. This kind of Disaster Resistance Structure having the capabilities to solve the problems of densely populated area of cities by the utilization of area in vertical expansion hybrid structure. We request to Government of India to make new plans and implementing it to save the lives from future disasters instead of unnecessary wants of development plans like Bullet Trains.

Keywords: history, irresponsibilities, unplanned social structure, humanity, hybrid structure, response spectrum analysis, DRIFT, and NODE displacement

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Authors: Amirul Adlan, Robert McCulloch, Scott Evans, Michael Parry, Jonathan Stevenson, Lee Jeys

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Background and Objectives: The gastrocnemius myofascial flap is used to manage soft-tissue defects over the anterior aspect of the knee in the context of a patient presenting with a sinus and periprosthetic joint infection (PJI) or extensor mechanism failure. The aim of this study was twofold: firstly, to evaluate the outcomes of gastrocnemius flaps performed by appropriately trained orthopaedic surgeons in the context of PJI and, secondly, to evaluate the infection-free survival of this patient group. Methods: We retrospectively reviewed 30 patients who underwent gastrocnemius flap reconstruction during staged revision total knee arthroplasty for prosthetic joint infection (PJI). All flaps were performed by an orthopaedic surgeon with orthoplastics training. Patients had a mean age of 68.9 years (range 50–84) and were followed up for a mean of 50.4 months (range 2–128 months). A total of 29 patients (97 %) were categorized into Musculoskeletal Infection Society (MSIS) local extremity grade 3 (greater than two compromising factors), and 52 % of PJIs were polymicrobial. The primary outcome measure was flap failure, and the secondary outcome measure was a recurrent infection. Results: Flap survival was 100% with no failures or early returns to theatre for flap problems such as necrosis or haematoma. Overall infection-free survival during the study period was 48% (13 of 27 infected cases). Using limb salvage as the outcome, 77% (23 of 30 patients) retained the limb. Infection recurrence occurred in 48% (10 patients) in the type B3 cohort and 67% (4 patients) in the type C3 cohort (p = 0.65). Conclusion: The surgical technique for a gastrocnemius myofascial flap is reliable and reproducible when performed by appropriately trained orthopaedic surgeons, even in high-risk groups. However, the risks of recurrent infection and amputation remain high within our series due to poor host and extremity factors.

Keywords: gastrocnemius flap, limb salvage, revision arthroplasty, outcomes

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Authors: Mhaned Oubounyt, Jan Baumbach

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Differences in co-expression networks between two or multiple cells (sub)types across conditions is a pressing problem in single-cell RNA sequencing (scRNA-seq). A key challenge is to define those co-variations that differ between or among cell types and/or conditions and phenotypes to examine small regulatory networks that can explain mechanistic differences. To this end, we developed SCANet, an all-in-one Python package that uses state-of-the-art algorithms to facilitate the workflow of a combined single-cell GCN (Gene Correlation Network) and GRN (Gene Regulatory Networks) pipeline, including inference of gene co-expression modules from scRNA-seq, followed by trait and cell type associations, hub gene detection, co-regulatory networks, and drug-gene interactions. In an example case, we illustrate how SCANet can be applied to identify regulatory drivers behind a cytokine storm associated with mortality in patients with acute respiratory illness. SCANet is available as a free, open-source, and user-friendly Python package that can be easily integrated into systems biology pipelines.

Keywords: single-cell, co-expression networks, drug-gene interactions, co-regulatory networks

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Authors: Olugbenga S. Alebiosu, Olusola H. Adekanmbi, Oluwatoyin T. Ogundipe

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Pollen and spores have been identified as major airborne bio-particles inducing respiratory disorders such as asthma, allergic rhinitis and atopic dermatitis among hypersensitive individuals. An aeropalynological study was conducted within a one year sampling period with a view to investigating the monthly depositional rate of atmospheric pollen and spores; influence of the immediate vegetation on airborne pollen distribution; allergenic potentials of dominant atmospheric pollen types at selected study locations in Bauchi and Taraba states, Northwestern Nigeria. A tauber-like pollen trap was employed in aerosampling with the sampler positioned at a height of 5 feet above the ground, followed by a monthly collection of the recipient solution for the sampling period. The collected samples were subjected to acetolysis treatment, examined microscopically with the identification of pollen grains and spores using reference materials and published photomicrographs. Plants within the surrounding vegetation were enumerated. Crude protein contents extracted from pollen types found to be commonly dominant at both study locations; Senna siamea, Terminalia cattapa, Panicum maximum and Zea mays were used to sensitize Musmusculus. Histopathological studies of bronchi and lung sections from certain dead M.musculus in the test groups was conducted. Blood samples were collected from the pre-orbital vein of M.musculus and processed for serological and haematological (differential and total white blood cell counts) studies. ELISA was used in determining the levels of serological parameters: IgE and cytokines (TNF-, IL-5, and IL-13). Statistical significance was observed in the correlation between the levels of serological and haematological parameters elicited by each test group, differences between the levels of serological and haematological parameters elicited by each test group and those of the control, as well as at varying sensitization periods. The results from this study revealed dominant airborne pollen types across the study locations; Syzygiumguineense, Tridaxprocumbens, Elaeisguineensis, Mimosa sp., Borreria sp., Terminalia sp., Senna sp. and Poaceae. Nephrolepis sp., Pteris sp. and a trilete fern also produced spores. This study also revealed that some of the airborne pollen types were produced by local plants at the study locations. Bronchi sections of M.musculus after first and second sensitizations, as well as lung section after first sensitization with Senna siamea, showed areas of necrosis. Statistical significance was recorded in the correlation between the levels of some serological and haematological parameters produced by each test group and those of the control, as well as at certain sensitization periods. The study revealed some candidate pollen allergens at the study locations allergy sufferers and also established a complexity of interaction between immune cells, IgE and cytokines at varied periods of mice sensitization and forming a paradigm of human immune response to different pollen allergens. However, it is expedient that further studies should be conducted on these candidate pollen allergens for their allergenicity potential in humans within their immediate environment.

Keywords: airborne, hypersensitive, mus musculus, pollen allergens, respiratory, tauber-like

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Authors: Saba Rahman, Arvind K. Jain, S. D. Bharti, T. K. Datta

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Chimneys are generally tall and slender structures with circular cross-sections, due to which they are highly prone to wind forces. Wind exerts pressure on the wall of the chimneys, which produces unwanted forces. Vortex-induced oscillation is one of such excitations which can lead to the failure of the chimneys. Therefore, vortex-induced oscillation of chimneys is of great concern to researchers and practitioners since many failures of chimneys due to vortex shedding have occurred in the past. As a consequence, extensive research has taken place on the subject over decades. Many laboratory experiments have been performed to verify the theoretical models proposed to predict vortex-induced forces, including aero-elastic effects. Comparatively, very few proto-type measurement data have been recorded to verify the proposed theoretical models. Because of this reason, the theoretical models developed with the help of experimental laboratory data are utilized for analyzing the chimneys for vortex-induced forces. This calls for reliability analysis of the predictions of the responses of the chimneys produced due to vortex shedding phenomena. Although several works of literature exist on the vortex-induced oscillation of chimneys, including code provisions, the reliability analysis of chimneys against failure caused due to vortex shedding is scanty. In the present study, the reliability analysis of chimneys against vortex shedding failure is presented, assuming the uncertainty in vortex shedding phenomena to be significantly more than other uncertainties, and hence, the latter is ignored. The vortex shedding is modeled as a stationary random process and is represented by a power spectral density function (PSDF). It is assumed that the vortex shedding forces are perfectly correlated and act over the top one-third height of the chimney. The PSDF of the tip displacement of the chimney is obtained by performing a frequency domain spectral analysis using a matrix approach. For this purpose, both chimney and random wind forces are discretized over a number of points along with the height of the chimney. The method of analysis duly accounts for the aero-elastic effects. The double barrier threshold crossing level, as proposed by Vanmarcke, is used for determining the probability of crossing different threshold levels of the tip displacement of the chimney. Assuming the annual distribution of the mean wind velocity to be a Gumbel type-I distribution, the fragility curve denoting the variation of the annual probability of threshold crossing against different threshold levels of the tip displacement of the chimney is determined. The reliability estimate is derived from the fragility curve. A 210m tall concrete chimney with a base diameter of 35m, top diameter as 21m, and thickness as 0.3m has been taken as an illustrative example. The terrain condition is assumed to be that corresponding to the city center. The expression for the PSDF of the vortex shedding force is taken to be used by Vickery and Basu. The results of the study show that the threshold crossing reliability of the tip displacement of the chimney is significantly influenced by the assumed structural damping and the Gumbel distribution parameters. Further, the aero-elastic effect influences the reliability estimate to a great extent for small structural damping.

Keywords: chimney, fragility curve, reliability analysis, vortex-induced vibration

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Authors: L. Kashyap, S. Jha, D. Shende, V. K. Mohan, P. Khanna, A. Aravindan, S. Kashyap, L. Singh, S. Aggarwal

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Obesity is associated with a chronic inflammatory state. During surgery, there is an interplay between anaesthetic and surgical stress vis-a-vis the already present complex immune state. Moreover, the postoperative period is dictated by inflammation, which is crucial for wound healing and regeneration. An excess of inflammatory response might hamper recovery besides increasing the risk for infection and complications. There is definite evidence of the immunosuppressive role of inhaled anaesthetic agents. This immune modulation may be brought into effect directly by influencing the innate and adaptive immunity cells. The effects of propofol on immune mechanisms in has been widely elucidated because of its popularity. It reduces superoxide generation, elastase release, and chemotaxis. However, there is no unequivocal proof of one’s superiority over the other. Hence, an anaesthetic regimen with lesser inflammatory potential and specific to the obese patient is needed. OBESITA trial protocol (2019) by Sousa and co-workers in progress aims to test the hypothesis that anaesthesia with sevoflurane results in a weaker proinflammatory response compared to propofol, as evidenced by lower IL-6 and other biomarkers and an increased macrophage differentiation into M2 phenotype in adipose tissue. IL-6 was used as the objective parameter to evaluate inflammation as it is regulated by both surgery and anesthesia. It is the most sensitive marker of the inflammatory response to tissue damage since it is released within minutes by blood leukocytes. We hypothesized that maintenance of anaesthesia with propofol would lead to less inflammation than that with desflurane. Aims: The effect of two anaesthetic techniques, total intravenous anaesthesia (TIVA) with propofol and desflurane, on surgical stress response was evaluated. The primary objective was to compare serum interleukin-6 (IL-6) levels before and after surgery. Methods: In this prospective single-blinded randomized controlled trial undertaken, 30 obese patients (BMI>30 kg/m2) undergoing laparoscopic bariatric surgery under general anaesthesia were recruited. Patients were randomized to receive desflurane or TIVA using a target-controlled infusion for maintenance of anaesthesia. As a marker of inflammation, pre-and post-surgery IL-6 levels were compared. Results: After surgery, IL-6 levels increased significantly in both groups. The rise in IL-6 was less with TIVA than with desflurane; however, it did not reach significance. IL-6 rise post-surgery correlated positively with the complexity of procedure and duration of surgery and anaesthesia, rather than anaesthetic technique. Both groups did not differ in terms of intra-operative hemodynamic and respiratory variables, time to awakening, postoperative pulmonary complications, and duration of hospital stay. The incidence of nausea was significantly higher with desflurane than with TIVA. Conclusion: Inflammatory response did not differ as a function of anaesthetic technique when propofol and desflurane were compared. Also, patient and surgical variables dictated post-operative inflammation more than the anaesthetic factors. Further, larger sample size is needed to confirm or refute these findings.

Keywords: bariatric, biomarkers, inflammation, laparoscopy

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Authors: Nelson R. Osungbemiro, Rafiu O. Sanni, Rotimi F. Olaniyan, Abayomi O. Olajuyigbe

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Bacteria flora of Clarias gariepinus collected from two natural habitats namely Owena River (freshwater) and Igbokoda lagoon (brackish water) were examined using standard microbiological procedures. Thirteen bacterial species were identified. The result indicated that from the identified bacteria isolated, Vibrio sp, Proteus sp. Shigella sp. and E. coli were present in both habitats (fresh and brackish waters). Others were habitat-selective such as Salmonella sp., Pseudomonas sp, Enterococcus sp, Staphylococcus sp. that were found only in freshwater habitat. While Branhamella sp, Streptococcus sp. and Micrococcus sp. were found in brackish water habitat. Bacteria load from Owena river (freshwater) was found to be the highest load recorded at 6.21 x 104cfu. T-test analysis also revealed that there was a marked significant difference between bacterial load in guts of sampled Clarias from fresh water and brackish water habitats.

Keywords: bacteria flora, gut, Clarias gariepinus, Owena river

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Authors: Lu Yang, Meiyang Song, Xiang Yu, Wenhao Zhou, Chuntao Feng

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To address the problem that the FM continuous-wave radar (FMCW) extracts human vital sign signals which are susceptible to noise interference and low reconstruction accuracy, a new detection scheme for the sign signals is proposed. Firstly, an improved complete ensemble empirical modal decomposition with adaptive noise (ICEEMDAN) algorithm is applied to decompose the radar-extracted thoracic signals to obtain several intrinsic modal functions (IMF) with different spatial scales, and then the IMF components are optimized by a BP neural network improved by immune genetic algorithm (IGA). The simulation results show that this scheme can effectively separate the noise and accurately extract the respiratory and heartbeat signals and improve the reconstruction accuracy and signal-to-noise ratio of the sign signals.

Keywords: frequency modulated continuous wave radar, ICEEMDAN, BP neural network, vital signs signal

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Authors: Francisco Fernandez de Castro

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The Conditional Cash Transfer (CCT) model gives monetary transfers to beneficiary families on the condition that they take specific education and health actions. According to the economic rationale of CCTs the poor need incentives to invest in their human capital because they are trapped by a lack of information and misleading beliefs. If left to their own decision, the poor will not be able to choose what is in their best interests. The basic assumption of the CCT model is that the poor need incentives to take care of their own education and health-nutrition. Due to the incentives (income cash transfers and conditionalities), beneficiary families are supposed to attend doctor visits and health talks. Children would stay in the school. These incentivized behaviors would produce outcomes such as better health and higher level of education, which in turn will reduce poverty. Based on a grounded theory approach to conduct a two-year period of qualitative data collection in northern Mexico, this study shows that this explanation is incomplete. In addition to the information failure and inadequate beliefs, there are structural barriers in everyday life of households that make health-nutrition and education investments difficult. In-depth interviews and observation work showed that the program takes for granted local conditions in which beneficiary families should fulfill their co-responsibilities. Data challenged the program’s assumptions and unveiled local obstacles not contemplated in the program’s design. These findings have policy and research implications for the CCT agenda. They bring elements for late programming due to the gap between the CCT strategy as envisioned by policy designers, and the program that beneficiary families experience on the ground. As for research consequences, these findings suggest new avenues for scholarly work regarding the causal mechanisms and social processes explaining CCT outcomes.

Keywords: conditional cash transfers, incentives, poverty, structural barriers

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Authors: Ntandazo Dlatu, Benjamin Longo-Mbenza, Andre Renzaho, Ruffin Appalata, Yolande Yvonne Valeria Matoumona Mavoungou, Mbenza Ben Longo, Kenneth Ekoru, Blaise Makoso, Gedeon Longo Longo

Abstract:

Background: The gap between complexities related to the integration of Tuberculosis /HIV control and evidence-based knowledge motivated the initiation of the study. Therefore, the objective of this study was to explore correlations between national TB management guidelines, multiple deprivation indexes, quantiles, components and levels of Tuberculosis control programme using mathematical modeling in rural O.R. Tambo District Health Facilities, South Africa. Methods: The study design used mixed secondary data analysis and cross-sectional analysis between 2009 and 2013 across O.R Tambo District, Eastern Cape, South Africa using univariate/ bivariate analysis, linear multiple regression models, and multivariate discriminant analysis. Health inequalities indicators and component of an impediment to the tuberculosis control programme were evaluated. Results: In total, 62 400 records for TB notification were analyzed for the period 2009-2013. There was a significant but negative between Financial Year Expenditure (r= -0.894; P= 0.041) Seropositive HIV status(r= -0.979; P= 0.004), Population Density (r = -0.881; P= 0.048) and the number of TB defaulter in all TB cases. It was shown unsuccessful control of TB management program through correlations between numbers of new PTB smear positive, TB defaulter new smear-positive, TB failure all TB, Pulmonary Tuberculosis case finding index and deprivation-concentration-dispersion index. It was shown successful TB program control through significant and negative associations between declining numbers of death in co-infection of HIV and TB, TB deaths all TB and SMIAD gradient/ deprivation-concentration-dispersion index. The multivariate linear model was summarized by unadjusted r of 96%, adjusted R2 of 95 %, Standard Error of estimate of 0.110, R2 changed of 0.959 and significance for variance change for P=0.004 to explain the prediction of TB defaulter in all TB with equation y= 8.558-0.979 x number of HIV seropositive. After adjusting for confounding factors (PTB case finding the index, TB defaulter new smear-positive, TB death in all TB, TB defaulter all TB, and TB failure in all TB). The HIV and TB death, as well as new PTB smear positive, were identified as the most important, significant, and independent indicator to discriminate most deprived deprivation index far from other deprivation quintiles 2-5 using discriminant analysis. Conclusion: Elimination of poverty such as overcrowding, lack of sanitation and environment of highest burden of HIV might end the TB threat in O.R Tambo District, Eastern Cape, South Africa. Furthermore, ongoing adequate budget comprehensive, holistic and collaborative initiative towards Sustainable Developmental Goals (SDGs) is necessary for complete elimination of TB in poor O.R Tambo District.

Keywords: tuberculosis, HIV/AIDS, success, failure, control program, health inequalities, South Africa

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Authors: Ezana Haddis Weldeghebrael

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Addis Ababa City Administration is engaged in a massive facelift of the inner-city. The paper, therefore, aims to analyze the challenges of the current urban regeneration effort by paying special attention to Lideta and Basha Wolde Chilot projects. To this end, the paper has adopted a documentary research strategy to collect the data and Institutionalist perspective as well as the concept of urban regeneration to analyze the data. The sources were selected based on relevance and recency. Academic research outputs were used primarily. However, where much scholastic publications are not available institutional reports, newspaper articles, and expert presentations were used. The major findings of the research revealed that although the second generation of urban redevelopment projects have attempted to involve affected groups and succeeded in designing better neighborhoods, they are riddled with three major drawbacks. The first one is institutional constraints, i.e. absence of urban redevelopment strategy as well as housing policy, broad definition of ‘public purpose’, little regard for informal businesses, limitation on rights groups, negotiation power not devolved at sub-city level and no plan for groups that cannot afford to pay the down payment for low-cost apartments. The second one is planning limitation, i.e. absence of genuine affected group participation as well as consultative level of public engagement. The third one is implementation failure, i.e. no regard to maintaining social bond, non-participatory and ill-informed resettlement, interference from senior government officials, failure to protect the poor from speculators, corruption and disregard to heritage buildings. Based on the findings, the paper concluded that the current inner-city redevelopment has failed to be socially sustainable and calls for enactment of housing policy as well as redevelopment strategy, affected group participation, on-site resettlement, empowering the Sub-city to manage the project and allowing housing rights groups to advocate for the poor slum dwellers.

Keywords: participation, redevelopment, planning, implementation, consultation

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Authors: Volkmar Nolting

Abstract:

Fatigue crack growth prediction has become an important topic in both engineering and non-destructive evaluation. Crack propagation is influenced by the mechanical properties of the material and is conveniently modelled by the Paris-Erdogan equation. The critical crack size and the total number of load cycles are calculated. From a Larson-Miller plot the maximum operational temperature can for a given stress level be determined so that failure does not occur within a given time interval t. The study is used to determine a reasonable inspection cycle and thus enhances operational safety and reduces costs.

Keywords: fracturemechanics, crack growth prediction, lifetime of a component, structural health monitoring

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Authors: S. Ramteke, K. S. Patel

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Aerosols are complex mixture of particulate matters (PM) inclusive of carbons, silica, elements, various salts, etc. Aerosols get deep into the human lungs and cause a broad range of health effects, in particular, respiratory and cardiovascular illnesses. They are one of the major culprits for the climate change. They are emitted by the high thermal processes i.e. vehicles, steel, sponge, cement, thermal power plants, etc. Raipur (22˚33'N to 21˚14'N and 82˚6'E) to 81˚38'E) is a growing industrial city in central India with population of two million. In this work, the distribution of inorganics (i.e. Cl⁻, NO³⁻, SO₄²⁻, NH₄⁺, Na⁺, K⁺, Mg²⁺, Ca²⁺, Al, Cr, Mn, Fe, Ni, Cu, Zn, and Pb) associated to the PM in the ambient air is described. The PM₁₀ in ambient air of Raipur city was collected for duration of one year (December 2014 - December 2015). The PM₁₀ was segregated into nine modes i.e. PM₁₀.₀₋₉.₀, PM₉.₀₋₅.₈, PM₅.₈₋₄.₇, PM₄.₇₋₃.₃, PM₃.₃₋₂.₁, PM₂.₁₋₁.₁, PM₁.₁₋₀.₇, PM₀.₇₋₀.₄ and PM₀.₄ to know their emission sources and health hazards. The analysis of ions and metals was carried out by techniques i.e. ion chromatography and TXRF. The PM₁₀ concentration (n=48) was ranged from 100-450 µg/m³ with mean value of 73.57±20.82 µg/m³. The highest concentration of PM₄.₇₋₃.₃, PM₂.₁₋₁.₁, PM₁.₁₋₀.₇ was observed in the commercial, residential and industrial area, respectively. The effect of meteorology i.e. temperature, humidity, wind speed and wind direction in the PM₁₀ and associated elemental concentration in the air is discussed.

Keywords: ambient aerosol, ions, metals, segregation

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Authors: Farrah Putri Salmanida, Mei-Li Wu, Rika Wahyuningtyas, Wen-Bin Chung, Hso-Chi Chaung, Ko-Tung Chang

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Within the field of immunotherapy, oncolytic virotherapy (OVT) employs dual approaches that directly eliminate tumor cells while preserving healthy ones and indirectly reprogram the tumor microenvironment (TME) to elicit antitumor responses. Within the TME, tumor associated macrophages (TAMs) manifest characteristics akin to those of anti-inflammatory M2 macrophages, thus earning the designation of M2-like TAMs. In prior research, two antigens denoted as A1 (g6Ld10T) and A3 (ORF6L5), derived from a complete sequence of ORF5 with partial sequence of ORF6 in Porcine Reproductive and Respiratory Syndrome Virus Genotype 2 (PRRSV-2), demonstrated the capacity to repolarize M2-type porcine alveolar macrophages (PAMs) into M1 phenotypes. In this study, we sought for utilizing OVT strategies by introducing A1 or A3 on TAMs to endow them with the anti-tumor traits of M1 macrophages while retaining their capacity to target cancer cells. Upon exposing human THP-1-derived M2 macrophages to a cross-species test with 2 µg/ml of either A1 or A3 for 24 hours, real time PCR revealed that A3, but not A1, treated cells exhibited upregulated gene expressions of M1 markers (CCR7, IL-1ß, CCL2, Cox2, CD80). These cells reacted to virus-derived antigen, as evidenced by increased expression of pattern-recognition receptors TLR3, TLR7, and TLR9, subsequently providing feedback in the form of type I interferon responses like IFNAR1, IFN-ß, IRF3, IRF7, OAS1, Mx1, and ISG15. Through an MTT assay, only after 15 µg/ml of A3 treatment could the cell viability decrease, with a predicted IC50 of 16.96 µg/ml. Interestingly, A3 caused dose-dependent toxicity to a rat C6 glial cancer cell line even at doses as low as 2.5 µg/ml and reached its IC50 at 9.419 µg/ml. Using Annexin V/7AAD staining and PCR test, we deduced that a significant proportion of C6 cells were undergoing the early apoptosis phase predominantly through the intrinsic apoptosis cascade involving Bcl-2 family proteins. Following this stage, we conducted a test on A3’s repolarization ability, which revealed a significant rise in M1 gene expression markers, such as TNF, CD80, and IL-1ß, in M2-like TAMs generated in vitro from murine RAW264.7 macrophages grown with conditioned medium of 4T1 breast cancer cells. This was corroborated by the results of transcriptome analysis, which revealed that the primary subset among the top 10 to top 30 significantly upregulated differentially expressed genes (DEGs) dominantly consisted of M1 macrophages profiles, including Ccl3, Ccl4, Csf3, TNF, Bcl6b, Stc1, and Dusp2. Our findings unveiled the remarkable potential of the PRRSV-derived antigen A3 to repolarize macrophages while also being capable of selectively inducing apoptosis in cancerous cells. While further in vivo study is needed for A3, it holds promise as an adjuvant by its dual effects in cancer therapy modalities.

Keywords: cancer cell apoptosis, interferon responses, macrophage repolarization, recombinant protein

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Authors: Qian Zhang, Dongkai Shen, Yan Shi

Abstract:

A new mechanical ventilator with automatic secretion clearance function can improve the secretion clearance safely and efficiently. However, in recent modeling studies on various mechanical ventilators, it was considered that human had one lung, and the coupling effect of double lungs was never illustrated. In this paper, to expound the coupling effect of double lungs, a mathematical model of a ventilation system of a bi-level positive airway pressure (BiPAP) controlled ventilator with secretion clearance was set up. Moreover, an experimental study about the mechanical ventilation system of double lungs on BiPAP ventilator was conducted to verify the mathematical model. Finally, the coupling effect of double lungs of the mathematical ventilation was studied by simulation and orthogonal experimental design. This paper adds to previous studies and can be referred to optimization methods in medical researches.

Keywords: double lungs, coupling effect, secretion clearance, orthogonal experimental design

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Authors: Kavyadevi N., Kaviya G., Gowsalya P., Janani M., Mohanraj S.

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Hevea brasiliensis, also known as the rubber tree, is one of the foremost assets of crops in the world. One of the most significant advantages of the Rubber Plant in terms of air oxygenation is its capacity to reduce the likelihood of an individual developing respiratory allergies like asthma. To construct such a system that can properly identify crop diseases and pests and then create a database of insecticides for each pest and disease, we must first give treatment for the illness that has been detected. We shall primarily examine three major leaf diseases since they are economically deficient in this article, which is Bird's eye spot, algal spot and powdery mildew. And the recommended work focuses on disease identification on rubber tree leaves. It will be accomplished by employing one of the superior algorithms. Input, Preprocessing, Image Segmentation, Extraction Feature, and Classification will be followed by the processing technique. We will use time-consuming procedures that they use to detect the sickness. As a consequence, the main ailments, underlying causes, and signs and symptoms of diseases that harm the rubber tree are covered in this study.

Keywords: image processing, python, convolution neural network (CNN), machine learning

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Authors: Alexandra K. Diem, Giles Richardson, Roxana O. Carare, Neil W. Bressloff

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Alzheimer's disease (AD) is the most common form of dementia and although it has been researched for over 100 years, there is still no cure or preventive medication. Its onset and progression is closely related to the accumulation of the neuronal metabolite Aβ. This raises the question of how metabolites and waste products are eliminated from the brain as the brain does not have a traditional lymphatic system. In recent years the rapid uptake of Aβ into cerebral artery walls and its clearance along those arteries towards the lymph nodes in the neck has been suggested and confirmed in mice studies, which has led to the hypothesis that interstitial fluid (ISF), in the basement membranes in the walls of cerebral arteries, provides the pathways for the lymphatic drainage of Aβ. This mechanism, however, requires a net reverse flow of ISF inside the blood vessel wall compared to the blood flow and the driving forces for such a mechanism remain unknown. While possible driving mechanisms have been studied using mathematical models in the past, a mechanism for net reverse flow has not been discovered yet. Here, we aim to address the question of the driving force of this reverse lymphatic drainage of Aβ (also called perivascular drainage) by using multi-scale numerical and analytical modelling. The numerical simulation software COMSOL Multiphysics 4.4 is used to develop a fluid-structure interaction model of a cerebral artery, which models blood flow and displacements in the artery wall due to blood pressure changes. An analytical model of a layer of basement membrane inside the wall governs the flow of ISF and, therefore, solute drainage based on the pressure changes and wall displacements obtained from the cerebral artery model. The findings suggest that an active role in facilitating a reverse flow is played by the components of the basement membrane and that stiffening of the artery wall during age is a major risk factor for the impairment of brain lymphatics. Additionally, our model supports the hypothesis of a close association between cerebrovascular diseases and the failure of perivascular drainage.

Keywords: Alzheimer's disease, artery wall mechanics, cerebral blood flow, cerebral lymphatics

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Authors: Jozef Jurcik, Miroslav Gutten, Milan Sebok, Daniel Korenciak, Jerzy Roj

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The paper presents the research results of electronic fuel injection system, which can be used for diagnostics of automotive systems. In the paper is described the construction and operation of a typical fuel injection system and analyzed its electronic part. It has also been proposed method for the detection of the injector malfunction, based on the analysis of differential current or voltage characteristics. In order to detect the fault state, it is needed to use self-learning process, by the use of an appropriate self-learning algorithm.

Keywords: electronic fuel injector, diagnostics, measurement, testing device

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Authors: Jovian Cheung, Thomas Kwok, Victor Wong

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Buildings are entwined with smart city developments. Building performance relies heavily on electrical and mechanical (E&M) systems and services accounting for about 40 percent of global energy use. By cohering the advancement of technology as well as energy and operation-efficient initiatives into the buildings, people are enabled to raise building performance and enhance the sustainability of the built environment in their daily lives. Digital transformation in the buildings is the profound development of the city to leverage the changes and opportunities of digital technologies To optimize the building performance, intelligent power quality and energy management system is developed for transforming data into actions. The system is formed by interfacing and integrating legacy metering and internet of things technologies in the building and applying big data techniques. It provides operation and energy profile and actionable insights of a building, which enables to optimize the building performance through raising people awareness on E&M services and energy consumption, predicting the operation of E&M systems, benchmarking the building performance, and prioritizing assets and energy management opportunities. The intelligent power quality and energy management system comprises four elements, namely the Integrated Building Performance Map, Building Performance Dashboard, Power Quality Analysis, and Energy Performance Analysis. It provides predictive operation sequence of E&M systems response to the built environment and building activities. The system collects the live operating conditions of E&M systems over time to identify abnormal system performance, predict failure trends and alert users before anticipating system failure. The actionable insights collected can also be used for system design enhancement in future. This paper will illustrate how intelligent power quality and energy management system provides operation and energy profile to optimize the building performance and actionable insights to revitalize an existing building into a smart building. The system is driving building performance optimization and supporting in developing Hong Kong into a suitable smart city to be admired.

Keywords: intelligent buildings, internet of things technologies, big data analytics, predictive operation and maintenance, building performance

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Authors: Peter Balco, Miriam Filipova

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The university education is generally concentrated on acquiring theoretical as well as professional knowledge. The right mix of these knowledges is key in creating innovative as well as inventive solutions. Despite the understanding of their importance by the professional community, these are promoted with problems and misunderstanding. The reason for the failure of many non-traditional, innovative approaches is the ignorance of Leadership in the process of their implementation, ie decision-making. In our paper, we focused on the role of Leadership in the educational process and how this knowledge can support decision-making, the selection of a suitable, optimal solution for practice.

Keywords: leadership, soft skills, innovation, invention, knowledge

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Authors: B. S. Premalatha, Kausalya Sahani

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Background: Glomus jugulare tumors arise within the jugular foramen and are commonly seen in females particularly on the left side. Surgical excision of the tumor may cause lower cranial nerve deficits. Cranial nerve involvement produces hoarseness of voice, slurred speech, and dysphagia along with other physical symptoms, thereby affecting the quality of life of individuals. Though oncological clearance is mainly emphasized on while treating these individuals, little importance is given to their communication, voice and swallowing problems, which play a crucial part in daily functioning. Objective: To examine the functions of voice, speech and swallowing outcomes of the subjects, following excision of glomus jugulare tumor. Methods: Two female subjects aged 56 and 62 years had come with a complaint of change in voice, inability to swallow and reduced clarity of speech following surgery for left glomus jugulare tumor were participants of the study. Their surgical information revealed multiple cranial nerve palsies involving the left facial, left superior and recurrent branches of the vagus nerve, left pharyngeal, left soft palate, left hypoglossal and vestibular nerves. Functional outcomes of voice, speech and swallowing were evaluated by perceptual and objective assessment procedures. Assessment included the examination of oral structures and functions, dysarthria by Frenchey dysarthria assessment, cranial nerve functions and swallowing functions. MDVP and Dr. Speech software were used to evaluate acoustic parameters of voice and quality of voice respectively. Results: The study revealed that both the subjects, subsequent to excision of glomus jugulare tumor, showed a varied picture of affected oral structure and functions, articulation, voice and swallowing functions. The cranial nerve assessment showed impairment of the vagus, hypoglossal, facial and glossopharyngeal nerves. Voice examination indicated vocal cord paralysis associated with breathy quality of voice, weak voluntary cough, reduced pitch and loudness range, and poor respiratory support. Perturbation parameters as jitter, shimmer were affected along with s/z ratio indicative of voice fold pathology. Reduced MPD(Maximum Phonation Duration) of vowels indicated that disturbed coordination between respiratory and laryngeal systems. Hypernasality was found to be a prominent feature which reduced speech intelligibility. Imprecise articulation was seen in both the subjects as the hypoglossal nerve was affected following surgery. Injury to vagus, hypoglossal, gloss pharyngeal and facial nerves disturbed the function of swallowing. All the phases of swallow were affected. Aspiration was observed before and during the swallow, confirming the oropharyngeal dysphagia. All the subsystems were affected as per Frenchey Dysarthria Assessment signifying the diagnosis of flaccid dysarthria. Conclusion: There is an observable communication and swallowing difficulty seen following excision of glomus jugulare tumor. Even with complete resection, extensive rehabilitation may be necessary due to significant lower cranial nerve dysfunction. The finding of the present study stresses the need for involvement of as speech and swallowing therapist for pre-operative counseling and assessment of functional outcomes.

Keywords: functional outcome, glomus jugulare tumor excision, multiple cranial nerve impairment, speech and swallowing

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