Search results for: micro and macrovascular complications

Authors: N. Gigauri, V. Kukhalashvili, A. Surmava, L. Intskirveli, L. Gverdtsiteli

Abstract:

Tbilisi, a large city of the South Caucasus, is a junction point connecting Asia and Europe, Russia and republics of the Asia Minor. Over the last years, its atmosphere has been experienced an increasing anthropogenic load. Numerical modeling method is used for study of Tbilisi atmospheric air pollution. By means of 3D non-linear non-steady numerical model a peculiarity of city atmosphere pollution is investigated during background western light air. Dust concentration spatial and time changes are determined. There are identified the zones of high, average and less pollution, dust accumulation areas, transfer directions etc. By numerical modeling, there is shown that the process of air pollution by the dust proceeds in four stages, and they depend on the intensity of motor traffic, the micro-relief of the city, and the location of city mains. In the interval of time 06:00-09:00 the intensive growth, 09:00-15:00 a constancy or weak decrease, 18:00-21:00 an increase, and from 21:00 to 06:00 a reduction of the dust concentrations take place. The highly polluted areas are located in the vicinity of the city center and at some peripherical territories of the city, where the maximum dust concentration at 9PM is equal to 2 maximum allowable concentrations. The similar investigations conducted in case of various meteorological situations will enable us to compile the map of background urban pollution and to elaborate practical measures for ambient air protection.

Keywords: air pollution, dust, numerical modeling, urban

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Authors: Jarmila Štěpánová, Martin Kudláček, Lukáš Jakubec

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The people with spinal cord injury are one of the least sport active members of our society. Their hypoactivity is determined by primary injury, i.e., the loss of motor function, the injured part of the body is connected with health complications and social handicap. Study performs one part of the standardization process of semi-structured interview PARA-SCI.CZ (Czech version of the Physical Activity Recall Assessment for People with Spinal Cord Injury), which measures the type, frequency, duration, and intensity of physical activity of people with spinal cord injury. The study focused on persons with paraplegia who use a wheelchair as their primary mode of mobility. The aim of this study was to perform a process to determine the criterion validity of PARA-SCI.CZ. The actual physical activity of wheelchair users was monitored during three days by using accelerometers Actigraph GT3X fixed on the non-dominant wrist, and semi-structured interview PARA-SCI.CZ. During the PARA-SCI.CZ interview, participants were asked to recall activities they had done over the past 3 days, starting with the previous day. PARA-SCI.CZ captured frequency, duration, and intensity (low, moderate, and heavy) of two categories of physical activity (leisure time physical activity and activities of a usual day). Accelerometer Actigraph GT3X captured duration and intensity (low and moderate + heavy) of physical activity during three days and nights. The study presented three potential recalculations of measured data. Standardization process of PARA-SCI.CZ is essential to critically approach issues of health and active lifestyle of persons with spinal cord injury in the Czech Republic. Standardized PARA-SCI.CZ can be used in practice by physiotherapists and sports pedagogues from the field of adapted physical activities.

Keywords: physical activity, lifestyle, paraplegia, semi-structure interview, accelerometer

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Authors: Najade Sheriff, Malaz Elsaddig, Kevin Jones

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Background: Death in the first month of life accounts for an increasing proportion of under-five mortality. Advancement to reduce this number is being made across the globe; however, progress is slowest in sub-Saharan Africa. Objectives: The study aims to identify differences between neonatal deaths of inpatient babies born in a hospital facility in rural Uganda to those of neonates admitted from the community and to explore whether they can be used to risk stratify neonatal admissions. Results: A retrospective chart review was conducted on records for neonates admitted to the Special Care Baby Unit (SCBU) Kitovu Hospital from 1st July 2016 to 21st July 2017. A total of 442 babies were admitted and the overall neonatal mortality was 24.8% (40% inpatient, 37% community, 23% hospital referrals). 40% of deaths occurred within 24 hours of admission and the majority were male (63%). 43% of babies were hypothermic upon admission, a significantly greater proportion of which were inpatient babies born in labour ward (P=0.0025). Intrapartum related death accounted for ½ of all inpatient babies whereas complications of prematurity were the predominant cause of death in the community group (37%). Severe infection does not seem like a significant factor of mortality for inpatients (2%) as it does for community admissions (29%). Furthermore, with 52.5% of community admissions weighing < 1500g, very low birth weight (VLBW) may be a significant risk factor for community neonatal death. Conclusion: The neonatal mortality rate in this study is high, and the leading causes of death are all largely preventable. A high rate of inpatient birth asphyxiation indicates the need for good quality facility-based perinatal care as well as a greater focus on the management of hypothermia, such as Kangaroo care. Moreover, a reduction in preterm deliveries is necessary to reduce associated comorbidities, and monitoring for signs of infection is especially important for community admissions.

Keywords: community, mortality, newborn, Uganda

Procedia PDF Downloads 191

Authors: Gurjit Singh, Gurmail Singh

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The shape of microchannels in microchannel heat sinks can have a significant impact on both heat transfer and fluid flow properties. Heat Transfer, pressure drop, and Some effects of microchannel shape on these properties. The shape of microchannels can affect the heat transfer performance of microchannel heat sinks. Channels with rectangular or square cross-sections typically have higher heat transfer coefficients compared to circular channels. This is because rectangular or square channels have a larger wetted perimeter per unit cross-sectional area, which enhances the heat transfer from the fluid to the channel walls. The shape of microchannels can also affect the pressure drop across the heat sink. Channels with a rectangular cross-section usually have higher pressure drop than circular channels. This is because the corners of rectangular channels create additional flow resistance, which leads to a higher pressure drop. Overall, the shape of microchannels in microchannel heat sinks can have a significant impact on the heat transfer and fluid flow properties of the heat sink. The optimal shape of microchannels depends on the specific application and the desired balance between heat transfer performance and pressure drop.

Keywords: heat transfer, microchannel heat sink, pressure drop, chape of microchannel

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Authors: Maryam Rasool, Farhan Munir, Fahad Nawaz, Saad Ahmad

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A patch antenna operating in the Ultra-Wide Band of frequency (3.1 GHz – 10.6 GHz) is designed with enhanced security from interference from other applications by incorporating the notching technique. Patch antennas in the Ultra-Wide Band are becoming widely famous due to their low power, light weight and high data rate capability. Micro strip patch antenna’s patch can be altered to increase its bandwidth and introduce UWB character in it. The designed antenna is a patch antenna consisting of a conductive sheet of metal mounted over a large sheet of metal called the ground plane with a substrate separating the two. Notched bands are public safety WLAN, WLAN and FSS. Different techniques used to implement the UWB antenna were individually implemented and there results were examined. V shaped patch was then chosen and modified to an arrow shaped patch to give the optimized results operating on the entire UWB region with considerable return loss. The frequency notch prevents the operation of the antenna at a particular range of frequency, hence minimizing interference from other systems. There are countless techniques for introducing the notch but we have used inverted C-shaped slots in the UWB patch to get the notch characteristics as output and also wavelength resonators to introduce notch in UWB band. The designed antenna is simulated in High Frequency Structural Simulator (HFSS) 13.0 by Ansoft.

Keywords: HFSS, Notch, UWB, WLAN

Procedia PDF Downloads 417

Authors: Elisa Maître

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The redeployment of tram networks in French cities has considerably modified public spaces and the way citizens use them. Above and beyond the image that trams have of contributing to the sustainable urban development, the question of safety for users in these spaces has not been studied much. This study is based on an analysis of use of public spaces laid out for trams, from the standpoint of legibility and safety concerns. The study also examines to what extent the complexity of the design process, with many interactions between numerous and varied players in this process has a role in the genesis of these problems. This work is mainly based on the analysis of links between the uses of these re-designed public spaces (through observations, interviews of users and accident studies) and the analysis of the design conditions and processes of the projects studied (mainly based on interviews with the actors of these projects). Practical analyses were based three points of view: that of the planner, that of the user (based on observations and interviews) and that of the road safety expert. The cities of Montpellier, Marseille and Nice are the three fields of study on which the demonstration of this thesis is based. On part, the results of this study allow showing that the insertion of tram poses some problems complication of public areas of French cities. These complications related to the restructuring of public spaces for the tram, create difficulties of use and safety concerns. On the other hand, interviews depth analyses, fully transcribed, have led us to develop particular dysfunction scenarios in the design process. These elements lead to question the way the legibility and safety of these new forms of public spaces are taken into account. Then, an in-depth analysis of the design processes of public spaces with trams systems would also be a way of better understanding the choices made, the compromises accepted, and the conflicts and constraints at work, weighing on the layout of these spaces. The results presented concerning the impact that spaces laid out for trams have on the difficulty of use, suggest different possibilities for improving the way in which safety for all users is taken into account in designing public spaces.

Keywords: public spaces, road layout, users, design process of urban projects

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Authors: Liping Wu, Durga Bhakta Pokharel, Junhua Dong, Changgang Wang, Lin Zhao, Wei Ke, Nan Chen

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Hazenite conversion coating was deposited on AZ31 Mg alloy in a deaerated phosphate solution containing 0.1 M K₂HPO₄ and 0.1 M Na₂HPO₄ (Na₀.₁K0₀.₁) with pH 9 at −0.8 V. The coating mechanism of hazenite was elucidated by in situ potentiostatic current decay, scanning electron microscopy (SEM), energy dispersive X-ray spectroscopy (EDS), X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS), Fourier transform infrared spectroscopy (FT-IR), electron probe micro-analyzer (EPMA) and differential scanning calorimetry (DSC). The volume of H₂ evolved during potentiostatic polarization was measured by a gas collection apparatus. The degradation resistance of the hazenite coating was evaluated in simulated body fluid (SBF) at 37℃ by using potentiodynamic polarization (PDP). The results showed that amorphous Mg(OH)₂ was deposited first, followed by the transformation of Mg(OH)₂ to amorphous MgHPO₄, subsequently the conversion of MgHPO₄ to crystallized K-struvite (KMgPO₄·6H₂O), finally the crystallization of crystallized hazenite (NaKMg₂(PO₄)₂·14H₂O). The deposited coating was composed of four layers where the inner layer is comprised of Mg(OH)₂, the middle layer of Mg(OH)₂ and MgHPO₄, the top layer of Mg(OH)₂, MgHPO₄ and K-struvite, the topmost layer of Mg(OH)₂, MgHPO₄, K-struvite and hazenite (NaKMg₂(PO₄)₂·14H₂O). The PD results showed that the hazenite coating decreased the corrosion rate by two orders of magnitude.

Keywords: magnesium alloy, potentiostatic technique, hazenite, mineral conversion coating

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Authors: Rahaf Mandura

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Background: Idiopathic intracranial hypertension (IIH) is a disorder with elevated intracranial pressure (ICP) more than 250 mm H₂O, without evidence of meningeal inflammation, space-occupying lesion, or venous thrombosis. The aim of this research is to study the clinical profile, evaluation, management, and visual outcome in a hospital-based population of IIH cases in Jeddah. Methodology: This is a retrospective observational study that included the medical records of all patients referred to neuro-ophthalmology service for evaluation of papilledema. The medical records have been reviewed from October 2018 to February 2020 at Jeddah Eye Hospital (JEH), Saudi Arabia. A total of fifty-one patients presented with papilledema in the studied period. Forty-seven patients met our inclusion criteria and were included in the study. Results: Most of the patients were females (43, 91.5%) with a mean age of presentation of 30.83±11.40 years. The most common presenting symptom was headache (40 patients, 85.1%), followed by transient visual obscuration (20 patients, 42.6%), and reduced visual acuity (15 patients, 31.9%). All 47 patients were started on medical treatment with oral acetazolamide with four patients (8.5%) shifted to topiramate because of the lack of response or intolerance to acetazolamide while four patients (8.5%) underwent lumbar-peritoneal shunt because of inadequate control of the disease despite the treatment with medical therapy. For both eyes, the change in visual acuity across all assessment points was statistically significant. Nevertheless, there were no significant changes in the visual field findings among all of the compared assessment points. Conclusion: The present study has shown that IIH-related papilledema is common in young female patients with headaches, transient visual obscurations and reduced visual acuity. Those are the commonest symptoms in our IIH population. Medical treatment of IIH is significantly efficacious and should be considered in order to enhance the prognosis of IIH-related complications. Therefore, the visual status should be frequently monitored for these patients.

Keywords: idiopathic intracranial hypertension, intracranial hypertension, papilledema, headache

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Authors: Eva Stefanovska, Estefania Cuenca, Aleksandra Momirov, Monika Fidanchevska, Liberato Ferrara, Emilija Fidanchevski

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Silica is used in construction materials as a part of natural raw materials or as an additive in powder form (micro and nano dimensions). SiO₂ particles in cement act as centers of nucleation, as a filler or as pozzolan material. In this regard, silica improves the microstructure of cementitious composites, increases the mechanical properties, and finally also results into improved durability of the final products. Improved properties of cementitious composites may lead to better structural efficiency, which, together with increased durability, results into increased sustainability signature of structures made with this kind of materials. The aim of the present work was to investigate the influence of silica on the properties of cement. Fly ash (as received and mechanically activated) and synthetized silica (sol-gel method using TEOS as precursor) was used in the investigation as source of silica. Four types of cement mixtures were investigated (reference cement paste, cement paste with addition of 15wt.% as-received fly ash, cement paste with 15 wt.% mechanically activated fly ash and cement paste with 14wt.% mechanically activated fly ash and 1 wt.% silica). The influence of silica on setting time and mechanical properties (2, 7 and 28 days) was followed. As a matter of fact it will be shown that cement paste with composition 85 wt. % cement, 14 wt.% mechanically activated fly ash and 1 wt. % SiO₂ obtained by the sol-gel method was the best performing one, with increased compressive and flexure strength by 9 and 10 % respectively, as compared to the reference mixture. Acknowledgements: 'COST Action CA15202, www.sarcos.eng.cam.ac.uk'

Keywords: cement, fly ash, mechanical properties, silica, sol-gel

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Authors: Naum Simanovsky, Vladimir Goldman, Michael Zaidman

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Background: The optimal algorithm for the management of symptomatic tarsal coalition is still under discussion in pediatric literature. It's debatable what surgical steps are essential to achieve the best outcome. Method: The investigators retrospectively reviewed the records of twelve patients with symptomatic tarsal coalition that were treated operatively between 2017 and 2019. Only painful flat feet were operated. Two patients were excluded from the study due to lack of sufficient follow-up. Ten of eleven feet were treated with the combination of calcaneal lengthening osteotomy (CLO) and resection of coalition (RC). Only one foot was operated with CLO alone. In half of our patients, Achilles lengthening was performed. For two children, medial plication was added. Short leg cast was applied to all children for 6-8 weeks, and soft shoe insoles for medial arch support were prescribed after. Demographic, clinical, and radiographic records were reviewed. The outcome was evaluated using American Orthopedic Foot and Ankle Society (AOFAS) Ankle Hindfoot Score. Results: There were seven boys and three girls. The mean age at the time of surgery was 13.9 (range 12 to 17) years, and the mean follow-up was 18 (range 8 to 34) months. The early complications included one superficial wound infection and dehiscence. Late complication includes two children with residual forefoot supination. None of our patients required additional operations during the follow-up period. All feet achieved complete deformity correction or dramatic improvement. In the last follow-up, seven feet were painless, and four children had some mild pain after intensive activities. All feet achieved excellent and good scoring on AOFAS. Conclusions: Many patients with talocalcaneal coalition also have rigid or stiff, painful, flat feet. For these patients, the resection of coalition with concomitant CLO can be safely recommended.

Keywords: Tarsal coalition, calcaneal lengthening osteotomy., flat foot, coalition resection

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Authors: Ramin Zargarbashi, Hamid Rabie, Behnam Panjavi, Hooman Kamran, Seyedarad Mosalamiaghili, Zohre Erfani, Seyed Peyman Mirghaderi, Maryam Salimi

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Background: Posterior shoulder dislocation is one of the disabling complications of brachial plexus birth injury (BPBI), and various treatment options, including capsule and surrounding muscles release for open reduction, humeral derotational osteotomy, and tendon transfers, have been recommended to manage it. In the present study, we aimed to determine the clinical outcome of open reduction with soft tissue release, tendon transfer, and glenoid osteotomy inpatients with BPBI and posterior shoulder dislocation or subluxation. Methods: From 2018 to 2020, 33 patients that underwent open reduction, glenoid osteotomy, and tendon transfer were included. The glenohumeral deformity was classified according to the Waters radiographic classification. Functional assessment was performed using the Mallet grading system before and at least two years after the surgery. Results: The patients were monitored for 26.88± 5.47 months. Their average age was 27.5±14 months. Significant improvement was seen in the overall Mallet score (from 13.5 to 18.91 points) and its segments, including hand to mouth, hand to the neck, global abduction, global external rotation, abduction degree, and external rotation degree. Hand-to-back score and the presence of trumpet sign were significantly decreased in the post-operation phase (all p values<0.001). The above-mentioned variables significantly changed for both infantile and non-infantile dislocations. Conclusion: Our study demonstrated that open reduction along with glenoid osteotomy improves retroversion, and muscle strengthening with different muscle transfers is an effective technique for BPBI.

Keywords: birth injuries, nerve injury, brachial plexus birth palsy, Erb palsy, tendon transfer

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Authors: Zeynep Küçükakça, Nezaket Parlak, Mesut Gür, Tahsin Engin, Hasan Küçük

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In the current research, the single phase fluid flow and heat transfer characteristics are experimentally investigated. The experiments are conducted to cover transition zone for the Reynolds numbers ranging from 100 to 4800 by fused silica and stainless steel microtubes having diameters of 103-180 µm. The applicability of the Logarithmic Mean Temperature Difference (LMTD) method is revealed and an experimental method is developed to calculate the heat transfer coefficient. Heat transfer is supplied by a water jacket surrounding the microtubes and heat transfer coefficients are obtained by LMTD method. The results are compared with data obtained by the correlations available in the literature in the study. The experimental results indicate that the Nusselt numbers of microtube flows do not accord with the conventional results when the Reynolds number is lower than 1000. After that, the Nusselt number approaches the conventional theory prediction. Moreover, the scaling effects in micro scale such as axial conduction, viscous heating and entrance effects are discussed. On the aspect of fluid characteristics, the friction factor is well predicted with conventional theory and the conventional friction prediction is valid for water flow through microtube with a relative surface roughness less than about 4 %.

Keywords: microtube, laminar flow, friction factor, heat transfer, LMTD method

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Authors: Magda Posani, Maria Do Rosario Veiga, Vasco Peixoto De Freitas

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The presented research considers the hygrothermal data acquired in the municipal library of Porto. The library is housed in an XVIII century convent and, among all the rooms in the construction, one, in particular, was chosen for the monitoring campaign because of the presence of a great number of historic books. Temperature and relative humidity, as well as CO₂ concentration, were measured for six consecutive months, in the period December 24th - June 24th. The indoor environment of the building is controlled with a heating and cooling system that is turned on only during the opening hours of the library. The ventilation rate is low because the windows are kept closed, and there is no forced ventilation. The micro-climate is analyzed in terms of users’ comfort and degradation risks for historic books and valuable building surfaces. Through a comparison between indoor and outdoor measured hygrothermal data, indoor relative humidity appears very stable. The influence of the hygroscopicity of books on the stabilization of indoor relative humidity is therefore investigated in detail. The paper finally discusses the benefits given by the presence of historic books in libraries with intermittent heating and cooling. The possibility of obtaining a comfortable and stable indoor climate with low use of HVAC systems in these conditions, while avoiding degradation risks for books and historic building components, is further debated.

Keywords: books, historic buildings, hygroscopicity, relative humidity

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Authors: Wang Zhiwei, Wang Weiwu

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The process of urbanization in China has entered a critical period of transformation from urban expansion and construction to delicate urban design, thus forming a new direction in the field of urban design. So far, catalyst theory has become a prominent guiding strategy in urban planning and design. In this paper, under the background of urban renewal, catalyst theory is taken as the guiding ideology to explore the method of urban design in shouxian county. Firstly, this study briefly introduces and analyzes the catalyst theory. Through field investigation, it is found that the city has a large number of idle Spaces, such as abandoned factories and schools. In the design, the idle Spaces in the county town are utilized and interlinked in space, and functional interaction is carried out from the pattern of the county town. On the one hand, the results showed that the catalyst theory can enhance the vitality of the linear street space with a small amount of monomer construction. On the other hand, the city can also increase the cultural and economic sites of the city without damaging the historical relics and the sense of alterations of the ancient city, to improve the quality of life and quality of life of citizens. The city micro-transformation represented by catalyst theory can help ancient cities like shouxian to realize the activation of the old city and realize the gradual development.

Keywords: catalytic theory, urban design, China's ancient city, Renaissance

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Authors: Siamak Yaghoubi, Vahideh Rashtchi, Marzieh Khezri, Hamid Kayalha, Monadi Hamidfar

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Background and objectives: Effective postoperative pain management in abdominal surgeries, which are painful procedures, plays an important role in reducing postoperative complications and increasing patient’s satisfaction. There are many techniques for pain control, one of which is Patient-Controlled Analgesia (PCA). The aim of this study was to compare the analgesic effects of morphine, paracetamol and ketorolac in the patients undergoing open cholecystectomy, using PCA method. Material and Methods: This randomized controlled trial was performed on 330 ASA (American Society of Anesthesiology) I-II patients ( three equal groups, n=110) who were scheduled for elective open cholecystectomy in Shahid Rjaee hospital of Qazvin, Iran from August 2013 until September 2015. All patients were managed by general anesthesia with TIVA (Total Intra Venous Anesthesia) technique. The control group received morphine with maximum dose of 0.02mg/kg/h, the paracetamol group received paracetamol with maximum dose of 1mg/kg/h, and the ketorolac group received ketorolac with maximum daily dose of 60mg using IV-PCA method. The parameters of pain, nausea, hemodynamic variables (BP and HR), pruritus, arterial oxygen desaturation, patient’s satisfaction and pain score were measured every two hours for 8 hours following operation in all groups. Results: There were no significant differences in demographic data between the three groups. there was a statistically significant difference with regard to the mean pain score at all times between morphine and paracetamol, morphine and ketorolac, and paracetamol and ketorolac groups (P<0.001). Results indicated a reduction with time in the mean level of postoperative pain in all three groups. At all times the mean level of pain in ketorolac group was less than that in the other two groups (p<0.001). Conclusion: According to the results of this study ketorolac is more effective than morphine and paracetamol in postoperative pain control in the patients undergoing open cholecystectomy, using PCA method.

Keywords: analgesia, cholecystectomy, ketorolac, morphine, paracetamol

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Authors: Swapna Guntupalli, Leela Madhuri Chalasani, Kshatri Jyothi, C. V. Rao, Bondili J. S.

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The study hypothesizes that enhanced biodegradation of Polycyclic Aromatic Hydrocarbons (PAHs) is achievable with an assemblage of microorganisms that are capable of producing biofilm and biosurfactants. Accordingly, PAHs degrading microorganism’s (bacteria, fungi, actinomycetes and yeast) were screened and grouped into different consortia based on their capabilities to produce biofilm and biosurfactants. Among these, Consortium BTSN09 consisting of bacterial fungal cocultures showed highest degradation due to the synergistic action between them. Degradation effiencies were evaluated using HPLC and GC-MS. Within 7days, BTSN09 showed 51% and 50.7% degradation of Phenanthrene (PHE) and Pyrene (PYR) with 200mg/L and 100 mg/L concentrations respectively in a liquid medium. In addition, several degradative enzymes like laccases, 1hydroxy-2-naphthoicacid dioxygenase, 2-carboxybenzaldehyde dehydrogenase, catechol1,2 dioxygenase and catechol2,3 dioxygenase activity was observed during degradation. Degradation metabolites were identified using GC-MS analysis and from the results it was confirmed that the metabolism of degradation proceeds via pthalic acid pathway for both PAHs. Besides, Microbial consortia also demonstrated good biosurfactant production capacity, achieving maximum oil displacement area and emulsification activity of 19.62 cm2, 65.5% in presence of PAHs as sole carbon source. Scanning Electron Microscopy analysis revealed exopolysaccharides (EPS) production, micro and macrocolonies formation with different stages of biofim development in presence of PAHs during degradation.

Keywords: PAHs, biosurfactant, biofilm, biodegradation

Procedia PDF Downloads 582

Authors: Marta Skwarecka, Patrycja Bloch, Rafal Walkusz, Oliwia Urbanowicz, Grzegorz Zielinski, Sabina Zoledowska, Dawid Nidzworski

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Upper respiratory tract infections are one of the most common reasons for visiting a general doctor. Streptococci are the most common bacterial etiological factors in these infections. There are many different types of Streptococci and infections vary in severity from mild throat infections to pneumonia. For example, S. pyogenes mainly contributes to acute pharyngitis, palatine tonsils and scarlet fever, whereas S. Streptococcus pneumoniae is responsible for several invasive diseases like sepsis, meningitis or pneumonia with high mortality and dangerous complications. There are only a few diagnostic tests designed for detection Streptococci from the infected throat of patients. However, they are mostly based on lateral flow techniques, and they are not used as a standard due to their low sensitivity. The diagnostic standard is to culture patients throat swab on semi selective media in order to multiply pure etiological agent of infection and subsequently to perform antibiogram, which takes several days from the patients visit in the clinic. Therefore, the aim of our studies is to develop and implement to the market a Point of Care device for the rapid identification of Streptococcus pyogenes and Streptococcus pneumoniae with simultaneous identification of antibiotic resistance genes. In the course of our research, we successfully selected genes for to-species identification of Streptococci and genes encoding antibiotic resistance proteins. We have developed a reaction to amplify these genes, which allows detecting the presence of S. pyogenes or S. pneumoniae followed by testing their resistance to erythromycin, chloramphenicol and tetracycline. What is more, the detection of β-lactamase-encoding genes that could protect Streptococci against antibiotics from the ampicillin group, which are widely used in the treatment of this type of infection is also developed. The test is carried out directly from the patients' swab, and the results are available after 20 to 30 minutes after sample subjection, which could be performed during the medical visit.

Keywords: antibiotic resistance, Streptococci, respiratory infections, diagnostic test

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Authors: Deepak Nathiya1, Ramesh Roop Rai, Pratima Singh1, Preeti Raj1, Supriya Suman, Balvir Singh Tomar

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Background: Sarcopenia is a catabolic state in liver cirrhosis (LC), accelerated with a breakdown of skeletal muscle to release amino acids which adversely affects survival, health-related quality of life, and response to any underlying disease. The primary objective of the study was to investigate the long-term effect of branched-chain amino acids (BCAA) supplementations on parameters associated with improved prognosis in sarcopenic patients with LC, as well as to evaluate its impact on cirrhotic-related events. Methods: We carried out a 24 week, single-center, randomized, open-label, controlled, two cohort parallel-group intervention trial comparing the efficacy of BCAA against lactoalbumin (L-ALB) on 106 sarcopenic liver cirrhotics. The BCAA (intervention) group was treated with 7.2 g BCAA per whereas, the lactoalbumin group was also given 6.3 g of L-Albumin. The primary outcome was to assess the impact of BCAA on parameters of sarcopenia: muscle mass, muscle strength, and physical performance. The secondary outcomes were to study combined survival and maintenance of liver function changes in laboratory and clinical markers in the duration of six months. Results: Treatment with BCAA leads to significant improvement in sarcopenic parameters: muscle strength, muscle function, and muscle mass. The total cirrhotic-related complications and cumulative event-free survival occurred fewer in the BCAA group than in the L-ALB group. Prognostic markers also improved significantly in the study. Conclusion: The current clinical trial demonstrated that long-term BCAAs supplementation improved sarcopenia and prognostic markers in patients with advanced liver cirrhosis.

Keywords: sarcopenia, liver cirrhosis, BCAA, quality of life

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Authors: Uchenna Cosmas Ugwu, Osmond Chukwuemeka Ene

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Globally, older adults are considered the most vulnerable groups to age-related diseases including diabetes mellitus, obesity, cardiovascular diseases, cancer and osteoporosis. With improved access to quality healthcare services, these complications can be prevented and the incidence rates reduced to the least occurrence. The aim of this study is to validate appropriate measures for improving quality healthcare services utilization among elderly persons in Nigeria and also to determine the significant association within demographic variables. A cross-sectional survey research design was adopted. Using a convenient sampling technique, a total of 400 experts (150 registered nurses and 250 public health professionals) with minimum of doctoral degree qualification were sampled and studied. A structured instrument titled “Expert-Based Healthcare Services Utilization Questionnaire (EBHSUQ) with .83 reliability index was used for data collection. All the statistical data analysis was completed using frequency counts, percentage scores and chi-square statistics. The results were significant at p≤0.05. It was found that quality healthcare services utilization by elderly persons in Nigeria would be improved if the services are: available (83%), affordable (82%), accessible (79%), suitable (77%), acceptable (77%), continuous (75%) and stress-free (75%). Statistically, significant association existed on quality healthcare services utilization with gender (p=.03<.05) and age (p=.01<.05) while none was observed on work experience (p=.23>.05), marital status (p=.11>.05) and employment category (p=.09>.05). To improve quality healthcare services utilization for elderly persons in Nigeria, the adoption of appropriate measures by Nigerian government and professionals in healthcare sectors are paramount. Therefore, there is need for collaborative efforts by the Nigerian government and healthcare professionals geared towards educating the general public through mass sensitization, awareness campaign, conferences, seminars and workshops for the importance of accessing healthcare services.

Keywords: elderly persons, healthcare services, cross-sectional survey research design, utilization.

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Authors: Ratnakar Rao, Subair Khan, Hari Haran

Abstract:

Posterior cruciate ligament (PCL) avulsion fractures is a rare condition and commonly mismanaged.Surgical reattachment has been shown to produce better result compared with conservative management.Only few techniques are reported in arthroscopic fixation of PCL Avulsion Fracture and they are complex.We describe a new technique in fixation of the PCL Avulsion fracture through a posterior trans septal portal using button fixation device (Mini Tight Rope). Eighteen patients with an isolated posterior cruciate ligament avulsion fracture were operated under arthroscopy. Standard Antero Medial Portal and Antero Lateral portals made and additional Postero Medial and Postero Lateral portals made and trans Septal portal established. Avulsion fracture identified, elevated, prepared. Reduction achieved using PCL Tibial guide (Arthrex) and fixation was achieved using Mini Tight Rope,Arthrex (2 buttons with a suture). Reduction confirmed using probe and Image intensifier. Postoperative assessment made clinically and radiologically. 15 patients had good to excellent results with no posterior sag or instability. The range of motion was normal. No complications were recorded per operatively. 2 patients had communition of the fragment while drilling, for one patient it was managed by suturing technique and the second patient PCL Reconstruction was done. One patient had persistent instability with poor outcome. Establishing trans septal portal helps in better visualization of the posterior compartment of the knee. Assessment of the bony fragment, preparation 0f the bone bed andit protects from injury to posterior neurovascular structures. Fixation using the button with suture (Mini Tight Rope) is stable and easily reproducible for PCL Avulsion fracture with single large fragment.

Keywords: PCL avulsion, arthroscopy, transeptal, minitight rope technique

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Authors: Hui-Yen Lee, Hsiu-Yun Wei, Guey-Jen Lin, Pi-Yueh Lee Lee

Abstract:

Background: Unplanned hospital readmissions increase healthcare costs and have been considered a marker of poor healthcare performance. The elderly face a higher risk of unplanned readmission due to elderly-specific characteristics such as deteriorating body functions and the relatively high incidence of complications after treatment of acute diseases. Purpose: The aim of this study was exploring the factors that relate to the unplanned readmission of elderly within 14 days of discharge at our hospital in southern Taiwan. Methods: We retrospectively reviewed the medical records of patients aged ≥65 years who had been re-admitted between January 2018 and December 2018.The Charlson Comorbidity score was calculated using previous used method. Related factors that affected the rate of unplanned readmission within 14 days of discharge were screened and analyzed using the chi-squared test and logistic regression analysis. Results: This study enrolled 829 subjects aged more than 65 years. The numbers of unplanned readmission patients within 14 days were 318 cases, while those did not belong to the unplanned readmission were 511 cases. In 2018, the rate of elderly patients in unplanned 14 days readmissions was 38.4%. The majority patients were females (166 cases, 52.2%), with an average age of 77.6 ± 7.90 years (65-98). The average value of Charlson Comorbidity score was 4.42±2.76. Using logistic regression analysis, we found that the gastric or peptic ulcer (OR=1.917 , P< 0.002), diabetes (OR= 0.722, P< 0.043), hemiplegia (OR= 2.292, P< 0.015), metastatic solid tumor (OR= 2.204, P< 0.025), hypertension (OR= 0.696, P< 0.044), and skin ulcer/cellulitis (OR= 2.747, P< 0.022) have significantly higher risk of 14-day readmissions. Conclusion: The results of the present study may assist the healthcare teams to understand the factors that may affect unplanned readmission in the elderly. We recommend that these teams give efficient approach in their medical practice, provide timely health education for elderly, and integrative healthcare for chronic diseases in order to reduce unplanned readmissions.

Keywords: unplanning readmission, elderly, Charlson comorbidity score, logistic regression analysis

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Authors: Jared Cheves, Amanda DeChent, Joyce Pan

Abstract:

Total knee replacements (TKAs) are one of the most common but painful surgical procedures performed in the United States. Currently, the gold standard for postoperative pain management is the utilization of opioids. However, in the wake of the opioid epidemic, the healthcare system is attempting to reduce opioid consumption by trialing innovative opioid sparing analgesic techniques such as continuous peripheral nerve blocks (CPNB) and continuous periarticular infiltration (CPAI). The alleviation of pain, particularly during the first 72 hours postoperatively, is of utmost importance due to its association with delayed recovery, impaired rehabilitation, immunosuppression, the development of chronic pain, the development of rebound pain, and decreased patient satisfaction. While both CPNB and CPAI are being used today, there is limited evidence comparing the two to the current standard of care or to each other. An extensive literature review was performed to explore the safety profiles and effectiveness of CPNB and CPAI in reducing reported pain scores and decreasing opioid consumption. The literature revealed the usage of CPNB contributed to lower pain scores and decreased opioid use when compared to opioid-only control groups. Additionally, CPAI did not improve pain scores or decrease opioid consumption when combined with a multimodal analgesic (MMA) regimen. When comparing CPNB and CPAI to each other, neither unanimously lowered pain scores to a greater degree, but the literature indicates that CPNB decreased opioid consumption more than CPAI. More research is needed to further cement the efficacy of CPNB and CPAI as standard components of MMA in TKA procedures. In addition, future research can also focus on novel catheter-free applications to reduce the complications of continuous catheter analgesics.

Keywords: total knee arthroplasty, continuous peripheral nerve blocks, continuous periarticular infiltration, opioid, multimodal analgesia

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Authors: Rehan Siddiqui, Brendan Quine

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The Radiance Enhancement (RE) and integrated absorption technique is applied to develop a synthetic model to determine the enhancement in radiance due to cloud scene and Shortwave upwelling Radiances (SHupR) by O2, H2O, CO2 and CH4. This new model is used to estimate the magnitude variation for RE and SHupR over spectral range of 900 nm to 1700 nm by varying surface altitude, mixing ratios and surface reflectivity. In this work, we employ satellite real observation of space orbiting Argus 1000 especially for O2, H2O, CO2 and CH4 together with synthetic model by using line by line GENSPECT radiative transfer model. All the radiative transfer simulations have been performed by varying over a different range of percentages of water vapor contents and carbon dioxide with the fixed concentration oxygen and methane. We calculate and compare both the synthetic and real measured observed data set of different week per pass of Argus flight. Results are found to be comparable for both approaches, after allowing for the differences with the real and synthetic technique. The methodology based on RE and SHupR of the space spectral data can be promising for the instant and reliable classification of the cloud scenes.

Keywords: radiance enhancement, radiative transfer, shortwave upwelling radiative flux, cloud reflectivity, greenhouse gases

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Authors: S. Gvazava, N. Khidasheli, G. Gordeziani, A. DL. Batako

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The work presented in this paper studied the tribological characteristics (wear resistance, friction coefficient) of austempered ductile iron (ADI) with different combinations of structural composition (upper bainite, lower bainite, retained austenite) in dry sliding friction. A range of structural states of the metal matrix was obtained by changing the regimes of isothermal quenching of high-strength cast iron. The tribological tests were carried out using two sets of isothermal quenched cast irons. After austenitization at 900°С for 60 minutes, the specimens from the first group were isothermally quenched at the 300°С temperature and the specimens from the second set – at 400°С. The investigations showed that the isothermal quenching increases the friction coefficient of high-strength cast irons. The friction coefficient was found to be in the range from 0.4 to 0.55 for cast irons, depending on the structures of the metal matrix. The quenched cast irons having lower bainite demonstrate higher wear resistance in dry friction conditions. The dependence of wear resistance on the amount of retained austenite in isothermal quenched cast irons has a nonlinear characteristic and reaches its maximum value when the content of retained austenite is about 15-22%. The boron micro-additives allowed to reduce the friction coefficient of ADI and increase their wear resistance by 1.5-1.7 times.

Keywords: wear resistance, dry sliding, austempering, ADI, friction coefficient, retained austenite, isothermal quenching

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Authors: Yoga Maulana Putra, Herry Hudrasyah

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The Internet has now become an important part of human life; it can be accessed through a computer or even a smartphone almost anywhere and anytime. The Internet has created many social media such as Facebook, Twitter, and Instagram. Instagram has been acquired by Facebook in 2012. Since then, Instagram is growing fast. And now, Instagram is transforming from photo-sharing social media into business tools. As the result, some new behavior has been discovered. Some of Instagram user is becoming popular. These people also being called minor celebrity and they are also being used as marketing tools by many companies to influencing or promoting their product or service. This minor celebrity is existing because of their behavior in using Instagram. The company is using the personal influence of the minor celebrity to promoting and influencing their product or service, and the minor celebrity gets paid as much as their rate card. And their rate card based on their followers and insight. This research is using a qualitative method. An interview is being done to 6 minor celebrities from many different categories such as photographer, travel blogger, lifestyle, food blogger, fashion, and healthcare. Theory of reasoned behavior is being used as the grounded theory to discover the reason for their behavior and personal influence to describe their way to influencing people. The result of the interview is most of the minor celebrities is influenced by their friend’s circle in the process of using Instagram. They also had a different way to use their personal influence to affect their followers when the company employs them.

Keywords: humanities and social sciences, Instagram, minor celebrity, social media

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Authors: Martin Dupuy, Solange Grunenwald, Pierre-Louis Colombo, Laurence Mahieu, Pomone Richard, Philippe Bartoli

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Endonasal endoscopic trans-sphenoidal surgery for pituitary tumours has become a mainstay of treatment over the last two decades. Although it is generally accepted that there is no significant difference between endoscopic versus microscopic approach for surgical outcomes (endocrine and ophthalmologic status), nasal morbidity seems to the benefit of endoscopic procedures. Minimally invasive endoscopic surgery needs an operative learning curve to achieve surgeon’s efficiency. This learning curve is now well known for surgical outcomes and complications rate, however, few data are available for nasal morbidity. The aim of our series is to document operative experience and nasal quality of life after (NQOL) endoscopic trans-sphenoidal surgery. The prospective pituitary surgical cohort consisted of 525 consecutives patients referred to our Skull Base Diseases Department. Endoscopic procedures were performed by a single neurosurgeon using an uninostril approach. NQOL was evaluated using the Sino-Nasal Test (SNOT-22), the Anterior Base Nasal Inventory (ASBNI) and the Skull Base Inventory Score (SBIS). Data were collected before surgery during hospital stay and 3 months after the surgery. The seventy first patients were compared to the latest 70 patients. There was no significant difference between comparison score before versus after surgery for SNOT-22, ASBNI and SBIS during the single surgeon’s learning curve. Our series demonstrates that in our institution there is no statistically significant learning curve for NQOL after uninostril endoscopic pituitary surgery. A careful progression through sinonasal structures with very limited mucosal incision is associated with minimal morbidity and preserves nasal function. Conservative and minimal invasive approach could be achieved early during learning curve.

Keywords: pituitary surgery, quality of life, minimal invasive surgery, learning curve, pituitary tumours, skull base surgery, endoscopic surgery

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Authors: Eunjoo Lee

Abstract:

Background: As the number of surgeries increases, the incidence of adverse events is likely to become more prevalent. Patients who are somewhat knowledgeable about surgery-related adverse events are more likely to engage in safety initiatives to prevent them. Objectives: To evaluate the impact of a smartphone application developed during the study to enhance patients’ knowledge of surgery-related adverse events during hospitalization. Design: Non-randomized, one group, measured pre- and post-intervention. Participants: Thirty-six hospitalized patients admitted to the orthopedics unit of a general hospital in South Korea. Methods. First, a smartphone application to enhance patients’ knowledge of surgery-related adverse events was developed through an iterative process, which included a literature review, expert consultation, and pilot testing. The application was installed on participants’ smartphones, and research assistants taught the participants to use it. Twenty-five true/false questions were used to assess patients’ knowledge of preoperative precautions (eight items), surgical site infection (five items), Foley catheter management (four items), drainage management (four items), and anesthesia-related complications (four items). Results: Overall, the percentage of correct answers increased significantly, from 57.02% to 73.82%, although answers related to a few specific topics did not increase that much. Although the patients’ understanding of drainage management and the Foley catheter did increase substantially after they used the smartphone application, it was still relatively low. Conclusions: The smartphone application developed during this study enhanced the patients’ knowledge of surgery-related adverse events during hospitalization. However, nurses must make an additional effort to help patients to understand certain topics, including drainage and Foley catheter management. Relevance to clinical practice: Insufficient patient knowledge increases the risk of adverse events during hospitalization. Nurses should take active steps to enhance patients’ knowledge of a range of safety issues during hospitalization, in order to decrease the number of surgery-related adverse events.

Keywords: patient education, patient participation, patient safety, smartphone application, surgical errors

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Authors: Jyoti Manandhar Shrestha, Saurab Raj Joshi, Maya Shrestha, Prashanna Shrestha, Kshitij Chaulagain

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Background: The widespread use of non-steroidal anti-inflammatory drugs has increased the incidence of ulcer and serious complications, such as perforation and bleeding. Although, the H2 receptor blockers and proton pump inhibitors decrease the acid secretion and promote healing of ulcer, their value in preventing relapse, recurrence, “acid rebound” after cessation of therapy and associated long term adverse effects limit their utility. So to minimize this, the herbal plant Aloe vera having anti-oxidant, anti-inflammatory, mucus secreting, cyto-protective and healing property is believed to cure the peptic ulcer. Objectives: To observe whether oral treatment with Aloe vera gel can prevent peptic ulcer. Indomethacin and ethanol were used to induce gastric ulcers. Thirty six albino rats of either sex were randomly allotted to six groups of six animals each. The negative control was pretreated with normal saline, the positive controls received ranitidine (20 mg/kg) and the test group received Aloe vera gel (300 mg/kg) orally for eight days. Then, after a 24 hour fast Indomethacin (20 mg/kg) or 80% ethanol (2ml) was administered orally to induce ulceration. At the end of the study, the rats were sacrificed, their stomachs opened, the ulcer index studied and tissues sent for histopathological examination. Results: It was observed that, in indomethacin treated group, the ulcer index in control group was 8.167 ± 1.72.In the Aloe vera pretreated animals, the ulcer index was 2.83 ± 1.72 and the standard ranitidine pretreated group ulcer index was 1.67 ± 1.36. In ethanol treated group, the ulcer index in control group was 7.5 ± 2.73. In the Aloe vera pretreated animals, the ulcer index was 2.67 ± 1.75 and the standard ranitidine pretreated group ulcer index was 1.33±1.21. Both ranitidine and Aloe vera gel significantly prevented stomach from gastric ulceration induced by indomethacin and ethanol. Conclusion: The results indicated that Aloe vera gel is effective against indomethacin and ethanol mediated gastric ulcer.

Keywords: Aloe vera gel, ethanol, indomethacin, peptic ulcer, ranitidine

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Authors: Mehwish Durrani, Rubina Nazli, Muhammad Abubakr, Muhammad Shafiq

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Objectives: To evaluate the high socio-economic status, urbanization, and decrease ambulation can lead to early osteoporosis in women reporting from Peshawar region. Study Design: Descriptive cross-sectional study was done. Sample size was 100 subjects, using 30% proportion of osteoporosis, 95% confidence level, and 9% margin of error under WHO software for sample size determination. Place and Duration of study: This study was carried out in the tertiary referral health care facilities of Peshawar viz PGMI Hayatabad Medical Complex, Peshawar, Khyber Pakhtunkhwa Province, Pakistan. Ethical approval for the study was taken from the Institutional Ethical Research board (IERD) at Post Graduate Medical Institute, Hayatabad Medical Complex, and Peshawar.The study was done in six months time period. Patients and Methods: Levels of CTX1 as a marker of bone degradation in radiographically assessed perimenopausal women was determined. These females were randomly selected and screened for osteoporosis. Hemoglobin in gm/dl, ESR by Westergren method as millimeter in 1 hour, Serum Ca mg/dl, Serum alkaline Phosphatase international units per liter radiographic grade of osteoporosis according to Singh index as 1-6 and CTX 1 level in pg/ml. Results: High levels of CTX1 was observed in perimenopausal osteoporotic women which were radiographically diagnosed as osteoporotic patients. The High socio-economic class also predispose to osteoporosis. Decrease ambulation another risk factor showed significant association with the increased levels of CTX1. Conclusion: The results of this study propose that minimum ambulation and high socioeconomic class both had significance association with the increase levels of serum CTX1, which in turn will lead to osteoporosis and to its complications.

Keywords: osteoporosis, CTX1, perimenopausal women, Hayatabad Medical Complex, Khyberpuktoonkhwa

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Authors: Wisam Ismail, Brendan Wooler, Penelope McManus

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Introduction: The public perception of implants has been damaged in the wake of recent negative publicity and increasingly we are finding patients wanting to avoid them. Planned lipo-modelling to enhance the volume of a Latissimus dorsi flap is a viable alternative to silicone implants and maintains a Totally Autologous Technique (TAT). Here we demonstrate that when compared to an Implant Assisted Technique (IAT), a TAT offers patients many benefits that offset the requirement of more operations initially, with reduced short and long term complications, reduced symmetrisation surgery and reduced revision rates. Methods. Data was collected prospectively over 7 years. The minimum follows up was 3 years. The technique was generally standardized in the hand of one surgeon. All flaps were extended LD flaps (ELD). Lipo-modelling was performed using standard techniques. Outcome measures were unplanned secondary procedures, complication rates, and contralateral symmetrisation surgery rates. Key Results Were: Lower complication rates in the TAT group (18.5% vs. 33.3%), despite higher radiotherapy rates (TAT=49%, IAT=36.8%), TAT was associated with lower subsequent symmetrisation rates (30.6% vs. 50.9%), IAT had a relative risk of 3.1 for subsequent unplanned procedure, Autologous patients required an average of 1.76 sessions of lipo-modelling, Conclusions: Using lipo-modelling to enable totally autologous LD reconstruction offers significant advantages over an implant assisted technique. We have shown a lower subsequent unplanned procedure rate, lower revision surgery, and less contralateral symmetrisation surgery. We anticipate that a TAT will be supported by patient satisfaction surveys and long-term patient-reported cosmetic outcome data and intended to study this.

Keywords: breast, Latissimus dorsi, lipomodelling, reconstruction

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