Search results for: ultrasound-guided peripheral nerve block

Authors: Yael Dubinsky, Orit Hazzan

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There is a constant need for hi-tech innovation to be decentralized to peripheral regions. This work describes how we applied design science research (DSR) principles to define what we refer to as the Sea of Galilee (SoG) method. The goal of the SoG method is to harness existing and new technological initiatives in peripheral regions to create a socio-technological network that can initiate and maintain hi-tech activities. The SoG method consists of a set of principles, a stakeholder network, and actual hi-tech business initiatives, including their infrastructure and practices. The three cycles of DSR, the Relevance, Design, and Rigor cycles, layout a research framework to sharpen the requirements, collect data from case studies, and iteratively refine the SoG method based on the existing knowledge base. We propose that the SoG method can be deployed by regional authorities that wish to be considered smart regions (an extension of the notion of smart cities).

Keywords: design science research, socio-technological initiatives, Sea of Galilee method, periphery stakeholder network, hi-tech initiatieves

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Authors: Aarti Agarwal, Ajmal Khan

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Background and Objective: Breathing difficulty is most distressing symptom for the patient and their caregivers providing palliative care to individuals with advanced malignancy. It needs to be tackled effectively and sometimes preemptively to provide relief from respiratory obstruction. Interventional procedures like tracheal stenting are becoming increasingly popular as a part of palliation for respiratory symptoms. We present a case of esophageal tumor earlier stented by Gastroenterologist to maintain esophageal patency, but the tumor outgrew to produce tracheal infiltration and thereby causing airway obstruction. Method and Result: 62-year-old man presented with unresectable Carcinoma oesophagus with inability to swallow. A metallic stent was placed by the gastroenterologist, to maintain esophageal patency and enable patient to swallow. Two months later, the patient returned to hospital in emergency with respiratory distress. CT neck and thorax revealed tumor infiltration through posterior tracheal wall. Lower extent of the tumor was till 1 cm above the carina. Airway stenting with Tracheo bronchial stent with Y configuration was planned under general anaesthesia with airway blocks. Superior Laryngeal Nerve Block, Glossopharyngeal block and Trans tracheal infiltration of local anaesthetics were performed. The patient was sedated with Fentanyl, Midazolam and propofol infusion but was breathing spontaneously. Once the rigid bronchoscope was placed inside trachea, breathing was supported with oxygen and sevoflurane. Initially, the trachea was cleared of tumor by coring. After creating space, tracheal stent was positioned and deployed. After stent placement patient was awakened, suctioned and nebulized. His respiratory stridor relieved instantaneously and was shifted to recovery. Conclusion: Airway blocks help in decreasing the incidence and severity of coughing during airway instrumentation thereby help in proper stent placement. They also reduce the requirement of general anaesthetics and hasten the post stenting recovery. Airway stent provided immediate relief to patient from symptoms of respiratory difficulty. Decision for early tracheal stenting may be taken for a select group of patients with high propensity for local spread, thereby avoiding respiratory complications and providing better quality of life in patients with inoperable malignancy.

Keywords: tracheal stent, respiratory difficulty, esophageal tumor, anaesthetic management

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Authors: Santosh Sharma Parajuli, Diwas Manandhar

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Background: Perioperative pain management plays an integral part in patients undergoing cardiac surgery. We studied the effect of Erector Spinae Plane block on acute postoperative pain reduction and 24 hours opioid consumption in adult cardiac surgical patients. Methods: Twenty-five adult cardiac surgical patients who underwent cardiac surgery with sternotomy in whom ESP catheters were placed preoperatively were kept in group E, and the other 25 patients who had undergone cardiac surgery without ESP catheter and pain management done with conventional opioid injection were placed in group C. Fentanyl was used for pain management. The primary study endpoint was to compare the consumption of fentanyl and to assess the numeric rating scale in the postoperative period in the first 24 hours in both groups. Results: The 24 hours fentanyl consumption was 43.00±51.29 micrograms in the Erector Spinae Plane catheter group and 147.00±60.94 micrograms in the control group postoperatively which was statistically significant (p <0.001). The numeric rating scale was also significantly reduced in the Erector Spinae Plane group compared to the control group in the first 24 hours postoperatively. Conclusion: Erector Spinae Plane block is superior to the conventional opioid injection method for postoperative pain management in CABG patients. Erector Spinae Plane block not only decreases the overall opioid consumption but also the NRS score in these patients.

Keywords: erector, spinae, plane, numerical rating scale

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Authors: Minakshi Jain, Sachin Yadav

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Gram Panchayat is the smallest unit of Democracy in India. Grassroots Democracy has been further strengthened by implementation of the 73rd Constitutional Amendment act (CAA) in 1992. To analyse the impact of grassroots democracy the three villages are selected, which have the representation of each section of the society. The selected villages belongs to the same block and district of Haryana state. Villages are selected to access the marginalized group such as women and other backward class. These groups are isolated and do not participate in the grassroots level development process. The caste continue to be a relevant factor in determining the rural leadership. The earlier models of Panchayati Raj failed to benefit the marginalized groups of the society. The 73rd CAA, advocates a uniform three tier system of Panchayat at District level (Zilla Panchayat), Taluka/Block level (Block Panchayat), and village level (Gram Panchayat). The socio-economic profile of representatives in each village is important factor in rural development. The study will highlight the socio-economic profile of elected members at gram Panchayat level, Block Level and District level. The analysis reveals that there is a need to educate and develop the capacity and capability of the elected representative. Training must be imparted to all of them to enable them to function as per provision in the act. The paper will analyse the impact of act on rural development than propose some measures to further strengthen the Panchayati Raj Institution (PRI’s) at grassroots level.

Keywords: democracy, rural development, marginalized people, function

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Authors: Raid Hommady, Waseem Al-Talalwah, Shorok Al Dorazi, Roger Soames

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The iliolumbar artery is a regular branch of posterior division of the internal iliac artery. The present study investigate 82 specimens to identify the origin of iliolumbar artery. The present study targets the sciatic nerve root supply from iliolumbar artery based on its origin and course. In present study, the ililumbar artery arose from the posterior division of internal iliac artery in 52.2%. In few cases, it arose from dorsomedial aspect of the internal iliac artery in 28.8%. In few cases, the iliolumbar artery arose from the dorsal aspects of the internal iliac artery as well as from the common and external iliac artery 1.7%. Also, the iliolumbar artery arose from the sciatic artery as well as from superior and inferior gluteal arteries in 5.1%. Conversely, it found to be congenital absent in 8.5%. Therefore, the posterior trunk of the internal iliac artery is the most common origin of the iliolumbar artery. With the origin variability of the iliolumbar artery, there is a vascular supply variability of the lumbosacral trunk and sacral root of sciatic nerve. The iliolumbar artery provides vascular supply for lumbosacral trunk 57.3% in whereas the sacral root in 5.1%. As a result, surgeons should pay attention to these variations to decrease iatrogenic fault.

Keywords: iliolumbar, sciatic artery, internal iliac, external iliac, posterior division

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Authors: Mohammad Vahedi Torshizi

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In this investigation, at first, bending stress, contact stress, Safety factor of bending and Safety factor of contact between sun gear and planet gear tooth was determined using mathematical equations. Also, The amount of Sun Revolution in, Speed carrier, power Transmitted of the sun, sun torque, sun peripheral speed, Enter the tangential force gears, was calculated using mathematical equations. According to the obtained results, maximum of bending stress and contact stress occurred in three plantary and low status of four plantary. Also, maximum of Speed carrier, sun peripheral speed, Safety factor of bending and Safety factor of contact obtained in four plantary and maximum of power Transmitted of the sun, Enter the tangential force gears, bending stress and contact stress was in three pantry and factors And other factors were equal in the two planets.

Keywords: bending stress, contact stress, plantary, mathematical equations

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Authors: Deniz Guven, Wil Ward, Jinming Duan, Li Bai

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Over the past two decades or so, Optical Coherence Tomography (OCT) has been used to diagnose retina and optic nerve diseases. The retinal nerve fibre layer, for example, is a powerful diagnostic marker for detecting and staging glaucoma. With the advances in optical imaging hardware, the adoption of OCT is now commonplace in clinics. More and more OCT images are being generated, and for these OCT images to have clinical applicability, accurate automated OCT image segmentation software is needed. Oct image segmentation is still an active research area, as OCT images are inherently noisy, with the multiplicative speckling noise. Simple edge detection algorithms are unsuitable for detecting retinal layer boundaries in OCT images. Intensity fluctuation, motion artefact, and the presence of blood vessels also decrease further OCT image quality. In this paper, we introduce a new method for segmenting three-dimensional (3D) OCT images. This involves the use of a Kalman filter, which is commonly used in computer vision for object tracking. The Kalman filter is applied to the 3D OCT image volume to track the retinal layer boundaries through the slices within the volume and thus segmenting the 3D image. Specifically, after some pre-processing of the OCT images, points on the retinal layer boundaries in the first image are identified, and curve fitting is applied to them such that the layer boundaries can be represented by the coefficients of the curve equations. These coefficients then form the state space for the Kalman Filter. The filter then produces an optimal estimate of the current state of the system by updating its previous state using the measurements available in the form of a feedback control loop. The results show that the algorithm can be used to segment the retinal layers in OCT images. One of the limitations of the current algorithm is that the curve representation of the retinal layer boundary does not work well when the layer boundary is split into two, e.g., at the optic nerve, the layer boundary split into two. This maybe resolved by using a different approach to representing the boundaries, such as b-splines or level sets. The use of a Kalman filter shows promise to developing accurate and effective 3D OCT segmentation methods.

Keywords: optical coherence tomography, image segmentation, Kalman filter, object tracking

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Authors: Ali Bayram, Burak Uz, Remzi Yiğiter

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The impairment of lipid metabolism in the central nervous system has been suggested as a critical factor of Alzheimer’s disease (AD) pathogenesis. Homo sapiens acyl-coenyme A synthetase short-chain family member 2 (ACSS2) gene encodes the enzyme acetyl-Coenzyme A synthetase (AMP forming; AceCS) providing acetyl-coenzyme A (Ac-CoA) for various physiological processes, such as cholesterol and fatty acid synthesis, as well as the citric acid cycle. We investigated ACSS2, transcript variant 1 (ACSS2*1), mRNA levels in the peripheral blood mononuclear cells (PBMC) of patients with AD and compared them with the controls. The study group comprised 50 patients with the diagnosis of AD who have applied to Gaziantep University Faculty of Medicine, and Department of Neurology. 49 healthy individuals without any neurodegenerative disease are included as controls. ACSS2 mRNA expression in PBMC of AD/control patients was 0.495 (95% confidence interval: 0.410-0.598), p= .000000001902). Further studies are needed to better clarify this association.

Keywords: Alzheimer’s disease, ACSS2 Genes, mRNA expression, RT-PCR

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Authors: Irati Barandiaran, Xabier Velasco-Iza, Galder Kortaberria

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Hybrid inorganic/organic nanostructured materials based on block copolymers are of considerable interest in the field of Nanotechnology, taking into account that these nanocomposites combine the properties of polymer matrix and the unique properties of the added nanoparticles. The use of block copolymers as templates offers the opportunity to control the size and the distribution of inorganic nanoparticles. This research is focused on the surface modification of inorganic nanoparticles to reach a good interface between nanoparticles and polymer matrices which hinders the nanoparticle aggregation. The aim of this work is to obtain a good and selective dispersion of Fe3O4 magnetic nanoparticles into different types of block copolymers such us, poly(styrene-b-methyl methacrylate) (PS-b-PMMA), poly(styrene-b-ε-caprolactone) (PS-b-PCL) poly(isoprene-b-methyl methacrylate) (PI-b-PMMA) or poly(styrene-b-butadiene-b-methyl methacrylate) (SBM) by using different grafting strategies. Fe3O4 magnetic nanoparticles have been surface-modified with polymer or block copolymer brushes following different grafting methods (grafting to, grafting from and grafting through) to achieve a selective location of nanoparticles into desired domains of the block copolymers. Morphology of fabricated hybrid nanocomposites was studied by means of atomic force microscopy (AFM) and with the aim to reach well-ordered nanostructured composites different annealing methods were used. Additionally, nanoparticle amount has been also varied in order to investigate the effect of the nanoparticle content in the morphology of the block copolymer. Nowadays different characterization methods were using in order to investigate magnetic properties of nanometer-scale electronic devices. Particularly, two different techniques have been used with the aim of characterizing synthesized nanocomposites. First, magnetic force microscopy (MFM) was used to investigate qualitatively the magnetic properties taking into account that this technique allows distinguishing magnetic domains on the sample surface. On the other hand, magnetic characterization by vibrating sample magnetometer and superconducting quantum interference device. This technique demonstrated that magnetic properties of nanoparticles have been transferred to the nanocomposites, exhibiting superparamagnetic behavior similar to that of the maghemite nanoparticles at room temperature. Obtained advanced nanostructured materials could found possible applications in the field of dye-sensitized solar cells and electronic nanodevices.

Keywords: atomic force microscopy, block copolymers, grafting techniques, iron oxide nanoparticles

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Authors: Seyedomid Fatemi

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The walls of the building, as the main intermediary between the outside and the inside of the building, play an important role in controlling the environmental conditions and ensuring the comfort of the residents, thus reducing the heating and cooling loads. Therefore, the use of suitable materials is considered one of the simplest and most effective ways to reduce the heating and cooling loads of the building, which will also save energy. Therefore, in order to achieve the goal of the research "Ranking of optimal materials for building walls," optimal materials for building walls in a temperate and humid climate (case example: Sari city) from the perspective of embodied energy, waste of electricity and gas energy, cost and reuse been investigated to achieve sustainable architecture. In this regard, using information obtained from Sari Municipality, design components have been presented by experts using the Delphi method. Considering the criteria of experts' opinions (cost and reuse), the amount of embodied energy of the materials, as well as the amount of waste of electricity and gas of different materials of the walls, with the help of the AHP weighting technique and finally with the TOPSIS technique, the best type of materials in the order of 1- 3-D Panel 2-ICF-, 3-Cement block with pumice, 4-Wallcrete block, 5-Clay block, 6-Autoclaved Aerated Concrete (AAC), 7-Foam cement block, 8-Aquapanel and 9-Reinforced concrete wall for use in The walls of the buildings were proposed in Sari city.

Keywords: optimum materials, building walls, moderate and humid climate, sustainable architecture, AHP-TOPSIS technique

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Authors: Abeer Ahmed Abdehameed

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Background: Diabetic sensorimotor polyneuropathy (DSP) is one of the most common micro vascular complications of type 2 diabetes. Loss of sensation is thought to contribute to lake of static and dynamic stability and increased risk of falling. Purpose: The purpose of this study was to compare the effects of low level laser (LLL) and monochromatic near infrared photo energy (MIRE) on pain , cutaneous sensation, static stability and index of lower limb blood flow in diabetic with peripheral neuropathy. Methods: Forty subjects with diabetic peripheral neuropathy were recruited for study. They were divided into two groups: The ( MIRE) group that included (20) patients and (LLL) group included (20) patients. All patients in the study had been subjected to various physical assessment procedures including pain, cutaneous sensation, Doppler flow meter and static stability assessments. The baseline measurements were followed by treatment sessions that conducted twice a week for 6 successive weeks. Results: The statistical analysis of the data had revealed significant improvement of the pain in both groups, with significant improvement in cutaneous sensation and static balance in (MIRE) group compared to (LLL) group; on the other hand results showed no significant differences on lower limb blood flow in both groups. Conclusion: Low level laser and monochromatic near infrared therapy can improve painful symptoms in patients with diabetic neuropathy. On the other hand (MIRE) is useful in improving cutaneous sensation and static stability in patients with diabetic neuropathy.

Keywords: diabetic neuropathy, doppler flow meter, low level laser, monochromatic near infrared photo energy

Procedia PDF Downloads 287

Authors: Antwi Kwaku Dei, Lyford Conrad Power

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This paper investigates the outcome of participating in the government of Ghana block farm program on rural households’ farm productivity, income, food security and nutritional status in Northern Ghana using cross-sectional data. Data analysis was done using the Instrumental Variable and the Heckman Selection Bias procedures. Our analysis indicates that participation in the block farm program significantly increased directly the productivity of maize, rice, and soybean by 21.3 percent, 15.8 percent, and 12.3 percent respectively. Also, the program participation was found to increase households’ farm income by 20 percent in northern Ghana. Furthermore, program participation was found to improve household food security and nutrition by 19 percent and 14 percent respectively through income effect. Based on the benefit-cost ratio of 1.59 the results from the study recommends that the program is expanded to other communities in the northern region. Further analysis indicates that rural households’ decision to participate in food security intervention programs is significantly influenced by factors including the gender of the household head, the age of the household head, and household size. Results of the study further show that gender of household head, household size, household monthly income, household assets, women educational status, the age of women, marital status of women, are significant determinants of food security and nutrition status in Northern Ghana.

Keywords: block farm program, farm productivity, , household food security, Northern Ghana

Procedia PDF Downloads 246

Authors: Kawar Salih

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It has been proven that designing sustainable buildings starts from early stages of urban design. The design of urban blocks specifically, is considered as one of the pragmatic strategies of sustainable urbanism. There have been previous studies that focused on the impact of urban block design and regulation on the outdoor thermal comfort in the semi-arid regions. However, no studies have been found that concentrated on that impact on the internal behavior of buildings of those regions specifically the daylight quality and energy performance. Further, most studies on semi-arid regions are focusing only on the cooling load reduction, neglecting the heating load. The study has focused on two parameters of urban block distribution which are the block orientation and the surface-to-volume ratio with the consideration of both heating and cooling loads of buildings. In Duhok (a semi-arid city in Kurdistan region of Iraq), energy consumption and daylight quality of different types of residential blocks have been examined using dynamic simulation. The findings suggest that there is a considerable higher energy load for heating than cooling, contradicting many previous studies about these regions. The results also highlight that the orientation of urban blocks can vary the energy consumption to 8%. Regarding the surface-to-volume ratio (S/V), it was observed that after the twice enlargement of the S/V, the energy consumption increased 15%. Though, the study demonstrates as well that there are opportunities for reducing energy consumption with the increase of the S/V which contradicts many previous research on S/V impacts on energy consumption. These results can help to design urban blocks with the bigger S/V than existing blocks in the city which it can provide better indoor daylight and relatively similar energy consumption.

Keywords: blocke orienation, building energy consumption, urban block design, semi-arid regions, surfacet-to-volume ratio

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Authors: Amit Bhattacharyya

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The economic scenario of any region does not show the real picture for the measurement of overall development. Therefore, economic development must be accompanied by social development to be able to make an assessment to measure the level of development. The spatial variation with respect to social development has been discussed taking into account the quality of functioning of a social system in a specific area. In this paper, an attempt has been made to study the spatial distribution of social infrastructural facilities and analyze the magnitude of regional disparities at inter- block level in Barddhman district. It starts with the detailed account of the selection process of social infrastructure indicators and describes the methodology employed in the empirical analysis. Analyzing the block level data, this paper tries to identify the disparity among the blocks in the levels of social development. The results have been subsequently explained using both statistical analysis and geo spatial technique. The paper reveals that the social development is not going on at the same rate in every part of the district. Health facilities and educational facilities are concentrated at some selected point. So overall development activities come to be concentrated in a few centres and the disparity is seen over the blocks.

Keywords: disparity, inter-block, social development, spatial variation

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Authors: Deepika Sudevan, Patrick Rozycki, Laurent Gornet

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This paper presents the experimental identification of the fatigue limit for pristine and impacted Carbon Fiber Reinforced Epoxy polymer (CFRP) woven composites based on the relatively new self-heating methodology for composites. CFRP composites of [0/90]8 and quasi isotropic configurations prepared using hand-layup technique are subjected to low energy impacts (20 J energy) simulating a barely visible impact damage (BVID). Runway debris strike, tool drop or hailstone impact can cause a BVID on an aircraft fuselage made of carbon composites and hence understanding the post-impact fatigue response of CFRP laminates is of immense importance to the aerospace community. The BVID zone on the specimens is characterized using X-ray Tomography technique. Both pristine and impacted specimens are subjected to several blocks of constant amplitude (CA) fatigue loading keeping R-ratio a constant but with increments in the mean loading stress after each block. The number of loading cycles in each block is a subjective parameter and it varies for pristine and impacted CFRP specimens. To monitor the temperature evolution during fatigue loading, thermocouples are pasted on the CFRP specimens at specific locations. The fatigue limit is determined by two strategies, first is by considering the stabilized temperature in every block and second is by considering the change in the temperature slope per block. The results show that both strategies can be adopted to determine the fatigue limit in both pristine and impacted CFRP composites.

Keywords: CFRP, fatigue limit, low energy impact, self-heating, WRM

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Authors: Krystian Wójcik, Sara Wróblewska, Marcin Łojek, Katarzyna Sobień

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Polish Geological Survey selected five of the most prospective areas for oil and gas exploration in Poland. They are dedicated to the 6th international tender round for hydrocarbon concessions, planned in 2022. The main exploration target of these areas is related to conventional and unconventional accumulations of gas and oil in the Carpathian basement, Carpathian Foredeep and Outer Carpathians (Block 413 – 414), as well as in the Carboniferous, Rotliegend, Main Dolomite (Block 208, Cybinka – Torzym, Zielona Góra West), and in the Mesozoic of the Polish Lowlands (Koło).

Keywords: concession policy, international tender, oil and gas exploration horizons, prospective areas

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Authors: Antonello Troncone, Luigi Pugliese, Andrea Parise, Enrico Conte

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The present study deals with the landslides periodically reactivated by groundwater level fluctuations owing to rainfall. The main type of movement which generally characterizes these landslides consists in sliding with quite small-displacement rates. Another peculiar characteristic of these landslides is that soil deformations are essentially concentrated within a thin shear band located below the body of the landslide, which, consequently, undergoes an approximately rigid sliding. In this context, a simple method is proposed in the present study to forecast the movements of this type of landslides owing to rainfall. To this purpose, the landslide body is schematized by means of a two-block model. Some analytical solutions are derived to relate rainfall measurements with groundwater level oscillations and these latter, in turn, to landslide mobility. The proposed method is attractive for engineering applications since it requires few parameters as input data, many of which can be obtained from conventional geotechnical tests. To demonstrate the predictive capability of the proposed method, the application to a well-documented landslide periodically reactivated by rainfall is shown.

Keywords: rainfall, water level fluctuations, landslide mobility, two-block model

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Authors: Sophio Kobauri, David Tugushi, Vladimir P. Torchilin, Ramaz Katsarava

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Hydrophobic / hydrophilically modified functional polymers are of high interest in modern biomedicine due to their ability to solubilize water-insoluble / poorly soluble (hydrophobic) drugs. Among the many approaches that are being developed in this direction, one of the most effective methods is the use of polymeric micelles (PMs) (micelles formed by amphiphilic block-copolymers) for solubilization of hydrophobic biologicals. For therapeutic purposes, PMs are required to be stable and biodegradable, although quite a few amphiphilic block-copolymers are described capable of forming stable micelles with good solubilization properties. For obtaining micelle-forming block-copolymers, polyethylene glycol (PEG) derivatives are desirable to use as hydrophilic shell because it represents the most popular biocompatible hydrophilic block and various hydrophobic blocks (polymers) can be attached to it. Although the construction of the hydrophobic core, due to the complex requirements and micelles structure development, is the very actual and the main problem for nanobioengineers. Considering the above, our research goal was obtaining biodegradable micelles for the solubilization of hydrophobic drugs and biologicals. For this purpose, we used biodegradable polymers– pseudo-proteins (PPs)(synthesized with naturally occurring amino acids and other non-toxic building blocks, such as fatty diols and dicarboxylic acids) as hydrophobic core since these polymers showed reasonable biodegradation rates and excellent biocompatibility. In the present study, we used the hydrophobic amino acid – L-phenylalanine (MW 4000-8000Da) instead of L-leucine. Amino-PEG (MW 2000Da) was used as hydrophilic fragments for constructing the suitable micelles. The molecular weight of PP (the hydrophobic core of micelle) was regulated by variation of used monomers ratios. Micelles were obtained by dissolving of synthesized amphiphilic polymer in water. The micelle-forming property was tested using dynamic light scattering (Malvern zetasizer NanoZSZEN3600). The study showed that obtaining amphiphilic block-copolymer form stable neutral micelles 100 ± 7 nm in size at 10mg/mL concentration, which is considered as an optimal range for pharmaceutical micelles. The obtained preliminary data allow us to conclude that the obtained micelles are suitable for the delivery of poorly water-soluble drugs and biologicals.

Keywords: amino acid – L-phenylalanine, pseudo-proteins, amphiphilic block-copolymers, biodegradable micelles

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Authors: Ankita Baidya, Vanishri Ganakumar, Ranveer S. Jadon, Piyush Ranjan, Rita Sood

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Septic embolism can have varied presentations and clinical considerations. Infected central venous catheters are commonly associated with septic emboli but peripheral vascular catheters are rarely implicated. We describe a rare case of septic pulmonary emboli related to infected peripheral venous cannulation caused by an unusual etiological agent. A young male presented with complaints of fever, productive cough, sudden onset shortness of breath and cellulitis in both the upper limbs. He was recently hospitalised for dengue fever and administered intravenous fluids through peripheral venous line. The patient was febrile, tachypneic and in respiratory distress, there were multiple pus filled bullae in left hand alongwith swelling and erythema involving right forearm that started at the site of cannulation. Chest examination showed active accessory muscles of respiration, stony dull percussion at the base of right lung and decreased breath sounds at right infrascapular, infraaxillary and mammary area. Other system examination was within normal limits. Chest X-ray revealed bilateral multiple patchy heterogenous peripheral opacities and infiltrates with right-sided pleural effusion. Contrast-enhanced computed tomography (CECT) chest showed feeding vessel sign confirming the diagnosis as septic emboli. Venous Doppler and 2D-echocardiogarm were normal. Laboratory findings showed marked leucocytosis (22000/mm3). Pus aspirate, blood sample, and sputum sample were sent for microbiological testing. The patient was started empirically on ceftriaxone, vancomycin, and clindamycin. The Pus culture and sputum culture showed Klebsiella pneumoniae sensitive to cefoperazone-sulbactum, piperacillin-tazobactum, meropenem and amikacin. The antibiotics were modified accordingly to antimicrobial sensitivity profile to Cefoperazone-sulbactum. Bronchoalveolar lavage (BAL) was done and sent for microbiological investigations. BAL culture showed Klebsiella pneumoniae with same antimicrobial resistance profile. On day 6 of starting cefoperazone-sulbactum, he became afebrile. The skin lesions improved significantly. He was administered 2 weeks of cefoperazone–sulbactum and discharged on oral faropenem for 4 weeks. At the time of discharge, TLC was 11200/mm3 with marked radiological resolution of infection and healed skin lesions. He was kept in regular follow up. Chest X-ray and skin lesions showed complete resolution after 8 weeks. Till date, only couple of case reports of septic emboli through peripheral intravenous line have been reported in English literature. This case highlights that a simple procedure of peripheral intravenous cannulation can lead to catastrophic complication of septic pulmonary emboli and widespread cellulitis if not done with proper care and precautions. Also, the usual pathogens in such clinical settings are gram positive bacteria, but with the history of recent hospitalization, empirical therapy should also cover drug resistant gram negative microorganisms. It also emphasise the importance of appropriate healthcare practices to be taken care during all procedures.

Keywords: antibiotics, cannula, Klebsiella pneumoniae, septic emboli

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Authors: A. K. Putri, A.Fitri, C. A. Batubara

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Diabetes Mellitus (DM) is a chronic disease that could cause complications. The complication can be Peripheral Arterial Disease (PAD) or Diabetic Neuropathy (DN). Peripheral Arterial Disease is checked by Ankle Brachial Index (ABI), DN is checked by Diabetic Neuropathy Examination (DNE) score. To determine the association of ABI and DNE score in DM type 2. This study uses a cross-sectional design. The subjects were DM patients at the neurology and endocrinology polyclinic at Haji Adam Malik Hospital Medan and its network hospital and this study subjects were examined for ABI and DNE scores. The data were analysed using the Fisher Exact statistics test. Demographics characteristic showed most of subject are female (51,6%), age range ≥ 60 (45.2% ; average 57,6 ± 9,8 years ), and history of DM 5-10 years (45,2%). The most patient ABI characteristics were mild PAD (42%) and moderate PAD (29%). The most patient DNE Score characteristics were≥ 3 (51,6%). There’s a significant relationship between ABI and DNE score in DM type 2 (p =0.016). Conclusion: There is a significant association between ABI and DNE scores in DM type 2 patients

Keywords: diabetic neuropathy, diabetes mellitus, ankle-brachial index, diabetic neuropathy examination

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Authors: A. Ojha, Y. K. Gupta

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Organophosphate (OP) pesticides are among the most widely used synthetic chemicals for controlling a wide variety of pests throughout the world. Chlorpyrifos (CPF), methyl parathion (MPT), and malathion (MLT) are among the most extensively used OP pesticides in India. DNA strand breaks and DNA-protein crosslinks (DPC) are toxic lesions associated with the mechanisms of toxicity of genotoxic compounds. In the present study, we have examined the potential of CPF, MPT, and MLT individually and in combination, to cause DNA strand breakage and DPC formation. Peripheral blood lymphocytes of rat were exposed to 1/4 and 1/10 LC50 dose of CPF, MPT, and MLT for 2, 4, 8, and 12h. The DNA strand break was measured by the comet assay and expressed as DNA damage index while DPC estimation was done by fluorescence emission. There was significantly marked increase in DNA damage and DNA-protein crosslink formation in time and dose dependent manner. It was also observed that MPT caused the highest level of DNA damage as compared to other studied OP compounds. Thus, from present study, we can conclude that studied pesticides have genotoxic potential. The pesticides mixture does not potentiate the toxicity of each other. Nonetheless, additional in vivo data are required before a definitive conclusion can be drawn regarding hazard prediction to humans.

Keywords: organophosphate, pesticides, DNA damage, DNA protein crosslink, genotoxic

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Authors: Sanchita B. Sarma, M. P. Nath

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Adequate analgesia following caesarean section decreases morbidity, hastens ambulation, improves patient outcome and facilitates care of the newborn. Intrathecal magnesium, an NMDA antagonist, has been shown to prolong analgesia without significant side effects in healthy parturients. The aim of this study was to evaluate the onset and duration of sensory and motor block, hemodynamic effect, postoperative analgesia, and adverse effects of magnesium or fentanyl given intrathecally with hyperbaric 0.5% bupivacaine in patients with mild preeclampsia undergoing caesarean section. Sixty women with mild preeclampsia undergoing elective caesarean section were included in a prospective, double blind, controlled trial. Patients were randomly assigned to receive spinal anesthesia with 2 mL 0.5% hyperbaric bupivacaine with 12.5 µg fentanyl (group F) or 0.1 ml of 50% magnesium sulphate (50 mg) (group M) with 0.15ml preservative free distilled water. Onset, duration and recovery of sensory and motor block, time to maximum sensory block, duration of spinal anaesthesia and postoperative analgesic requirements were studied. Statistical comparison was carried out using the Chi-square or Fisher’s exact tests and Independent Student’s t-test where appropriate. The onset of both sensory and motor block was slower in the magnesium group. The duration of spinal anaesthesia (246 vs. 284) and motor block (186.3 vs. 210) were significantly longer in the magnesium group. Total analgesic top up requirement was less in group M. Hemodynamic parameters were similar in both the groups. Intrathecal magnesium caused minimal side effects. Since Fentanyl and other opioid congeners are not available throughout the country easily, magnesium with its easy availability and less side effect profile can be a cost effective alternative to fentanyl in managing pregnancy induced hypertension (PIH) patients given along with Bupivacaine intrathecally in caesarean section.

Keywords: analgesia, magnesium, pre eclampsia, spinal anaesthesia

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Authors: Manoj Deepak, N. Mathivanan, K. Venkatachalam

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Nerve root stenosis is one of the main cause for back pain. There are many methods both conservative and surgical to treat this disease. It is pertinent to decompress the spine to a proper extent so as to avoid the recurrence of symptoms. But too much of an aggressive approach also has its disadvantages. We present one of the methods to effectively decompress the nerve with better results. Our study was carried out in 52 patients with foramina stenosis between 2008 to 2011.We carried out the surgical procedure of shaving off the medial part of the facet joint so as to decompress the root. We selected those patients who had symptoms of claudication for more than 2 years. They had no signs of instability and they underwent conservative treatment for a period of 2 months before the procedure. Oswersty scoring was used to record the functional level of the patient before and after the procedure. All patients were followed up for a period of minimum 2.5 years. After evaluation for a minimum of 2.5 years, 34 patients had no evidence of recurrence of symptoms with improvement in the functional level.7 patients complained of minimal pain but their functional quality had improved postop. Six patients had symptoms of lumbar canal disease which reduced with conservative treatment. 5 patients required spinal fusion surgeries in the later period. Conclusion: Thus, we can effectively conclude that our procedure is safe and effective in reducing the symptoms in those patients with neurogenic claudication.

Keywords: facetectoemy, stenosis, decompression, Lumbar Foraminal Stenosis, hemi-facetectomy

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Authors: M. Abdollahi, S. N. Moghaddas Tafreshi

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Expanded polystyrene (EPS) geofoam is often used in below ground applications in geotechnical engineering. A most recent configuration system implemented in roadways to protect lifelines such as buried pipes, electrical cables and culvert systems could be consisted of two EPS geofoam blocks, “posts” placed on each side of the structure, an EPS block capping, “beam” put atop two posts, and soil cover on the beam. In this configuration, a rectangular void space will be built atop the lifeline. EPS blocks will stand all the imposed vertical forces due to their strength and deformability, thus the lifeline will experience no vertical stress. The present paper describes the results of a numerical study on the post and beam configuration subjected to the static loading. Three-dimensional finite element analysis using ABAQUS software is carried out to investigate the effect of different parameters such as beam thickness, soil thickness over the beam, post height to width ratio, EPS density, and free span between two posts, on the stress distribution and the deflection of the beam. The results show favorable performance of EPS geofoam for protecting sensitive infrastructures.

Keywords: beam, EPS block, numerical analysis, post, stress distribution

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Authors: Nihad Karim Chowdhury, Mohammad Sanaullah Chowdhury, Muhammed Jamshed Alam Patwary, Rubel Biswas

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In content-based 3D shape retrieval system, achieving high search performance has become an important research problem. A challenging aspect of this problem is to find an effective shape descriptor which can discriminate similar shapes adequately. To address this problem, we propose a new shape descriptor for 3D shape models by combining multi-resolution with multi-block center-symmetric local binary pattern operator. Given an arbitrary 3D shape, we first apply pose normalization, and generate a set of multi-viewed 2D rendered images. Second, we apply Gaussian multi-resolution filter to generate several levels of images from each of 2D rendered image. Then, overlapped sub-images are computed for each image level of a multi-resolution image. Our unique multi-block CS-LBP comes next. It allows the center to be composed of m-by-n rectangular pixels, instead of a single pixel. This process is repeated for all the 2D rendered images, derived from both ‘depth-buffer’ and ‘silhouette’ rendering. Finally, we concatenate all the features vectors into one dimensional histogram as our proposed 3D shape descriptor. Through several experiments, we demonstrate that our proposed 3D shape descriptor outperform the previous methods by using a benchmark dataset.

Keywords: 3D shape retrieval, 3D shape descriptor, CS-LBP, overlapped sub-images

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Authors: Deborah Zelinsky

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The retina filters millions of incoming signals into a smaller amount of exiting optic nerve fibers that travel to different portions of the brain. Most of the signals are for eyesight (called "image-forming" signals). However, there are other faster signals that travel "elsewhere" and are not directly involved with eyesight (called "non-image-forming" signals). This article centers on the neurons of the optic nerve connecting to parts of the limbic system. Eye care providers are currently looking at parvocellular and magnocellular processing pathways without realizing that those are part of an enormous "galaxy" of all the body systems. Lenses are modifying both non-image and image-forming pathways, taking A.M. Skeffington's seminal work one step further. Almost 100 years ago, he described the Where am I (orientation), Where is It (localization), and What is It (identification) pathways. Now, among others, there is a How am I (animation) and a Who am I (inclination, motivation, imagination) pathway. Classic eye testing considers pupils and often assesses posture and motion awareness, but classical prescriptions often overlook limbic involvement in visual processing. The limbic system is composed of the hippocampus, amygdala, hypothalamus, and anterior nuclei of the thalamus. The optic nerve's limbic connections arise from the intrinsically photosensitive retinal ganglion cells (ipRGC) through the "retinohypothalamic tract" (RHT). There are two main hypothalamic nuclei with direct photic inputs. These are the suprachiasmatic nucleus and the paraventricular nucleus. Other hypothalamic nuclei connected with retinal function, including mood regulation, appetite, and glucose regulation, are the supraoptic nucleus and the arcuate nucleus. The retino-hypothalamic tract is often overlooked when we prescribe eyeglasses. Each person is different, but the lenses we choose are influencing this fast processing, which affects each patient's aiming and focusing abilities. These signals arise from the ipRGC cells that were only discovered 20+ years ago and do not address the campana retinal interneurons that were only discovered 2 years ago. As eyecare providers, we are unknowingly altering such factors as lymph flow, glucose metabolism, appetite, and sleep cycles in our patients. It is important to know what we are prescribing as the visual processing evaluations expand past the 20/20 central eyesight.

Keywords: neuromodulation, retinal processing, retinohypothalamic tract, limbic system, visual processing

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Authors: Huixia Shi, Can Hu, Jun Zhu, Hongling Guo, Haiyan Li, Hongyan Du

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The identification of human body fluids during forensic investigations is a critical step to determine key details, and present strong evidence to testify criminal in a case. With the popularity of DNA and improved detection technology, the potential question must be revolved that whether the suspect’s DNA derived from saliva or semen, menstrual or peripheral blood, how to identify the red substance or aged blood traces on the spot is blood; How to determine who contribute the right one in mixed stains. In recent years, molecular approaches have been developing increasingly on mRNA, miRNA, DNA methylation and microbial markers, but appear expensive, time-consuming, and destructive disadvantages. Physicochemical methods are utilized frequently such us scanning electron microscopy/energy spectroscopy and X-ray fluorescence and so on, but results only showing one or two characteristics of body fluid itself and that out of working in unknown or mixed body fluid stains. This paper focuses on using chemistry methods Raman spectroscopy and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry to discriminate species of peripheral blood, menstrual blood, semen, saliva, vaginal secretions, urine or sweat. Firstly, non-destructive, confirmatory, convenient and fast Raman spectroscopy method combined with more accurate matrix-assisted laser desorption/ionization time-of-flight mass spectrometry method can totally distinguish one from other body fluids. Secondly, 11 spectral signatures and specific metabolic molecules have been obtained by analysis results after 70 samples detected. Thirdly, Raman results showed peripheral and menstrual blood, saliva and vaginal have highly similar spectroscopic features. Advanced statistical analysis of the multiple Raman spectra must be requested to classify one to another. On the other hand, it seems that the lactic acid can differentiate peripheral and menstrual blood detected by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, but that is not a specific metabolic molecule, more sensitivity ones will be analyzed in a forward study. These results demonstrate the great potential of the developed chemistry methods for forensic applications, although more work is needed for method validation.

Keywords: body fluids, identification, Raman spectroscopy, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry

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Authors: Sundip Charmode, Simmi Mehra, Sudhir Kushwaha, Shalom Philip, Pratik Amrutiya, Ranjna Jangal

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Introduction: Quadrangular space syndrome involves compression of the axillary nerve and posterior circumflex humeral artery and its management in few cases, requires surgical decompression. The current study reviews the surgical approaches used in the decompression of neurovascular structures and presents our reflections and recommendations. Methods: Four human cadavers, in the Department of Anatomy were used for dissection of the Axillae and the Scapular region by the senior residents of the Department of Anatomy and Department of Orthopedics, who dissected quadrangular space in the eight upper limbs, using anterior and posterior surgical approaches. Observations: Posterior approach to identify the quadrangular space and secure its contents was recognized as the easier and much quicker method by both the Anatomy and Orthopedic residents, but it may result in increased postoperative morbidity. Whereas the anterior (Delto-pectoral) approach involves more skill but reduces postoperative morbidity. Conclusions: Anterior (Delto-pectoral) approach with suggested modifications can prove as an effective method in surgical decompression of quadrangular space syndrome. The authors suggest more cadaveric studies to facilitate anatomists and surgeons with the opportunities to practice and evaluate older and newer surgical approaches.

Keywords: surgical approach, anatomical approach, decompression, axillary nerve, quadrangular space

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Authors: Chieh-Fu Chang, Wan-Hsin Hsieh

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We have proposed a novel scheme— iterative word-extension (IWE) to enhance the cliff effect of Reed-Solomon codes regarding the error performance at a specific Eb/N0. The scheme can be readily extended to block codes and the important properties of IWE are further investigated here. In order to select proper block codes specifying the desired cliff Eb/N0, the associated features of IWE are explored. These properties and features grant IWE ability to enhance security regarding the received Eb/N0 in physical layer so that IWE scheme can cooperate with the traditional presentation layer approach — cryptography, to meet the secure requirements in diverse applications. The features and feasibility of IWE scheme in satellite communication are finally discussed.

Keywords: security, IWE, cliff effect, space communications

Procedia PDF Downloads 391

Authors: S. alireza Mirghasemi, Shervin Rashidinia, Mohammadsaleh Sadeghi, Mohsen Talebizadeh, Narges Rahimi Gabaran, S. Shahin Eftekhari, Sara Shahmoradi

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Purpose: There are various pin-in-plaster methods for treating distal radius fractures. This study is meant to introduce a modified technique of pin-in-plaster. Materials and methods: Fifty-four patients with distal radius fractures were followed up for one year. Patients were excluded if they had type B fractures according to AO classification, multiple injuries or pathological fractures, and were treated more than 7 days after injury. Range of motion and functional results were evaluated. Radiographic parameters including radial inclination, tilt, and height, were measured preoperatively and postoperatively. Results: The average radial tilt was 10.6° and radial height was 10.2 mm at the sixth month postoperatively. Three cases of pin tract infection were recorded, who were treated totally with oral antibiotics. There was no case of pin loosening. Of total 73 patients underwent surgery, three cases of radial nerve irritation were recorded at the time of cast removal. All of them resolved at the 6th month follow up. No median nerve compression and carpal tunnel syndrome have found. We also had no case of tendon injury. Conclusion: Our modified technique is effective to restore anatomic congruity and maintain reduction.

Keywords: distal radius fracture, percutaneous pinning, pin-in-plaster, modified method of pin-in-plaster, operative treatment

Procedia PDF Downloads 479