Correlation between spinal column length and the spread of subarachnoid hyperbaric bupivacaine in the term parturient

Background: Anaesthetists frequently tailor the subarachnoid local anaesthetic dosage according to parturient height to achieve sensory blockade up to the T4 dermatome for lower segment Caesarean sections (LSCSs). Studies that have been conducted have demonstrated that height does not affect the spread of subarachnoid hyperbaric bupivacaine. This study aimed to find the correlation between the spinal column length of termparturients and the highest level of sensory blockade after spinal anaesthesia.Methods: The authors studied 60 singleton term parturients of American Society of Anesthesiologists (ASA) physical status I or II scheduled for elective LSCSs. The length of the spinal column was taken as an averageof three measurements from the C7 spinous process to the sacral hiatus in a sitting upright and facing forward position. Spinal anaesthesia was given by administering 1.8 ml of 0.5% hyperbaric bupivacaine and 25 μg fentanyl through the L3/L4 or L4/L5 intervertebral space. The level of sensory blockade was assessed using pin-prick testing for pain sensation. Linear regression analysis was used to analyse the correlation; R < 0.25 indicates no correlation with the level of significance being < 0.05.Results: The spinal column lengths measured were between 42.2 cm and 85.8 cm (median: 58.5 cm). Spinal anaesthesia given was adequate for all patients, with the highest levels of anaesthesia ranging from T8 to T2 with sensory levels between T6 and T4. The parturients’ spinal column length showed no correlation with the highest level of sensory blockade achieved, namely R = 0.11.Conclusions: The study found no correlation between the parturients’ spinal column length and the highest level of sensory blockade achieved.Keywords: spinal anaesthesia; spinal column; hyperbaric bupivacaine; parturients; lower segment Caesarean section (LSCS

Design and Development of Domestic Cyclone Dust Collector System Using TRIZ And CCD Method

In conventional vacuum cleaners, filter media or filter bags are used to physically separate dust and debris from flowing air streams. However, in such systems, the vacuum cleaner's efficiency diminishes over time as more debris is accumulated on the filter surface. In this study, a two-stage cyclone dust collector system was proposed, which can be attached to existing vacuum cleaners. The system was designed and developed using the integrated Theory of Inventive Problem Solving (TRIZ) and Classical Cyclone Design (CCD) method. The TRIZ method was implemented during the idea generation stage, where specific design solution strategies were reviewed. Theoretical analysis of the selected design was carried out using Classical Cyclone Design (CCD) method. Finally, a full-scale working prototype of the cyclone dust collector was fabricated for evaluation. Based on results, the cyclone dust collector system provides more than 99% fractional efficiency and 96% overall collection efficiency for particles with an average diameter of over 50 μm. The pressure drops and airflow inside the cyclone dust collector were also analysed. The results suggest that the proposed cyclone dust collector system would provide better filtration efficiency and less maintenance compared to the conventional system

Determination of Optimal Electrospinning Distance and Applied Voltage for Polyacrylonitrile Electrospun Fibre Production

Electrospinning process is highly dictated by electric field strength. Thus, two key parameters i.e., electrospinning distance and applied voltage, determine the quality of electrospun fibres. Incorrect selection of these parameters will result in poor fibre qualities. There ought to be an optimal combination of electrospinning distance and applied voltage to produce best quality fibres from a given material. In this study, the optimal combination of electrospinning distance and applied voltage was assessed based on consistency of electrospinning process, amount of fibre, fibre morphology, and average fibre diameter. Polyacrylonitrile (PAN) electrospun fibre samples were prepared at different combinations of electrospinning distance and applied voltage. Scanning electron microscopy and image analysis were conducted to assess the quality and average diameter of the fibres. The results indicate that for electrospinning of PAN, the distance should be between 10 and 20 cm with a 15 to 20 kV of applied voltages. Findings from this study is crucial for producing optimal fibre quality in PAN electrospun nanofibre synthesis

Improving economic evaluations in stroke : A report from the ESO Health Economics Working Group

Introduction Approaches to economic evaluations of stroke therapies are varied and inconsistently described. An objective of the European Stroke Organisation (ESO) Health Economics Working Group is to standardise and improve the economic evaluations of interventions for stroke. Methods The ESO Health Economics Working Group and additional experts were contacted to develop a protocol and a guidance document for data collection for economic evaluations of stroke therapies. A modified Delphi approach, including a survey and consensus processes, was used to agree on content. We also asked the participants about resources that could be shared to improve economic evaluations of interventions for stroke. Results Of 28 experts invited, 16 (57%) completed the initial survey, with representation from universities, government, and industry. More than half of the survey respondents endorsed 13 specific items to include in a standard resource use questionnaire. Preferred functional/quality of life outcome measures to use for economic evaluations were the modified Rankin Scale (14 respondents, 88%) and the EQ-5D instrument (11 respondents, 69%). Of the 12 respondents who had access to data used in economic evaluations, 10 (83%) indicated a willingness to share data. A protocol template and a guidance document for data collection were developed and are presented in this article. Conclusion The protocol template and guidance document for data collection will support a more standardised and transparent approach for economic evaluations of stroke care.Peer reviewe

Depression and anxiety symptoms post-stroke/TIA:prevalence and associations in cross-sectional data from a regional stroke registry

BACKGROUND: Mood disorders are commonly seen in those with cerebrovascular disease. Literature to-date has tended to focus on depression and on patients with stroke, with relatively little known about post-stroke anxiety or mood disorder in those with transient ischaemic attack (TIA). We aimed to describe prevalence of depression and anxiety symptoms in stroke and TIA cohorts and to explore association with clinical and socio-demographic factors. METHODS: We used a city wide primary care stroke registry (Glasgow Local Enhanced Service for Stroke - LES). All community dwelling stroke-survivors were included. We described cross-sectional prevalence of depression and anxiety symptoms using the Hospital Anxiety and Depression Scale (HADS). Data on clinical and demographic details was collected and univariable and multivariable analyses performed to describe associations with HADS scores. We examined those with a diagnosis of 'stroke' and 'TIA' as separate cohorts. RESULTS: From 13,283 potentially eligible stroke patients in the registry, we had full HADS data on 4,079. Of the 3,584 potentially eligible TIA patients, we had full HADS data on 1,247 patients. Across the stroke cohort, 1181 (29%) had HADS anxiety scores suggestive of probable or possible anxiety; 993 (24%) for depression. For TIA patients, 361 (29%) had anxiety and 254 (21%) had depression. Independent predictors of both depression and anxiety symptoms were female sex, younger age and higher socioeconomic deprivation score (all p < 0.001). CONCLUSION: Using HADS, we found a high prevalence of anxiety and depression symptoms in a community-based cohort of patients with cerebrovascular disease

Stroke Risk in Patients With Reduced Ejection Fraction After Myocardial Infarction Without Atrial Fibrillation.

BACKGROUND: Stroke can occur after myocardial infarction (MI) in the absence of atrial fibrillation (AF). OBJECTIVES: This study sought to identify risk factors (excluding AF) for the occurrence of stroke and to develop a calibrated and validated stroke risk score in patients with MI and heart failure (HF) and/or systolic dysfunction. METHODS: The datasets included in this pooling initiative were derived from 4 trials: CAPRICORN (Effect of Carvedilol on Outcome After Myocardial Infarction in Patients With Left Ventricular Dysfunction), OPTIMAAL (Optimal Trial in Myocardial Infarction With Angiotensin II Antagonist Losartan), VALIANT (Valsartan in Acute Myocardial Infarction Trial), and EPHESUS (Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study); EPHESUS was used for external validation. A total of 22,904 patients without AF or oral anticoagulation were included in this analysis. The primary outcome was stroke, and death was treated as a "competing risk." RESULTS: During a median follow-up of 1.9 years (interquartile range: 1.3 to 2.7 years), 660 (2.9%) patients had a stroke. These patients were older, more often female, smokers, and hypertensive; they had a higher Killip class; a lower estimated glomerular filtration rate; and a higher proportion of MI, HF, diabetes, and stroke histories. The final stroke risk model retained older age, Killip class 3 or 4, estimated glomerular filtration rate ≤45 ml/min/1.73 m2, hypertension history, and previous stroke. The models were well calibrated and showed moderate to good discrimination (C-index = 0.67). The observed 3-year event rates increased steeply for each sextile of the stroke risk score (1.8%, 2.9%, 4.1%, 5.6%, 8.3%, and 10.9%, respectively) and were in agreement with the expected event rates. CONCLUSIONS: Readily accessible risk factors associated with the occurrence of stroke were identified and incorporated in an easy-to-use risk score. This score may help in the identification of patients with MI and HF and a high risk for stroke despite their not presenting with AF

Understanding the concept of al-ibtila’ (trial) in personality development: the Muslim flood victims’ experience

Religious coping plays an important role to rehabilitate victims affected by traumatic life events. Islamic teachings emphasizes al-ibtila' (trial) concept that serves in understanding the concept of qada’ (fate) and qadar (destiny).This study explored al-ibtila’ in coping with traumatic events by achieving sense of personal control in situations that produce distress and torment, as exhibited by 2014 flood victims in Temerloh, Pahang.This study analyzed their understanding, genuine acceptance, and relationship between understanding of al-ibtila' and personality development in overcoming trauma. A mixed-method approach was applied, comprising methods of documentation, interviews (five interview subjects selected by sequential sampling), and survey questionnaires (300 flood victims as respondents). Data from documentation and interviews were analyzed using the inductive approach (qualitative) in a descriptive study, while survey data were analyzed using descriptive and inferential statistical tests (quantitative). The findings gave evidence of significant positive effects in dealing with flood disaster stress from three aspects: the understanding, acceptance, and relationship between understanding of al-ibtila' with good personality development.These results emphasized the need to include understanding and acceptance of al-ibtila' as part of God’s plan in the face of traumatic events, indicating that highly optimistic flood victims can positively deal with traumatic events

Predicting stroke in heart failure and reduced ejection fraction without atrial fibrillation

Background and Aims: Patients with heart failure with reduced ejection fraction (HFrEF) are at significant risk of stroke. Anticoagulation reduces this risk in patients with and without atrial fibrillation (AF), but the risk-to-benefit balance in the latter group, overall, is not favourable. Identification of patients with HFrEF, without AF, at the highest risk of stroke may allow targeted and safer use of prophylactic anticoagulant therapy. Methods: In a pooled patient-level cohort of the PARADIGM-HF, ATMOSPHERE, and DAPA-HF trials, a previously derived simple risk model for stroke, consisting of three variables (history of prior stroke, insulin-treated diabetes, and plasma N-terminal pro-B-type natriuretic peptide level), was validated. Results: Of the 20,159 patients included, 12,751 patients did not have AF at baseline. Among patients without AF, 346 (2.7%) experienced a stroke over a median follow-up of 2.0 years (rate 11.7 per 1000 patient-years). The risk for stroke increased with increasing risk score: fourth quintile HR 2.35 (95%CI 1.60-3.45); fifth quintile HR 3.73 (2.58-5.38), with the first quintile as reference. For patients in the top quintile, the rate of stroke was 21.2 per 1000 patient-years, similar to participants with AF not receiving anticoagulation (20.1 per 1000 patient-years). Model discrimination was good with a C-index of 0.84 (0.75-0.91). Conclusions: It is possible to identify a subset of HFrEF patients without AF with a stroke risk equivalent to that of patients with AF who are not anticoagulated. In these patients, the risk-to-benefit balance might justify the use of prophylactic anticoagulation, but this hypothesis needs to be tested prospectively

Prospect and potential of Burkholderia sp. against Phytophthora capsici Leonian: a causative agent for foot rot disease of black pepper

Foot rot disease is a very destructive disease in black pepper in Malaysia. It is caused by Phytophthora capsici Leonian, which is a soilborne pathogenic protist (phylum, Oomycota) that infects aerial and subterranean structures of many host plants. This pathogen is a polycyclic, such that multiple cycles of infection and inoculum production occur in a single growing season. It is more prevalent in the tropics because of the favourable environmental conditions. The utilization of plant growth-promoting rhizobacteria (PGPR) as a biological control agent has been successfully implemented in controlling many plant pathogens. Many studies on the exploration of beneficial organisms have been carried out such as Pseudomonas fluorescens, which is one of the best examples used for the control of Fusarium wilt in tomato. Similarly, P. fluorescens is found to be an effective biocontrol agent against the foot rot disease in black pepper. Nowadays there is tremendous novel increase in the species of Burkholderia with either mutualistic or antagonistic interactions in the environment. Burkholderia sp. is an indigenous PGPR capable of producing a large number of commercially important hydrolytic enzymes and bioactive substances that promote plant growth and health; are eco-friendly, biodegradable and specific in their actions; and have a broad spectrum of antimicrobial activity in keeping down the population of phytopathogens, thus playing a great role in promoting sustainable agriculture today. Hence, in this book chapter, the potential applications of Burkholderia sp. to control foot rot disease of black pepper in Malaysia, their control mechanisms, plant growth promotion, commercial potentials and the future prospects as indigenous PGPR were discussed in relation to sustainable agriculture