Identification of lumbar intervertebral space: palpation versus ultrasound technique among obese subjects

Accurate identification of the intervertebral space (IVS) is necessary during central neuraxial blockade, especially in spinal anaesthesia, to avoid untoward spinal cord injury. Ultrasound guided examination has been shown to be more accurate compared to palpation, but these studies were performed on subjects of various body weights. We conducted our prospective observational study on obese subjects and compared the performance by anaesthesiologists of various levels of anaesthetic experience. Obese subjects with body mass index (BMI) ≥ 30 kg/m2 scheduled for elective surgery were recruited following explanation and written consent. With the subjects in the sitting position, an investigator located the L3-L4 IVS by ultrasound and used an invisible ultraviolet marker pen to mark the upper border, lower border and midpoint (“Point M”) of the space. Two anaesthesiologists of varying levels of experience, categorized as Performer 1 and Performer 2, then located the L3-L4 IVS by palpation. The distance between this point and Point M was measured and recorded. Thirty-two subjects with mean BMI 35.4±6.0 kg/m2 were recruited. The mean intervertebral distance at L3-L4 on ultrasound was 1.5 cm [range 1.2-1.8 cm]. By palpation, the L3-L4 IVS was correctly identified by 56.3%, while a higher IVS was mistaken to be L3-L4 by 23.4% of all performers. The space was correctly identified by 50% of junior anaesthesiologists and 62.5% of the senior counterparts. There was fair agreement between the two categories, with kappa = 0.375 and p = 0.028. In conclusion, there was a sizeable discrepancy between the anaesthesiologists’ estimation by palpation and the actual location of the L3-L4 IVS by ultrasound among obese subjects. This observation was in fair agreement among anaesthesiologists of various levels of anaesthetic experience. The ultrasound-guided technique is useful for better identification of lumbar IVS especially in obese subjects

Incidence of maternal desaturation among patients undergoing elective caesaraen section under regional anaesthesia

This was a prospective observational study to identify the incidence and possible risk factors for maternal desaturation following neuraxial blockade for elective caesarean section (CS). Patients with body mass index (BMI) ≥ 30 kg/m2 at the first antenatal consultation were identified and classified into the obese group. Neuraxial blockade in the form of subarachnoid block (SAB) or combined spinal-epidural (CSE) was performed. Mean arterial pressure (MAP) and oxygen saturation (SpO2) were recorded at baseline and at 5-minute intervals following neuraxial blockade. Desaturation, defined as SpO2 < 94% for more than 30 seconds without artifacts, was managed with oxygen therapy and other appropriate measures. Newborn Apgar score and umbilical cord blood gases were analysed. Among a total of 254 recruited patients, 69 (27.2%) were obese and were associated with significantly higher age, parity, previous CS and pre-existing diabetes mellitus. The incidence of oxygen desaturation was 1.2%, involving three patients in the non obese group. These desaturation episodes were short-lived and associated with intraoperative hypotension. Six patients, two of whom in the obese group, received rescue oxygen therapy following intraoperative events such as deteriorating SpO2 or hypotension. The mean MAP was significantly lower at baseline and at 5 minutes post neuraxial blockade in the non obese group, which could account for the occurrence of desaturation in this group only. There were no significant inter-group differences in terms of neonatal outcome, umbilical cord blood gases and changes in mean SpO2 post neuraxial blockade. In conclusion, the current practice of not routinely giving supplementary oxygen to patient during elective CS at our institution is deemed to be safe, provided continuous SpO2 monitoring is available throughout the surgery. Further randomised clinical trials are indicated to investigate the impact of maternal obesity and of labouring patients presenting for urgent or emergency CS on intraoperative oxygen desaturation

High intrinsic biosorption efficiency of cattle manure on Cr(VI): a potential low-cost fibre-rich biosorbent

Fibre-rich manure derived from grass-fed cattle showed significantly higher intrinsic sorption efficiency on Cr(VI) solution as compared to corncob, sawdust and cogon grass. This observation could be attributed to the ligneous nature and rough surface morphology of the cattle manure. Four-factor, three-level, face-centred composite design (FCCD) suggested the process was greatly affected by initial pH of the solution, contact time and sorbent dosage (p50% adsorption efficiency. It is predicted that both physisorption and chemisorption are involved in the sorption process

Analgesia combinada raquiperidural em trabalho de parto: seus efeitos sobre o desfecho do parto

ResumoJustificativa e objetivosA analgesia combinada raquiperidural (RP) tornou‐se uma opção cada vez mais popular para o trabalho de parto tradicional devido ao seu rápido início de ação e ao resultado confiável. Este foi um estudo prospectivo de amostragem conveniente para determinar os efeitos da RP sobre o desfecho do parto.MétodosForam incluídas 110 parturientes primigestas saudáveis, com gestação única de ≥ 37 semanas e na fase ativa do trabalho de parto. As pacientes foram designadas para os grupos RP (n=55) ou não RP (n=55) com base em seus consentimentos para a analgesia combinada RP. As parturientes do grupo não RP receberam outros métodos de analgesia para o parto. As durações do primeiro e segundo estágio do trabalho de parto, as taxas de parto vaginal instrumental e cesariana de emergência e os escores de Apgar foram comparados.ResultadosA média de duração do primeiro e segundo estágio do trabalho de parto não foi significativamente diferente entre os dois grupos. As taxas de parto instrumental não foram significativamente diferentes entre os grupos, RP (11%) versus não RP (16%). A incidência ligeiramente maior de cesariana no grupo RP (16% versus 15% no não RP) não foi estatisticamente significativa. O desfecho neonatal em termos de índice de Apgar foi inferior a 7.ConclusãoNão houve diferenças significativas em relação à duração do trabalho, às taxas de parto vaginal instrumental e cesariana de emergência e ao desfecho neonatal em parturientes que receberam RP para analgesia de parto em comparação com aquelas que não receberam.AbstractBackground and objectivesCombined spinal–epidural (CSE) has become an increasingly popular alternative to traditional labour epidural due to its rapid onset and reliable analgesia provided. This was a prospective, convenient sampling study to determine the effects of CSE analgesia on labour outcome.MethodsOne hundred and ten healthy primigravida parturients with a singleton pregnancy of ≥37 weeks gestation and in the active phase of labour were studied. They were enrolled to the CSE (n=55) or Non‐CSE (n=55) group based on whether they consented to CSE analgesia. Non‐CSE parturients were offered other methods of labour analgesia. The duration of the first and second stage of labour, rate of instrumental vaginal delivery and emergency cesarean section, and Apgar scores were compared.ResultsThe mean duration of the first and second stage of labour was not significantly different between both groups. Instrumental delivery rates between the groups were not significantly different (CSE group, 11% versus Non‐CSE group, 16%). The slightly higher incidence of cesarean section in the CSE group (16% versus 15% in the Non‐CSE group) was not statistically significant. Neonatal outcome in terms of Apgar score of less than 7 at 1 and 5min was similar in both groups.ConclusionThere were no significant differences in the duration of labour, rate of instrumental vaginal delivery and emergency cesarean section, and neonatal outcome in parturients who received compared to those who did not receive CSE for labour analgesia

Patients with more comorbidities have better detection of chronic conditions, but poorer management and control:findings from six middle-income countries

Background The burden of non-communicable diseases (NCDs) is rising rapidly in middle-income countries (MICs), where NCDs are often undiagnosed, untreated and uncontrolled. How comorbidity impacts diagnosis, treatment, and control of NCDs is an emerging area of research inquiry and have important clinical implications as highlighted in the recent National Institute for Health and Care Excellence guidelines for treating patients suffering from multiple NCDs. This is the first study to examine the association between increasing numbers of comorbidities with being undiagnosed, untreated, and uncontrolled for NCDs, in 6 large MICs. Methods Cross-sectional analysis of the World Health Organisation Study of Global Ageing and Adult Health (WHO SAGE) Wave 1 (2007–10), which consisted of adults aged ≥18 years from 6 populous MICs, including China, Ghana, India, Mexico, Russia and South Africa (overall n = 41, 557). Results A higher number of comorbidities was associated with better odds of diagnosis for hypertension, angina, and arthritis, and higher odds of having treatment for hypertension and angina. However, more comorbidities were associated with increased odds of uncontrolled hypertension, angina, arthritis, and asthma. Comorbidity with concordant conditions was associated with improved diagnosis and treatment of hypertension and angina. Conclusion Patients with more comorbidities have better diagnosis of chronic conditions, but this does not translate into better management and control of these conditions. Patients with multiple NCDs are high users of health services and are at an increased risk of adverse health outcomes. Hence, improving their access to care is a priority for healthcare systems

The potential of tropical fruit peels as ion exchangers for water hardness removal

The presence of high amount of mineral compounds such as calcium (Ca2+) and magnesium (Mg2+) in water attributed to occurrence of water hardness. Hard water causes lime scale in the kettle when boiling, and forms reddish brown stains on the clothes after washing. This study was carried out to investigate peels of durian, jackfruit and passion fruit as a potential cation exchanger for water hardness removal determining by EDTA titration. A synthetic hard water of 714.05 mg CaCO3/L was prepared to evaluate the removal efficiency of cation exchangers prepared from raw and sodium hydroxide-citric acid (NaOH-CA) modified fruit peels for 30 min, 60 min, and 90 min contact times. Results showed that raw peel of durian had the highest (p ≤ 0.05) efficiency (24%) for water hardness removal followed by jackfruit (21.87%) and passion fruit (6.5%). This was because the total cellulose content in durian peel powder and fibre was higher as compared to jackfruit peel and passion fruit peel. Hydroxyl group in the cellulose was the main group responsible in ion exchange with Ca2+ and Mg2+ for water hardness removal. For NaOH-CA modified peels, jackfruit demonstrated the highest (p ≤ 0.05) water hardness removal efficiency (62.05%) as compared to passion fruit (29.63%) and durian (10.42%) for 90 min contact time. This phenomenon can be explained by citric acid anhydride produced from esterification. Citric acid anhydride produced was combined with hydroxyl groups of cellulose and hemicellulose and formed the ester linkage and increased the number of carboxylate groups on the ion exchange surface. Result showed that water retention capacity is directly proportional to water hardness removal efficiency for modified fruit peels (R2 = 0.8181). This evidence that water retention capacity of lignocellulosic material is a good indicator of cross-linking which has a direct effect on ion exchange capability. Both raw durian peel and NaOH-CA modified jackfruit peel showed great ability in water hardness removal, hence the cost of chemicals involved in modification has to be considered for a good recommendation as great potential lignocellulosic material to be used for water hardness removal

Physicochemical and sensory analyses of high fibre bread incorporated with corncob powder

The primary objectives of the present work were to produce corncob powder (CCP) from corncobs and incorporate the CCP into bread formulation in order to develop high fibre bread, and to investigate the physicochemical and sensory properties of the produced high fibre bread (HFB). The corncobs were collected and washed before they underwent the grinding and drying processes. The obtained CCP was incorporated into the bread formulation in three different proportions (5, 10 and 20%) to partially substitute bread flour in the formulation. All three bread samples and the control (0% CCP in the formulation) were analysed to obtain their physicochemical and sensory properties. The incorporation of CCP significantly affected the texture, colour and volume attributes of the produced breads. Increasing the content of CCP in the formulation was found to be responsible for firmer, smaller and darker bread loaves as compared to the composite bread samples. The bread formulation incorporated with 10% CCP had the highest mean scores (7.00) of overall acceptability among all the other formulations, and it was comparable to the commercial breads in the current market

Comparing efficacy of octyl-cyanoacrylate dermabond adhesive glue versus vicryl 3/0 suture for closure of caesarean section skin incision in UKMMC- a prospective randomised controlled trial.

This is a prospective randomised controlled trial conducted at a tertiary hospital on 82 women who underwent caesarean section. The study group, 41 women underwent dermabond skin closure whereas the control group, 41 women had subcuticular vicryl skin closure. Anaesthesia, prophylactic antibiotic, operative technique and post-operative oral analgesia was standardised between both groups. Outcomes that were measured at day 2 before discharge and at postoperative day 10-14 were pain score using VAS, duration and total analgesic dose (after day 2), time taken for skin closure and adverse events between both groups in particular inflammation, surgical site infection and allergic reaction (itching)

Comparing Postoperative Sore Throat (POST) following intubation using Macintosh Laryngoscope Versus C-MAC® Video Laryngoscope

Postoperative sore throat (POST) is a common complication with incidence of 30-90% when intubation was done using conventional Macintosh laryngoscope. Although POST is usually self-limiting and with no long-term morbidity, it can lead to patient’s discomfort and dissatisfaction in the postoperative period. The objective of this study was to compare the incidence of POST following intubation using Macintosh laryngoscope and C-MAC® videolaryngoscope (VL) at various time intervals post anaesthesia. This prospective randomised controlled study comprised of 128 patients with American Society of Anesthesiologists (ASA) I and II status who underwent elective surgery under general anaesthesia in Universiti Kebangsaan Malaysia Medical Centre. All recruited patients have normal airway and divided randomly into Group 1 and Group 2 that used Macintosh laryngoscope and C-MAC® VL during intubation, respectively. Patients were evaluated for sore throat, hoarseness of voice, dysphagia and coughing at recovery, 6 hours, 12 hours and 24 hours after intubation. Severity of POST was assessed using numerical rating scale (NRS). Incidence of POST was found to be higher in the Macintosh laryngoscope group (61.9%) compared to C-MAC® VL group (47.9%) although the difference was not statistically significant (p=0.107). Median pain score was used to assess the severity of POST, showing low and comparable in both groups at all time intervals. There were also no significant differences seen in hoarseness of voice, coughing and dysphagia for both groups during postoperation. Incidence of POST following intubation using C-MAC® VL and conventional Macintosh laryngoscope were comparable. This study revealed that severity of POST was generally low in both groups