Intraarticular use of tranexamic acid during primary total knee arthroplasty

Background: Tranexamic acid (TXA) is effective in reduction of blood loss after major surgical procedures. In TKA surgeries, it is commonly administered intravenously. Since there are contraindications of systemic use of TXA, local/intraarticular TXA can also be used. The efficacy of both systemic and local TXA administration is demonstrated in the literature. The aim was to assess the effect of intraarticular TXA during total knee arthroplasty in terms of total blood loss and transfusion rate. Methods: A total of 50 TKA in 34 patients were included in this prospective study.  Patients received one dose of intraarticular TXA of 3 g after skin closure and before deflation of the tourniquet. Results: The mean total blood loss in intra-articular TXA was 456.9 ml. None of the patients required transfusion postoperatively including those who underwent bilateral staged TKR. Mean postoperative hemoglobin loss was 1.07. Conclusions: TXA reduced blood loss and transfusion requirement. Intra-articular administration of TXA seems to be more effective in terms of reducing total blood loss and transfusion rates. We recommend administration of topical TXA in primary TKA in healthy patients to decrease perioperative blood loss

Study of surgical management of fracture of proximal humerus by PHILOS plate and screws

Background: Proximal humerus fracture accounts for about 5% of all fractures in recent advances proximal humerus fractures are often managed operatively with PHILOS plate which provides greater angular stability and study was aimed at to assess functional outcome of PHILOS plate fixation in proximal humerus fractures.Methods: Prospective study of 31 cases of proximal humerus fractures admitted and operated in Kempegowda Institute of Medical Sciences Hospital November 2017 to May 2019 of which 4 patients died due to medical comorbidities so 27 patients were studied. Follow-up of these patients was done at 6 weeks, 12 weeks and 24 weeks with functional evaluation was done using Constant and Murley (CM) scoring and disabilities of the arm, shoulder and hand (DASH) scoring.Results: CM scoring and DASH scoring was applied to analyze the functional outcome among the cases. Most of the patients had excellent outcome (52%) followed by good (26%), fair (8%) and poor (15%) outcome according to CM scoring and according to DASH scoring 20.21 was mean score and mean CM score was 77.62. Complications observed were impingement in 1 patient, avascular necrosis in 2 patient and non union in 1 case.Conclusions: We conclude that the use of PHILOS plate for the fixation of proximal humerus fractures is a good device as it provides rigid fixation and early mobilisation and prevented complications. Precontoured locking plates work on the principle of angular stability, divergent screws, less disruption of vascularity and less chances of plate failure

Biochar formulation using alkaline pre-treated oil palm trunks and oil palm frond

Biochar is charcoal made from plant material and agricultural biomass. The biochar is produced by slow thermo-chemical pyrolysis of biomass materials and has been proven of its benefits in soi l enrichment and as a combined material for industrial heat ing fuel. In the present research, biochar formulation was made to utilize two types of oil palm t ree biomass; oil palm t runk (OPT) and oil palm frond (OPF). The best combination of both materials was evaluated in terms of calorific heat value, moisture and ash content and compared with the standard biochar. In addition, t reated OPT and OPF were compared with the untreated material to further enhance the characteristic of the biochar

Characteristics and Preliminary Study of Ceramic Concretes

One of the most adaptable and frequently used building materials in the world is concrete. It is flexible in terms of size and shape, sturdy, long-lasting, low-maintenance, fireproof, and easy to use. However, further research is needed to increase the durability and sustainability of this material since concrete technology is still in developing industry. Therefore, it's crucial to comprehend how microstructure and characteristics interact in terms of how they affect concrete's strength, dimensional stability, and durability. The findings of this research are crucial in identifying the properties and characteristics of the ceramic concrete used for bridge construction or others. Advanced research to ascertain the hardness and physical qualities and features of ceramic concrete material is required. Thus, it will help to produce a reliable data for engineer to refer for their future works or project. To ascertain its hardness and physical characteristics, research has been conducted on ceramic concrete for several types of grades. In the current study, the ceramic concrete was tested through the physical and Vickers-hardness tests. The X-Ray Diffraction (XRD) and Scanning Electron Microscopy (SEM) on samples were performed to observe the phases and morphology of the ceramic concrete, respectively. For results of physical testing, the density and water absorption correlate to each other by the denser of the sample, the lower of water absorption and the porosity level of the ceramic concrete. Based on the Vickers micro hardness test, it can be seen that longer curing days affected the hardness, where the concretes of grade 30 and 40 at 28 curing days had better hardness value. Next, Scanning Electron Microscopy (SEM) on samples shown almost same microstructure, while the dominant phase of all ceramic concrete grades was SiO2 by the XRD analysis. In summary, better properties of ceramic concretes were indicated at 28 curing days for both grades of ceramic concretes

Hybrid memristor-CMOS implementation of logic gates design using LTSpice

In this paper, a hybrid memristor-CMOS implementation of logic gates simulated using LTSpice. Memristors' implementation in computer architecture designs explored in various design structures proposed by researchers from all around the world. However, all prior designs have some drawbacks in terms of applicability, scalability, and performance. In this research, logic gates design based on the hybrid memristor-CMOS structure presented. 2-inputs AND, OR, NAND, NOR, XOR, and XNOR are demonstrated with minimum components requirements. In addition, a 1-bit full adder circuit with high performance and low area consumption is also proposed. The proposed full adder only consists of 4 memristors and 7 CMOS transistors. Half design of the adder base on the memristor component created. Through analysis and simulations, the memristor implementation on designing logic gates using memristor-CMOS structure demonstrated using the generalized metastable switch memristor (MSS) model and LTSpice. In conclusion, the proposed approach improves speed and require less area

Interventions to improve spontaneous adverse drug reaction reporting by healthcare professionals and patients:systematic review and meta-analysis

The aim of this study was to evaluate the effectiveness of interventions used for improving ADR reporting by patients and healthcare professionals. A systematic review of literature was conducted by searching Medline, Embase and Cochrane Central Register of Controlled of Trials. Meta-analysis of randomized controlled trials (RCTs; = 5) was conducted to estimate the pooled risk ratio for the effectiveness of interventions on ADR reporting rates. Data from observational studies were synthesized using narrative synthesis approach. A total of 28 studies were included. All except one study targeted healthcare professionals using educational, technological, policy, financial and/or mixed interventions. The results showed that financial and face-to-face educational interventions improved quality and quantity of ADR reporting when compared with interventions not involving face-to-face interactions. However, the quality of studies was generally low. Meta-analysis showed a statistically significant 3.5-fold overall increase in reporting of ADRs [RR 3.53; 95% CI (1.77,7.06)] in the intervention group compared to the control. There was a lack of consideration of theory and sustainability in the design of the interventions. There is a need to develop and test theory-based interventions and target patient reporting. More research needs to be conducted in the low- and middle-income countries.This study was funded by University of Birmingham

Evaluation of various antibiotics used in the treatment of cellulitis at a tertiary care hospital

Background: Cellulitis is an inflammation of the skin and subcutaneous tissues, usually resulting from microbial invasion. It may occur as a result of tissue injury. The mainstay of treatment includes antibiotic therapy based on the susceptibility and severity of infection. The aim of the study is to evaluate various antibiotics used in the treatment of cellulitis at a tertiary care hospital.Methods: Participants were patients referred by Dermatologists, General surgeons with acute and complicated cellulitis. Demographic data, Clinical and biochemical data were analyzed at admission. Then the time taken for improvement of symptoms and length of stay were analyzed.Results: A total of 58 patients were included in the study of which 38(65.5%) patients were male and 20(34.4%) patients were female. Patients having comorbid conditions were found to be having higher length of stay (mean±SD-13.7±3.6 days), severity of infection and antibiotic therapy. Patients with diabetes(mean±SD-16.8±4days) have higher length of stay and slow wound healing. Patients with left leg cellulitis 32(55%) were higher than the right leg cellulitis 17(29%). The reason behind this remains undetermined, which highlights scope for future research in this region.Conclusions: Management of patients was done with mono or dual/combination antibiotic therapy or surgical treatment was done based on clinical response. According to our study patients with co-morbidities especially Diabetes have slow prognosis of cellulitis as they required longer length of stay in a hospital and prolonged treatment. Rational clinical decision on the use of various antibiotics shall be implemented based on evidence-based methods such as iv-to-po shift, regular evaluation of clinical response and stepping down to a narrow-spectrum to reduce the length of stay which can improve the paradigm and the positive clinical response for the management of cellulitis

The construction of the Malaysian Educators Selection Inventory (MEdSI): a large scale assessment initiative / Joharry Othman...[et al.]

of a nation’s human resource is undeniable. In Malaysia, teaching has always been perceived as a financially secure and relatively easy job by many, resulting in mass application for entry into teacher education programmes. Many of those who aspire and opto to go into the teaching profession however do so regardless of their personal interests, potential, and values. Pursuing a program that does not fit a person’s personality and interest – despite initially having good academic credentials and excellent co-curricular involvement in school – may result in unsatisfactory academic performance, frustration, change of program and even withdrawal at college level. Hence, in the quest for selecting suitable teacher trainee candidates, a psychometrically sound instrument known as the Malaysian Educators Selection Inventory (MEdSI) was developed as a screening measure to filter the large number of teacher hopefuls. This paper specifically describes the theoretical basis and the constructs of the instrument developed

Conchology variations in species identification of Pachychilidae (Mollusca, Gastropoda, Cerithiodea) through multivariate analysis

Pachychilidae is one of the freshwater gastropod family which was previously known under the Potamididae and Thiaridae families. Studies on freshwater gastropods especially on conchcology examinantions are still inadequate compared to marine gastropods. Morphological and morphometric studies of gastropods are practically used to identify and differentiate between species and necessary to complement molecular studies due to its low cost and tolerable resolving power of discrimination. The aim of the current study is to provide information on morphological and morphometric characteristics of Pachychilidae in Bintulu, Sarawak stream. A total of 20 individuals from each species of Sulcospira testudinaria, Sulcospira schmidti, Brotia siamensis, and Tylomelania sp. from Pachychilidae familiy were collected at three different sites from a small stream within the Bintulu area. Fourteen measurement of shell morphometrics were converted into proportioned ratios and analysed for univariate and multivariate analysis. Three shell morphometric (Aperture width, AW; Whorl width, WW2; and, Interior anterior length, AINL) of Pachychilidae indicated significant differences (P < 0.05) between species. However, multivariate analysis revealed that these shell morphometrics are pre-eminent factors to discriminate genus Sulcospira, Brotia and Tylomelania, as well as between Sulcospira species. This current study also suggests that these three characteristics are unique to Sulcospira species due to strong distinction among species. Findings on these three characteristics are significant for Sulcospira spp. as this study is the first shell morphometric report on the Pachychilidae species in Sarawak

Knowledge and perceptions towards cardiovascular disease prevention among patients with type 2 diabetes mellitus: A review of current assessments and recommendations

Introduction: Patients with type 2 diabetes mellitus (T2DM) are at significantly higher risk of developing cardiovascular disease (CVD). There is scarcity of literature reviews that describes and summarises T2DM patients' knowledge and perception about CVD prevention. Objectives: To describe and summarise the assessment of knowledge and perceptions about CVD risk and preventive approaches among patients with T2DM. Methods: A scoping review methodology was adopted, and three scientific databases, Google Scholar, Science Direct and PubMed were searched using predefined search terms. A multistage screening process that considered relevancy, publication year (2009-2019), English language, and article type (original research) was followed. We formulated research questions focused on the assessment of levels of knowledge and perceptions of the illness relevant to CVD prevention and the identification of associated patients' characteristics. Results: A total of 16 studies were included. Patients were not confident to identify CVD risk and other clinical consequences that may occur in the prognostic pathway of T2DM. Furthermore, patients were less likely to identify all CV risk factors indicating a lack of understanding of the multi-factorial contribution of CVD risk. Patients' beliefs about medications were correlated with their level of adherence to medications for CVD prevention. Many knowledge gaps were identified, including the basic disease expectations at the time of diagnosis, identification of individuals' CVD risk factors and management aspects. Knowledge and perceptions were affected by patients' demographic characteristics, e.g., educational level, race, age, and area of residence. Conclusion: There are knowledge gaps concerning the understanding of CVD risk among patients with T2DM. The findings necessitate educational initiatives to boost CVD prevention among patients with T2DM. Furthermore, these should be individualised based on patients' characteristics and knowledge gaps, disease duration and estimated CVD risk