Assessment of physicians’ knowledge of Glasgow Coma Score

Background: Glasgow Coma Scale (GCS) is the most commonly used tool in assessing comatose patients. It is simple, easily communicable, and useful in prognostication and determination of the treatment modality in head injury. Unfortunately, a high percentage of clinicians who are not in the emergency or neurological services are not conversant with this life‑saving tool.Objective: The objective of this study was to assess the level of knowledge of GCS among physicians practicing in a tertiary institution in South‑East Nigeria, and to evaluate the call for a new and simpler scoring system.Materials and Methods: This study was carried out using the instrument of a structured‑questionnaire in Nnamdi Azikiwe University Teaching Hospital Nnewi, a federal government tertiary health institution in South‑East Zone of Nigeria, which is a 350‑bed facility employing about 550 medical doctors of different adres.Results: A total of 139 questionnaires were distributed to the doctors practicing in the institution who consented to participating in the study. The questionnaires were completed at the point of their administration and completed questionnaires were retrieved on the spot, and data were collated, and analyzed with the Statistical Package for Social Sciences, SPSS version 17.0. Statistical significance was calculated with the chi square, P ≤ 0.5. The modal age group was 20‑30 years 66 (48%), and most were resident doctors 99 (66.2%). One week prior to the questionnaire distribution, 56 (42.1%) had been actively involved in emergency care of patients, and 41 (30%) could not recall what GCS stood for. Medical and house officers showed a better knowledge of GCS.Conclusion: There was a poor knowledge of GCS among a good number of physicians practicing in our setting and hence, continuing medical education on GCS is strongly advocated.Key words: Head injury, inter‑rater reliability, prognostication, traum

Establishing the content validity in Hong Kong of the prioritised criteria of consultation competence in the Leicester Assessment Package (LAP)

Objective: To test the content validity in Hong Kong of the prioritised criteria of consultation competence in the Leicester Assessment Package (LAP). Design: A detailed questionnaire was sent to doctors with experience of family medicine in Hong Kong to seek their views on the seven prioritised consultation categories and 39 component competences in the LAP on a six-point scale (strongly approve to strongly disapprove). Respondents also had the opportunity to reject or suggest alternative categories, components and/or weightings. Background demographic and professional data were collected. Subjects: 489 full members of the HKCFP with current Hong Kong postal address. Main outcome measure: The respondents' collated levels of approval of the LAP consultation categories, component competences and weightings and any consensus for changes. Results: There was a response rate of 57%. Of the respondents 92%, and 82% to 97% either strongly approved or approved of the overall LAP set of consultation categories and the individual categories respectively. Thirty-seven of the 39 suggested component competences were supported by more than 80% of respondents. There was little support for excluding, including or shifting any categories or component competences. Ninety-three percent of respondents were in favour of the need to identify priorities between any categories of consultation competence and 88% of respondents expressed approval of the suggested weightings. Conclusion: The high levels of approval from respondents suggest that the content validity of the categories and components of consultation competence in the LAP has been established in Hong Kong and that the LAP weightings of consultation categories have also been validated. Indeed, the results closely correlate with the findings of the original study in the United Kingdom. The LAP criteria of consultation competence may be used with confidence as measures against which consultation performance can be judged in formative or regulatory assessment (and improvement) of consultation competence in family medicine in Hong Kong.published_or_final_versio

Patterns of spinal injury in a new neurosurgical centre: A 2-year prospective study

Background: Spinal injury is a major cause of morbidity and mortality worldwide. Road traffic accident is the main aetiologic factor, affecting mostly the male gender in the >15 – 40-year age group. The aim of this study was to establish our local hospital patterns of spinal injury and compare them with published reports.Methods and Patients: A prospective study of all spinal injury patients treated in our service in the two-year period, April 21, 2006 – April 20, 2008 was undertaken. Data collection was done using a structured proforma from the time of admission into our service to the time of discharge, and subsequent follow-up in the few cases that kept to their appointment. Data was then collated and simple data analysis done.Results: Spinal injury was diagnosed in 62 of our 826 patients, mostly males, aged >15-40years 28 (45.2%), and road traffic accident was the main aetiologic factor with an unusually high case incidence from motorcycles. There were neurological deficits in 49(79%) and cervical cord injuries were the most common. Evaluation of the injuries was mostly with plain radiography, and treatment was non-operative in all cases. Complete cord injuries remained without improvement, and complications were mostly pressure ulcers, with no incident of deep venous thrombosis. Mortality was 13(21%).Conclusion: Spinal injury was an important indication for neurosurgical consultations in our service. Complete cord injuries were more common than incomplete injuries contrary to other previous reports, and the case incidence from motorcycles was remarkably high

The molecular control of tomato fruit quality traits: the trade off between visual attributes, shelf life and nutritional value

Tomato (Solanum lycopersicum) is an established model to study fleshy fruit development and ripening and is an important crop in terms of its economic and nutritional value. Tomato fruit quality is a function of metabolite content which is prone to physiological changes related to fruit development and ripening. It has been described some ripening tomato mutants, delayed fruit deterioration (DFD), non-ripening (NOR) and ripening-inhibitor (RIN) which substantially extend “shelf life” in tomato for up to several months when defined in terms of softening, water loss and resistance to postharvest biotic infection. However, it is not known whether this extension in “shelf life” is in fact a desirable objective from the perspective of nutritional quality of the fruits. The aim of this work was to use a metabolomics approach join to genomic tools to characterize compositional changes (sugars, amino acids, organic acids and carotenoids) of non-softening tomato mutants reported (DFD, NOR and RIN) in comparison with the normally softening fruits (Ailsa Craig and M82) during ripening and postharvest shelf-life. Important results related with ripening gene expression and metabolic evolutions are shown

Traumatic Brain Injury in the Accident and Emergency Department of a Tertiary Hospital in Nigeria

Background: Traumatic brain injury is a major public health problem in Nigeria, as it could be associated with long term and life long deficits. Unlike other parts of the world, in our country, motorcycles are possibly the main cause of this injury. Unfortunately, we do not have a national epidemiological data base yet. This study was aimed at defining the peculiar demographic and associated risk factors in traumatic brain injury among our patients, as part of a multiinstitutional data pool for a future meta-analysis to generate the national data base.Methods: This was a 24-month retrospective study of all head injury patients who met the criteria for traumatic brain injury in the Accident and Emergency Department of a tertiary health institution. Data were collected from the emergency cards and case notes, then collated and analyzed using the descriptive statistics on SPSS 13, with the p value taken as <0.05.Results: A total of 9,444 patients were attended to during the 24 months; 510 (5.4%) of them met the inclusion criteria for the study. This translated to a presentation rate of 5.3 cases per week and an incidence rate of 2,710 per 100,000 per year. Males accounted for 404 (79.2%) of the cases. The peak age incidence (31.2%) was in the >20 – 30 year age group. Traders constituted the highest occupational group 125 (24.5%). Most (58.8%) of the cases resulted from motorcycle accident. There were 28 deaths giving a mortality rate of 5.5% or 148 deaths per 100,000 per year.Conclusion: The risk factors were the male gender, motorcycle riding, illiteracy, trading, extremes of age and active daytime period of 12:01 – 18:00hours. The incidence rate was much higher than in the developed countries, but could reduce with the use of crash helmets, seat belts, speed limits and safety/protective vehicular devices, with better road rehabilitation

Acute ischaemic stroke during short-term travel to high altitude

This is a case report of a young healthy adult who had acute cerebral infarcts after a short-term visit to high-altitude area. He developed acute onset of right-sided limb weakness and right hemianopia a few hours after arrival at an altitude of 3600 m by train. He was initially treated for high-altitude cerebral oedema but later computed tomography and magnetic resonance imaging confirmed ischaemic infarcts in the medial left occipital lobe and left thalamus. Subsequent investigations, including laboratory tests and imaging including an echocardiogram, revealed no culpable predisposing factors.published_or_final_versio

Assessment of soil radon potential in Hong Kong, China, using a 10-point evaluation system

Radon and its progenies have been ranked second of being responsible for lung cancer in humans. Hong Kong has four major groups of uranium-rich plutonic and volcanic rocks and is suffering from radon emanated therefrom. However, there is a lack of radon potential maps in Hong Kong to resolve the spatial distribution of radon-prone areas. A ten-point radon potential system was developed in Germany (2005) to predict radon potential using both the in situ geogenic and geographic parameters under hierarchical ranking. Primarily, the ten-point system requires the desk study of the geological environment of sampling sites, which has an advantage of saving resources and manpower in extensive radon potential mapping over the traditional soil radon concentration sampling method. This paper presents a trial of radon potential mapping in Hong Kong to further verify the system. Despite some slight departures, the system demonstrates an acceptable correlation with soil radon concentrations (R 2 = 0.62-0.66) from 768 samples of mainly intermediate radon potential. Hong Kong has a mean soil radon concentrations of 58.9 kBqm -3, while the radon potential from the ten-point system achieves an average of 4.93 out of 10 over the territory. The vicinity of fault zone showed high soil radon concentrations and potentials, which were conducive to uranium enrichment and rapid soil-gas diffusion near faults. High uranium-238 content in soil was found to cause high soil radon concentration with a large R 2, 0.84. The Jurassic granite and volcanic crystal tuff cover more than 85 % of the whole Hong Kong area, and they show relatively high radon concentrations (Geometric mean 83 and 49 kBqm -3, respectively) which are associated with their high uranium contents (Geometric mean 234 and 197 Bqkg -1, respectively). While indoor radon concentration is an important factor for radon risk assessment, this study has not considered the correlation between indoor radon concentration and radon potential. The reason is that almost all buildings in Hong Kong are high-rise buildings where indoor radon concentrations are governed only by the radium content in the building materials and the ventilation conditions. © 2012 The Author(s).published_or_final_versio

Nucleophilic substitution by amide nitrogen in the aromatic rings of [zn − H]˙+ ions; the structures of the [b2 − H − 17]˙+ and [c1 − 17]+ ions

Peptide radical cations that contain an aromatic amino acid residue cleave to give [zn − H]˙+ ions with [b2 − H − 17]˙+ and [c1 − 17]+ ions, the dominant products in the dissociation of [zn − H]˙+, also present in lower abundance in the CID spectra. Isotopic labeling in the aromatic ring of [Yπ˙GG]+ establishes that in the formation of [b2 − H − 17]˙+ ions a hydrogen from the δ-position of the Y residue is lost, indicating that nucleophilic substitution on the aromatic ring has occurred. A preliminary DFT investigation of nine plausible structures for the [c1 − 17]+ ion derived from [Yπ˙GG]+ shows that two structures resulting from attack on the aromatic ring by oxygen and nitrogen atoms from the peptide backbone have significantly better energies than other isomers. A detailed study of [Yπ˙GG]+ using two density functionals, B3LYP and M06-2X, with a 6-31++G(d,p) basis set gives a higher barrier for attack on the aromatic ring of the [zn − H]˙+ ion by nitrogen than by the carbonyl oxygen. However, subsequent rearrangements involving proton transfers are much higher in energy for the oxygen-substituted isomer leading to the conclusion that the [c1 − 17]+ ions are the products of nucleophilic attack by nitrogen, protonated 2,7-dihydroxyquinoline ions. The [b2 − H − 17]˙+ ions are formed by loss of glycine from the same intermediates involved in the formation of the [c1 − 17]+ ions.postprin

The global aerosol-cloud first indirect effect estimated using MODIS, MERRA, and AeroCom

Aerosol-cloud interactions (ACI) represent a significant source of forcing uncertainty in global climate models (GCMs). Estimates of radiative forcing due to ACI in Fifth Assessment Report range from −0.5 to −2.5 W m−2. A portion of this uncertainty is related to the first indirect, or Twomey, effect whereby aerosols act as nuclei for cloud droplets to condense upon. At constant liquid water content this increases the number of cloud droplets (Nd) and thus increases the cloud albedo. In this study we use remote-sensing estimates of Nd within stratocumulus regions in combination with state-of-the-art aerosol reanalysis from Modern-Era Retrospective Analysis for Research and Applications version 2 (MERRA2) to diagnose how aerosols affect Nd. As in previous studies, Nd is related to sulfate mass through a power law relationship. The slope of the log-log relationship between Nd and SO4 in maritime stratocumulus is found to be 0.31, which is similar to the range of 0.2–0.8 from previous in situ studies and remote-sensing studies in the pristine Southern Ocean. Using preindustrial emissions models, the change in Nd between preindustrial and present day is estimated. Nd is inferred to have more than tripled in some regions. Cloud properties from Moderate Resolution Imaging Spectroradiometer (MODIS) are used to estimate the radiative forcing due to this change in Nd. The Twomey effect operating in isolation is estimated to create a radiative forcing of −0.97 ± 0.23 W m−2 relative to the preindustrial era