Life cycle assessment of biogas used for the provision of thermal household energy in developing countries

The utilization of dried dung as fuel for household cooking stoves is very common in rural areas of developing countries. The objective of this study was to compare the environmental impacts for the provision of cooking heat from biogas with the utilization of dung cakes. For this purpose, the method of life cycle assessment was used for assessing the impact categories global warming potential, acidification potential, eutrophication potential and human toxicity potential. The results show that anaerobic digestion at household scale can contribute to the reduction of greenhouse gases (GHG?s) as well as several other emissions in rural areas

Protection against severe malaria by hemoglobin S and C: A quantitative understanding of the cytoadhesion behavior of Plasmodium falciparum infected erythrocytes

To avoid clearance by the spleen, P. falciparum-infected erythrocytes adhere to the microvascular endothelial cells lining the blood vessels and sequester in the microvasculature of vital organs. Cytoadhesion results in reduced blood perfusion and inflammatory endothelial cell activation. While the parasite matures during the intraerythrocytic cycle, the infected erythrocyte undergoes a series of modifications including altered morphology, reduced deformability and increased adhesiveness. These properties govern the cytoadherence process and determine the dynamic adhesion behavior under physiological flow conditions. Several red blood cell polymorphisms, including sickle hemoglobin and hemoglobin C, have been associated with protection against severe malaria and malaria-related death. The mechanisms underlying this protection are poorly understood but it might be conferred, in part, by the reduced binding capability of infected erythrocytes to microvascular endothelial cells. Here, we quantitatively compared the adhesion dynamics of infected wild-type and sickle cell trait erythrocytes, at different parasite developmental stages, using flow chamber assays. Differences in the dynamic adhesion behavior were observed for trophozoite and schizont-stages. While a discoid shape in early stage caused flipping of the infected cell, an almost spherical cell at the late stage of the intraerythrocytic cycle results in a regular rolling motion. We further showed that changes in mechanical and adhesive properties of infected sickle cell trait erythrocytes resulted in substantial differences in the flipping and rolling dynamics, relative to infected wild-type erythrocytes, which led to a reduced contact time and predicted contact area to the endothelial cells as well as a reduced firm adherence. As a consequence of the differential firm and dynamic adhesion behavior, infected sickle trait-erythrocytes were less likely to activate microvascular endothelial cells, which in turn, might reduce the pathology observed in sickle cell trait individuals infected with P. falciparum. Overall, our findings improve the understanding of the protection mechanism against severe malaria conferred by sickle hemoglobin

The use of etoricoxib to treat an idiopathic stabbing headache: a case report

According to the International Headache Society, idiopathic stabbing headache (ISH), an indomethacin-responsive headache syndrome, is a paroxysmal disorder of short duration manifested as head pain occurring as a single stab or a series of stabs involving the area supplied in the distribution of the first division of the trigeminal nerve. Stabs last for approximately a few seconds, occurring and recurring from once to multiple times per day in an irregular frequency, with no underlying attributable disorder

Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain

Background: Low-back pain with leg pain (sciatica) may be caused by a herniated intervertebral disc exerting pressure on the nerve root. Most patients will respond to conservative treatment, but in carefully selected patients, surgical discectomy may provide faster relief of symptoms. Primary care clinicians use patient history and physical examination to evaluate the likelihood of disc herniation and select patients for further imaging and possible surgery. Objectives: (1) To assess the performance of tests performed during physical examination (alone or in combination) to identify radiculopathy due to lower lumbar disc herniation in patients with low-back pain and sciatica; (2) To assess the influence of sources of heterogeneity on diagnostic performance. Search strategy: We searched electronic databases for primary studies: PubMed (includes MEDLINE), EMBASE, and CINAHL, and (systematic) reviews: PubMed and Medion (all from earliest until 30 April 2008), and checked references of retrieved articles. Selection criteria: We considered studies if they compared the results of tests performed during physical examination on patients with back pain with those of diagnostic imaging (MRI, CT, myelography) or findings at surgery. Data collection and analysis: Two review authors assessed the quality of each publication with the QUADAS tool, and extracted details on patient and study design characteristics, index tests and reference standard, and the diagnostic two-by-two table. We presented information on sensitivities and specificities with 95% confidence intervals (95% CI) for all aspects of physical examination. Pooled estimates of sensitivity and specificity were computed for subsets of studies showing sufficient clinical and statistical homogeneity. Main results: We included 16 cohort studies (median N = 126, range 71 to 2504) and three case control studies (38 to100 cases). Only one study was carried out in a primary care population. When used in isolation, diagnostic performance of most physical tests (scoliosis, paresis or muscle weakness, muscle wasting, impaired reflexes, sensory deficits) was poor. Some tests (forward flexion, hyper-extension test, and slump test) performed slightly better, but the number of studies was small. In the one primary care study, most tests showed higher specificity and lower sensitivity compared to other settings. Most studies assessed the Straight Leg Raising (SLR) test. In surgical populations, characterized by a high prevalence of disc herniation (58% to 98%), the SLR showed high sensitivity (pooled estimate 0.92, 95% CI: 0.87 to 0.95) with widely varying specificity (0.10 to 1.00, pooled estimate 0.28, 95% CI: 0.18 to 0.40). Results of studies using imaging showed more heterogeneity and poorer sensitivity. The crossed SLR showed high specificity (pooled estimate 0.90, 95% CI: 0.85 to 0.94) with consistently low sensitivity (pooled estimate 0.28, 95% CI: 0.22 to 0.35). (aut. ref.

Acute intestinal failure: international multicenter point-of-prevalence study

Background & aims: Intestinal failure (IF) is defined from a requirement or intravenous supplementation due to failing capacity to absorb nutrients and fluids. Acute IF is an acute, potentially reversible form of IF. We aimed to identify the prevalence, underlying causes and outcomes of acute IF. Methods: This point-of-prevalence study included all adult patients hospitalized in acute care hospitals and receiving parenteral nutrition (PN) on a study day. The reason for PN and the mechanism of IF (if present) were documented by local investigators and reviewed by an expert panel. Results: Twenty-three hospitals (19 university, 4 regional) with a total capacity of 16,356 acute care beds and 1237 intensive care unit (ICU) beds participated in this study. On the study day, 338 patients received PN (21 patients/1000 acute care beds) and 206 (13/1000) were categorized as acute IF. The categorization of reason for PN was revised in 64 cases (18.9% of total) in consensus between the expert panel and investigators. Hospital mortality of all study patients was 21.5%; the median hospital stay was 36 days. Patients with acute IF had a hospital mortality of 20.5% and median hospital stay of 38 days (P > 0.05 for both outcomes). Disordered gut motility (e.g. ileus) was the most common mechanism of acute IF, and 71.5% of patients with acute IF had undergone abdominal surgery. Duration of PN of ≥42 days was identified as being the best cut-off predicting hospital mortality within 90 days. PN ≥ 42 days, age, sepsis and ICU admission were independently associated with 90-day hospital mortality. Conclusions: Around 2% of adult patients in acute care hospitals received PN, 60% of them due to acute IF. High 90-day hospital mortality and long hospital stay were observed in patients receiving PN, whereas presence of acute IF did not additionally influence these outcomes. Duration of PN was associated with increased 90-day hospital mortality