Surface EMG of Abdominal Muscles as a Tool to Predict the Ambulation Outcome in T6-T12 Motor Complete Paraplegics: An Observational study

INTRODUCTION: The ancient Edwin Smith Papyrus (written by an Egyptian physician around 3,000 to 2,500 years B.C.), speaks of a spinal cord lesion as “an ailment not to be treated”. In the past, a spinal cord injury almost always meant certain death, or at best a lifetime of struggles to survive secondary complications. Such was the approach to this condition until World War I1, when new programs for medical treatment and rehabilitation reduced mortality rates following spinal cord injury from over 80 percent in World War I to below 10 percent by 1946. We have come a long way from such times. AIM OF THE STUDY: To evaluate whether abdominal muscle Surface EMG activity can predict outcome of ambulatory capacity in patients with spinal cord lesions with NLI (Neurological Level of Injury) at T6-T12. OBJECTIVES: 1. To prospectively examine whether abdominal muscle activity using surface EMG can independently predict ambulation outcome in paraplegics with NLI at T6 to T12. 2. To examine if the sensory level of a thoracic paraplegic correlates with presence of surface EMG activity in the muscle groups examined. HYPOTHESIS: Presence of abdominal muscle activity as measured by surface EMG is a predictor of functional ambulation outcome among thoracic paraplegics. MATERIALS AND METHODS: STUDY DESIGN: The present study is an observational study to evaluate the use of surface EMG (SEMG) of the anterior abdominal musculature as an independent predictor of ambulation outcome in thoracic level paraplegics. As per current standards, neurological level of injury (NLI) at the thoracic level is determined by clinical examination of the sensory level and this is used as a guide for goal setting and prognostication of ambulation. We also examined Beevor’s Sign as a predictor of ambulation outcome. Beevor’s sign was recorded positive if there was an upward shift of the umbilicus when a supine lying patient raised his head voluntarily. Positive Beevor’s Sign indicates abdominal muscle weakness is present. The Negative Beevor’s Sign occurred in the following situations; ٭ Weak/Poor upper and lower abdominal muscle strength. ٭ Fair upper and lower abdominal muscle strength. ٭ Good upper and lower abdominal muscle strength. i.e., upper and lower abdominal muscle groups had similar strength. The Positive Beevor’s Sign occurred in the following situations. ٭ Upper abdominals good, lower abdominals fair/poor. ٭ Upper abdominal fair, lower abdominals poor. As such the abdominal muscle strength was also documented. SUBJECTS: Institutional Review Board approval was obtained before initiating the study. A recording of abdominal muscle activity using surface EMG was initially done on a volunteer (normal subject) at the Movement Analysis Laboratory, CMC, Bagayam. Twenty patients who were undergoing in-patient rehabilitation in the department of PMR and who fulfilled the inclusion criteria were recruited for the study. They were recruited into the study once they progressed to parallel bar ambulation with bilateral KAFO, they were recruited. Signed Informed Consent Form stating that the patient is being voluntarily recruited was initially obtained from the patient. Inclusion Criteria: 1. Paraplegics with ASIA Impairment Scale A and B and NLI T6 to 12. 2. Subjects recruited must be within the age group15-60 years. Exclusion Criteria: 1. Patients with spinal cord injury with spinal instability. 2. Patients with progressive pathology of spinal cord such as tumours. 3. Patients with complications such as acute deep vein thrombosis, persistant pulmonary problems, pressure sores, contractures of lower limb. 4. Patients with motor incomplete paraplegia i.e., ASIA Impairment Scale C, D and E and NLI above D6 and below D12. 5. Age 60 years. CONCLUSIONS: 1. There was a statistically significant correlation of surface EMG amplitudes of of external obliques, internal obliques, total obliques as well as upper rectus plus obliques with crutch walking. There was a statistically significant correlation of surface EMG amplitude of internal obliques and lower rectus plus obliques with walker ambulation to at least 250m (i.e., FAS at least 4). This can be of significance in prediciting the ambulatory capacity in patients with T6-T12 spinal cord lesions. 2. Correlation between surface EMG and Neurological Level of Injury was not statistically significant. Neurological Level of Injury as determined by the ASIA scale may not be sufficient to predict ambulatory outcome in thoracic level paraplegics. 3. Statistically significant correlation was not present between NLI or Beevor’s sign with the ambulatory capacity using any of the outcome measures studied. Hence, SEMG may be a better predictor of ambulatory outcome than the existing predictors (NLI and Beevor’s Sign) among T6-T12 spinal cord injured patients

A Study to Assess the Effectiveness of Structured Teaching Programme on Knowledge Regarding Iron Deficiency Anemia and its Prevention among the Primi Antenatal Mothers at Shridevi Institute of Medical Sciences, Tumkur, Karnataka, India

Background: Iron deficiency is the most common nutritional disorder in the world today, affecting approximately 25% of the world’s population. Where there are three basic mechanisms for developing anemia, mainly (i) blood loss (hemorrhage); (ii) decreased production of red cells; and (iii) increased destruction of red cells. Anemia during pregnancy has been shown to be associated with a two-fold risk for preterm delivery and a three-fold risk for low birth-weight4 as well as maternal mortality.Materials and Methods: True experimental one group pre-test and posttest design was adopted to select the samples. 50 samples were selected by using non-probability convenient sampling. An evaluative research approach was used to assess the knowledge on iron deficiency anemia. The collected data was analyzed and interpreted based on descriptive and inferential statistics.Result: The result showed that antenatal mothers who are attending antenatal clinic in Shridevi hospitals are not having adequate knowledge on iron deficiency anemia

ATOMISTIC AND EXPERIMENTAL DETERMINATION OF THE STRUCTURAL AND THERMOPHYSICAL PROPERTIES OF THE ACCIDENT TOLERANT FUEL MATERIALS

The tragic nuclear accident at the Fukushima-Daiichi power station in Japan brought in to our attention the risk associated with the current design of reactors based on uranium dioxide (UO2) fuel and zirconium cladding. As an offshoot, the research towards accident tolerant nuclear fuel (ATF) that can withstand the loss of coolant for a long time while improving thermal efficiency has gained momentum. Most desirable thermophysical properties expected of an ATF is high thermal conductivity, the lack of which leads to the poor dissipation and rapid meltdown at the core of the fuel pellet during the loss of coolant. Several approaches are being considered by researchers across the world to improve the thermal conductivity of nuclear fuels. Apart from the state of art of uranium-based fuels, there is a renewed interest in thorium-based fuels (especially thorium dioxide (ThO2) and thorium nitride (ThN)) in the quest of ATF. This thesis focuses on evolutionary fuel concepts based on thoria fuels. Unlike UO2, the information regarding the thermophysical properties of ThO2 fuels, and the additive materials under the normal operating conditions and the extreme accident conditions are not well known. Therefore, in this thesis, the computational techniques such as density functional theory (DFT) and classical molecular dynamics (MD) are used to determine the thermophysical properties of the thoria fuel, surrogate of thoria CeO2 and additive materials such as SiC and BeO. One of the significant limitations in the front end of the thoria fuel cycle has the difficulty of fabricating dense pellets by conventional sintering techniques. Hence the processing of thoria fuels by the spark plasma sintering (SPS) was proposed, and the effect of the sintering parameters on the density, microstructure and the thermal conductivity of ThO2 fuel was established. Finally, using SPS, a novel composite fuel of ThO2-SiC has been fabricated with the enhanced thermal conductivity

Bioremediation of lead and nickel contaminated soil by Eudrilus eugeniae and the characterization of synthesized nanoparticles

Bionanotechnology has emerged for developing a green and ecofriendly technology for recycling the non-destructive waste materials and cleaning the environment .the present study focuses on the bioremediation of heavy metal contaminated soil and safe disposal of heavy metals and minerals with the help of earthworms , namely Eudrilus eugeniae as an ecofriendly technique. The characterization studies were conducted on these heavy metal nanoparticle in soil by Dynamic Light Scattering to determine the particle size; Atomic Absorption Spectroscopy to analyze the free elements present and X-ray Diffraction study to determine the toxic chemical compounds and minerals present in the soil. Bioremediation of lead and nickel contaminated study using Eudrilus eugeniae was found very efficient. The study shows that the lead and nickel levels have reduced to the safety standard levels. Eudrilus eugeniae were able to accumulate lead and nickel contaminants in their tissue and reduce them to nano-sized particles

1.6V Wide Linear Range Subthreshold OTA Using 130nm CMOS Technology

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An Analysis of the Extension Workers Empowerment in Pidie Jaya Regency

This study aims to determine the factors that affect the level of empowerment of extension workers in Pidie Jaya. The data used are primary data obtained from the results of filling out a questionnaire of 112 extension workers in Pidie Jaya. The analytical method used is using Ordinal Regression. Ordinal regression analysis is a statistical method that describes the relationship between a response variable and more than one predictor variable where the response variable is more than two categories and the measurement scale is level. The results of the study concluded that the level of empowerment of the extension workers in Pidie Jaya was significantly influenced by the socio-cultural support and supporting factors

Assessment of Patient Satisfaction upon Establishment of Pharmaceutical Care in Oncology

A cancer diagnosis places considerable stress on patients and their families. They find themselves discomfort with the strange health system; making serious decisions with long term consequences; living with uncertainness about the nature, cause and indefinite progress of the disease; living with a disrupted family, work, social life and facing the possibility of becoming increasingly dependent on othersthat patients seem to show good response with satisfaction towards patient counselling upon pharmaceutical care in oncology. Patient satisfaction is beneficial to improve patients’ quality of life, thereby leading to achieve positive clinical outcome.Currently, patients are well satisfied about cancer treatment information with the general set up. But the introduction of pharmaceutical care could still improve the level of satisfaction to maximize the clinical benefits. The counseling on complementary treatments is yet to be improved as most of the patients are somehow satisfied with the information given about that. Different age groups and education levels show difference in satisfaction level and our way of approach should be set in that way to bring considerable improvement for all of them. A need based information education is always preferable to satisfy all kind of patients. We found significant progress with higher satisfaction upon knowledge on side effects and its management by the establishment of pharmaceutical care. This knowledge will improve patient compliance and enables then to cope up with further treatment odalities.Identifying the pharmacist by the patient is the first step of progress from which pharmaceutical care services can grow further. At present, the profession of oncology pharmacist is at a very low level and scarcely identified by patient. Similar studies concentrating on various areas of pharmaceutical care can improve the profession as well as patients’ outcome

Effect of Neoadjuvant Chemotherapy in Advanced Ovarian Carcinoma

INTRODUCTION: Ovarian cancer is the second most common gynecological malignancy. Most cases are diagnosed late, because effective screening methods are not available and the malignancy is often asymptomatic for a long time. Surgical resection of the tumor remains the cornerstone of treatment. But in 70% of patients with advanced disease optional debulking cannot be obtained. Interval debulking surgery after giving neo adjuvant chemotherapy helps in optimal debulking and improved the overall survival. AIM OF THE STUDY: The aim of the study is to know the tumor clearance effect of neo adjuvant chemotherapy in advanced chemotherapy in terms of optimal debulking ascitic fluid volume reduction, blood transfusion requirements and to compare it with those who have not received neo adjuvant chemotherapy. METHODS: This is a prospective study, conducted in patients with advanced ovarian carcinoma. Patients who underwent IDS for stage IIIC or IV advanced ovarian carcinoma were selected for the study and the results were compared with those who underwent primary debulking surgery. CONCLUSION: Neo adjuvant chemotherapy is significantly more effective in achieving optimal cytoreduction and reducing ascitic fluid volume in advanced ovarian cancer. Blood transfusion is significantly less in neo adjuvant chemotherapy group. Adhesions are found to be significantly less in NACT group