Introduction of the Canadian CT Head Rule Reduces CT Scan Use in Minor Head Injury

Background: The burden of traumatic brain injury (TBI) is rising in  developing countries. Minor head injuries accounts for majority of non-fatal head injury and is associated with significant resource use. The utility of the CT scan in cases of mild head injury is undetermined although a big  proportion of our patients are offered the investigation. We hypothesized that the introduction of the Canadian CT head rule (CCTHR) will reduce the utilization rate.Methods: Eighty four eligible patients diagnosed with minor head injury were recruited at the Accident and Emergency Department. The proportion of CT scan orders before (Group I-42 patients) and after (Group II- 42 patients) the introduction of the CCTHR was determined. Treatment in  Group I patients followed the primary physician orders while group II patients were offered CT scans only if they presented with ‘high risk’ features of the CCTHR. Group II patients with ‘moderate’ risk factors were admitted for observation or discharged as appropriate to the rule.Results: The proportion of CT scans ordered in Group I was 95.2% while that in Group II was 21.4%. The proportion of patients with moderate risk factors Group I was 90.5%, representing the proportion of patients who did not require a CT scan. None of the patients required neurosurgical  intervention and all had good recovery on follow up.Conclusion: The proportion of mild head injury patients requiring a CT scan at AKUH is 21.4%. Limiting CT scans to only this group was not associated with adverse outcomes. It is the recommended that CT scan rates for mild head injury be capped at 25% to save time and money currently being expended.Key Words: Canadian CT Head Rule, Minor Head Injury, Outcome

Liver abscesses in dromedary camels: Pathological characteristics and aerobic bacterial aetiology

The study was carried out at Nyala abattoirs, South Darfur State, Sudan during a period from 2009 to 2011. Slaughtered camels (822) were examined for pathological changes of liver abscesses and identification of the involved aerobic bacteria. Grossly, a total of 111 (13.5%) liver abscesses were recorded in different camel ages; 90 (81.1%) were less than seven years old and 21 (18.9%) were more than seven years old. Histopathology of sectioned tissues revealed necrotic abscesses with infiltration of inflammatory cells, hydropic degeneration with swelling of hepatocytes comprising the sinusoid and different size of vacuoles in the hepatic cells. Proliferation of bile ducts with fibrous tissue and infiltration of inflammatory cells was also recorded. Investigation of bacteria revealed 90 aerobic isolates; they were identified to 52 (57.8%) gram positive cocci, 20 (22.2%) gram positive rods and 18 (20.0%) gram negative rods. Staphylococcus spp. (41.1%), Corynebacterium spp. (17.9%) and Streptococcus spp. (13.3%) were the most frequently identified bacteria involved in liver abscesses of camels in the region. Further studies are required to assess the pathogenicity of bacterial isolates from camel livers. This is particularly important from a public health perspective, since some people of Sudan are known to consume raw camel liver.Keywords: Aerobic bacterial, Dromedary camels, Liver abscesses, Pathology, Suda

Blockchain in supply chain management: Australian manufacturer case study

The recent explosion of interest around Blockchain and capabilities of this technology to track all types of transaction more transparently and securely motivate us to explore the possibilities Blockchain offers across the supply chain. This paper examines whether Blockchain makes a good fit for use in an Australian manufacturer supply chain. To address this, the research uses Technology Acceptance Model (TAM) as a framework from the literature. Blockchain allows us to have permissioned or permission-less distributed ledgers where stakeholders can interact with each other. It details how Blockchain works and the mechanism of hash algorithms which allows for greater security of information. It also focuses on the supply chain management and looks at the intricacies of a manufacturers supply chain. We present a review of the processes in place of an electrical manufacturer and the problems faced in the supply chain. A model is proposed in using public and private Blockchains to overcome these issues. The proposed solution has the potential to bring greater transparency, validity across the supply chain, and improvement of communication between stakeholders involved. We also point out some potential issues that should be considered if adopting Blockchain.N/

A randomized two arm phase III study in patients post radical resection of liver metastases of colorectal cancer to investigate bevacizumab in combination with capecitabine plus oxaliplatin (CAPOX) vs CAPOX alone as adjuvant treatment

<p>Abstract</p> <p>Background</p> <p>About 50% of patients with colorectal cancer are destined to develop hepatic metastases. Radical resection is the most effective treatment for patients with colorectal liver metastases offering five year survival rates between 36-60%. Unfortunately only 20% of patients are resectable at time of presentation. Radiofrequency ablation is an alternative treatment option for irresectable colorectal liver metastases with reported 5 year survival rates of 18-30%. Most patients will develop local or distant recurrences after surgery, possibly due to the outgrowth of micrometastases present at the time of liver surgery. This study aims to achieve an improved disease free survival for patients after resection or resection combined with RFA of colorectal liver metastases by adding the angiogenesis inhibitor bevacizumab to an adjuvant regimen of CAPOX.</p> <p>Methods/design</p> <p>The Hepatica study is a two-arm, multicenter, randomized, comparative efficacy and safety study. Patients are assessed no more than 8 weeks before surgery with CEA measurement and CT scanning of the chest and abdomen. Patients will be randomized after resection or resection combined with RFA to receive CAPOX and Bevacizumab or CAPOX alone. Adjuvant treatment will be initiated between 4 and 8 weeks after metastasectomy or resection in combination with RFA. In both arms patients will be assessed for recurrence/new occurrence of colorectal cancer by chest CT, abdominal CT and CEA measurement. Patients will be assessed after surgery but before randomization, thereafter every three months after surgery in the first two years and every 6 months until 5 years after surgery. In case of a confirmed recurrence/appearance of new colorectal cancer, patients can be treated with surgery or any subsequent line of chemotherapy and will be followed for survival until the end of study follow up period as well. The primary endpoint is disease free survival. Secondary endpoints are overall survival, safety and quality of life.</p> <p>Conclusion</p> <p>The HEPATICA study is designed to demonstrate a disease free survival benefit by adding bevacizumab to an adjuvant regime of CAPOX in patients with colorectal liver metastases undergoing a radical resection or resection in combination with RFA.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov Identifier NCT00394992</p

Oral medications including clomiphene citrate or aromatase inhibitors with gonadotropins for controlled ovarian stimulation in women undergoing in vitro fertilisation

We thank:• Richard Kirubakaran, Cochrane South Asia, Prof. BV Moses Centre for Evidence-Informed Health Care and Health Policy, Christian Medical College, Vellore, India;• Marian Showell, Information Specialist for the Cochrane Gynaecology and Fertility Group;• Editorial team of the Cochrane Gynaecology and Fertility Group for their support and assistancePeer reviewedPublisher PD

Serum CA 19-9 as a Marker of Resectability and Survival in Patients with Potentially Resectable Pancreatic Cancer Treated with Neoadjuvant Chemoradiation

Purpose The role of carbohydrate antigen (CA) 19-9 in the evaluation of patients with resectable pancreatic cancer treated with neoadjuvant therapy prior to planned surgical resection is unknown. We evaluated CA 19-9 as a marker of therapeutic response, completion of therapy, and survival in patients enrolled on two recently reported clinical trials. Patients and Methods We analyzed patients with radiographically resectable adenocarcinoma of the head/uncinate process treated on two phase II trials of neoadjuvant chemoradiation. Patients without evidence of disease progression following chemoradiation underwent pancreaticoduodenectomy (PD). CA 19-9 was evaluated in patients with a normal bilirubin level. Results We enrolled 174 patients, and 119 (68%) completed all therapy including PD. Pretreatment CA 19-9 <37 U/ml had a positive predictive value (PPV) for completing PD of 86% but a negative predictive value (NPV) of 33%. Among patients without evidence of disease at last follow-up, the highest pretreatment CA 19-9 was 1,125 U/ml. Restaging CA 19-9 <61 U/ml had a PPV of 93% and a NPV of 28% for completing PD among resectable patients. The area under the receiver-operating characteristics curve of pretreatment and restaging CA 19-9 levels for completing PD was 0.59 and 0.74, respectively. We identified no association between change in CA 19-9 and histopathologic response (P = 0.74). Conclusions Although the PPV of CA 19-9 for completing neoadjuvant therapy and undergoing PD was high, its clinical utility was compromised by a low NPV. Decision-making for patients with resectable PC should remain based on clinical assessment and radiographic staging.PublishedN/

Characterization of crop residues from false banana/Ensete ventricosum/in Ethiopia in view of a full-resource valorization

Research ArticleFalse banana /Ensete ventricosum [Welw.] Cheesman/ is exploited as a food crop in Ethiopia where it represents an important staple food. The plant is harvested and large amounts of biomass residues are originated, mainly from the pseudo stem (i.e., fiber bundles obtained from the leaf sheaths after being scrapped to produce starchy food) and the inflorescence stalk. These materials were studied in relation to their summative chemical composition, composition of lignin, lipophilic and polar extracts. Moreover, their structural characteristics, in view of their valorization, were scrutinized. The analytical studies were performed with the aid of FTIR, GC/MS, Py-GC/MS and SEM. The fiber bundles are aggregates of mainly long and slender fibers with low ash, extractives and lignin contents (3.8%. 4.4% and 10.5% respectively) and high holocellulose and α-cellulose contents (87.5% and 59.6% respectively). The hemicelluloses in the fibers are mostly highly acetylated xylans and the lignin is of the H-type (H:G:S, 1:0.7:0.8). This lignin composition is in line with the FTIR peaks at 1670 cm-1 and 1250 cm-1.The inflorescence stalk has high ash content (12.3% in the main stalk and 24.6% in fines) with a major proportion of potassium, high extractives (25.9%), and low lignin and α-cellulose contents (5.8% and 17.9% respectively). The stalk includes numerous starch granules in the cellular structure with the predominant presence of parenchyma. The potential valorization routes for these materials are clearly different. The fiber bundles could be used as a fiber source for paper pulp production with the possibility of a prior hemicelluloses removal while the inflorescence stalk has nutritional value for food and fodder. Furthermore, it can also be used for sugar fermentation productsinfo:eu-repo/semantics/publishedVersio

Imaging in assessing hepatic and peritoneal metastases of gastric cancer: a systematic review

<p>Abstract</p> <p>Background</p> <p>Hepatic and peritoneal metastases of gastric cancer are operation contraindications. Systematic review to provide an overview of imaging in predicting the status of liver and peritoneum pre-therapeuticly is essential.</p> <p>Methods</p> <p>A systematic review of relevant literatures was performed in Pubmed/Medline, Embase, The Cochrane Library and the China Biological Medicine Databases. QUADAS was used for assessing the methodological quality of included studies and the bivariate model was used for this meta-analysis.</p> <p>Results</p> <p>Totally 33 studies were included (8 US studies, 5 EUS studies, 22 CT studies, 2 MRI studies and 5 18F-FDG PET studies) and the methodological quality of included studies was moderate. The result of meta-analysis showed that CT is the most sensitive imaging method [0.74 (95% CI: 0.59-0.85)] with a high rate of specificity [0.99 (95% CI: 0.97-1.00)] in detecting hepatic metastasis, and EUS is the most sensitive imaging modality [0.34 (95% CI: 0.10-0.69) ] with a specificity of 0.96 (95% CI: 0.87-0.99) in detecting peritoneal metastasis. Only two eligible MRI studies were identified and the data were not combined. The two studies found that MRI had both high sensitivity and specificity in detecting liver metastasis.</p> <p>Conclusion</p> <p>US, EUS, CT and ¹⁸F-FDG PET did not obtain consistently high sensitivity and specificity in assessing liver and peritoneal metastases of gastric cancer. The value of laparoscopy, PET/CT, DW-MRI, and new PET tracers such as ¹⁸F-FLT needs to be studied in future.</p