Doing Pre-operative Investigations in Emergency Department; a Clinical Audit

Introduction: Pre-operative investigations for emergency surgical patients differ between centers. Following established guidelines can reduce unnecessary investigation, cost of treatment and hospital stay. The present audit was carried out to evaluate the condition of doing pre-operative investigations for three common surgical emergencies compared to National Institute for Health and Care Excellence (NICE) guidelines and local criteria.Methods: A retrospective clinical audit of acute-appendicitis, abscess and hernia patients admitted to the emergency department was carried out over a one-year period from July 2014 to July 2015. Data of laboratory investigations, their indication, cost and duration of hospital stay was collected and compared with NICE-guidelines.Results: A total of 201 patients were admitted to the emergency department during the audit period. These included 77(38.3%) cases of acute-appendicitis, 112 (55.7%) cases of abscesses, and 12 (6%) cases of hernia. Investigations not indicated by NICE-guidelines included 42 (20.9%) full blood counts, 29 (14.4%) random blood sugars, 26 (12.9%) urea tests, 4 (2%) chest x-rays, 13 (6.5%) electrocardiographs, and 58 (28.9%) urine analyses. These cost 25,675 Rupees (245.46 Dollars) in unnecessary investigation costs and 65.7 days of additional hospital stay.Conclusions: Unnecessary investigations for emergency surgical patients can be reduced by following NICE-guidelines. This will reduce workload on emergency services, treatment costs and the length of hospital stay

Outcomes of patients with double/triple expressor diffuse large B-cell lymphoma (DLBCL) treated with R-DA-EPOCH/R-CHOP: A single-center experience

In Pakistan 76.4% of all NHLs to be diagnosed as DLBCLs. The survival of R-CHOP is better compared to the DA-REPOCH treatment regimen. A prospective follow-up study was conducted with 113 patients to study the outcomes of treatment. Multivariable cox-proportional hazard model was used to estimate the hazard ratios in patients receiving these treatment regimens considering p-value ≤0.05 significant. The survival rate among double/triple expressor lymphoma patients received R-DA-EPOCH was 82.8%, and 83.3% received R-CHOP. For double/triple expressor lymphoma patients received R-DA-EPOCH. The findings of our study demonstrated that the survival rate in both R-CHOP and R-DA-EPOCH is mostly similar

Urban ecosystem services on the local level: urban green spaces as providers

Ecosystem services are provided at different spatial and service/functional scales. The local level is the basic unit for ecosystem services, especially when it comes to the human dimension of urban landscapes. These services are provided by green elements (patches) or basic complex ecosystems (green areas) which differ from their neighbourhoods through their structures and functions. This study reviews the generally available knowledge on urban green functions and services at the site level and explains them by using own studies in five different cities in three different continents related to distinct ecosystem services. This allows the development of a methodology to evaluate and compare ecosystem services at the site level. The methodology is based at two levels, patch and green space, and includes the relationship with the surrounding green and built-up space. Different urban green space types are characterized by their internal structures of vegetation, size, shape and location in relation to at least a semi-quantitative scaling of their urban ecosystem services. The evaluated urban green spaces are public urban green spaces. The urban ecosystem services assessed include climate regulation, biodiversity, nature experience, recreation and health. The actual urban challenges, such as land use change, adaptation to climate change, demographic change and urban cultural diversity, demand a systematic and very concrete monitoring of urban ecosystem services at the site level.Fil: Breuste, Jürgen. University of Salzburg. Department of Geography and Geology; AustriaFil: Schnellinger, Johanna. University of Salzburg. Department of Geography and Geology; AustriaFil: Qureshi, Salman. Birmingham City University. School of Architecture; Reino UnidoFil: Faggi, Ana Maria. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Museo Argentino de Ciencias Naturales; Argentin

Diagnostic Biomarkers for Alzheimer's Disease Using Non-Invasive Specimens

Studies in the field of Alzheimer's disease (AD) have shown the emergence of biomarkers in biologic fluids that hold great promise for the diagnosis of the disease. A diagnosis of AD at a presymptomatic or early stage may be the key for a successful treatment, with clinical trials currently investigating this. It is anticipated that preventative and therapeutic strategies may be stage-dependent, which means that they have a better chance of success at a very early stage-before critical neurons are lost. Several studies have been investigating the use of cerebrospinal fluid (CSF) and blood as clinical samples for the detection of AD with a number of established core markers, such as amyloid beta (Aβ), total tau (T-tau) and phosphorylated tau ( tau), being at the center of clinical research interest. The use of oral samples-including saliva and buccal mucosal cells-falls under one of the least-investigated areas in AD diagnosis. Such samples have great potential to provide a completely non-invasive alternative to current CSF and blood sampling procedures. The present work is a thorough review of the results and analytical approaches, including proteomics, metabolomics, spectroscopy and microbiome analyses that have been used for the study and detection of AD using salivary samples and buccal cells. With a few exceptions, most of the studies utilizing oral samples were performed in small cohorts, which in combination with the existence of contradictory results render it difficult to come to a definitive conclusion on the value of oral markers. Proteins such as Aβ, T-tau and tau, as well as small metabolites, were detected in saliva and have shown some potential as future AD diagnostics. Future large-cohort studies and standardization of sample preparation and (pre-)analytical factors are necessary to determine the use of these non-invasive samples as a diagnostic tool for AD

Online Education and Internet Connectivity Problems: A Perspective of the Teachers and Undergraduate Dental Students

OBJECTIVES Assessment of difficulties and glitches regarding internet connectivity faced by undergraduates and teachers during online learning.  METHODOLOGY This study was conducted using an online questionnaire. 186 undergraduate students and teachers were included from CMH, Lahore. The duration of this study was 3 months. . RESULTS There was found to be no statistical difference in reluctance to use online platforms (p=0.17), frequent loss of internet (p=0.181), difficulty in dealing with the loss of connection (p=0.181), disturbance in planned schedule due to loss of connection (p=0.213), lagging behind in schedule (p=0.630), inability to convey the message (p=0.093), lack of internet in remote areas (p=0.302), lack of training to deal with connection problems (p=0.766), poor connection due to technical problems in devices (p=0.089) and poor quality internet (p=0.740) among faculty and students. CONCLUSION The problems due to internet connectivity issues in online education were faced more by students as compared to faculty

Students' Mathematical Understanding of Online Learning: Evaluation of Triangular and Rectangular Materials

The purpose of this research is to find out a comprehensive picture of students' mathematical understanding in the online learning process, especially in the triangle and quadrilateral material. The study was conducted on 20 students in MTs. Nurul Islah Gegelang. The qualitative research method was chosen. Interactive analysis is applied to obtain in-depth information related to interpreting research findings. Data collection is done by using zoom meeting. The research data are in the form of test scores for mathematical understanding abilities, observation sheets related to the online learning process carried out and in-depth interviews to determine students' mathematical understanding abilities. The results of the study showed that, out of 20 students, only 8 students scored 30 and 12 were below. The ability of students' mathematical understanding in the online learning process was still very poor, especially in the concept of triangles and quadrilaterals. Students' understanding is still limited to memorizing properties without understanding in detail the characteristics of each flat shape. Students still have difficulty in applying formulas to triangles and quadrilaterals in solving problems.

Improving the low-energy muon beam quality of the LEM beamline at PSI: Characterisation of ultra-thin carbon foils

The Low-Energy Muon beamline (LEM) at the Paul Scherrer Institute currently stands as the world's only facility providing a continuous beam of low-energy muons with keV energies for conducting muon spin rotation experiments on a nanometer depth scale in heterostructures and near a sample's surface. As such, optimizing the beam quality to reach its full potential is of paramount importance. One of the ongoing efforts is dedicated to improving the already applied technique of single muon tagging through the detection of secondary electrons emerging from an ultra-thin carbon foil. In this work, we present the results from installing a thinner foil with a nominal thickness of 0.5 $\mu g~cm^{-2}$ and compare its performance to that of the previously installed foil with a nominal thickness of 2.0 $\mu g~cm^{-2}$. Our findings indicate improved beam quality, characterized by smaller beam spots, reduced energy loss and straggling of the muons, and enhanced tagging efficiency. Additionally, we introduce a method utilizing blue laser irradiation for cleaning the carbon foil, further improving and maintaining its characteristic

Response of eltrombopag in immune thrombocytopenia and acquired idiopathic aplastic anemia: A single-center experience

Eltrombopag has been used in ITP and found its use in AA armamentarium recently. We retrospectively analyzed 61 patients at a tertiary care center in Pakistan from January 2015 to January 2021. They included patients with severe AA who were refractory to at least one course of immunosuppressive therapy and persistent/chronic ITP who have received at least one previous treatment for ITP. Responses to Eltrombopag in our population were comparable to real-world experiences while tolerable hepatotoxicity and GI issues were notable. We found Eltrombopag to be a safe and efficacious agent for treating patients with ITP and AA

PERANCANGAN DAN PEMBUATAN ALAT PENGGULUNG TALI PLASTIK DUA ROLL DENGAN PENGGERAK MOTOR LISTRIK

Abstrak: Alat penggulung tali rafia adalah suatu alat yang digunakan untuk menggulung tali rafia yang digerakkan oleh motor listrik yang tujuannya agar bahan yang digulung lebih mudah untuk di angkut dan disimpan. Pada proses merancang dan membuat alat penggulung tali rafia dengan dua roll penggerak motor listrik dilakukan perhitungan daya rencana 0,25 HP atau ¼ HP (0,1864 Kw) yang digunakan pada motor listrik, putaran pully poros yang digerakkan adalah 233 rpm, dan roll penggulung adalah 6,16 N/mm2, kecepatan alat penggulung tali rafia ini tergantung pada panjang tali rafia yang akan digulung. Semakin panjang tali yang digulung akan semakin lama waktu yang diperlukan untuk proses penggulungan.Alat penggulung tali rafia ini sesuai yang diharapkan dan memperoleh gulungan yang tertata dan teratur dengan ukuran sesuai yang diharapkan.Kata kunci: penggulung, rancangan, tali rafi