Diagnostic Accuracy Of Acromioaxillosuprasternal Notch Index For Prediction Of Difficult Airway Taking Cormack And Lehane Grading System As Gold Standard

Background: General anesthesia is still needed for several surgical interventions and requires endotracheal intubation. The difficult airway is a well-known entity, and a long list of predicting scores is present, yet a high degree of diagnostic accuracy still needs to be improved. Acromioaxillosuprasternal notch index (AASI) has shown some excellent results in recent times. Objective: Its objective is to determine the diagnostic accuracy of acromioaxillosuprasternal notch index for predicting difficult airways and to take the Cormack and Lehane grading system as the gold standard. Methodology:   In this study, adults of both genders aged 20 to 70 years undergoing any surgery under general anesthesia having ASA class I to IV were included. AASI score of equal or less than 0.49 was taken as difficult airway while on Cormack and Lehane grade; it was labeled as yes where grade III or IV was seen. Results: The total number of cases were 350 cases, out of which 218 (62.29%) were males, and 132 (37.71%) were females. The mean age was 40.20±12.86 years, and the mean BMI was 24.71±3.13 (table 17). There were 294 (84%) cases in ASA Class I and II and 56 (14%) in class III and IV. Difficult intubation on AASI was seen in 54 (15.43%) and 57 (16.29%) cases on Cormack and Lehane grading.  The diagnostic accuracy of AASI for prediction of difficult intubating a difficult was 96.29% with sensitivity of 90.74%, specificity of 97.30%, PPV of 85.96%, NPV of 98.29% with p= 0.001. This difference was also statistically significant with all the confounding variables like age, gender, ASA class, and BMI.  Conclusion: The acromioaxillosuprasternal notch index is a significant predictor for tubing a difficult airway and taking Cormack and Lehane's grading as the gold standard. This difference is considerably better regarding age, gender, BMI, and ASA class.&nbsp

Formulation and stability of topical water in oil emulsion containing corn silk extract

Purpose: To formulate the water in oil (W/O) emulsion of corn silk (CS) extract and to evaluate its stability at various storage conditions.Methods: Ethanol CS extract was prepared using maceration (cold) technique. A 4 % CS emulsion was prepared using varying concentrations of liquid paraffin, ABIL EM90 and water. The formulations were kept at 25 oC for 28 days and to screen out the less stable formulations. The remaining formulations were further stressed at 40 oC to choose the most stable formulation. The optimized formulation was evaluated for physical characteristics including phase separation, rheology and mean droplet size. The physical stability of the formulation was evaluated by monitoring these parameters over a period of 12 weeks at 8, 25, 40 and 40 oC, and 75 % RH.Results: The chosen formulation showed good resistance to phase separation on centrifugation under all storage conditions. Rheological behavior followed non-Newtonian pseudoplastic pattern at various storage conditions. Mean droplet size of freshly prepared formulation was 2.98 ± 1.32 μm and did not show significant (p < 0.05) changes at normal storage conditions (8 and 25 oC).Conclusion: The findings indicate that the developed CS extract W/O emulsion is stable and therefore may be suitable for topical use on skin as an antioxidant preparation.Keywords: Corn silk, Emulsion, Nonionic surfactant, Rheology, Flow index, Droplet size, Non-Newtonian pseudoplasti

Contegra valved conduit in the paediatric population: an exciting prospect for right ventricle to pulmonary artery reconstruction; experience and outcomes at Aga Khan University

Objective: The focus of this study is to share the experience and outcomes of Contegra graft implantation in the paediatric and adult population in Pakistan. Methods: Between May 2007 and July 2011, 16 patients, underwent implantation of a Contegra valved conduit. All operations were performed through a median sternotomy with cardiopulmonary bypass. Indications included: Pulmonary atresia with ventricular septal defect (n=11), Tetralogy of Fallot with absent Pulmonary Valve (PV) syndrome (n=2), double outlet right ventricle, transposition of great arteries and pulmonary stenosis (n=1), isolated aortic valve disease (n=1) and a pseudo-aneurysm with infective endocarditis (n=1).Conduit sizes varied between 16-22 mm. Results: The three in hospital deaths were unrelated to the Contegra valved conduit. One patient was lost to follow up. Of the 12 survivors, 10 are currently free from re-operation or complications related to the conduit while one needed distal pulmonary artery dilatation owing to critical stenosis and another had severe Valvular regurgitation. Echocardiographic evaluation of the Contegra valved conduit demonstrated no haemodynamically significant valve regurgitation in 10 patients. Conclusion: In this small review of 16 operations using the Contegra valved conduit for Right Venticular Outflow Tract (RVOT) reconstruction in the paediatric population, we observed good post operative results concerning conduit function. The Contegra conduit provides an excellent substitute to the homograft with satisfactory early and mid-term results though long term results are awaited in Pakista

Midterm results of bovine jugular vein conduit for right ventricular outflow tract reconstruction

Objective: To evaluate the midterm results of Contegra conduit. Methods: The retrospective study comprised patient record at Aga Khan University Hospital, Karachi, of conduits implanted between May 2007 and June 2012. Data collection was made from the clinical notes and from serial echocardiograms by a single cardiologist. The last followup echocardiography was done at the time of data collection in June 2012. SPSS 19 was used for statistical analysis. Results: A total of 18 conduits had been implanted (16-22mm) during the study period. Median age at the time of surgery was 9 years (range: 2.5-16 years). Early mortality was seen in 3 (16.66%) patients, but none was Contegra related. Of the remaining 15 patients, 2 (13.33%) with a diagnosis of Pulmonary Atresia-Ventricular Septal Defect with hypoplastic peripheral Pulmonary Arteries (PA), developed severe distal pressure gradient (50mmHg) across Contegra over a median period of 18 months (range: 12-24 months), with resultant severe regurgitation and needed percutaneous intervention. There was no thrombosis, calcification, anuerysmal dilation or late deaths. Conclusion: At midterm followup, Contegra conduit was associated with low re-intervention rates with satisfactory haemodynamic results. However, long-term durability must be determined for this conduit, especially in patients with Pulmonary Atresia-Ventricular Septal Defect with hypoplastic peripheral Pulmonary Arteries

A Novel Dual Ultrawideband CPW-Fed Printed Antenna for Internet of Things (IoT) Applications

This paper presents a dual-band coplanar waveguide (CPW) fed printed antenna with rectangular shape design blocks having ultrawideband characteristics, proposed and implemented on an FR4 substrate. The size of the proposed antenna is just 25 mm × 35 mm. A novel rounded corners technique is used to enhance not only the impedance bandwidth but also the gain of the antenna. The proposed antenna design covers two ultrawide bands which include 1.1–2.7 GHz and 3.15–3.65 GHz, thus covering 2.4 GHz Bluetooth/Wi-Fi band and most of the bands of 3G, 4G, and a future expected 5G band, that is, 3.4–3.6 GHz. Being a very low-profile antenna makes it very suitable for the future 5G Internet of Things (IoT) portable applications. A step-by-step design process is carried out to obtain an optimized design for good impedance matching in the two bands. The current densities and the reflection coefficients at different stages of the design process are plotted and discussed to get a good insight into the final proposed antenna design. This antenna exhibits stable radiation patterns on both planes, having low cross polarization and low back lobes with a maximum gain of 8.9 dB. The measurements are found to be in good accordance with the simulated results

Reliability Analysis of a Horizontal Axis Wind Turbine

Wind is one of the cheapest and cleanest sources of energy. However, large and frequent fluctuations in wind intensity and directions cause serious problems in harvesting this energy. Wind turbines are subjected to many limiting conditions, which lead to their failure or degraded performance. Therefore, reliability is a very important parameter that governs the overall performance of wind energy system. This paper describes a methodology for the reliability and availability analysis of a horizontal axis wind turbine. The discussed methodology is used to conduct reliability and availability analysis of AOC15/50 wind turbine, which is widely used in Atlantic Canada and USA. The methodology comprises of four steps. First step involves assessment of failure modes using Failure Mode and Effect Analysis (FMEA) approach. Subsequently interrelationship among different components is deduced and represented using event tree analysis technique. Later based on operational characteristics, environmental condition (load), and failure characteristics reliability of each individual component is computed. Finally, Knowing the interrelationship and reliability of each components, reliability of complete system is assessed using fault tree analysis. Having maintainability characteristics known this procedure is repeated to calculate availability. Paper also includes discussion on 3 state Markov analyses for wind turbine system. It helps modeling degrading and total failure scenarios leading to better estimation of overall availability of the system round the year or during lifetime of system

Reliability and condition monitoring of a wind turbine

Wind is one of the cheapest and cleanest sources of energy. However, large and frequent fluctuations in wind intensity and directions can cause serious problems in harvesting this energy. Wind turbines are subjected to many unexpected environmental loads, which can be catastrophic in nature for the wind turbine system. Like any other industrial equipment wind turbines also require some type of monitoring system which is able to predict the up coming faults of the most sensitive components of the system to save it from a major disaster. This paper highlights the ongoing research on reliability analysis and condition monitoring system required for a small-scale wind turbine system AOC15/50, which is widely used in Atlantic Canada and USA. The paper describes the importance of safety system and lay ground work for sensor specification, sensor mounting and configuration requirements for magnetic tip brake and yaw bearing which were proved to be the least reliable components in an extensive reliability analysis. The paper describes condition monitoring instrumentation, data acquisition system and data analysis methodology

NOVEL STUDY FOR CHEMICAL COMPOSITION OF AL-AHDAB CRUDE OIL

Thisn research included determination of chemical composition of al-ahdaab crude oil (kute- Iraq) using liquid – solid chromatography. The current researched included to separation the component of crude oil by column chromatography was packing with alumina (AL2O3) as a stationary–phases and several solvent as a mobile phase. . The results of crude oil fractionations were 17.01% Asphaltene, 82.99% Maltene, which separated to (Paraffinic) (saturated) 44.11%, Aromatic 30.11% and Resin 4.20%. Crude oil fractionation were characterized using Nuclear Magnetic Resonance H1NMR and Fourier Transform Infrared Spectrometer FT-IR to determine the chemical composition of each part, which is that represents the first study and a novel results. This study also clarified the paraffinic compounds are represented the main part of materials in crude oil composition

Kinetics of endoglucanase and cellobiohydrolase production by parent and mutant derivative of moderately thermotolerant Bacillus subtilis GQ 301542 on optimized medium

A moderately thermotolerant bacterial strain was isolated from the hot spring of Tatta Pani (AJ and K) Pakistan and was designated as Bacillus subtilis strain GQ 301542 after biochemical, morphological and 16S rDNA sequence analysis. This strain and its catabolite repression resistant mutant CRM197 were utilized for the study of different production kinetic parameters of both endoglucanase and cellobiohydrolase. Time course study on one monomeric (glucose), one dimeric (maltose) and two polymeric substrates (-cellulose and wheat straw) was carried out at different time intervals (4 - 28 h, after each 4 h) for determining the maximum enzyme productivity on a particular substrate. Maximum rate of endoglucanase production by the mutant (53.1 IU/L/h) was significantly (P = 0.0007) higher than that (23.7 IU/L/h of the parental organism following their growth on glucose in Dubos salts medium while the optimum product yields (Yp/s) was calculated as 69.0 IU/g S (parent) and 82.3 IU/g S (mutant) for cellobiohydrolase production. Deoxy-D-glucose resistant mutant was significantly (p = 0.03 to 0.0007) improved over its parental strain with respect to some substrate consumption and all product formation parameters and can easily degrade cellulosic biomass for production of fermentable carbohydrates.Key words: Cellobiohydrolase, endoglucanase, thermotolerant, Bacillus subtilis

Post-Treatment of Synthetic Polyphenolic 1,3,4 Oxadiazole Compound A3, Attenuated Ischemic Stroke-Induced Neuroinflammation and Neurodegeneration

Ischemic stroke is categorized by either permanent or transient blood flow obstruction, impeding the distribution of oxygen and essential nutrients to the brain. In this study, we examined the neuroprotective effects of compound A3, a synthetic polyphenolic drug product, against ischemic brain injury by employing an animal model of permanent middle cerebral artery occlusion (p-MCAO). Ischemic stroke induced significant elevation in the levels of reactive oxygen species and, ultimately, provoked inflammatory cascade. Here, we demonstrated that A3 upregulated the endogenous antioxidant enzymes, such as glutathione s-transferase (GST), glutathione (GSH), and reversed the ischemic-stroke-induced nitric oxide (NO) and lipid peroxidation (LPO) elevation in the peri-infarct cortical and striatal tissue, through the activation of endogenous antioxidant nuclear factor E2-related factor or nuclear factor erythroid 2 (Nrf2). In addition, A3 attenuated neuroinflammatory markers such as ionized calcium-binding adapter molecule-1 (Iba-1), cyclooxygenase-2 (COX-2), tumor necrotic factor-α (TNF-α), toll-like receptors (TLR4), and nuclear factor-κB (NF-κB) by down-regulating p-JNK as evidenced by immunohistochemical results. Moreover, treatment with A3 reduced the infarction area and neurobehavioral deficits. We employed ATRA to antagonize Nrf2, which abrogated the neuroprotective effects of A3 to further assess the possible involvement of the Nrf2 pathway, as demonstrated by increased infarction and hyperexpression of inflammatory markers. Together, our findings suggested that A3 could activate Nrf2, which in turn regulates the downstream antioxidants, eventually mitigating MCAO-induced neuroinflammation and neurodegeneration