Performance Evaluation of Modified Bitumen with Replaced Percentage of Waste Cooking Oil & Tire Rubber with Bagasse Ash as Modifier

Flexible pavements are the major type of pavement use in recent days. Bitumen is the main constituent’s part of flexible pavement. Bitumen is the by-produce of petroleum. The depleting reserve of petroleum led researcher to look for alternative binder. This research work explicitly aim at replacing certain percentage of bitumen with Tire Rubber powder (TR), Waste Cooking Oil (WCO) in the presence of Bagasse Ash (BA) as a modifier. Physical test were performed to determine optimum percentages of TR, WCO and BA that can be used as a percentage replacement in bitumen. Result shows that up to 20 % of bitumen can be successfully replaced without affecting performance of bitumen. Performance Tests such as Dynamic Shear Rheometer, Rotatory thin film oven, Pressure aging Vessel and Bending Beam Rheometer were performed on modified samples for its physical and rheological properties. Modified bitumen showed good resistance against rutting, skidding and low temperature cracking. The research work directly contribute in developments of alternative binder for flexible pavement which is a leading research trend these days and environmental friendly initiative

Utility of Inferior Turbinoplasty in the Autonomic System

The inferior turbinates are important anatomical nasal structures that provide warmth, humidification, and filtration of the inspired air to provide optimal conditioning for lung function. Besides these well-established basic functions, the turbinates are also important in immune function as the interface between the airway and the environment. Proper functioning of the inferior turbinates relies on an intact autonomic system, which maintains homeostasis within the nasal cavity. The autonomic nervous system innervates the submucosal glands and the vasculature within the inferior turbinate, resulting in control of major turbinate functions: nasal secretions, nasal patency, and amount of warmth and humidification provided. This study will summarize the normal and abnormal autonomic processes that contribute to the inferior turbinate as an autonomic organ

Spectrum of Head Trauma at Tertiary Care Military Hospital CMH Quetta, Pakistan

Objective: The objective of this study was to determine the etiological spectrum, injury patterns and outcome of head injured patients at tertiary care military hospital CMH Quetta.Materials and Methods: This descriptive study includes all patients of head trauma coming to trauma centre at CMH Quetta, Pakistan. Patients with associated injuries of other organs were excluded from the study. We noted the detailed clinical history and examination, demographics, mechanism of injury, treatment offered (operative / non operative) and analyzed the details of operative procedure (craniotomy, craniectomy, elevation of compound depressed fracture, scalp suturing), morbidity and outcome (according to Glasgow outcome scale). Data was analyzed using SPSS version 16.Results: There were 1026 patients (856 males and 170 females) eligible to be included in the study. The mean age of the patient was 28.9 ± 19.2 years SD. Majority of the patients belonged to the age group 21 – 40 years. The commonest cause of head injury was Road traffic accident 507 (49.41%), fall 273 (26.6%), gunshot wound 97 (9.45%), bomb blast injury 76 (7.41%), sports related 35 (3.41%), mine blast 25 (2.44%) and splinter injury 13 (1.27%) of patients. CT Brain findings were contusions in 116 (11.3%), isolated fractures in 45 (4.38%), SDH in 44 (4.28%), EDH in 43 (4.19%), DAI (diffuse axonal injury) in 36 (3.51%), compound depressed fractures in 16 (1.55%), frontal sinus fractures in 14 (1.36%), combined EDH / SDH in 6 (0.58%) and normal CT brain findings in 706 (68.81%) patients. 662 (64.52%%) patients were managed conservatively and 364 (35.47%) underwent operative management. Major operations (craniotomy / craniectomy / elevation of compound depressed skull fracture) were performed in 138 (13.45%) and minor operations (suturing of scalp laceration) were performed in 226 (22.03%). Good recovery was seen in 894 (87.13%), moderate disability in 26 (2.53%) and severe disability in 12 (1.16%) whereas 16 (1.56 %) patients remained vegetative. The mortality was 78 (7.6%).Conclusion: In Pakistan, head injury contributes significantly to mortality and morbidity. Road traffic accident, history of fall and gunshot are the commonest causes of head injury. Appropriate medical care facilities needs to be established at district and tehsil level to provide prompt and adequate care to head injured patients

Mechanical Behavior of Normal Concrete Reinforced with Kantharo Suter Fiber

Physical characteristics of concrete can be enhanced by addition of different materials in various proportions. Fibrous substances, such as, steel, synthetic, glass, and natural fibers not only increase the structural and tensile strength but also cohesion of concrete by overcoming micro cracks and deficiencies in concrete. In this study, the effect of Kantharo suter fibers (animal hair) on compressive, flexural and split tensile strength, and workability of plain concrete was determined. For that, experiments were conducted on concrete cubes, beams and cylinders by adding different proportions of Kantharo suter fibers from 0.125 to 1.0 percentage by weight of cement. In each proportion of Kantharo suter fibers, three cubes, three cylinders and one beam were casted and cured for 28 days. The acquired results were compared with the plain cement concrete specimens. It was discovered from the results that 0.375 percentages of Kantharo suter fibers in normal concrete was optimum by weight of cement. The strength parameters and slump of concrete showed better results than control mixes even without using any admixture in the specimens. This study could also be enhanced using combinations of different fibers and other admixtures

Role of Ventriculoperitoneal Shunt for Haemorrhagic or Ischemic Strokes Causing Hydrocephalus

Posterior fossa hemorrhagic involve or infract associated hydrocephalus are serious neurosurgical emergencies which requires immediate and prompt action.Purpose: To highlight the role of VP shunt in the management plan of Hydrocephalus caused by spontaneous hemorrhagic or ischemic infarcts.Material and Methods: This is retrospective study of 16 cases over a period of 4 years from March 2007 to March 2011 conducted simultaneously at Neurosurgical departments of CMH Lahore, CMH Multan and Farooq Hospital Lahore.Results: A total of 16 cases were included in this study and all those patients underwent some sort of CSF diversion procedure for obstructive hydrocephalus. Ten Patients (62.5%) were male and six (37.5%) patients were female. The age ranged from 32 – 70 years with mean age of 53.4 years. Clinically all patients presented with headache, vomiting and neck pain followed by loss of consciousness. Glasgow coma scale ranged from 5/15 to 12/15. The radiological findings were those of hemorrhagic or ischemic infarcts causing obstructive hydro-cephalus. Patients were broadly divided into two main groups with eight patients in each group. Group A inclu-ded 6 males and 2 females, all these patients were managed conservatively for the hemorrhagic or ischemic strokes while they underwent VP Shunt for the obstructive hydrocephalus. Two of these patients (a male and a female) had thalamic bleed (hemorrhagic stroke) with third ventricular blockade. These two patients were also managed by VP Shunt only. Outcome of patients in group A was excellent in 7 patients whereas one patients developed complications with prolonged hospital stay but ultimately recovered and discharged. Group B inclu-ded 8 patients (4 male and 4 female) who underwent hematoma evacuation of cerebellar bleed along with place-ment of external ventricular drain (EVD). EVD was converted to VP Shunt in six patients when they deteriorated after blocking EVD on 5th post operative day. 2 patients out of these eight did not deteriorate on EVD blockade and VP Shunt was not passed in these patients and they had excellent recovery. One patient died in group B. One patient required redo surgery due to Shunt Blockade and had poor recovery whereas two more patients had poor recovery due to other reasons including poor neurological status pre operatively. Two patients had fairly good recovery after converting EVD into VP Shunt.Conclusion: Obstructive hydrocephalus caused by hemorrhagic stroke or infarcts is a relatively rare entity requiring some sort of CSF diversion. Patients who are having smaller hematomas with hydrocephalus and GCS more than 8/15 can be managed with VP Shunt alone

SARS-CoV-2 epitopes inform future vaccination strategies

All currently approved COVID-19 vaccines utilize the spike protein as their immunogen. SARS-CoV-2 variants of concern (VOCs) contain mutations in the spike protein, enabling them to escape infection- and vaccination-induced immune responses to cause reinfection. New vaccines are hence being researched intensively. Studying SARS-CoV-2 epitopes is essential for vaccine design, as identifying targets of broadly neutralizing antibody responses and immunodominant T-cell epitopes reveal candidates for inclusion in next-generation COVID-19 vaccines. We summarize the major studies which have reported on SARS-CoV-2 antibody and T-cell epitopes thus far. These results suggest that a future of pan-coronavirus vaccines, which not only protect against SARS-CoV-2 but numerous other coronaviruses, may be possible. The T-cell epitopes of SARS-CoV-2 have gotten less attention than neutralizing antibody epitopes but may provide new strategies to control SARS-CoV-2 infection. T-cells target many SARS-CoV-2 antigens other than spike, recognizing numerous epitopes within these antigens, thereby limiting the chance of immune escape by VOCs that mainly possess spike protein mutations. Therefore, augmenting vaccination-induced T-cell responses against SARS-CoV-2 may provide adequate protection despite broad antibody escape by VOCs

Prediction of early distant recurrence in upfront resectable pancreatic adenocarcinoma: A multidisciplinary, machine learning-based approach

Despite careful selection, the recurrence rate after upfront surgery for pancreatic adenocarcinoma can be very high. We aimed to construct and validate a model for the prediction of early distant recurrence (<12 months from index surgery) after upfront pancreaticoduodenectomy. After exclusions, 147 patients were retrospectively enrolled. Preoperative clinical and radiological (CT-based) data were systematically evaluated; moreover, 182 radiomics features (RFs) were extracted. Most significant RFs were selected using minimum redundancy, robustness against delineation uncertainty and an original machine learning bootstrap-based method. Patients were split into training (n = 94) and validation cohort (n = 53). Multivariable Cox regression analysis was first applied on the training cohort; the resulting prognostic index was then tested in the validation cohort. Clinical (serum level of CA19.9), radiological (necrosis), and radiomic (SurfAreaToVolumeRatio) features were significantly associated with the early resurge of distant recurrence. The model combining these three variables performed well in the training cohort (p = 0.0015,HR = 3.58,95%CI = 1.98–6.71) and was then confirmed in the validation cohort (p = 0.0178,HR = 5.06,95%CI = 1.75–14.58). The comparison of survival curves between low and high-risk patients showed a p-value <0.0001. Our model may help to better define resectability status, thus providing an actual aid for pancreatic adenocarcinoma patients’ management (upfront surgery vs. neoadjuvant chemotherapy). Independent validations are warranted

The relationship between a child's postural stability and manual dexterity

The neural systems responsible for postural control are separate from the neural substrates that underpin control of the hand. Nonetheless, postural control and eye-hand coordination are linked functionally. For example, a stable platform is required for precise manual control tasks (e.g. handwriting) and thus such skills often cannot develop until the child is able to sit or stand upright. This raises the question of the strength of the empirical relationship between measures of postural stability and manual motor control. We recorded objective computerised measures of postural stability in stance and manual control in sitting in a sample of school children (n = 278) aged 3–11 years in order to explore the extent to which measures of manual skill could be predicted by measures of postural stability. A strong correlation was found across the whole sample between separate measures of postural stability and manual control taken on different days. Following correction for age, a significant but modest correlation was found. Regression analysis with age correction revealed that postural stability accounted for between 1 and 10 % of the variance in manual performance, dependent on the specific manual task. These data reflect an interdependent functional relationship between manual control and postural stability development. Nevertheless, the relatively small proportion of the explained variance is consistent with the anatomically distinct neural architecture that exists for ‘gross’ and ‘fine’ motor control. These data justify the approach of motor batteries that provide separate assessments of postural stability and manual dexterity and have implications for therapeutic intervention in developmental disorders

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

Cigarette Smoking Habits among University Students: Prevalence and Associated Factors

Smoking is the main cause of morbidity and mortality in the world and is estimated to kill 5 million people each year worldwide. If current patterns of tobacco consumption continue, smoking will kill more than 8 million people each year globally by the year 2030, with 80% of these deaths in the developing countries. This study aimed to determine the prevalence and associated factors of cigarette smoking among male university students in Muzaffarabad, Pakistan. A descriptive cross-sectional study was conducted among 542 male students at University of Azad Jammu &amp; Kashmir in Muzaffarabad from July to December 2015. The socio-demographic characteristics and cigarette smoking behavior of the students were measured by using a standardized pre-tested self-administrated validated questionnaire in English. The overall prevalence of cigarette smoking among students was found to be 49.4%. The mean age of starting cigarette smoking was 19.2 2.73 years. Age, marital status and education were found significantly associted with cigarette smoking behavior (p-value&lt;0.05). The most common reason for cigarette smoking was stress alleviation (35.0%) followed by peer pressure (24.5%). As cigarette smoking is considerably higher among students. There is a need to develop effective tobacco control measures among university students in Muzaffarabad