Analgesic effects of caudal dexmedetomidine versus midazolam combined with bupivacaine on postoperative pain following paediatric infraumbilical surgeries

Background: There is continued search for an ideal adjuvant necessitated by the limited duration of singleshot caudal block. The study aimed to compare the analgesic effects of caudal 1.5 µg/kg dexmedetomidine versus 50 µg/kg midazolam combined with 0.20% bupivacaine in children.Methods: Following ethical approval and parental consent, 66 American Society of Anesthesiologists (ASA) class I or II children aged 1-6 years were randomized into three groups (A, B, and C) of 22 each. All patients had laryngeal mask airway (LMA) general anaesthesia induced with propofol and maintained with isoflurane in 100% oxygen. Group A received 1 ml/kg 0.20% bupivacaine and 1.5 µg/kg dexmedetomidine (1 ml), B received 1 ml/kg 0.20% bupivacaine plus 50 µg/kg midazolam (1 ml) while C received 1 ml/kg 0.20% bupivacaine and 0.9% normal saline (1 ml), via the caudal space. Pain was assessed using the face, leg, arm, cry, consolability (FLACC) scale. The time to first analgesic request, (TTFAR) was defined as the period from caudal injection to pain score of ≥4. Analgesic was given when FLACC score was ≥4.Results: All 66 children completed the study. The TTFAR was longest in group A (14.4±2.36), followed by group B (12.0±3.69), and shortest in group C (5.6±1.45), p=0.01, with greatest 24 hours analgesic consumption in group C, p=0.01.Conclusions: Caudal dexmedetomidine or midazolam combined with bupivacaine significantly prolonged the analgesic duration, with superiority of dexmedetomidine over midazolam group in analgesic profile

Pharmacoeconomics in Africa: needs, prospect and challenges

Africa as a continent has experienced a continuous increase in the cost of healthcare as its demands increase. With many of these African countries living below the poverty threshold, Africans continue to die from preventable and curable diseases. Population increases have led to an increase in demands for healthcare, which unfortunately have been met with inequitable distribution of drugs. Hence, the outcomes from healthcare interventions are frequently not maximized. These problems notably call for some economic principles and policies to guide medication selection, procurement, or donation for population prioritization or health insurance. Pharmacoeconomics drives efficient use of scarce or limited resources to maximize healthcare benefits and reduce costs. It also brings to play tools that rate therapy choice based on the quality of life added to the patient after a choice of intervention was made over an alternative. In this paper, we commented on the needs, prospect, and challenges of pharmacoeconomics in Africa

Phenotyping and genotyping of CYP2C19 using comparative metabolism of proguanil in sickle‐cell disease patients and healthy controls in Nigeria

Polymorphic expression of metabolic enzymes have been identified as one of the key factors responsible for the interindividual/ethnic/racial variability in drug metabolism and effect. In Nigeria, there is a disproportionately high incidence of sickle‐cell disease (SCD), a condition characterized by painful crisis frequently triggered by malaria. Proguanil, a substrate of the polymorphic CYP2C19, is a chemoprophylactic antimalarial drug widely used among SCD patients in Nigeria. This study aimed to conduct a comparative CYP2C19 phenotyping among SCD patients and healthy controls and to compare the results with those previously reported. One hundred seventy‐seven unrelated subjects comprising 131 SCD patients and 46 non‐SCD volunteers were phenotyped. This was carried out by collecting pooled urine samples over 8 h following PG administration. Proguanil and its major CYP2C19‐dependent metabolites were measured by high‐performance liquid chromatography. Metabolic ratios (MRs) were computed and employed in classifying subjects into poor or extensive metabolizers. Among SCD group, 130 (99.2%) were extensive metabolizers (EMs) and 1 (0.8%) was poor metabolizer (PM) of PG, while 95.7 and 4.3% non‐SCDs were EMs and PMs, respectively. MRs ranged from 0.02 to 8.70 for SCD EMs and from 0.22 to 8.33 for non‐SCD EMs. Two non‐SCDs with MRs of 18.18 and 25.76 and the SCD with MR of 16.77 regarded as PMs had earlier been genotyped as CYP2C19*2/*2. Poor metabolizers of proguanil in SCD patients are reported for the first time. Regardless of clinical significance, a difference in metabolic disposition of proguanil and CYP2C19 by SCDs and non‐SCDs was established

Assessing audience’s willingness to curb digital piracy: A gender perspective

Rising incidences of piracy in the entertainment/creative industry in Nigeria are increasing concerns about the sustainability of the industry and the livelihood of content creators. The United Nations’ Sustainable Development Goal 1 (SDG 1) aims to end poverty at all levels and in all places by the year 2030, but this goal faces a challenge if personal and corporate investments of moviemakers are lost to piracy. Studies have shown that profit-seeking pirates are not the only ones who do damage to the industry, but end-users also share unauthorised digital contents. The purpose of this research is to investigate the connection between gender and willingness of the audience, who in this case are undergraduate students of a government-owned university in Lagos, to see piracy curbed. Multistage sampling was used to cluster the population into faculties and departments. A sample of 199 was selected purposively based on the respondents’ knowledge of digital piracy, and a 20-item questionnaire was used for data gathering. Using t-test to analyse the data, the result shows that there was no significant difference between the views of female and male respondents. Cohen’s d analysis also indicates that there is a negligible effect size. While respondents participated in digital file-sharing, they did not consider their stoppage of the habit relevant to curbing piracy in Nigeria. Hence, the study recommends proper enlightenment of end-users to understand their significant role in digital piracy

Combined approach of perioperative 18F-FDG PET/CT imaging and intraoperative 18F-FDG handheld gamma probe detection for tumor localization and verification of complete tumor resection in breast cancer

<p>Abstract</p> <p>Background</p> <p>¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT) has become an established method for detecting hypermetabolic sites of known and occult disease and is widely used in oncology surgical planning. Intraoperatively, it is often difficult to localize tumors and verify complete resection of tumors that have been previously detected on diagnostic PET/CT at the time of the original evaluation of the cancer patient. Therefore, we propose an innovative approach for intraoperative tumor localization and verification of complete tumor resection utilizing ¹⁸F-FDG for perioperative PET/CT imaging and intraoperative gamma probe detection.</p> <p>Methods</p> <p>Two breast cancer patients were evaluated. ¹⁸F-FDG was administered and PET/CT was acquired immediately prior to surgery. Intraoperatively, tumors were localized and resected with the assistance of a handheld gamma probe. Resected tumors were scanned with specimen PET/CT prior to pathologic processing. Shortly after the surgical procedure, patients were re-imaged with PET/CT utilizing the same preoperatively administered ¹⁸F-FDG dose.</p> <p>Results</p> <p>One patient had primary carcinoma of breast and a metastatic axillary lymph node. The second patient had a solitary metastatic liver lesion. In both cases, preoperative PET/CT verified these findings and demonstrated no additional suspicious hypermetabolic lesions. Furthermore, intraoperative gamma probe detection, specimen PET/CT, and postoperative PET/CT verified complete resection of the hypermetabolic lesions.</p> <p>Conclusion</p> <p>Immediate preoperative and postoperative PET/CT imaging, utilizing the same ¹⁸F-FDG injection dose, is feasible and image quality is acceptable. Such perioperative PET/CT imaging, along with intraoperative gamma probe detection and specimen PET/CT, can be used to verify complete tumor resection. This innovative approach demonstrates promise for assisting the oncologic surgeon in localizing and verifying resection of ¹⁸F-FDG positive tumors and may ultimately positively impact upon long-term patient outcomes.</p

A four-surface schematic eye of macaque monkey obtained by an optical method

AbstractSchematic eyes for four Macaca fascicularis monkeys were constructed from measurements of the positions and curvatures of the anterior and posterior surfaces of the cornea and lens. All of these measurements were obtained from Scheimpflug photography through the use of a ray-tracing analysis. Some of these measurements were also checked (and confirmed) by keratometry and ultrasound. Gaussian lens equations were applied to the measured dimensions of each individual eye in order to construct schematic eyes. The mean total power predicted by the schematic eyes agreed closely with independent measurements based on retinoscopy and ultrasound results, 74.2 ± 1.3 (SEM) vs 74.7 ± 0.3 (SEM) diopters. The predicted magnification of 202 μm/deg in one eye was confirmed by direct measurement of 205 μm/deg for a foveal laser lesion. The mean foveal retinal magnification calculated for our eight schematic eyes was 211 ± (SEM) μm/deg, slightly less than the value obtained by application of the method of Rolls and Cowey [Experimental Brain Research, 10, 298–310 (1970)] to our eight eyes but just 4% more than the value obtained by application of the method of Perry and Cowey [Vision Research, 12, 1795–1810 (1985)]

Modeling surf zone tracer plumes : 1. Waves, mean currents, and low-frequency eddies

Author Posting. © American Geophysical Union, 2011. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Journal of Geophysical Research 116 (2011): C11027, doi:10.1029/2011JC007210.A model that accurately simulates surf zone waves, mean currents, and low-frequency eddies is required to diagnose the mechanisms of surf zone tracer transport and dispersion. In this paper, a wave-resolving time-dependent Boussinesq model is compared with waves and currents observed during five surf zone dye release experiments. In a companion paper, Clark et al. (2011) compare a coupled tracer model to the dye plume observations. The Boussinesq model uses observed bathymetry and incident random, directionally spread waves. For all five releases, the model generally reproduces the observed cross-shore evolution of significant wave height, mean wave angle, bulk directional spread, mean alongshore current, and the frequency-dependent sea surface elevation spectra and directional moments. The largest errors are near the shoreline where the bathymetry is most uncertain. The model also reproduces the observed cross-shore structure of rotational velocities in the infragravity (0.004 < f < 0.03 Hz) and very low frequency (VLF) (0.001 < f < 0.004 Hz) bands, although the modeled VLF energy is 2–3 times too large. Similar to the observations, the dominant contributions to the modeled eddy-induced momentum flux are in the VLF band. These eddies are elliptical near the shoreline and circular in the mid surf zone. The model-data agreement for sea swell waves, low-frequency eddies, and mean currents suggests that the model is appropriate for simulating surf zone tracer transport and dispersion.This research was supported by SCCOOS, CA Coastal Conservancy, NOAA, NSF, ONR, and CA Sea Grant.2012-05-1

Paving the way for research findings: writers' rhetorical choices in education and applied linguistics

Notwithstanding the existence of previous investigations into how research results are presented in different academic disciplines, fewer studies have looked into how authors pave the way for their results, the interdisciplinary differences in ‘result pavements’, and the interconnections between their communicative functions and linguistic choices. Using the techniques of genre analysis, I have analyzed two corpora of research reports in applied linguistics and education in order to identify the possible ways in which experienced writers schematically pave the way for their findings. Using evidence based on authentic research articles, this study demonstrates how writers set the stage for their research results by (i) demonstrating their control of the structure and flow of result-related information, (ii) connecting past research with a current finding while furnishing pertinent background elements that lead the readership progressively to specific findings, (iii) regenerating readers’ interest in their initial research purposes, and (iv) deploying locatives to embed results in a ‘space-saving strategy’ aimed at presenting an abridged Results section. I have also analyzed interdisciplinary differences in the frequencies of these rhetorical steps and the range of intricate linguistic mechanisms employed by authors as communicative resources in each step to establish a smooth rhetorical transition that sets the stage for their research results

Re-creation of site-specific multi-directional waves with non-collinear current

Site-specific wave data can be used to improve the realism of tank test conditions and resulting outputs. If this data is recorded in the presence of a current, then the combined conditions must be re-created to ensure wave power, wavelength and steepness are correctly represented in a tank. In this paper we explore the impacts of currents on the wave field and demonstrate a simple, effective methodology for re-creating combined wave-current scenarios. Regular waves, a parametric unidirectional spectrum, and a complex site-specific directional sea state were re-created with current velocities representing 0.25, 0.5, and 1.0 m/s full scale. Waves were generated at a number of angles relative to the current, providing observations of both collinear and non-collinear wave-current interactions. Wave amplitudes transformed by the current were measured and corrected linearly, ensuring desired frequency and wavenumber spectra in the presence of current were obtained. This empirical method proved effective after a single iteration. Frequency spectra were within 3% of desired and wave heights normally within 1%. The generation-measurement-correction procedure presented enables effective re-creation of complex wave-current scenarios. This capability will increase the realism of tank testing, and help de-risk devices prior to deployment at sea