Biomechanical and morphological aspects of abdominal aortic aneurysm growth and rupture

Abdominal aortic aneurysms (AAAs) are dilatations of the abdominal aorta that pose a risk of rupture. The only effective treatment is intervention prior to rupture, but this is also associated with mortality and morbidity. It is therefore important to weigh the risks of intervention with the potential benefit. Current treatment guidelines recommend using the maximal aneurysm diameter (Dmax) as the indicator for rupture risk, and rec- ommend considering intervention in men with AAAs > 55 mm, and >50 mm in women. Patients with small AAAs are put in surveillance, and the Dmax is followed until it reaches the threshold. The current policy is relatively efficient on a population-level but lacks specificity for individuals. Some patients rupture before this threshold, and many remain stable despite passing it. Aneurysm growth is often described as erratic, but measure- ments are affected by several levels of uncertainty. Biomechanical assessment, where 3D models of AAAs from computed tomography angiographies (CTAs) are analysed by finite element analysis, may improve risk prediction. In the first study a population-based cohort of 192 patients with ruptured AAAs and CT imaging available at rupture were studied. A significant portion of patients ruptured with AAAs smaller than 60 mm, 10% of men and 27 % of women. When normalizing Dmax for body surface area (so-called aortic size index) there was, however, was not difference between the sexes. In an analysis of small, ruptured AAAs compared to Dmax, age and sex-matched asymptomatic AAAs, peak wall rupture index (PWRI), but not peak wall stress (PWS) was increased in the ruptured AAAs. In the second study, a cohort of 100 patients with at least three computed tomog- raphy examinations were analysed with 3D morphological and biomechanical analysis. The growth pattern of AAAs appeared continuous and conferred well to a linear growth model. The evolution of the different analysed indices, Dmax, aneurysm volume and bio- mechanical stress did, however, not parallel each other. Intraluminal thrombus (ILT) grew faster than the lumen, but lumen volume growth was more closely related to increase in biomechanical stress. In the third study, a cohort of 67 patients with 109 CTA examinations prior to rupture were identified. The relation between biomechanical variables and time-to-rupture was investigated. In small and medium sized AAAs (< 70 mm), PWRI, but not PWS, was associ- ated with time-to-rupture, also when adjusting for potential confounders, aneurysm size and sex. The results further show that women have an approximately two-fold increased hazard ratio for AAA rupture, compared to men, when adjusted for AAA size. In the fourth study lumen area is indicated as a potentially useful rupture risk marker. Ruptured AAAs, compared to Dmax-matched asymptomatic AAAs, have a larger luminal area, and the luminal area is related to biomechanical stress, even when adjusting for an- eurysm size, or ILT area. In conclusion, the results of this thesis indicate areas of potential improvement in the current care of patients with AAAs, explores the 3D growth of AAAs, and strengthens the potential role for biomechanical analysis. These results may in the future have rele- vance for personalizing timing of treatment for patients with AAAs, and the evaluation of pharmacological therapy for AAAs

Perception of Labour Pain among Rural Women Presenting to A Tertiary Hospital in Kenya

Background: Childbirth results in severe pain for many women. In many hospitals in Resource-Limited Countries (RLCs), women endure the pain of labour with little or no pain relief. There have not been any studies done within 36 hours of a recent delivery to determine how rural Kenyan women perceive the pain of labour, and whether they have embraced the concept of labour analgesia.Objectives: To find out how rural women who had recently given birth at the Moi Teaching and Referral Hospital (MTRH) rate the severity of their pain, and whether the expectations of these women with regards to pain relief for labour were met.Design: A retrospective cohort study.Setting: The Moi Teaching and Referral Hospital (MTRH) post-natal wards.Subjects: Women who had had a normal vaginal delivery in the preceding 36 hours.Interventions: A structured questionnaire was administered.Results: Three hundred and eighy nine women who fulfilled the eligibility criteria were interviewed. Two hundred and eighty seven (73.8%) of 389 women rated their pain as severe to unbearable. Only 43 (11.0%) received any labour analgesia. This was in the form of an anti-spasmodic injection (Buscopan®). Thirty four (79%) of the 43 women who received an anti-spasmodic rated the pain relief obtained as good to very good. The level of knowledge of possible labour analgesia options was very low. Three hundred and thirty four (86%) of 389 women indicated that they would want to be given analgesia for future deliveries.Conclusion: The majority of rural women who give birth at the MTRH do so without any labour analgesia. Although the level of knowledge is low regarding possible labour analgesia options, the majority of these women would welcome medical intervention that would reduce their discomfort. There is need to  establish a formal labour analgesia service at MTRH and to educate rural Kenyan women on the various labour analgesia options, to enable them make informed choices regarding their use

Muodostelmaluistelijan palauttava harjoitusohjelma hengityksen näkökulmasta

Muodostelmaluistelu on joukkuelaji, jonka harrastajilla on todettu olevan hengityksen sujuvuuden ongelmia. Tässä näyttävyyteen tähtäävässä lajissa on korostettu pitkään mm. yliojentunutta ryhtiä ja vatsan vetämistä tiukasti sisäänpäin. Fysioterapiavastaanotolle on tullut urheilijoita tästä lajista paljon toiminnallisten hengityshäiriöiden vuoksi. Usein näillä urheilijoilla on haasteena juuri kehon ylijännittynyt tila ja ongelmia harjoittelusta palautumisessa. Palautuminen ja kehon sekä elimistön toiminnan häiriöt voivat voimistua epätasapainoisen hengityksen myötä. Työssä selvitettiin hengityksen merkitystä palautumiseen ja keinoja hengityksen sujuvuuden kehittämiseen. Tämän opinnäytetyön tarkoituksena oli kehittää hengityksen sujuvuuteen keskittyvä palautumiseen tähtäävä harjoitusohjelma, joka soveltuu hyvin muodostelmaluistelijoille. Työn tuloksena tehtiin yhteistyökumppanina toimineen muodostelmaluistelujoukkue Marigold IceUnityn tarpeisiin soveltuvan hengitysharjoitusohjelma, jota voidaan hyödyntää joukkueen palauttavassa harjoittelussa. Tavoitteena on tuoda joukkueen urheilijoille ja valmentajille lisää tietoutta oikeanlaisesta hengityksestä ja sen merkityksestä urheilussa. Tämä työ on monimuotoinen opinnäytetyö, jonka tuotoksena syntynyt kirjallinen harjoitusohjelma luovutetaan yhteistyökumppanille. Ohjelman harjoitteet perustuvat alan kirjallisuudesta ja tutkimuksista kerättyyn teoriatietoon. Lähteenä on näiden lisäksi käytetty myös hengitysfysioterapiaan erikoistuneiden fysioterapeuttien haastattelussa kertomia kokemuksia.Synchronized skating is team sport, where athletes have been recognized to have prob-lems with their breathing. In this imposing sport over straightened pose and strictly retracted stomach are emphasized. Many athletes of this sport have come to physiotherapist due to dysfunctional breathing. Usually the challenge of the athletes is over tensed body and problems with recovering from the training. Recovery can slow down and body can get unbalanced because of the dysfunctional breathing. In this work was examined the significance of breathing in recovery and ways to develop the functions of breathing. The purpose of this thesis was to develop breathing exercises and a recovering exercise program for figure skaters. An exercise program was made for the cooperation partner of this work, Marigold IceUnity, to be used as a part of the training routine for the team. In addition, the aim was to inform athletes and couches of the team about the significance of breathing in sports and proper way of breathing. This work is a functional thesis. The exercise program as an output of this work will be handed over to the cooperation partner. The exercises of the program is based on facts from literature and researches in the area of physiotherapy. As well as those references, respiratory specialized physiotherapists were interviewed

Editorial: Critical care applications: bridging high, medium and low-income settings.

This Research Topic explores the advancement of critical care in low- and middle-income countries (LMICs) with a focus on processes and technologies. Farré et al. introduce a cost-effective method for developing pneumotachographs to measure flow and volume in mechanical ventilation, while Herbst et al. address issues like hypoxemia management and oxygen conservation. Barros-Poblete et al. highlight improvements in early mobilization practices in LMIC ICUs, and Brotherton et al. compare prediction models for in-hospital mortality in LMIC settings. Additionally, Ab Rahman et al. provide insights into COVID-19 outcomes in Malaysian ICUs. These studies underscore the importance of context-specific research and the potential for LMIC innovations to enhance care globally

Ventilator-associated pneumonia in critically ill African patients on stress ulcer prophylaxis

Background: Stress ulcer prophylaxis is an integral part of the care of the criticallyill. Agents that alter gastric pH may predispose these patients to gastric colonisation,with subsequent pneumonia and/or sepsis. Cytoprotective agents such as sucralfatepreserve gastric acidity and may be protective.Objective: To determine whether African patients on sucralfate as stress-ulcer prophylaxis have a lower incidence of gastric colonisation and ventilator-associated pneumonia than those on ranitidine.Design: Randomised case-control studySetting: Kenyatta National Hospital Intensive Care UnitSubjects: Patients on ventilatory support for 48 hours or more Interventions: Sixty-eight critically ill patients were randomly assigned to either ranitidine or sucralfate as stress ulcer prophylaxis. Paired samples were taken from gastric and tracheal aspirates at admission, 48 hours and day six. Pneumonia was diagnosed using the Clinical Pulmonary Infection Score.Main outcome measures: Death or the development of pneumonia.Results: Although gastric colonisation rates were similar in the two groups, the incidence of pneumonia was lower in the sucralfate group (17.6% vs. 23.5%, p=0.4). In 63.6% of patients with both gastric colonisation and airway infection, the same organism was isolated from the two sites (p&lt;0.01). The majority of the organisms isolated were multi-drug resistant.Conclusion: Compared with ranitidine, sucralfate did not offer significant reduction in either gastric colonisation or ventilator-associated pneumonia in critically ill African patients

Hepatitis C virus (HCV) infection in Africa: a review

Hepatitis C virus (HCV) is a viral pandemic and a leading cause of chronic liver disease. This review highlights the epidemiology and management of Hepatitis C in Africa. We searched for articles on medline using the terms, "Hepatitis C", "Prevalence", "Epidemiology", "Africa" and "Treatment". The bibliographies of the articles found were used to find other references. We included articles published after 1995 only. The data was summarized and presented in tables and figures. Africa has the highest WHO estimated regional HCV prevalence (5.3%). Egypt has the highest prevalence (17.5%) of HCV in the world. Genotypes commonly found in Africa are 1, 4 and 5. Genotype 3 is found in Egypt and parts of Central Africa. Blood transfusion is a major means of acquisition of HCV infection. While treatment with peginterferon and ribavirin is recommended for patients with chronic HCV, no data were found on their use in Africa. Neither were there any data on definitive management (liver transplantation) for those with end stage disease. Data on HCV infection in Africa are scarce. This suggests that hepatitis C is still a neglected disease in many countries. Limited data exist in literature on HCV in Africa.Pan African Medical Journal 2013; 14:4

Masters of the Universe - Kuinka tehdään opettavainen taideteos?

Masters of the Universe – Kuinka tehdään opettavainen taideteos?, on taiteen kandidaatin opinnäytetyö, joka esittelee yhden veistoksen takana olevaa ajatusta ja merkityksiä. Opinnäyte on tehty oppaan muotoon ja sitä seuraamalla on periaatteessa mahdollista luoda oma opettavainen taideteos. Ainakin, jos omaa kuvanveiston ja keramiikan perusteet. Opinnäytetyö on kaksiosainen ja yhtäältä siinä annetaan ohje opettavaisen keraamisen veistoksen tekemiseksi ja toisaalta käsitellään teoksen merkitysten takana olevaa ajatuskulkua lähdekirjallisuuden avulla. Merkitysten rakentajina toimineena lähdekirjallisuutena on käytetty 14 sosiaalipsykologian artikkelia vuosilta 2009-2020. Nämä julkaisut käsittelevät muun muassa sosioekonomisen aseman vaikutusta yksilön empatiaan, eettisyyteen ja omakuvaan. Kaksoisrakenteen avulla on pyritty avaamaan ajatustyötä keramiikan käsinrakentamisen aikana. Itselleni käsinrakentaminen on miltei meditatiivinen prosessi ja usein ajatukseni pyörivät senhetkisen työni merkityksissä. Esimerkkiveistosta tehdessäni ajatukseni olivat yhteiskunnallisessa eriarvoisuudessa ja erityisesti sitä ruokkivissa asenteissa sekä kulttuurissa, joka on näiden asenteiden takana. Samoin, kuin siinä mitä seurauksia tällaisella kulttuurilla on meitä ympäröivän luonnon ja sen kautta myös itsemme selviämisen kannalta. Opinnäyte on esimerkki yhdenlaisesta luovasta prosessista, jossa merkitykset rakentuvat tarinalliseksi kokonaisuudeksi keraamiseen veistokseen. Onnistutaanko tässä – jää lukijan arvioitavaksi. Se on myös puheenvuoro nykyisen kulttuurimme muuttamiseksi yksilöllisyyttä ja taloudellista valtaa korostavasta empaattisemmaksi ja humaanimmaksi

Safe Thrombolysis During Pregnancy for Recurrent Acute Ischaemic Stroke Due to Concomitant Isolated Left Ventricular Non-Compaction and Bilateral Foetal Posterior Communicating Arteries

Isolated left ventricular non-compaction (ILVNC) is a rare congenital cardiomyopathy and is associated with arrhythmias, heart failure and thromboembolism including ischaemic stroke. Pregnancy is a relative contraindication to thrombolysis for acute ischaemic stroke, although case reports suggest the treatment can be given in selected cases. We report a case of recurrent cryptogenic strokes in a 36-year-old female who was thrombolysed with good outcome at 37 weeks’ gestation and was eventually found to have ILVNC as the cause. She had a predilection to recurrent posterior circulatory strokes due to foetal posterior communicating arteries. To our knowledge this is the first case report of safe thrombolysis for acute ischaemic stroke in pregnancy caused by ILVN

C’mon, Follow Me Across the Rainbow and I’ll Show You the Way to the Dream Valley.

Abstract My thesis is the result of four years of determined work. The starting point for it can be considered the course organized in 2018, during which I got to learn about the handbuilding of ceramics. It was love at first sight. In the following years, I used all possible time from my studies to develop my own technique and the content meanings of my works. During that time, I felt that a large part of the compulsory studies was mainly in the way and a retarder for the development of my own expression. I do appreciate wide-ranging knowledge and general education - a certain kind of renaissance humanity. However, you also need to be able to recognize what is essential for you in terms of your own goal and what is not - you cannot familiarize yourself with everything that comes your way in life. You must delve deeper into the things you have a real passion for, leave some for a more superficial examination or simply pass by with favor. Fortunately, my degree was already my second and I was able to get credits from my previous studies and work history credited to my bachelor's degree. Otherwise, I simply wouldn't have had enough time to develop my own passion. I am also grateful for the opportunity to complete the Contemporary Design master's program with a large number of my own projects – in which I count this thesis as well. In my thesis, I present my way of making art in my main artistic line. The contexts of my works are intuitively connected to the children's popular culture figures I use as models. After this connection is born, I familiarize myself with the topic by reading related studies in social psychology, political psychology and other studies that look at the topic from a humane perspective. I do this wading through literature while building the physical characters of my works. I don't actively try to create meanings for work based on the texts I read, but I let my brain take it easy with digesting, combining and assimilating things with what I read and the sculptures at hand. In this sculptural installation, that aforementioned intuitive connection was born between the My Little Pony TV series and toy figures and the right-wing populist movement. I used first generation My Little Pony figures as models for the sculptures. I handbuilt a herd of ceramic ponies whose withers vary in height from about 60-90 cm. The coloring of the ponies is created with engobes and glazes. Their manes and tails are horse hair and ponies have individual colored silk scarves as accessories. As a building material for the quintessential meanings embedded in the work, I familiarized myself with social psychology, political psychology, political communication, and political studies dealing with populism while making the ponies. The production part of this thesis has been on display in Huuto Gallery in Helsinki and in Art Centre Ahjo in Joensuu during summer 2022. Text part of thesis intends to show my artistic process where the assimilation of knowledge that functions as a builder of meanings goes hand in hand with the actual process of making the concrete artwork. This has been implemented in such a way that the text and the making of the work presented in pictures run parallel. My actual process is not that straight forward, but I found that this is best way to try to interpret it in this thesis

Single shot Fascia iliaca compartment block by an orthopaedic resident analgesia following hip surgery

Background: Trauma and surgery are among the leading causes of acute pain globally. However, acute pain is inadequately managed in approximately 50% of these patients. Fascia Iliaca Compartment Block (FICB) is an inexpensive regional anaesthesia that offers additional pain control as part of multimodal analgesia. Objective: The study assessed the efficacy of a single shot FICB in reducing post-operative pain when administered by an orthopaedic resident. Design: This was a two-arm single blinded Randomized Controlled Trial (RCT) among patients who had undergone hip surgery at a Kenyan tertiary hospital between July 2017 and March 2019. Methods: Those in the intervention arm received a single shot block administered through the landmark technique while the control arm received systemic analgesia alone. Pain intensity was assessed using the numerical rating scale after hip surgery with the limb in anatomical position and flexed at 15 degrees. Results: Thirty five participants were randomized into each arm of the trial. The mean pain scores significantly declined at two, four and six hours following hip surgery in the intervention arm. The block failure rate was six (17%). Neck of femur fracture diagnosis and posterior surgical approach were associated with FICB failure (p=0.001). Conclusions: Pain relief following hip surgery was superior for the first 6 hours in patients who received FICB based on the landmark technique by an orthopaedic resident compared to standard of care. Failure could be attributed to surgical approach. Recommendations: A formal education program on FICB should be introduced for orthopaedic residents in a bid to improve&nbsp; postoperative pain management following hip surgery in low resource settings. Key words: Postoperative pain, Fascia iliaca compartment block, Hip surgery, Numerical rating scale