Effects of intravenous diclofenac on postoperative sore throat in patients undergoing laparoscopic surgery at Aga Khan University Hospital, Nairobi: a prospective, randomized, double blind controlled trial

Background: Postoperative sore throat is the commonest complication after endotracheal intubation. The efficacy of intravenous non-steroidal anti-inflammatory drugs in alleviating postoperative sore throat has not been investigated. Objective: To evaluate the effect of intravenous diclofenac sodium on the occurrence and severity of postoperative sore throat. Methods: 42 in-patients scheduled for laparoscopic surgery were randomized into two equal groups to receive either a single dose of 75mg intravenous diclofenac sodium in addition to standard treatment taken at our hospital for the prevention of postoperative sore throat or to receive standard treatment only. All patients were interviewed postoperatively at 2, 6 and 18 hours. Data of the baseline characteristics, the incidence and severity of sore throat were collected. If sore throat was present, a Visual Analogue Score was used to assess its severity. Results: The baseline characteristics of the participants were similar. The majority of the patients undergoing laparoscopic surgery were women. There was no statistically significant difference in the occurrence or severity of postoperative sore throat between the diclofenac and standard treatment groups at 2, 6 and 18 hours postoperatively. Conclusion: Intravenous diclofenac sodium does not reduce the occurrence or severity of postoperative sore throat

Computational analysis of pathogen-borne metallo β-lactamases reveals discriminating structural features between B1 types

<p>Abstract</p> <p>Background</p> <p>Genes conferring antibiotic resistance to groups of bacterial pathogens are cause for considerable concern, as many once-reliable antibiotics continue to see a reduction in efficacy. The recent discovery of the metallo β-lactamase <it>blaNDM-1 </it>gene, which appears to grant antibiotic resistance to a variety of Enterobacteriaceae <it>via </it>a mobile plasmid, is one example of this distressing trend. The following work describes a computational analysis of pathogen-borne MBLs that focuses on the structural aspects of characterized proteins.</p> <p>Results</p> <p>Using both sequence and structural analyses, we examine residues and structural features specific to various pathogen-borne MBL types. This analysis identifies a linker region within MBL-like folds that may act as a discriminating structural feature between these proteins, and specifically resistance-associated acquirable MBLs. Recently released crystal structures of the newly emerged NDM-1 protein were aligned against related MBL structures using a variety of global and local structural alignment methods, and the overall fold conformation is examined for structural conservation. Conservation appears to be present in most areas of the protein, yet is strikingly absent within a linker region, making NDM-1 unique with respect to a linker-based classification scheme. Variability analysis of the NDM-1 crystal structure highlights unique residues in key regions as well as identifying several characteristics shared with other transferable MBLs.</p> <p>Conclusions</p> <p>A discriminating linker region identified in MBL proteins is highlighted and examined in the context of NDM-1 and primarily three other MBL types: IMP-1, VIM-2 and ccrA. The presence of an unusual linker region variant and uncommon amino acid composition at specific structurally important sites may help to explain the unusually broad kinetic profile of NDM-1 and may aid in directing research attention to areas of this protein, and possibly other MBLs, that may be targeted for inactivation or attenuation of enzymatic activity.</p

The evolution of dispersal in a Levins’ type metapopulation model

We study the evolution of the dispersal rate in a metapopulation model with extinction and colonisation dynamics, akin to the model as originally described by Levins. To do so we extend the metapopulation model with a description of the within patch dynamics. By means of a separation of time scales we analytically derive a fitness expression from first principles for this model. The fitness function can be written as an inclusive fitness equation (Hamilton’s rule). By recasting this equation in a form that emphasizes the effects of competition we show the effect of the local competition and on the local population size on the evolution of dispersal. We find that the evolution of dispersal cannot be easily interpreted in terms of avoidance of kin competition, but rather that increased dispersal reduces the competitive ability. Our model also yields a testable prediction in term of relatedness and life history parameters

Evaluation of galvanic technologies available for bridge structures

The use of sacrificial anode technologies to treat corrosion damaged concrete is an option that can be considered in specific cases. This is a rapidly growing field with many new innovations appearing in the market. The sacrificial anode technologies currently available are generally less powerful than impressed current cathodic protection but they are much less complex to apply. The technology requires no installed power supply and the installation of electrical cables is mainly limited to non-critical monitoring. Uncontrolled anode-steel shorts present no problems to system function and stray current corrosion of discontinuous steel is limited. In many cases the technology can be targeted to areas of need. In general, the output of a sacrificial anode system cannot be adjusted to manage a corrosion risk. However, some sacrificial anode systems have been used in both an impressed current and a sacrificial role and future corrosion risk may be addressed by turning the system into an impressed current system, or by applying a brief impressed current treatment to arrest the corrosion process

Cardiorespiratory fitness levels and their association with cardiovascular profile in patients with rheumatoid arthritis: a cross-sectional study.

OBJECTIVE: The aim of this study was to investigate the association of different physical fitness levels [assessed by the maximal oxygen uptake (VO2max) test] with cardiovascular disease (CVD) risk factors in patients with RA. METHODS: A total of 150 RA patients were assessed for cardiorespiratory fitness with a VO2max test and, based on this, were split in three groups using the 33rd (18.1 ml/kg/min) and 66th (22.4 ml/kg/min) centiles. Classical and novel CVD risk factors [blood pressure, body fat, insulin resistance, cholesterol, triglycerides, high-density lipoprotein (HDL), physical activity, CRP, fibrinogen and white cell count], 10-year CVD risk, disease activity (DAS28) and severity (HAQ) were assessed in all cases. RESULTS: Mean VO2max for all RA patients was 20.9 (s.d. 5.7) ml/kg/min. The 10-year CVD risk (P = 0.003), systolic blood pressure (P = 0.039), HDL (P = 0.017), insulin resistance and body fat (both at P < 0.001), CRP (P = 0.005), white blood cell count (P = 0.015) and fibrinogen (P < 0.001) were significantly different between the VO2max tertiles favouring the group with the higher VO2max levels. In multivariate analyses of variance, VO2max was significantly associated with body fat (P < 0.001), HDL (P = 0.007), insulin resistance (P < 0.003) and 10-year CVD risk (P < 0.001), even after adjustment for DAS28, HAQ and physical activity. CONCLUSION: VO2max levels are alarmingly low in RA patients. Higher levels of VO2max are associated with a better cardiovascular profile in this population. Future studies need to focus on developing effective behavioural interventions to improve cardiorespiratory fitness in RA

Physical activity awareness and preferences in rheumatic diseases: a qualitative study

Background: Physical inactivity is the fourth leading cause of death (1) and a risk factor for cardiovascular disease (CVD). Patients with rheumatic diseases (RDs), especially rheumatoid arthritis (RA), report low cardiorespiratory fitness levels (2), placing them at an increased risk of premature mortality and CVD.Published versio

Operational flexibility options in power plants with integrated post-combustion capture

Flexibility in power plants with amine based carbon dioxide (CO2) capture is widely recognised as a way of improving power plant revenues. Despite the prior art, its value as a way to improve power plant revenues is still unclear. Most studies are based on simplifying assumptions about the capabilities of power plants to operate at part load and to regenerate additional solvent after interim storage of solvent. This work addresses this gap by examining the operational flexibility of supercritical coal power plants with amine based CO2 capture, using a rigorous fully integrated model. The part-load performance with capture and with additional solvent regeneration, of two coal-fired supercritical power plant configurations designed for base load operation with capture, and with the ability to fully bypass capture, is reported. With advanced integration options configuration, including boiler sliding pressure control, uncontrolled steam extraction with a floating crossover pressure, constant stripper pressure operation and compressor inlet guide vanes, a significant reduction of the electricity output penalty at part load is observed. For instance at 50% fuel input and 90% capture, the electricity output penalty reduces from 458 kWh/tCO2 (with conventional integration options) to 345 kWh/tCO2 (with advanced integration options), compared to a reduction from 361 kWh/tCO2 to 342 kWh/tCO2 at 100% fuel input and 90% capture. However, advanced integration options allow for additional solvent regeneration to a lower magnitude than conventional integration options. The latter can maintain CO2 flow export within 10% of maximum flow across 30–78% of MCR (maximum continuous rating). For this configuration, one hour of interim solvent storage at 100% MCR is evaluated to be optimally regenerated in 4 h at 55% MCR, and 3 h at 30% MCR, providing rigorously validated useful guidelines for the increasing number of techno-economic studies on power plant flexibility, and CO2 flow profiles for further studies on integrated CO2 networks

A Condensation-Ordering Mechanism in Nanoparticle-Catalyzed Peptide Aggregation

Nanoparticles introduced in living cells are capable of strongly promoting the aggregation of peptides and proteins. We use here molecular dynamics simulations to characterise in detail the process by which nanoparticle surfaces catalyse the self- assembly of peptides into fibrillar structures. The simulation of a system of hundreds of peptides over the millisecond timescale enables us to show that the mechanism of aggregation involves a first phase in which small structurally disordered oligomers assemble onto the nanoparticle and a second phase in which they evolve into highly ordered beta-sheets as their size increases

The lacuna of capital, the state and war? The lost global history and theory of Eastern agency

In this article I seek to constructively engage Alex Anievas’s seminal book that is deservedly the subject of this forum. For Anievas has become a key figure in the revival of Trotskyism in IR and his is one of the first book-length treatments of the New Trotskyist theory of the international. My critique is meant merely as a constructive effort to push his excellent scholarship further in terms of developing his non-Eurocentric approach. In the first section I argue that his book represents a giant leap forward for the New Trotskyist IR. However, in the following sections I argue that although undeniably a brave attempt nevertheless, in the last instance, Anievas falls a few steps short in realising a genuinely non-Eurocentric account of world politics. This is because while he certainly restores or brings in ‘the lost theory and history of IR’ that elevates class forces to a central role in shaping world politics, nevertheless he fails to bring in ‘the lost global theory and history of Eastern agency’ that constitutes, in my view, the key ingredient of a non-Eurocentric approach to world politics. I also argue that while his anti-reductionist ontological credentials are for the most part extremely impressive, nevertheless, I argue that these are compromised in his analysis of Hitler’s racism. Finally, in the conclusion I ask whether the theoretical architecture of the New Trotskyism in IR is capable of developing a non-Eurocentric approach before concluding in the affirmative with respect to its modern revisionist incarnation of which Anievas is in the vanguard

The Population Structure of Glossina palpalis gambiensis from Island and Continental Locations in Coastal Guinea

Guinea is the country with the highest prevalence of sleeping sickness in West Africa, and we undertook a population genetics analysis there of the most dangerous tsetse fly species of West Africa, Glossina palpalis gambiensis. Our aims were to estimate effective population size and the degree of isolation between coastal sites on the mainland of Guinea (including Dubréka, a highly prevalent sleeping sickness focus) and Loos Islands in order to get the most possible accurate vision of feasibility and sustainability of anti-tsetse strategies of these sites. We found very low migration rates of tsetse between sites except between those situated in the Dubréka area, which seems to contain a widely distributed panmictic tsetse population (i.e. a population where mating occurs at random). Effective population sizes on Loos islands estimated with various techniques all converged to surprisingly small values. These values might be explained by a recent decrease in tsetse numbers on Kassa Island due to bauxite mining activities. But on the other sites, other explanations have to be found, including possible variance in reproductive success. Our genetic results suggest that different control strategies should be advised on the mainland (reduction in tsetse densities, no elimination) compared to the islands (total elimination feasible). This approach could be extended to many areas where vector control of Human and Animal Trypanosomoses is contemplated