Does spinal surgery for spinal tuberculosis during active infection predispose to post operative surgical site infection?: Experience From Kenyatta national hospital

Background: Spinal Tuberculosis (TB) is the most common form of skeletal TB. Its incidence has seen an increase over the past 3 decades due to the AIDS epidemic. Absolute non-operative treatment was offered in pre antibiotic era. Surgery has become an integral component in the management of spinal TB in current practice. The rate of SSI varies from 2% to 20% for all surgical spinal procedures.Objective: Does spinal surgery for spinal tuberculosis during active infection predispose to post operative Surgical Site Infection (SSI). The aim of this study was to note the incidence of infection in patients undergoing spinal surgery for tuberculosis.Methods: All patients who had complete medical records and had surgery for spinal tuberculosis were recruited into the study. The study period was from 2005 to 2015. Relevant data was collected and appropriately analyzed.Results: For all the patients, chemotherapy was started immediately after tuberculosis of the spine was diagnosed. Five patients had involvement of the lumbar region, one patient with involvement of the cervical region and the rest had involvement of the thoracic region. One patient had 3 vertebrae involved, 3 patients had one vertebrae involved and 14 patients had 2 vertebrae involved. Out of the 18 patients, 12 showed improvement after surgery, 4 patients had no difference after surgery and 2 patients worsened after surgery. Two patients showed improvement after 1 week; 3 patients after 2 weeks; 3 patients after 1 month; 4 patients after 2 months. Of the patients who worsened; 1 patient worsened by 1 grade while another worsened by 2 grades. No patient had any SSI. This was irrespective of whether they had instrumented spine surgery or not.Conclusion: This study shows that spinal surgery for spinal tuberculosis does not lead to increased surgical site infection even in the presence of active tuberculosis infection. Addition of spinal instrumentation to the surgical strategy does not predispose to increased infection rate. Larger studies need to be carried out to validate this data.Key words: Spinal tuberculosis, Spinal surgery, Surgical site infection

Solution to Eigenvalue Problems of Antisymmetric Cross-ply and Antisymmetric Angle-ply Laminated Plates Using Affine Transformations

Using affine transformations and suitably recasting the buckling vibration differential equations, the eigenvalue problem of anti-symmetric cross-ply and antisymmetric angle-ply laminated rectangular plates has been reduced to a function of two strong material constants, the generalized rigidity ratio, whose range is in the closed interval from 0 to 1, and the ratio of principal lamina stiffness. With the reduction in number of constants an exhaustive parameter study of buckling and vibration solution trends, is possible. The buckling coefficients decrease with decreasing value of generalized rigidity ratio for both antisymmetric cross-ply and antisymmetric angle-ply laminates. For a given aspect ratio, and ratio of principal lamina stiffnesses, the buckling and frequency coefficient for antisymmetric cross-ply laminates vary linearly with the value of the generalized rigidity ratio, so that one may accurately interpolate between the values of the generalized rigidity ratio. The buckling and frequency coefficients increase with increasing F for antisymmetric cross-ply laminates. No such trend could be established for antisymmetric angle-ply laminates. A simple and fairly accurate method has been established for estimating the buckling and vibration coefficients for anti-symmetric cross-ply laminates

Saturation of adrenomedullin receptors plays an important role in reducing pulmonary clearance of adrenomedullin during the late stage of sepsis

AbstractAdrenomedullin (AM) is a potent vasodilator that plays a major role in the cardiovascular response during the progression of sepsis. Although pulmonary clearance of AM (i.e., the primary site of AM clearance) is reduced during the late, hypodynamic stage of sepsis, the role of AM receptors under such conditions remains unclear. This study was carried out to test the hypothesis that saturation of AM receptors is responsible for the decreased clearance of AM in the lungs during sepsis. Polymicrobial sepsis was induced in male adult rats by cecal ligation and puncture (CLP). At 20 h after CLP (i.e., the late phase), 125I-labeled rat AM was administered through the jugular vein, both with (+) and without (−) pre-injection of the human AM fragment AM22–52 (an AM receptor antagonist). Pulmonary tissue samples were harvested after 30 min and the radioactivity was determined. In addition, lung levels of AM were determined at 5 and 20 h after CLP by radioimmunoassay. Alterations in gene expression of the recently identified AM receptor subunits calcitonin receptor-like receptor (CRLR) and receptor activity modifying protein-2 and -3 (RAMP-2 and -3) were assessed in the lungs by reverse transcription–polymerase chain reaction (RT–PCR) at 5 and 20 h after CLP. The results indicate that there was a significant decrease in pulmonary [125I]AM clearance at 20 h in −AM22–52 CLP animals. Lung clearance in +AM22–52 sham animals was significantly lower than in −AM22–52 sham animals and was not statistically different from the −AM22–52 CLP group. There was no statistical difference between +AM22–52 and −AM22–52 CLP groups. However, there was a significant increase in lung AM levels at 20 but not 5 h after CLP. In addition, RAMP-3 expression was significantly upregulated at 5 but not 20 h after CLP. There were no alterations in the expression of CRLR or RAMP-2 at either time point. These results suggest that pulmonary AM receptors become saturated as more AM enters the bloodstream, thereby reducing the ability of the lungs to clear this peptide during late sepsis. Early upregulation of RAMP-3 may be a compensatory mechanism to help clear the upregulated AM from the bloodstream. The lack of upregulation of RAMP-3 during late sepsis could also contribute to the decreased clearance observed during this phase

Ewald methods for inverse power-law interactions in tridimensional and quasi-two dimensional systems

In this paper, we derive the Ewald method for inverse power-law interactions in quasi-two dimensional systems. The derivation is done by using two different analytical methods. The first uses the Parry's limit, that considers the Ewald methods for quasi-two dimensional systems as a limit of the Ewald methods for tridimensional systems, the second uses Poisson-Jacobi identities for lattice sums. Taking into account the equivalence of both derivations, we obtain a new analytical Fourier transform intregral involving incomplete gamma function. Energies of the generalized restrictive primitive model of electrolytes ($\eta$-RPM) and of the generalized one component plasma model ($\eta$-OCP) are given for the tridimensional, quasi-two dimensional and monolayers systems. Few numerical results, using Monte-Carlo simulations, for $\eta$-RPM and $\eta$-OCP monolayers systems are reported.Comment: to be published in Journal of Physics A: Mathematical and Theoretical (19 pages, 2 figures and 3 tables

L-arginine: A unique amino acid for improving depressed wound immune function following hemorrhage

Objective: To determine whether L-arginine has any salutary effects on wound immune cell function following trauma-hemorrhage. Background. Depressed wound immune function contributes to an increased incidence of wound infections following hemorrhage. Although administration of L-arginine has been shown to restore depressed cell-mediated immune responses following hemorrhage potentially by maintaining organ blood flow, it remains unknown whether Larginine has any salutary effects on the depressed local immune response at the wound site. Methods: Male mice were subjected to a midline laparotomy and polyvinyl sponges were implanted subcutaneously in the abdominal wound prior to hemorrhage (35 +/- 5 mm Hg for 90 min and resuscitation) or sham operation. During resuscitation mice received 300 mg/kg body weight L-arginine or saline (vehicle). Sponges were harvested 24 h thereafter, wound fluid collected and wound immune cells cultured for 24 h in the presence of LPS. Pro- (IL-1beta, IL-6) and anti-inflammatory (IL-10) cytokines were determined in the supernatants and the wound fluid. In addition, wounds were stained for IL-6 immunohistochemically. In a separate set of animals, skin and muscle blood flow was determined by microspheres. Results: The capacity of wound immune cells to release IL-1beta and IL-6 in vitro was significantly depressed in hemorrhaged mice receiving vehicle. Administration of L-arginine, however, improved wound immune cell function. In contrast, in vivo the increased IL-6 release at the wound site was decreased in L-arginine-treated mice following hemorrhage. Moreover, IL-10 levels were significantly increased in the wound fluid in hemorrhaged animals receiving L-arginine compared to vehicle-treated mice. In addition, the depressed skin and muscle blood flow after hemorrhage was restored by L-arginine. Conclusions: Thus, L-arginine might improve local wound cell function by decreasing the inflammatory response at the wound site. Since L-arginine protected wound immune cell function this amino acid might represent a novel and useful adjunct to fluid resuscitation for decreasing wound complications following hemorrhage. Copyright beta 2002 S. Karger AG, Basel

PREVALENCE OF TRICHOMONIASIS IN DOMESTIC AND WILD PIGEONS AND ITS EFFECTS ON HEMATOLOGICAL PARAMETERS

The present study was conducted to determine the prevalence of trichomoniasis and its effect on some blood parameters in pigeons. A total of 100 samples from the pigeons (50 wild and 50 domestic) were collected during the months of March and April 2005. Higher prevalence (P<0.05) was recorded in wild pigeons (60%) than in domestic pigeon (26%). The overall prevalence recorded was 43%, being non significantly higher in April (56%) than in March (30%). In infected pigeons, there was significant (P<0.05) decrease in hemoglobin concentration number of monocytes packed cell volume, body weight, than healthy birds. Likewise, the values of total leukocyte count, lymphocytes and eosinophils were higher significantly (P<0.05) in infected pigeons than the healthy ones. While, no significant difference was observed for heterophils count when infected and healthy birds were compared. It was concluded that trichomonad infection is quite common in wild, as well as in domestic, pigeons under the prevailing cage system

Formative evaluation of a mobile liquid portion size estimation interface for people with varying literacy skills

Chronically ill people, especially those with low literacy skills, often have difficulty estimating portion sizes of liquids to help them stay within their recommended fluid limits. There is a plethora of mobile applications that can help people monitor their nutritional intake but unfortunately these applications require the user to have high literacy and numeracy skills for portion size recording. In this paper, we present two studies in which the low- and the high-fidelity versions of a portion size estimation interface, designed using the cognitive strategies adults employ for portion size estimation during diet recall studies, was evaluated by a chronically ill population with varying literacy skills. The low fidelity interface was evaluated by ten patients who were all able to accurately estimate portion sizes of various liquids with the interface. Eighteen participants did an in situ evaluation of the high-fidelity version incorporated in a diet and fluid monitoring mobile application for 6 weeks. Although the accuracy of the estimation cannot be confirmed in the second study but the participants who actively interacted with the interface showed better health outcomes by the end of the study. Based on these findings, we provide recommendations for designing the next iteration of an accurate and low literacy- accessible liquid portion size estimation mobile interface