Neonatal Intensive Care Units Nurses' Attitude Toward Advantages and Disadvantages of Open vs Closed Endotracheal Suction

Background: The vital issue of protecting the airway and maintaining ventilation in preterm infants makes tracheal suctioning an important procedure. The decision to use closed or open endotracheal suction method depends on the clinical status of infants and the nurses’ skills and preferences. Objectives: The current study aimed to compare the two methods based on the perceptions of the nurses working in Neonatal Intensive Care Units (NICU). Patients and Methods: A comparative-descriptive study carried out on 35 NICU nurses in Taleghani and Al-Zahra teaching hospitals in Tabriz, Iran, in 2013. Data were collected by self-administered questionnaire (13 Items). Data analysis, including t-test was performed using SPSS Ver. 13. A P ≤ 0.05 was considered statistically sig­nificant. Results: According to the nurses’ point of view, there are differences between characteristics of open and closed endotracheal suctioning methods (P < 0.001). By using closed endotracheal suction, the risk of traumatizing airway, developing pneumonia, increasing intracranial pressure, prolonging emergency suctioning, developing intra-ventricular hemorrhage, blood stream infection, physiological instability and lowering positive end-expiratory pressure (PEEP) are reduced. Meanwhile, lower cost, lower risk of extubation, comfort and easy washing procedure were reported as advantages of open suction. Conclusion: Closed endotracheal suctioning was evaluated to be better than the open method in the preterm neonates. More studies, especially experimental and efficient cost analysis, are recommended

A Study on Diagnostic Methodology and Symptomatology of Peenisam (Rhinosinusitis)

INTRODUCTION: The signs and symptoms of Peenisam mentioned in Siddha literature may be correlated with Rhinosinusitis in Modern disease of classification. The comparative studies of Siddha system of Medicine bring to light high level of medical knowledge the Siddhars had. Rhino Sinusitis affects a tremendous proportion of population, accounts for millions of visits to Primary care Physicians each year, Rhino Sinusitis is a major health care issue that affects in a large proportion. The incidence of chronic sinusitis in Southern Asian countries like India is 136,657,953 out of 1,065,070,607 (US Census Bureau, 2004). More than 120 million Indians suffer from at least one episode of acute sinusitis each year. The prevalence of sinusitis has soared in the last decade due to increased pollution, urban sprawl, and increased resistance to antibiotics. The incidence of morbidity and mortality among patients with complications of sinusitis has been reported to range from 5% to 40%. A sizable number of patients visit National Institute of Siddha with the clinical features of ‘Peenisam’. The study of Peenisam will be helpful to standardize the diagnosis of Peenisam through Sage Nagamunivar’s symptomatology description, which will help clinicians to follow a standard line of treatment and adopt proper preventive measures, so that visits to hospital will get reduced. Detailed study of the disease Peenisam through the symptomatology mentioned in the Siddha literature will enable the physicians to choose appropriate treatement from the wide range of medicines found scattered in the literature with indications of Rhinosinusitis with specific symptomatology groups. Medicines indicated for one group of symptomatology of the same disease may not be found to be a mainstay of therapy to another. Hence emphasis on the study of symptomatology is very vital for the institution of right kind of treatment. The study was aimed at evolving a set of exclusive Siddha diagnostic methods for Peenisam and to correlate the symptoms of Peenisam with that of closely resembling condition in modern medical literature. By relating the ancient Siddha literature with today’s, there will be both augmention of the knowledge of diagnosis and its treatment. The author was aimed at delving in depth into the clinical features mentioned under highly prevailing disease ‘Peenisam’ by Sage Nagamunivar and to structure the Siddha diagnosis and prognostic pattern of Peenisam. AIM AND OBJECTIVES: AIM: To conduct a study on Peenisam as mentioned in Nagamunivar Thalai Noi Maruthuvam, thereby to evolve a diagnostic methodology for Peenisam in Siddha system of medicine. OBJECTIVES: Primary Objectives: 1. To elucidate a diagnostic methodology for Peenisam. 2. To conduct the cause and clinical course of the disease by keen observation on the symptoms of Peenisam. 3. To correlate clinically, the symptoms of Peenisam with that of closely resembling condition in modern medical literature which in turn helps in globalization of Siddha system among other medical systems. Secondary Objectives: 1. To analyse literally on the etiology, pathogenesis, Clinical presentation of Peenisam. 2. To help in deriving a proper line of treatment and preventive measures for Peenisam based on Siddha system of medicine by evolving a diagnostic method for the disease. MATERIALS AND METHODS: STUDY TYPE: Observational study. STUDY DESIGN: An analytical open label, single centric study. STUDY PLACE: Department of Noi Naadal, Ayothidoss Pandithar Hospital, National Institute of Siddha, Tambaram Sanatorium, Chennai-47. STUDY PERIOD: • Total period - 1year. • Recruitment for the study - upto 10 months. • Data entry analysis - 1 month. • Report preparation and submission - 1 month. Sample size: Total – 50, Patients – 40, Healthy volunteers – 10. SELECTION CRITERIA: INCLUSION CRITERIA: 1. Age 18-60yrs. 2. Headache. 3. Mucous discharge from the nose. 4. H/o recurrent sneezing. 5. Nasal polyp. 6. Halitosis. CONCLUSION: The author had come out with valuable results from the study on Peenisam, validating the clinical features of Peenisam elucidated in an ultra short poetic segment by Sage Nagamunivar and also a proper Siddha diagnostic methodology had been elucidated for the disease. The symptoms and signs mentioned in Sage Nagamuni literature are in close conformity with that of Rhinosinusitis mentioned in modern medical literature. The patients reported with the symptoms of Peenisam were subjected to the standard set of investigations, the results and findings of the investigations were suggestive of Rhinosinusitis according to modern classification of disease. The fact that Peenisam which has Kabam as the major etiological factor, according to the Sage Nagamunivar text, was validated by the findings of Oil on urine sign/Neikkuri showing up shapes of pearl beaded appearance of the oil drop in 70% of cases. It is certainly a case of Peenisam, the cases were diagnosed with one hundred percent confidence as Peenisam because the aetiological factors mentioned in the literature and that the elicited history of patients conforms to be the same. Mannikkadai nool findings were also validated for the range 8 ¼ - 9 ¼ which indicates the chances of Peenisam occurrence. Almost all the patients diagnosed as Peenisam had positive radiological evidence conforming to the correlation of disease with RhinoSinusitis. From the analysis done between Peenisam cases and Control group, notable variations were observed in both Siddha and Modern parameters. Finally, with the observations and results of various parameters like eight fold examination, manikkadai nool, astrology, seasonal factor, etc it was found that all of them point to the development or vitiation of Kabha and Pitha humours leading to the disease Peenisam. From this study findings validation, some therapeutic guidelines were framed for the treatment of Peenisam. Thus the author concludes by throwing lights on the validation of symptomatology and exclusive Siddha diagnostic methodology for Peenisam, so that a physician can arrive at proper treatment procedures by rightly diagnosing the disease

MyoRing implantation in keratoconic patients: 3 years follow-up data

Purpose: To evaluate long-term follow-up data on implantation of a full-ring intra-corneal implant (MyoRing) for management of keratoconus. Methods: A total of 40 keratoconic eyes of 37 consecutive patients who had undergone MyoRing implantation using the Pocket Maker microkeratome (Dioptex, GmbH, Linz, Austria) and completed 3 years of follow-up appointments were included in this retrospective study. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refraction and keratometry (K) readings were measured and evaluated preoperatively, and 3 years, postoperatively. Results: No intraoperative complications were observed in this case series. Three years postoperatively, there was a significant improvement in UDVA, CDVA, K readings, spherical equivalent (SE), and manifest sphere and cylinder (P < 0.05 for all comparisons). UDVA was significantly improved from 1.14 ± 0.27 to 0.30 ± 0.21 LogMAR (P = 0.001), CDVA was also improved from 0.52 ± 0.23 to 0.18 ± 0.12 LogMAR (P = 0.001), SE was decreased by 4.35 diopters (D) and average keratometric values were reduced by 2.34 D (P = 0.001). Overall, 81 of subjects were moderately to highly satisfied 3 years after surgery and 64.90 agreed to have the fellow eye implanted with MyoRing. Conclusion: MyoRing implantation using the Pocket Maker microkeratome was found to be a minimally invasive procedure for improving visual acuity and refraction in the majority of the patients with keratoconus. © 2016 Journal of Ophthalmic and Vision Research

LASEK for the correction of hyperopia with mitomycin C using SCHWIND AMARIS excimer laser: one-year follow-up

AIM: To evaluate the efficacy, safety and predictability of laser-assisted sub-epithelial keratectomy (LASEK) for the correction of hyperopia using the SCHWIND AMARIS platform. METHODS: This retrospective single-surgeon study includes 66 eyes of 33 patients with hyperopia who underwent LASEK with mitomycin C (MMC). The median age of patients was 35.42±1.12y (ranging 18 to 56y). In each patient LASEK was performed using SCHWIND AMARIS excimer laser. Postoperatively clinical outcomes were evaluated in terms of predictability, safety, efficacy, subjective and objective refractions, uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA) and adverse events. RESULTS: The mean baseline refraction was 3.2±1.6 diopters (D) (ranging 0 to 7 D). The mean pre-operative and postoperative spherical equivalent (SE) were 2.34±1.76 (ranging -1.25 to 7 D) and 0.30±0.84 (ranging -0.2 to 0.8 D) respectively (P=0.001). The mean hyperopia was 0.63±0.84 D (ranging -1.75 to 2.76 D) 6 to 12mo postoperatively. Likewise, the mean astigmatism was 0.68±0.43 D (range 0 to 2 D) with 51 (77.3) and 15 (22.7) eyes within ±1 and ±0.50 D respectively. The safety index and efficacy index were 1.08 and 1.6 respectively. CONCLUSION: LASEK using SCHWIND AMARIS with MMC yields good visual and refractive results for hyperopia. Moreover, there were no serious complications. Copyright 2015 by the IJO Press

Assessing breast cancer risk among Iranian women using the gail model

Background: Breast cancer risk assessment is a helpful method for estimating development of breast cancer at the population level. Materials and Methods: In this cross-sectional study, participants consisted of a group of 3,847 volunteers (mean ± SD age: 463 ± 7.59 years) in a convenience sample of women referred to health centers affiliated to Tehran University of Medical Sciences in Tehran, Iran. The risk of breast cancer was estimated by applying the National Cancer Institute's online version of the Gail Risk Assessment Tool. Results: Some 24.9 of women reported having one first-degree female relative with breast cancer, with 8.05 of them having two or more first-degree relatives with breast cancer. The mean five-year risk of breast cancer for all participants was 1.61±0.73, and 9.36 of them had a five-year risk of breast cancer > 1.66. The mean lifetime risk of breast cancer was 11.7±3.91. Conclusions: The Gail model is useful for assessing probability of breast cancer in Iranian women. Based on the their breast cancer risk, women may decide to accept further screening services

NEERKURI BY SAGE THERAIYAR - A REVIEW ON SIDDHA WAY OF URINE EXAMINATION IN THE LIGHT OF CONTEMPORARY CLINICAL METHODS

The Siddha system is said to have emerged in antiquity, from the highly evolved consciousness of the Siddhars. The clarified intellect and heightened intuition of Sage Theraiyar, resulting from Yogic powers, enabled to expound to the world the signs of a disease in the Urine of a person in his treatise “Theraiyar Neerkuri Vaithyam†a book that details urine examination findings for diagnostic and prognostic purposes. The present paper deals with scientific validation of Neerkuri (urine examination), an important diagnostic tool in Siddha system of medicine. The methodology of diagnosis in Siddha system is based on eight fold examination of pulse, tactile perception, tongue, color and complexion, speech, eyes, stools and urine. Of all these parameters, Urine examination has gained paramount importance next to pulse examination. This paper parallels analyses the signs of urine examination between a few quotes from Sage Theraiyar text and modern text. This is an attempt to understand the Siddha system of diagnosing pathological conditions which are a non-invasive, highly cost effective procedure which can be used for both diagnostic and prognostic purposes

Prevalence of Gram-negative bacteria in ventilator-associated pneumonia in neonatal intensive care units: A systematic review and meta-analysis protocol

Introduction: Ventilator-associated pneumonia (VAP) is a common and potentially lethal problem among mechanically ventilated neonates in neonatal intensive care units (NICUs). The main pathogenic bacteria of VAP in NICUs are Gram-negative pathogens, which show a general decline in sensitivities to commonly used antibiotics, but their true prevalence is not known. Methods and analysis: We aim to provide a systematic review of studies measuring the prevalence of Gram-negative bacteria in VAP in NICUs. We will search PubMed, SCOPUS, EMBASE and the ISI Web of Science, as well as the Google Scholar search engine with no restriction on language. Full copies of articles will be identified by a defined search strategy and will be considered for inclusion against predefined criteria. Study selection and data extraction will be performed by 2 independent reviewers. Statistical analysis will include the identification of data sources and documentation of estimates, as well as the application of the randomeffects and fixed-effects meta-analysis models. This will allow us to aggregate prevalence estimates and account for between-study variability in calculating the overall pooled estimates and 95 CI for the prevalence of Gram-negative bacteria in VAP in NICUs. Heterogeneity will be evaluated using the I2 and ÷2 statistical tests to determine the extent of variation in effect estimates due to heterogeneity rather than chance. Publication bias and data synthesis will be assessed by funnel plots and Begg's and Egger's tests using STATA software V.13. This systematic review protocol was prepared according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses Protocols (PRISMA-P) 2015 Statement. Ethics and dissemination: No ethical issues are predicted. These findings will be published in a peerreviewed journal and presented at national and international conferences. Trial registration number: CRD42016036048. © 2016 Published by the BMJ Publishing Group Limited

Sourcing Process – A Supply Chain Management Perspective to Meet Consumer Demand with Special Reference to Solitaire Diamond Brand Sold in Damas Outlets, Dubai

Diamond in a supplier‟s catalogue encompasses a steady price appreciation and less volatility. Strategic sourcing for diamond is based on the assessment of needs and exploration of the legal mining process, and the allied risks. This paper analyses the sourcing process for managing the supply chain with special reference to Damas, Dubai where an organisation has functional expertise at every level but lacks expertise in the value chain

Type specific Real time PCR for detection of human herpes virus 6 in schizophrenia and bipolar patients: A case control study

Background: Schizophrenia (SC) and bipolar disorder (BD) are among the most devastating diseases worldwide. There are several lines of evidence suggesting that viruses may play significant roles in the etiology of these mental disorders. The aim of this study was the detection of HHV-6A/B in the peripheral blood mononuclear cells (PBMC) of SC and BD patients versus the healthy control (HC) subjects using a new method of type-specific Real time PCR analysis. Methods: A type-specific Real time PCR was performed for simultaneous detection and typing of HHV-6A/B in the PBMCs of 120 SC and BD patients and 75 HCs. Results: Only one case of HHV-6B out of 120 (0.8 ) SC and BD patients and two cases of HHV-6A (2.7 ) in 75 HCs were detected. Conclusions: The low levels of HHV-6 detection in PBMCs, severely limited the capacity of this study to investigate the association between the presence of HHV-6 and BD or SC in this population, thus no conclusions can be drawn in this regard. Meanwhile this study introduces a Real time PCR based method for type specific detection of HHV-6A/B in clinical samples. © 2015 Yavarian et al

Effective Communication Protocols for Verification on SoC Using FPGA

ABSTRACT A System on Chip (SoC) is an integrated circuit that integrates all components of a computer or other electronic system into a single chip. It may contain digital, analog, mixed-signal, and often radio frequency functions all on a single chip substrate. Traditionally, Engineers have employed simulation acceleration, emulation and/or an FPGA prototype to verify and debug both hardware and software for SOC design prior to tape out. So that design effective communication protocols are important for efficient verification on SOC.A serial communication interface based on FPGA (Field Programmable Gate Array) has been designed in this paper, used for data communication with other equipment. It guarantees the realization of the serial communication function under the condition of without any increasing in hardware resources