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@#Self-management education program (SMEP) is essential in the knee osteoarthritis (OA) management. While the benefits of tailored SMEP have been highlighted in the literature, evidence on the effects of tailored knee OA SMEP for multiethnic populations, such as in Malaysia, remains limited. Therefore, the aim of this study was to conduct an intervention study on a tailored SMEP among Malaysian older adults who aged 60 years and above with knee OA. Participants aged 60 years and over with a diagnosis of knee OA were recruited. The intervention comprised four weekly structured group SMEP which was developed specifically for the multicultural population in Malaysia. Symptom’s severity and functional performance were assessed at baseline and six-week follow-up using the Knee Injury and Osteoarthritis Outcome Score questionnaire (KOOS), 30 seconds sit to stand (30sST), time up and go (TUG), chair sit and reach (CSR), back stretch (BS), handgrip strength (HGS) and two-minute walk (2MW) tests. Of the 32 individuals recruited, 30 participants, mean age of 66.77 (±6.42) years, completed the post-intervention assessment. Improvements in mean KOOS domains scores were observed by between 1.3% - 8.6% from baseline to follow-up. Significant differences between baseline and followup scores were identified for 30sST (p < 0.05), TUG ( p < 0.001) and 2MW (p < 0.001) tests. A 4-week tailored SMEP delivered face to face by a physiotherapist, improved lower limb muscle strength, mobility, balance and endurance. Larger randomized controlled trials regarding the long-term effects of SMEP for older adults with OA is warranted.
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Peptic ulcer disease remains one of the most common outpatient diagnosis in GI clinical practice. A large majority of cases are contributed to H.pylori infection and/or NSAID use. Other less common causes are Zollinger Ellison syndrome, antral G-cell hyperfunction, trauma, burns, smoking and psychologic stress. The three most common complications are bleeding, perforation and obstruction. Perforated peptic ulcers presents as acute abdomen to the emergency department usually. Ulcer recurrence is often related to H.pylori and/or NSAIDs. It can also be due to gastrin secreting tumors or even smoking. Recurrence of peptic ulcer perforation has limited documentation and has no standardized method of management. With an unknown incidence, it's a surgeon's dilemma and has to be managed speci?c to each presentation. Here, I would like to discuss a case of a 70 year old man, who presented with recurrent episodes of duodenal perforation in an interval of 2 years.
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@#Online health information have a role in enhancing health in older adults. However, age-related physiological changes and non-senior friendly websites proved to be a challenge for older adults. Research investigating older adults’ preferences of features in health information websites is limited. Thus, in this review, we aim to summarize older adults’ preferences regarding the design and content of health websites. Medline, CINAHL, Cochrane Library, Scopus, Journal of Medical Internet Research (JMIR) and Google Scholar were searched for relevant articles in February 2018, using key words ‘older adults’, ‘Internet’, ‘health information’ and ‘usability’. The methodological quality of included studies was evaluated using the McMaster critical appraisal tools by two independent reviewers. Individual study design, participants’ characteristics, and identified preferences for health website features were extracted and summarized narratively. (PROSPERO registration number: CRD42018096281). Five studies (3 qualitative, 2 quantitative) were included in this review. The quality appraisal score ranged from 32% to 83%. The web feature preferences of older adults were grouped into three domains: web presentation factors, web navigation factors and health information preferences. The results highlight older adults have specific preferences when engaging with online content. This review suggests that readable text, simple design, consistent layout and straightforward web navigation are the preferred priorities for a health information website for older adults. Findings from this review may be useful to healthcare professionals and developers to understand older adults’ preferences pertaining to web design and contents in health websites specifically designed for this population.
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STUDY DESIGN: A biomechanical study. PURPOSE: To develop a predictive model for pullout strength. OVERVIEW OF LITERATURE: Spine fusion surgeries are performed to correct joint deformities by restricting motion between two or more unstable vertebrae. The pedicle screw provides a corrective force to the unstable spinal segment and arrests motions at the unit that are being fused. To determine the hold of a screw, surgeons depend on a subjective perioperative feeling of insertion torque. The objective of the paper was to develop a machine learning based model using density of foam, insertion angle, insertion depth, and reinsertion to predict the pullout strength of pedicle screw. METHODS: To predict the pullout strength of pedicle screw, an experimental dataset of 48 data points was used as training data to construct a model based on different machine learning algorithms. A total of five algorithms were tested in the Weka environment and the performance was evaluated based on correlation coefficient and error matrix. A sensitive study of various parameters for obtaining the best combination of parameters for predicting the pullout strength was also preformed using the L9 orthogonal array of Taguchi Design of Experiments. RESULTS: Random forest performed the best with a correlation coefficient of 0.96, relative absolute error of 0.28, and root relative squared error of 0.29. The difference between the experimental and predicted value for the six test cases was not significant (p >0.05). CONCLUSIONS: This model can be used clinically for understanding the failure of pedicle screw pullout and pre-surgical planning for spine surgeon.
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Objective: Central vein occlusion is a common complication related to central vein catheter insertion for haemodialysis which can be unmasked by an ipsilateral fistula creation, leading to a dysfunctional arteriovenous fistula (AVF). We describe an extra-anatomical venous bypass surgical procedure performed to maintain vascular access and reduce the symptoms of swelling of the ipsilateral upper limb, neck and face. Materials and Methods: We report 20 consecutive patients with end-stage renal failure (ESRF) who had central vein occlusion and were not amenable to endovascular intervention. They underwent extra-anatomical vein to vein surgical bypass. The axillary and iliac or femoral veins were approached via infraclavicular and extraperitoneal groin incisions respectively. In all the patients, an externally supported 6 or 8 mm polytetrafluoroethylene (PTFE) graft was used as a conduit and was tunnelled extra-anatomical. All patients had double antiplatelet (Aspirin and Clopidogrel) therapy post-operatively. Results: Substantial improvement in the facial, neck and upper limb swelling was noticed following this diversion surgery. The vein to vein bypass was patent at 12 months in 10 out of 20 patients. Graft infection occurred in two (10%) cases. Re-thrombectomy or assisted patency procedure (stent/plasty) was done in four (20%) cases. The patients with preoperative fistula flow rate of more than 1500 ml/min and post-operative graft flow rate of more than a 1000 ml/min were patent at 12 months (P=0.025 and p=0.034 respectively). Conclusion. Axillary to iliac/femoral vein bypass can salvage functioning ipsilateral fistula threatened by occluded upper central vein and relieve their upper limb obstructive venous symptoms.
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ABSTRACT In this work, the physicochemical and blood compatibility properties of prepared PU/Bio oil nanocomposites were investigated. Scanning electron microscope (SEM) studies revealed the reduction of mean fiber diameter (709 ± 211 nm) compared to the pristine PU (969 nm ± 217 nm). Fourier transform infrared spectroscopy (FTIR) analysis exposed the characteristic peaks of pristine PU. Composite peak intensities were decreased insinuating the interaction of the bio oilTM with the PU. Contact angle analysis portrayed the hydrophobic nature of the fabricated patch compared to pristine PU. Thermal gravimetric analysis (TGA) depicted the better thermal stability of the novel nanocomposite patch and its different thermal behavior in contrast with the pristine PU. Atomic force microscopy (AFM) analysis revealed the increase in the surface roughness of the composite patch. Activated partial thromboplastin time (APTT) and prothrombin time (PT) signified the novel nanocomposite patch ability in reducing the thrombogenicity and promoting the anticoagulant nature. Finally the hemolytic percentage of the fabricated composite was in the acceptable range revealing its safety and compatibility with the red blood cells. To reinstate, the fabricated patch renders promising physicochemical and blood compatible nature making it a new putative candidate for wound healing application.
Subject(s)
Humans , Polyurethanes/chemistry , Materials Testing , Nanocomposites/ultrastructure , Surface Properties , Microscopy, Electron, Scanning , Spectroscopy, Fourier Transform Infrared , Nanocomposites/chemistry , Membranes, ArtificialABSTRACT
STUDY DESIGN: Biomechanical study. PURPOSE: To determine the effect of density, insertion angle and reinsertion on pull-out strength of pedicle screw in single and two screw-rod configurations. OVERVIEW OF LITERATURE: Pedicle screw pull-out studies have involved single screw construct, whereas two screws and rod constructs are always used in spine fusions. Extrapolation of results using the single screw construct may lead to using expensive implants or increasing the fusion levels specifically in osteoporotic bones. METHODS: Single screw and two screw pull-out strength tests were carried out according to American Society for Testing and Materials F 543-07 on foam models to test the effect of density, insertion angle and reinsertion using poly axial pedicle screws. RESULTS: Bone density was the most significant factor deciding the pull-out strength in both single and two screw constructs. The difference in pull-out strength between single screw and two screw configurations in extremely osteoporotic bone model (80 kg/m3) was 78%, whereas in the normal bone model it was 48%. Axial pull-out value was highest for the single screw configuration; in the two screw configuration the highest pull-out strength was at 10°-15°. There was an 18% reduction in pull-out strength due to reinsertion in single screw configuration. The reinsertion effect was insignificant in the two screw configuration. CONCLUSIONS: A significant difference in response of various factors on holding power of pedicle screw between single and two-screw configurations is evident. The percentage increase in pull-out strength between single and two screw constructs is higher for osteoporotic bone when compared to normal bone. Reinsertion has no significant effect on pull-out strength in the two screw rod configuration.
Subject(s)
Bone Density , Osteoporosis , Pedicle Screws , SpineABSTRACT
STUDY DESIGN: Biomechanical study. PURPOSE: To determine the effect of density, insertion angle and reinsertion on pull-out strength of pedicle screw in single and two screw-rod configurations. OVERVIEW OF LITERATURE: Pedicle screw pull-out studies have involved single screw construct, whereas two screws and rod constructs are always used in spine fusions. Extrapolation of results using the single screw construct may lead to using expensive implants or increasing the fusion levels specifically in osteoporotic bones. METHODS: Single screw and two screw pull-out strength tests were carried out according to American Society for Testing and Materials F 543-07 on foam models to test the effect of density, insertion angle and reinsertion using poly axial pedicle screws. RESULTS: Bone density was the most significant factor deciding the pull-out strength in both single and two screw constructs. The difference in pull-out strength between single screw and two screw configurations in extremely osteoporotic bone model (80 kg/m3) was 78%, whereas in the normal bone model it was 48%. Axial pull-out value was highest for the single screw configuration; in the two screw configuration the highest pull-out strength was at 10°-15°. There was an 18% reduction in pull-out strength due to reinsertion in single screw configuration. The reinsertion effect was insignificant in the two screw configuration. CONCLUSIONS: A significant difference in response of various factors on holding power of pedicle screw between single and two-screw configurations is evident. The percentage increase in pull-out strength between single and two screw constructs is higher for osteoporotic bone when compared to normal bone. Reinsertion has no significant effect on pull-out strength in the two screw rod configuration.
Subject(s)
Bone Density , Osteoporosis , Pedicle Screws , SpineABSTRACT
<p><b>OBJECTIVE</b>To isolate novel actinomycetes and to evaluate their antibacterial activity.</p><p><b>METHODS</b>Three soil samples were collected from Vengodu (village) in Kanchipuram district, Tamil Nadu, India. Actinomycetes were isolated using serial dilution and plating method on actinomycetes isolation agar.</p><p><b>RESULTS</b>Totally 35 isolates were obtained on the basis of colony characteristics on actinomycetes isolation agar. All the isolates were screened for antibacterial activity by cross streak method. Medium and optimization of day were done for the potent strains using Nathan's agar well diffusion method. Isolation of bioactive compounds from significant active isolates was done by using different media. The most active isolate VAS 10 was identified as Actinobacterium Loyola PBT VAS 10 (accession No. JF501398) using 16s rRNA sequence method. The hexane, ethyl acetate, dichloromethane and butanol extracts of VAS 10 were tested against bacteria. The maximum antibacterial activity was observed in dichloromethane and ethyl acetate; maximum zones of inhibition were observed against Enterococcus durans. The rRNA secondary structure and the restriction sites of Actinobacterium Loyola VAS 10 were predicted using Genebee and NEBCutter online tools respectively.</p><p><b>CONCLUSIONS</b>The present study showed that among the isolated actinomycetes, Actinobacterium Loyola PBT VAS 10 (accession No. JF501398) showed good antibacterial activity against the tested bacteria.</p>
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Animals , Actinobacteria , Chemistry , Physiology , Anti-Bacterial Agents , Pharmacology , Antibiosis , Physiology , Bacillus subtilis , Enterobacter aerogenes , Escherichia coli , India , Microbial Sensitivity Tests , Phylogeny , RNA, Ribosomal, 16S , Genetics , Soil Microbiology , Species Specificity , Vibrio parahaemolyticusABSTRACT
Nanotechnology is manipulating matter at nanometer level and the application of the same to medicine is called nanomedicine. Nanotechnology holds promise for advanced diagnostics, targeted drug delivery, and biosensors. In the long-term, medical nanorobots will allow instant pathogen diagnosis and extermination, individual cell surgery in vivo, and improvement of natural physiological function. Current research is focusing on fabrication of nanostructures, nanoactuators, and nanomotors, along with means to assemble them into larger systems, economically and in great numbers.