Correlation between subjective and objective voice analysis pre- and post-shift among teleoperators in a tertiary hospital.

OBJECTIVE: Teachers and singers have been extensively studied and are shown to have a greater tendency to voice disorders. This study aimed to investigate the correlation between subjective and objective voice analysis pre- and post-shift among teleoperators in a tertiary hospital. METHODS: This was a prospective cohort study. Each patient underwent pre- and post-shift voice analysis. RESULTS: Among 42 teleoperators, 28 patients (66.7 per cent) completed all the tests. Female predominance (62 per cent) was noted, with a mean age of 40 years. Voice changes during working were reported by 48.1 per cent. Pre- and post-shift maximum phonation time (p < 0.018) and Voice Handicap Index-10 (p < 0.011) showed significant results with no correlation noted between subjective and objective assessment. CONCLUSION: Maximum phonation time and Voice Handicap Index-10 are good voice assessment tools. The quality of evidence is inadequate to recommend 'gold standard' voice assessment until a better-quality study has been completed.

Computed tomography analysis of the anterior ethmoid genu of the frontal recess in non-diseased sinuses.

OBJECTIVE: Knowledge of anatomical variations of the frontal recess and frontal sinus and recognition of endoscopic landmarks are vital for safe and effective endoscopic sinus surgery. This study revisited an anatomical landmark in the frontal recess that could serve as a guide to the frontal sinus. METHOD: Prevalence of the anterior ethmoid genu, its morphology and its relationship with the frontal sinus drainage pathway was assessed. Computed tomography scans with multiplanar reconstruction were used to study non-diseased sinonasal complexes. RESULTS: The anterior ethmoidal genu was present in all 102 anatomical sides studied, independent of age, gender and race. Its position was within the frontal sinus drainage pathway, and the drainage pathway was medial to it in 98 of 102 cases. The anterior ethmoidal genu sometimes extended laterally and formed a recess bounded by the lamina papyracea laterally, by the uncinate process anteriorly and by the bulla ethmoidalis posteriorly. Distance of the anterior ethmoidal genu to frontal ostia can be determined by the height of the posterior wall of the agger nasi cell rather than its volume or other dimensions. CONCLUSION: This study confirmed that the anterior ethmoidal genu is a constant anatomical structure positioned within frontal sinus drainage pathway. The description of anterior ethmoidal genu found in this study explained the anatomical connection between the agger nasi cell, uncinate process and bulla ethmoidalis and its structural organisation.

Co-infection relationship with Epstein-Barr virus in gastroduodenal diseases with Helicobacter Pylori. Quantitative PCR and EBNA-1 gene-based approach.

Objective: Helicobacter pylori (Hp) and Epstein-Barr virus (EBV) are involved in gastric cancer (GC) etiology. EBV/Hp co- infection was thought synergistically increase gastroduodenal disease occurence. We aimed to determine the presence of EBV/Hp co-infection in gastroduodenal diseases. Methods: The study group had 68 Hp (+) cases [25 GC, 13 IM (intestinal metaplasia), 30 PU (peptic ulcer)], and the control group had 40 NUD (non-ulcer dyspepsia) cases [20 Hp+, 20 Hp-]. EBV-DNA was detected by non-polymorphic EBNA-1 gene-based qPCR. EBV/EBNA-1 IgG levels were determined by quantitative and qualitative ELISA methods, respectively. Results: EBV-DNA positivity was 32% (8/25), 6.6% (2/30) and 5% (1/20) in GC, PU and NUD Hp (+) cases, respectively. There was a significant difference (p = 0.001) between GC (32%) and NUD Hp (+) (5%) cases in terms of EBV-DNA positivity. Mean EBV-DNA copy numbers were 6568.54 ± 20351, 30.60 ± 159.88 and 13.85 ± 61.93 for GC, PU, and NUD, respectively. In terms of the mean EBV-DNA copy number, a significant difference was found between the groups (p = 0.005). In terms of EBV/EBNA-1 IgG antibody positivity, no significant difference was found between GC and NUD cases (p = 0.248). EBV DNA positivity was found to be significant (odds ration [OR] = 26.71 (p=0.009, %95CI 2.286- 312.041) in multivariate logistic regression. Conclusioin: Although we had a small number of GC cases, it can be suggested that the estimated risk created by the synergistic effect based on the addition of EBV increased 26 times in the presence of Hp in GC.

Current advancements on the fabrication, modification, and industrial application of zinc oxide as photocatalyst in the removal of organic and inorganic contaminants in aquatic systems.

Industrial wastewaters contain hazardous contaminants that pollute the environment and cause socioeconomic problems, thus demanding the employment of effective remediation procedures such as photocatalysis. Zinc oxide (ZnO) nanomaterials have emerged to be a promising photocatalyst for the removal of pollutants in wastewater owing to their excellent and attractive characteristics. The dynamic tunable features of ZnO allow a wide range of functionalization for enhanced photocatalytic efficiency. The current review summarizes the recent advances in the fabrication, modification, and industrial application of ZnO photocatalyst based on the analysis of the latest studies, including the following aspects: (1) overview on the properties, structures, and features of ZnO, (2) employment of dopants, heterojunction, and immobilization techniques for improved photodegradation performance, (3) applicability of suspended and immobilized photocatalytic systems, (4) application of ZnO hybrids for the removal of various types of hazardous pollutants from different wastewater sources in industries, and (5) potential of bio-inspired ZnO hybrid nanomaterials for photocatalytic applications using renewable and biodegradable resources for greener photocatalytic technologies. In addition, the knowledge gap in this field of work is also highlighted.

Influence of various Cu/Fe ratios on the surface properties of green synthesized Cu-Fe-BTC and it`s relation to methylene blue adsorption.

The incorporation of different percentages of Fe2+ into copper benzene-1,3,5-tricarboxylate (CuBTC) was successfully carried out at room-temperature synthesis with water as the only solvent. The XRD and XPS analysis shows that the Fe2+ were substituted into the paddlewheel structure. The incorporation of 18% Fe2+ into CuBTC can increase the surface area and porosity of the framework. The BET surface area of Cu82Fe18BTC (1240 m2/g) was significantly higher than CuBTC (708 m2/g). Further increase in the Fe2+ percentage will reduce the surface area of the compound. The presence of Fe2+ in the framework successfully disturbs the pore formation and widens the pore size on the surface of these compounds. This as well as the pHpzc, which is related to the surface acidity of the resulting bimetallic organic framework (BMOF), play an important role in the adsorption process. Cu53Fe47BTC with an adsorption capacity of 94.42 mg/g shows approximately 6 times greater adsorption capacity against MB compared to CuBTC. This shows that by utilizing a different ratio of Cu and a second metal, it is possible to effectively design the surface morphology of BMOF for specific applications.

Comparative study of chemically synthesized and low temperature bio-inspired Musa acuminata peel extract mediated zinc oxide nanoparticles for enhanced visible-photocatalytic degradation of organic contaminants in wastewater treatment.

Zinc oxide (ZnO) photocatalysts were successfully synthesized via chemical and green, environmentally-benign methods. The work highlights the valorization of banana peel (BP) waste extract as the reducing and capping agents to produce pure, low temperature, highly crystalline, and effective ZnO nanoparticles with superior photocatalytic activities for the removal of hazardous Basic Blue 9 (BB9), crystal violet (CV), and cresol red (CR) dyes in comparison to chemically synthesized ZnO. Their formation and morphologies were verified by various optical spectroscopic and electron microscopic techniques. XRD results revealed that the biosynthesized ZnO exhibited 15.3 nm crystallite size when determined by Scherrer equation, which was smaller than the chemically synthesized ZnO. The FTIR spectra confirmed the presence of biomolecules in the green-mediated catalyst. EDX and XPS analyses verified the purity and chemical composition of ZnO. Nitrogen sorption analysis affirmed the high surface area of bio-inspired ZnO. Maximum removal efficiencies were achieved with 30 mg green ZnO catalyst, 2.0 × 10-5 M BB9 solution, alkaline pH 12, and irradiation time 90 min. Green-mediated ZnO showed superior photodegradation efficiency and reusability than chemically synthesized ZnO. Therefore, this economical, environment-friendly photocatalyst is applicable for the removal of organic contaminants in wastewater treatment under visible light irradiation.

Study on the incidence of adverse events during intra-hospital transfer of critical care patients from emergency department.

INTRODUCTION: Emergency department (ED) plays a main role in the initial management of patients who are critically ill. These patients require intra-hospital transfer for continuation of care. Adverse events can occur during this short duration and the distance of intra -hospital transfer. The aims of this study were to determine the incidence of adverse events during intrahospital transfer from ED and to determine the factors associated. METHODOLOGY: This was a cross-sectional observational study done from November 2017 until December 2017 at ED Hospital Sultan Abdul Halim (HSAH), a 650-bedded tertiary hospital in the state of Kedah. All patients that were triaged to red zone, age 18 years and above, and involved in intra-hospital transfer to critical coronary unit, intensive care unit and wards were included. All cases were documented in proforma by the accompanying staff. RESULTS: Among the 170 critically ill patients, only 29 patients (17.1%) experienced adverse events during intra-hospital transfer. The adverse events seen were hypotension (12.4%), desaturation (3.5%) and dislodged peripheral line (2.4%). Cardiorespiratory related diagnosis was the commonest presentation. Intra-hospital transfer during morning shift and evening shift has 79.5% (b=-1.59, OR=0.21, 95% CI: 0.06, 0.69, p=0.011) and 75.6% ((b=-1.41, OR=0.24, 95% CI: 0.08, 0.73, p=0.012) lesser odds of experiencing adverse events compare to night shift. Patients with vasopressor/inotropes had 9 times higher odds of experiencing adverse events during transportation, compared to patients with no vasopressor/inotropes (b=2.27, OR=9.70, 95% CI: 3.39, 27.72, p<0.001). CONCLUSIONS: Critical care patients who are involved in intrahospital transfer were at risk of adverse events such as hypotension, desaturation and dislodge peripheral line. Risk identification and maintaining level of care is important to minimize the adverse events during transfer. Patients had higher rates of adverse events if they were transferred during night shifts and on inotropic/vasopressor support.

The impact of ZnO configuration as an external layer on the sensitivity of a bi-layer coated polymer optical fiber probe.

Salinity magnitude changes are a critical factor for determining the chemistry of natural water bodies and biological processes. Label-free refractive index sensors are promising devices for detecting these changes. A polymer optical fiber (POF) sensor modified with cladding treatment and a bi-layer zinc oxide/silver (ZnO/Ag) nanostructure coating to determine sodium chloride concentration changes through refractive index variations in water is experimentally demonstrated. The use of three ZnO nanostructure shapes, nanoparticles and horizontally and vertically oriented nanorods, as an external layer and a broad spectrum light source from the visible (Vis) to the near infrared (NIR) region are investigated to achieve optimum sensitivity. The rms roughness, optical band-gap and zeta potential (ZP) value for the vertically oriented sample are 148 nm, 3.19 eV and 5.96 mV, respectively. In the NIR region the wavelength-intensity sensitivity values of probes coated with ZnO nanoparticles and horizontally and vertically oriented nanorods are 104 nm RIU-1-12 dB RIU-1, 63 nm RIU-1-10 dB RIU-1 and 146 nm RIU-1-22 dB RIU-1, respectively, and in the Vis area the values are 65 nm RIU-1-14 dB RIU-1, 58 nm RIU-1-11 dB RIU-1 and 89 nm RIU-1-23 dB RIU-1, respectively. The maximum amplitude sensitivity is obtained for the probe coated with vertically aligned ZnO nanorods in the NIR area due to the deeper penetration of evanescent waves, a higher surface-volume ratio, better crystallinity, more adhesive interactions with salt molecules, larger surface roughness and higher-order dispersion compared to the other coated ZnO nanostructures.

Pre-grafting histological studies of skin grafts cryopreserved in α helix antarctic yeast oriented antifreeze peptide (Afp1m).

A number of living creatures in the Antarctic region have developed characteristic adaptation of cold weather by producing antifreeze proteins (AFP). Antifreeze peptide (Afp1m) fragment have been designed in the sequence of strings from native proteins. The objectives of this study were to assess the properties of Afp1m to cryopreserve skin graft at the temperature of -10 °C and -20 °C and to assess sub-zero injuries in Afp1m cryopreserved skin graft using light microscopic techniques. In the present study, a process was developed to cryopreserve Sprague-Dawley (SD) rat skin grafts with antifreeze peptide, Afp1m, α-helix peptide fragment derived from Glaciozyma antractica yeast. Its viability assessed by different microscopic techniques. This study also described the damages caused by subzero temperatures (-10 and -20 °C) on tissue cryopreserved in different concentrations of Afp1m (0.5, 1, 2, 5 and 10 mg/mL) for 72 h. Histological scores of epidermis, dermis and hypodermis of cryopreserved skin grafts showed highly significant difference (p < 0.01) among the different concentrations at -10 and -20 °C. In conclusion, the integrity of cryopreserved skin grafts with lower concentrations of Afp1m (0.5, 1 and 2 mg/mL) or at -20 °C was not maintained. The present study attested that Afp1m is a good cryoprotective agent for the cryopreservation of skin graft. Higher Afp1m concentrations (5 and 10 mg/mL) at -10 °C found to be suitable for the future in vivo study using (SD) rat skin grafts.

An FBG magnetic sensor for oil flow monitoring in sandstone core.

Monitoring the oil movement using a non-contact optical fiber probe during enhanced oil recovery is a novel technique to increase the efficiency of the process by distinguishing the oil position in the reservoir. A partially unclad fiber Bragg grating (FBG) coated with Fe3O4 nanoparticles as a magnetic field sensor is experimentally demonstrated. A series of six FBGs reflecting different wavelengths are fixed on the surface of sandstone. Nanofluids containing magnetite nanoparticles and alkaline-surfactant-polymer are injected continuously in two separate steps into the sandstone, which is saturated with 20% oil and 80% brine. The chamber is equipped with a solenoid that acts as a magnetic field generator. The changes in the magnetic field strength depended on the FBG-solenoid distance and the density of localized injected nanoparticles near the FBGs leads to a shift of the reflected wavelength of each single FBG accordingly. The shift is caused by the interference of different propagating modes reflected from the core-cladding and cladding-magnetite layer interfaces. The intensity of the FBG spectra decreases by injecting the nanofluid and vice versa for surfactant injection. The sensor response time of ∼21 s confirms the high reliability and repeatability of the sensing scheme. Movement of oil along the sandstone alters the wavelength shift in the FBG spectra.

Pump distribution effect in dual-wavelength Raman-erbium random distributed feedback fiber laser.

This work demonstrates a simple dual-wavelength random distributed feedback fiber laser via excitation of the Raman-erbium hybrid gain by a single pump source. Lasing wavelengths at 1568 nm and 1595 nm with 48.48 dBm maximum OSNR were generated without the need for physical reflectors. Enhancements were performed using pump power distribution and a seeded feedback to reduce the peak disparity to only 0.16 dB. The long cavity hybrid random laser with its balanced and broadly spaced dual-wavelength output offers immense potential for long distance dual laser applications.

Low Free T3 was Associated with Poor Glycemic Control in Type 2 Diabetes in a Hospital Based Study in Bangladesh.

Clinical significance of low free T3 (FT3) has not been well explained in patients with type 2 diabetes mellitus (T2DM); FT3 level may be associated with diabetes control and also with diabetic complications. This cross-sectional study was carried out among 153 (mean age 46.8±12 years; female 68%, mean duration of diabetes 5.5±0.53 years, 63.4% either overweight or obese) non-pregnant adults with T2DM who had no acute illness and were unaware about their thyroid function status from July 2016 to December 2016. Serum TSH, free T4 (FT4) and FT3 were measured in all patients by radioimmunoassay (RIA). Patients having subnormal FT3 level with normal TSH and FT4 levels were labeled as having low FT3 syndrome. The mean HbA1c of the study subjects was 8.3±1.7%, serum TSH 2.24±0.34µIU/mL, FT4 16.5±6.56fmol/mL and FT3 was 5.36±1.74fmol/mL. Among them, 9.15% were found to have low FT3 syndrome. There was no statistical difference of FT3 level between males and females (5.87±1.50 vs. 5.99±1.85fmol/mL, mean±SD; p=0.165) and among different BMI groups (p=0.179). Patients with uncontrolled diabetes had lower FT3 than those with controlled diabetes (5.91±1.83 vs. 6.15±1.21fmol/mL, mean±SD, p=0.024). The frequency of low FT3 syndrome was 11.1% in uncontrolled diabetic patients whereas none of the patients with controlled diabetes had low FT3. FT3 level showed positive correlations with the duration of diabetes (r=0.296, p=0.002) and FT4 level (r=0.490, p<0.001) only in female subjects. A fair number of clinically stable T2DM patients had low FT3 in our study. Patients with uncontrolled diabetes had lower FT3 than those with controlled diabetes.

Dual-wavelength, mode-locked erbium-doped fiber laser employing a graphene/polymethyl-methacrylate saturable absorber.

Mode-locked fiber laser incorporating a saturable absorber is an attractive configuration due to its stability and simple structure. In this work, we demonstrate a dual-wavelength passively mode-locked erbium-doped fiber laser employing a graphene/polymethyl-methacrylate saturable absorber. A laser resonator is developed based on dual cavity architecture with unidirectional signal oscillation, which is connected by a fiber branch sharing a common gain medium and saturable absorber. Dual wavelength mode-locked fiber lasers are observed at approximately 1530 and 1560 nm with 22.6 mW pump power threshold. Soliton pulse circulates in the laser cavity with pulse duration of 900 and 940 fs at shorter and longer wavelengths, respectively. This work presents a viable option in developing a low threshold mode-locked laser source with closely spaced dual wavelength femtosecond pulses in the C-band wavelength region.

Van Wyk and Grumbach Syndrome: An Unusual Presentation of Hypothyroism.

An 18 years-old-girl presented one and half years back with the complaints of short stature, retarded growth, and menorrhagia with sudden severe lower abdominal pain; was diagnosed as bilateral ovarian cysts and underwent bilateral ovarian cystectomy. Later on she was incidentally diagnosed as a case of hypothyroidism when she had been experiencing slowly enlarging left lower abdominal mass with dull ache for the 5 month and then was transferred to the department of Endocrinology for further evaluation. Detailed work up revealed her short stature with obesity, delayed bone age and other features of hypothyroidism which was confirmed by thyroid function testing. She had enlarged left ovary with multiple follicles as shown in ultrasonography. Magnetic resonance imaging (MRI) showed sellar mass which was suspicious of macroadenoma. Levothyroxine replacement was started and she had a dramatic improvement of her problems with disappearance of the ovarian cysts and sellar mass.

Ramadan Perspective Epidemiology and Education in Diabetes (RAPEED) Study.

Ramadan fasting is one of the five pillars of Islam and is obligatory for all healthy adult and adolescent Muslims. A significant number of patients with diabetes observe fasting during Ramadan. The objectives of this Ramadan Perspective Epidemiology and Education in Diabetes (RAPEED) study were to find out the current knowledge, attitude, and practices about Ramadan fasting among people with diabetes in Bangladesh. This retrospective cross-sectional study recruited 648 subjects with diabetes mellitus attending the Endocrinology outpatient department of a tertiary level hospital of Bangladesh within two months of the end of Ramadan in 2016. Socio-demographic data, data related to diabetes treatment, complications and co-morbidities; changes in lifestyle and diabetes treatment during Ramadan and frequency of hypoglycemia were collected from all. The mean age of the study population was 50.32±12.1 years and the majority (98.6%) had type 2 diabetes and 63.9% were overweight or obese. The majority (89.35%) of the patients fasted in Ramadan and among them, more than half of the fasters received physicians' advice for Ramadan fasting (60.6%) and changed diabetes medication (69.90%) during Ramadan. Although the amount of total food consumption was unchanged in more than one half (60.6%) of the fasters, majority of them reduced sugar-sweet intake (75.5%), increased fluid drinking (75.8%) and decreased physical activity (75.8%) during the month. A large portion (37.48%) of them did not check blood glucose and more than half (54.06%) of fasters failed to visit their physicians during Ramadan. Among them 14.85% experienced mild to moderate episodes of hypoglycemia and none had severe hypoglycemia and the most (61.6%) episodes of hypoglycemia occurred in the late evening. Hypoglycemic episodes were more frequent among insulin users, patients who had received fasting advice from physicians and in those who had adjusted diabetes drugs before Ramadan fasting. Safe Ramadan fasting is a great challenge not only for the patients but also the consulting physicians. Current study reflects the necessity of both physicians' expertise and patients' awareness for safe fasting.

Wavelength-tunable single longitudinal mode fiber optical parametric oscillator.

We demonstrate a ring cavity single longitudinal mode fiber optical parametric oscillator using a passive sub-ring cavity and an unpumped erbium doped fiber configured with an external fiber mirror for single mode selection. The unpumped erbium doped fiber uses its saturable absorption characteristic to generate a self-induced narrowband filter when two counter-propagating waves interfere inside the fiber. A single longitudinal mode laser is obtained with a linewidth of 17.35 kHz at a pump power of 31.2 dBm. A 3.8 nm tuning range from 1536.5 nm to 1540.3 nm is achieved with a signal-to-noise ratio of about 60 dB. The power stability of the single longitudinal mode laser is 2.07 dB over a period of 30 minutes.

Facial carbuncle - a new method of conservative surgical management plus irrigation with antibiotic-containing solution.

OBJECTIVE: This paper reports on a non-conventional method for the management of facial carbuncles, highlighting its superiority over conventional surgical treatment in terms of cosmetic outcome and shorter duration of wound healing. BACKGROUND: The mainstay of treatment for carbuncles involves the early administration of antibiotics in combination with surgical intervention. The conventional saucerisation, or incision and drainage, under normal circumstances results in moderate to large wounds, which may need secondary surgery such as skin grafting, resulting in a longer duration of wound healing and jeopardising cosmetic outcome. CASE REPORTS: The reported three cases presented with extensive carbuncles over the chin, face and lips region. In addition to early commencement of intravenous antibiotics, the pus was drained, with minimal incision and conservative wound debridement, with the aim of maximal skin conservation. This was followed by thrice-daily irrigation with antibiotic-containing solution for a minimum of 2 consecutive days. The wounds healed within two to four weeks, without major cosmetic compromise. CONCLUSION: The new method showed superior cosmetic outcomes, with a shorter duration of wound healing. Conservative surgical management can be performed under regional anaesthesia, which may reduce morbidity and mortality; patients with facial carbuncles often have higher risks with general anaesthesia.

Effects of Raman pump power distribution on output spectrum in a multi-wavelength BRFL: publisher's note.

This publisher's note amends the author list and Acknowledgments of a recent publication [Opt. Express23, 25570 (2015)].

Effects of Raman pump power distribution on output spectrum in a multi-wavelength BRFL.

This paper aims to investigate changes in multi-wavelength Brillouin-Raman fiber laser (MBRFL) spectra characteristics that are influenced by variation of Raman pump power distribution along the two fiber-entry points. This is carried out by incorporating a Raman pump source with a set of couplers with various ratios. In this arrangement, the optimization of pumping ratio is properly carried out to achieve high number of lasing lines with 20 GHz spacing which yield the highest peak power discrepancy between odd- and even-order lasing lines and an excellent Stokes optical signal-to-noise ratio (S-OSNR). Employment of 50/50 coupler offers 212 flat amplitude channels with an average 27.5 dB S-OSNR and -10 dBm Stokes peak power when the Brillouin pump wavelength is set at 1543 nm. Achievements such flat and wide bandwidth MBRFL spectrum with 20 GHz spacing and excellent S-OSNR utilizing just a single pump source is significant in terms of simplicity and flexibility.