Frequency and Predictors of Non-compliance to Dietary Recommendations Among Hypertensive Patients

Compliance to dietary recommendations among hypertensive people is a major health care issue. Non-compliance can nullify the effects of even the most scientific and optimum treatment plan. The main aim of this study was to determine the frequency and predictors of non-adherence in our region. We also investigated the possible factors based on patient opinions that could increase compliance. A sample of 400 adult patients, diagnosed with hypertension for at least 3 years, who visited Civil Hospital during the time period April–June 2013 were included in this cross sectional study. Patient data and opinions were collected by two trained interviewers using a pre-coded questionnaire. Compliance was assessed based on patients self report. More than three quarters (n = 310, 77.5 %) of the hypertensive patients were non-compliant. More than one social gathering in a week, peer-influence, no friends to follow the recommended diet plan and lack of believe regarding diet as an effective measure to control blood pressure were found to be the significant predictors of non-compliance (P values <0.0001). Counseling was thought to be the most effective way by the patients to increase adherence. Non-compliance to dietary recommendations is a major problem prevalent especially in Pakistan. There is an urgent need for doctors and nurses to counsel their patients effectively to prevent future morbidities and mortalities because of non-compliance.     

MRI findings of intracranial anomalies associated with cephalocele—a case series

Introduction

Cephalocele is a relatively rare cranial dysraphism characterised by herniation of intracranial structures through the skull. Surgical management is primarily necessary where a risk of infection through communication of the lesion with the intracranial space exists, a risk of rupture, or for cosmetic purposes. Cephalocele is often associated with venous anomalies such as vertical embryonic positioning of the straight sinus, splitting of the superior sagittal sinus, vein of Galen elongation, along with tenting of the tentorium [Morioka et al. Childs Nerv Syst 25:309–315, 2009]

Patients

Here, we report four cases of cephalocele with pre-operative MRI imaging retrospectively studied, demonstrating associated venous anomalies. Three of these patients went on to have uncomplicated, corrective surgery, while one was managed conservatively.

Results

All four cases demonstrated the main venous drainage going through a persistent falcine sinus to drain into the superior sagittal sinus. Upward tenting of the tentorium was observed in three cases (cases 1, 3 and 4). Two of our cases demonstrated other venous anomalies frequently reported in the literature, namely splitting of the superior sagittal sinus and absence of the transverse sinus (case 1) and communication of the cephalocele with the superior sagittal sinus and absence of the straight sinus (case 2).

Conclusion

The association between cephalocele and venous anomalies suggests that pre-operative MRI should be mandatory for a full evaluation of a suspicious midline cranial lesion in order to evaluate the safety of corrective surgery.     

Inferiorly based thigh flap for reconstruction of defects around the knee joint

Background:

Soft-tissue defects around the knees are common in injured limbs and in the same injury the leg is often involved and the thigh is spared. Furthermore due to pliable and relatively lax skin, we have used inferiorly based thigh flap to reconstruct defects around knee joint.

Aims and Objectives:

The aim of this study is to evaluate the use of inferiorly based thigh flap to cover soft-tissue defects over the proximal one-third of the leg, patellar region, knee, and lower thigh.

Materials and Methods:

This study was conducted during the period between October 2011 and February 2013. Inferiorly based anteromedial thigh fasciocutaneous flap was performed on 12 patients and inferiorly based anterolateral thigh fasciocutaneous flap on four patients. The sites of the soft-tissue defects included patellar regions, infrapatellar region, upper one-third of leg, lower thigh, and over the knee joint.

Results:

Patients were evaluated post-operatively in terms of viability of flap, the matching of the flap with the recipient site, and donor site morbidity. All the flaps survived well except one which developed distal marginal flap loss, one in which wound dehiscence was noticed, and two in which mild venous congestion was observed. Venous congestion in two patients subsided on its own within 3 days. One patient with wound dehiscence achieved complete healing by secondary intention. Patient who developed distal flap loss required debridement and skin grafting. No appreciable donor site morbidity was encountered. Skin colour and texture of the flap matched well with the recipient site.

Conclusions:

The inferiorly based thigh flap is a reliable flap to cover the defect over proximal one-third of the leg, patellar region, knee, and lower thigh.KEY WORDS: Defect around the knee joint, inferiorly based thigh flap, perforator based flap     

Distally based posterior tibial artery perforator flap for coverage of defects around the ankle,heel and lower third of leg

Introduction

Reconstruction of distal leg region remained a difficult task. Free flaps had long been considered as a gold standard for these regions. However, due to various limitations of the free flap, a local fasciocutaneous flap could be considered as a good alternative. In this study, the use of a distally based posterior tibial artery perforator flap had been evaluated in the coverage of defects around the ankle, heel, and lower third of a leg. The study also outlined the donor-site morbidity and the technical details of the surgical procedure.

Methods

In this prospective study, a total of 42 patients with distal lower leg defects were included. The defects were located on the lower third of the leg (n?=?23), ankle (n?=?11), and heel (n?=?8). Reconstruction was performed using distally pedicled posterior tibial artery perforator flaps. Patients were evaluated in terms of viability of the flap, functional gain, and donor-site morbidity. The technical details of the operative procedure have also been outlined.

Results

All the flaps survived well, with the exception of one patient, who experienced complete flap loss. Minor complications were, however, noted in four other patients: One patient developed superficial epidermolysis; one developed postoperative venous congestion, which subsided within 3 days by conservative means, and in two patients, partial loss of the skin graft occurred at the donor site but healed completely with dressing and antibiotics. The patients were followed up for an average period of 6 months, ranging from 1 to 13 months. Donor-site morbidity was minimal.

Conclusions

It was concluded that the distally based pedicled posterior tibial artery perforator flap was a reliable, easy, less time-consuming, and versatile procedure for covering the defects around the ankle, heel, and lower third a leg. Level of Evidence: Level IV, therapeutic study     

An advanced and efficient Co3O4/C nanocomposite for the oxygen evolution reaction in alkaline media

The design of efficient nonprecious catalysts for the hydrogen evolution reaction (HER) or the oxygen evolution reaction (OER) is a necessary, but very challenging task to uplift the water-based economy. In this study, we developed a facile approach to produce porous carbon from the dehydration of sucrose and use it for the preparation of nanocomposites with cobalt oxide (Co₃O₄). The nanocomposites were studied by the powder X-ray diffraction and scanning electron microscopy techniques, and they exhibited the cubic phase of cobalt oxide and porous structure of carbon. The nanocomposites showed significant OER activity in alkaline media, and the current densities of 10 and 20 mA cm⁻² could be obtained at 1.49 and 1.51 V versus reversible hydrogen electrode (RHE), respectively. The impedance study confirms favorable OER activity on the surface of the prepared nanocomposites. The nanocomposite is cost-effective and can be capitalized in various energy storage technologies.

The design of efficient nonprecious catalysts for the hydrogen evolution reaction (HER) or the oxygen evolution reaction (OER) is a necessary, but very challenging task to uplift the water-based economy.     

Double cascade dressed MOSFET from doped Eu3+and Pr3+ in a host YPO4

In this paper, we study double cascade dressed optical metal oxide semiconductor field-effect transistor (MOSFET) by exploiting enhancement and suppression for mixed-phase (hexagonal + tetragonal) of Eu³⁺:YPO₄ and different phases (hexagonal + tetragonal and pure tetragonal) of Pr³⁺:YPO₄ crystals. We report variation of fine structure energy levels in different doped ions (Eu³⁺ and Pr³⁺) in the host YPO crystal. We compared multi-level energy transition from a single dressing laser with single level energy transition from double cascade dressing lasers. Gate delay facilitates multi-energy level dressed transition and is modeled through a Hamiltonian. Based on the results of double cascade dressing, we have realized MOSFET for logic gates (inverter and logic not and gate) with a switching contrast of about 92% using a mixed phase of Pr³⁺:YPO₄.

By changing different parameters of single and double lasers, we observed the dressed energy level transition from single to multi-level with a single laser. Each sample responded based on their ions'' structure and phase symmetry in the host YPO crystal.     

Endophytic Microbes from Diverse Wheat Genotypes and Their Potential Biotechnological Applications in Plant Growth Promotion and Nutrient Uptake

Proceedings of the National Academy of Sciences, India Section B: Biological Sciences - Endophytic microbes residing inside the tissues of plants play a significant role to enhance the growth and...     

An Experimental Investigation of Static Properties of Bio-Oils and SAE40 Oil in Journal Bearing Applications

Considerable research has been conducted in the past decade and a half regarding the bio-lubricants potential to replace mineral-based lubricants as mainstream lubricants such as engine oil, hydraulic oil, compressor oil, and metalworking oil. This study studied several bio-lubricants (rapeseed oil, palm olein, and soybean oil) and a mineral-based lubricant, SAE40. The bio-lubricants have better physiochemical, tribological characteristics and environmental friendly nature, and are promising to replace mineral-based lubricants. In this study, a journal bearing test rig (JBTR) was developed in order to investigate the effect of journal speed on the temperature of oil film with time. Additionally, the load-carrying capacity of bio-oils was tested against the mineral-based lubricant SAE40 by adding a load on the journal. For all three speeds, i.e., 1000, 1500, and 2000 rpm, the bio-lubricants recorded minimum temperature. At 1000 rpm, rapeseed oil recorded a 9.2% lower temperature than SAE40. Similarly, at 2000 rpm, rapeseed oil recorded a minimum temperature that was 2.5% lower than SAE40; in comparison, at 1500 rpm, palm olein recorded a minimum temperature that was 1.8% less than SAE40. Overall, the results of this study revealed that bio-oils recorded a lower temperature rise than mineral oil. These results are very encouraging for further research in this area.