Current Patterns of Prehospital Trauma Care in Kampala,Uganda and the Feasibility of a Lay-First-Responder Training Program

Background  

Uganda currently has no organized prehospital emergency system. We sought to measure the current burden of injury seen by lay people in Kampala, Uganda and to determine the feasibility of a lay first-responder training program.     

Additive Manufacturing of Ti-Based Intermetallic Alloys: A Review and Conceptualization of a Next-Generation Machine

TiAl-based intermetallic alloys have come to the fore as the preferred alloys for high-temperature applications. Conventional methods (casting, forging, sheet forming, extrusion, etc.) have been applied to produce TiAl intermetallic alloys. However, the inherent limitations of conventional methods do not permit the production of the TiAl alloys with intricate geometries. Additive manufacturing technologies such as electron beam melting (EBM) and laser powder bed fusion (LPBF), were used to produce TiAl alloys with complex geometries. EBM technology can produce crack-free TiAl components but lacks geometrical accuracy. LPBF technology has great geometrical precision that could be used to produce TiAl alloys with tailored complex geometries, but cannot produce crack-free TiAl components. To satisfy the current industrial requirement of producing crack-free TiAl alloys with tailored geometries, the paper proposes a new heating model for the LPBF manufacturing process. The model could maintain even temperature between the solidified and subsequent layers, reducing temperature gradients (residual stress), which could eliminate crack formation. The new conceptualized model also opens a window for in situ heat treatment of the built samples to obtain the desired TiAl (γ-phase) and Ti₃Al (α₂-phase) intermetallic phases for high-temperature operations. In situ heat treatment would also improve the homogeneity of the microstructure of LPBF manufactured samples.     

Radiological thickness measurement using a liquid ionization chamber electronic portal imaging device.

We present a method of calibrating the Portal Vision electronic portal imaging device to obtain radiological thickness maps for compensator design. In this method, coefficients are derived to describe the relationship between intensity and thickness for a set of water-equivalent blocks. The effects of four parameters were studied: (a) The dose response of the system was measured and found to be describable by a square-root function. (b) The calibration data and images were taken with a wedge in situ. The effects of using different wedges and different wedge orientations were investigated. The intrinsic accuracy of the accelerator/imager system was found to be 1.9 mm, for both 15 degrees and 30 degrees wedges. Changing the wedge orientation between calibration and imaging and rotating the calibration coefficients accordingly led to an error of 3.5 mm. (c) The variation in detector response with gantry angle was measured and corrected. The residual error in this process was 2.4 mm. (d) The use of a model to correct the effects of imaging with different field sizes was investigated and found to yield a residual error of 2.9 mm. The overall error in image calibrations was approximately 4 mm or 2% in dose. This is considered to be sufficiently small for the intended use of designing compensators for tangential breast irradiation.     

Intensity-modulated radiotherapy improves target coverage, spinal cord sparing and allows dose escalation in patients with locally advanced cancer of the larynx.

BACKGROUND AND PURPOSE: An investigation has been carried out into the potential of intensity-modulated radiotherapy (IMRT) to improve the coverage of the targets and the sparing of the spinal cord (SC) in radiotherapy treatment of the larynx and bilateral cervical lymph nodes, in patients with advanced larynx cancer. PATIENTS AND METHODS: Conventional radiotherapy (CRT) and IMRT plans were produced for six patients to treat the larynx (PTV1) and lymph nodes (PTV2) to 50 Gy (phase 1). A second plan was created to treat the PTV1 to 65 Gy and PTV2 to 50 Gy (phases 1 and 2). The potential to escalate the dose to both the larynx (to 67 Gy) and the nodes (to 56 Gy) was investigated for the IMRT plans. RESULTS: The phase 1 treatment gave average minimum doses (dose received by 99% volume) of 38.1 (+/-8.2) and 48.5 (+/-0.2)Gy for PTV1, treated by CRT and IMRT, respectively, and 35.9 (+/-2.9) and 46.2 (+/-1.8)Gy for PTV2. For the two phase treatment the average minimum doses to PTV1 were 51.6 (+/-8.2) (CRT) and 62.1 (+/-0.7)Gy (IMRT) (p=0.028) and for PTV2 were 36.2 (+/-2.9) (CRT) and 46.8 (+/-0.5)Gy (IMRT) (P=0.0004). The average maximum doses (dose received by 1% volume) to the SC were 42.5 (+/-1.9) (CRT) and 37.9 (+/-1.4)Gy (IMRT) (P=0.01). For the dose escalated IMRT plans the minimum dose to PTV1 was 64.6 (+/-0.5) and 50.8 (+/-1.8)Gy to PTV2. The average SC maximum was 41.5 (+/-1.6)Gy. CONCLUSIONS: IMRT offers improved target homogeneity and reduces irradiation of the SC. This sparing of normal tissue structures is sufficient that significant dose escalation of both the larynx and lymph nodes may be possible.     

High Diversity of Human Non-Polio Enterovirus Serotypes Identified in Contaminated Water in Nigeria

Human enteroviruses (EVs) are highly prevalent in sewage and have been associated with human diseases with complications leading to severe neurological syndromes. We have used a recently developed molecular method to investigate the presence of EVs in eight samples collected in 2017–2018 from water streams contaminated by drainage channels in three different locations in Nigeria. A total of 93 human EV strains belonging to 45 different serotypes were identified, far exceeding the number of strains and serotypes found in similar samples in previous studies. Next generation sequencing analysis retrieved whole-capsid genomic nucleotide sequences of EV strains belonging to all four A, B, C, and D species. Our results further demonstrate the value of environmental surveillance for the detection of EV transmission of both serotypes commonly associated with clinical syndromes, such as EV-A71, and those that appear to circulate silently but could eventually cause outbreaks and disease. Several uncommon serotypes, rarely reported elsewhere, were detected such as EV-A119, EV-B87, EV-C116, and EV-D111. Ten EV serotypes were detected in Nigeria for the first time and two of them, CV-A12 and EV-B86, firstly described in Africa. This method can be expanded to generate whole-genome EV sequences as we show here for one EV-D111 strain. Our data revealed phylogenetic relationships of Nigerian sewage strains with EV strains reported elsewhere, mostly from African origin, and provided new insights into the whole-genome structure of emerging serotype EV-D111 and recombination events among EV-D serotypes.     

Cardiovascular effects of Ekebergia capensis Sparrm (Meliaceae) ethanolic leaf extract in experimental animal paradigms

Summary

The purpose of this study was to examine the in vivo effects of Ekebergia capensis leaf ethanolic extract (EKE) on the blood pressure of anaesthetised normotensive male Wistar rats and conscious weanling Dahl salt-sensitive (DSS) rats, which develop hypertension as they age. To investigate possible mechanism(s) of the extract’s hypotensive effects, the contractile or relaxant responses to EKE in the absence or presence of reference drugs were evaluated in Wistar rat isolated aortic rings precontracted with methoxamine hydrochloride (ME, 10 μM).Acute intravenous administration of EKE elicited hypotensive responses in anaesthetised animals, while sub-chronic treatment with the extract averted the development of high blood pressure in weanling DSS rats. Isometric recordings of methoxamine hydrochloride (ME) pre-contracted, isolated, endothelium-intact and -denuded aortic rings revealed concentration-dependent relaxation responses to EKE (1–160 mg/ml). The potency was significantly less in the endothelium-denuded rings. Inhibitors of endothelium-derived relaxing factor (EDRF), L-NAME, methylene blue and indomethacin significantly reduced EKE-evoked vasorelaxations in endothelium-intact aortic rings.These results indicate that the vasorelaxant effect of EKE was in part mediated via EDRF-dependent or -independent pathways. These observations suggest that the hypotensive effect of EKE was in part mediated via modulation of total peripheral resistance of the vascular smooth muscles.     

Do race,gender, and source of payment impact on anesthetic technique for inguinal hernia repair?

STUDY OBJECTIVE: To evaluate the potential differences in the type of anesthesia provided to patients of different race, gender, and source of payment undergoing inguinal hernia repair (IHR). DESIGN: Retrospective cohort study. SETTING: Ambulatory surgical centers/National Survey of Ambulatory Surgery. PATIENTS: 5810 patients older than 14 years who underwent IHR in an ambulatory surgical center. INTERVENTIONS: Inguinal hernia repair under different types of anesthesia. MEASUREMENTS: The association of race, gender, and source of payment with different types of anesthesia for IHR as determined by multivariate regression analysis. RESULTS: Significant discrepancies in the use of various anesthetics between patients of different race, gender, and source of payment were found. Patients identified as black and those of other minority groups were significantly more likely to receive general anesthesia compared with those identified as white (odds ratio [OR] 2.76, confidence interval [CI] 1.96-3.88 and OR 1.66, CI 1.14-2.42, respectively). Those identified as black were less likely to receive epidural anesthesia compared with their white counterparts (OR 0.36, CI 0.14-0.95). Women were less likely than men to undergo IHR with epidural anesthesia (OR 0.5, 95% CI 0.3-0.85). CONCLUSION: Significant discrepancies in the use of various anesthetics for IHR between patients of different race, gender, and insurance status were found. Despite limitations inherent to secondary data analysis, the findings raise the possibility that nonmedical factors may influence anesthetic management.