Trapping of low and high refractive index nano-spherical particles by using a highly focused Laguerre-Gaussian beam.

We have investigated the trapping force on low and high refractive index nano-particles using a highly focused Laguerre-Gaussian beam. An analytical expression for the gradient force has been derived in closed form. It was clearly found that the increase of the beam mode p causes a substantial increase in the number of trapping zones, which frequently increases the number of particles to be captured simultaneously. Also, the decrease of p values would increase the trap area, which consequently leads to simultaneous trapping of multiple particles in the same area. The change of p, l, Δ n, and z 1 values has a direct influence on the gradient forces. The smaller values of scattering and thermal forces relative to the gradient force values represent essential conditions for the stability of the trapping performance.

Calculation of the optical forces exerted on a nano-dielectric sphere induced by a pulsed Laguerre-Gaussian beam.

Theoretically, we investigated the optical force exerted on a nano-dielectric sphere illuminated by a pulsed Laguerre-Gaussian beam. In the frame of the dipole approximation, analytical expressions for the optical force were derived. Based on these analytical expressions, the effects of pulse duration τ and beam mode order (l,p) on the optical force were studied. It is recognized that the optical force values and the trapping regions are remarkably affected by changing pulse duration and mode parameters. Our results show good agreement with the results obtained by other authors for the use of a continuous Laguerre-Gaussian beam and pulsed Gaussian beam.

Iced towel - a novel method to revert supraventricular tachycardia in a paediatric patient.

Supraventricular tachycardia (SVT) is the commonest tachyarrhythmia among paediatric age group. Modified Valsalva manoeuvre can be attempted in a stable child. We discuss here a case of a 6-year-old boy who presented with stable SVT and iced towel was applied to his face to revert the tachyarrhythmia. This method was well tolerated by the child without any complications. The SVT was successfully reverted, and pictures were taken to capture the simple but effective method.

Hyperkalemia measurement between Blood Gas Analyser and Main Laboratory Biochemistry Analyser.

INTRODUCTION: Potassium level is measured for patients with high risk of hyperkalemia in the emergency department (ED) using both blood gas analyser (BGA) and biochemistry analyser (BCA). The study was conducted to evaluate the correlation and agreement of potassium measurement between BGA and BCA. MATERIALS AND METHODS: This is a prospective cross-sectional study on the data obtained from Hospital Universiti Sains Malaysia (Hospital USM) from Jun 2018 until May 2019. Blood samples were taken via a single prick from venous blood and sent separately using 1ml heparinised syringe and were analysed immediately in ED using BGA (Radiometer, ABL800 FLEX, Denmark) and another sample was sent to the central laboratory of Hospital USM and analysed by BCA (Architect, C8000, USA). Only patients who had potassium levels ≥5.0mmol/L on blood gas results were included. A total of 173 sample pairs were included. The correlation and agreement were evaluated using Passing and Bablok regression, Linear Regression and Bland-Altman test. RESULT: Of the 173 sample pairs, the median of potassium level based on BGA and BCA were 5.50mmol/L (IQR: 1.00) and 5.90mmol/L (IQR: 0.95) respectively. There was significant correlation between two measurements (p<0.001, r: 0.36). The agreement between the two measurements showed within acceptable mean difference which was 0.27 mmol/L with 95% limit of agreement were 1.21mmol/L to 1.73mmol/L. CONCLUSION: The result of blood gas can be used as a guide for initial treatment of hyperkalaemia in critical cases where time is of the essence. However, BCA result is still the definitive value.

Access to primary healthcare services and associated factors in urban slums in Nairobi-Kenya.

BACKGROUND: Access to primary healthcare is crucial for the delivery of Kenya's universal health coverage policy. However, disparities in healthcare have proved to be the biggest challenge for implementing primary care in poor-urban resource settings. In this study, we assessed the level of access to primary healthcare services and associated factors in urban slums in Nairobi-Kenya. METHODS: The data were drawn from the Lown scholars' study of 300 randomly selected households in Viwandani slums (Nairobi, Kenya), between June and July 2018. Access to primary care was measured using Penchansky and Thomas' model. Access index was constructed using principal component analysis and recorded into tertiles with categories labeled as poor, moderate, and highest. Generalized ordinal logistic regression analysis was used to determine the factors associated with access to primary care. The adjusted odds ratios (AOR) and 95% confidence intervals were used to interpret the strength of associations. RESULTS: The odds of being in the highest access tertile versus the combined categories of lowest and moderate access tertile were three times higher for males than female-headed households (AOR 3.05 [95% CI 1.47-6.37]; p < .05). Households with an average quarterly out-of-pocket healthcare expenditure of ≥USD 30 had significantly lower odds of being in the highest versus combined categories of lowest and moderate access tertile compared to those spending ≤ USD 5 (AOR 0.36 [95% CI 0.18-0.74]; p < .05). Households that sought primary care from private facilities had significantly higher odds of being in the highest versus combined categories of lowest and moderate access tertiles compared to those who sought care from public facilities (AOR 6.64 [95% CI 3.67-12.01]; p < .001). CONCLUSION: In Nairobi slums in Kenya, living in a female-headed household, seeking care from a public facility, and paying out-of-pocket for healthcare are significantly associated with low access to primary care. Therefore, the design of the UHC program in this setting should prioritize quality improvement in public health facilities and focus on policies that encourage economic empowerment of female-headed households to improve access to primary healthcare.

Propagation of fully and partially coherent flat-topped multi-Gaussian beams through axicons.

Theoretically, we have investigated the propagation of fully and partially coherent flat-topped multi-Gaussian beams through classical and logarithmic axicons. The stationary phase method applied to the Fresnel diffraction integral for intensity distribution has led to applicable relationships. The influences of axicon base angle, beam width, beam flatness, and coherence length with intensity distribution were studied. A number of results have been analyzed and discussed revealing some important conclusions. During this investigation, a specific interest has been given toward producing uniform intensity and long focal depth.

Psychometric properties of the Malay version of motivation scales in drug treatment.

INTRODUCTION: In recognition of the role of motivation in drug use treatment, patient motivational screening instruments are needed for strategic planning and treatment. The aims of this study were to evaluate the reliability and validity of the Malay version of the Treatment Motivation Scale, and to compare the motivational levels of patients receiving substance abuse treatment with different modalities (inpatient vs. outpatient). The motivational scale consists of three scales: problem recognition, desire for help and treatment readiness. METHOD: A convenience sample of 102 patients was recruited from four Cure and Care Service Centres in Malaysia. RESULTS: Principal component analysis with varimax rotation supported two-factor solutions for each subscale: problem recognition, desire for help and treatment readiness, which accounted for 63.5%, 62.7% and 49.1% of the variances, respectively. The Cronbach's alpha coefficients were acceptable for the overall measures (24 items: ∝ = 0.89), the problem recognition scale (10 items; ∝ = 0.89), desire for help (6 items; ∝ = 0.64) and treatment readiness scale (8 items; ∝ = 0.60). The results also indicated significant motivational differences for different modalities, with inpatients having significantly higher motivational scores in each scale compared to outpatients. CONCLUSION: The present study pointed towards the favourable psychometric properties of a motivation for treatment scale, which can be a useful instrument for clinical applications of drug use changes and treatment.

A clinicopathological study of women with adnexal masses presenting with acute symptoms.

BACKGROUND: Abdominal pain is one of the most common presentations of adnexal pathology in gynecology. Early diagnosis and intervention is essential especially in adolescent girls and reproductive age group women to conserve reproductive function. AIM: The purpose of the following study is to assess the clinicopathologic outcome of women with adnexal masses presenting with acute pain. SUBJECTS AND METHODS: A retrospective study of women with adnexal masses who had surgical intervention for acute symptoms from June 2007 to May 2012 was undertaken. During the study period, a total of 57 women were operated for adnexal masses as emergency. RESULTS: Of the 57 women operated for adnexal masses as emergency, the most common pathology was teratoma 26% (15/57) followed by corpus luteal hemorrhage (16%) and endometriosis (14%). Laparoscopy was the initial surgical approach in just over 50% of patients, but surgery was completed laparoscopically only in about one-third of patients. Conservative surgery in the form of ovarian cystectomy was possible in 70% of patients. CONCLUSION: Complications of adnexal masses such as torsion and hemorrhage are common causes of acute abdominal pain. Timely diagnosis of the adnexal pathology and surgical intervention will help to preserve the reproductive outcome. Conservative surgery was possible in 70% of our study group.

Utilization of fentanyl buccal tablets in England: exploring off-label use reported in a cohort study.

BACKGROUND: Fentanyl citrate buccal tablets are indicated for the treatment of breakthrough pain (BTP) in cancer, in adults who are receiving maintenance opioid therapy for chronic cancer pain. OBJECTIVE: One of the objectives of this study was to describe the utilization characteristics of patients prescribed fentanyl buccal and to assess how the product is being used in relation to the terms of license of marketing approval. METHODS: An observational post-marketing cohort study was conducted. For the analysis of this study, exposure data were collected from dispensed prescriptions issued by general practitioners (GPs) between March 2009 and June 2011. Outcome data (indication, event, patient demographic and selected clinical characteristics) were collected by sending questionnaires to GPs at least 6 months after the drug was first prescribed. Summary descriptive statistics were calculated. RESULTS: The cohort consisted of 551 patients, of which 54.8% (n = 302 patients) were female. The median age for the cohort was 62 years (interquartile range: 50-72 years), with one patient (0.2%) aged less than 18 years. A primary indication of BTP in cancer was reported for 61.9% (n = 341) patients. Regular opioid therapy was reported upon starting the treatment for 383 patients (69.5% of cohort). In total, 69 patients (12.5%) had one or more contraindications for use. The most frequent initial titration dose was 100 µg/day (n = 247). CONCLUSIONS: The final study results show that fentanyl buccal is largely being prescribed according to the terms of the license in general practice in England, but off-licence use and use in the presence of contraindications and warnings have been reported.

Impressive echocardiographic images of a rare pathology: Aneurysm of the mitral valve - Report of two cases and review of the literature.

Aneurysm of the mitral valve (AMV) is rarely reported. The etiology of this unusual pathology is commonly attributed to aortic valve endocarditis (AVE) with aortic regurgitation (AR) or connective tissue disease. We present two recent cases of AMV with good correlation between pre-operative trans-esophageal echocardiography (TEE), intra-operative real-time 3-dimensional echocardiography (RT-3D-Echo) and surgical findings. The importance of diligent surveillance by TEE in patients with AVE for occurrence of AMV is emphasized. The literature on this topic is briefly reviewed.

Are acute coronary syndrome patients admitted during off-duty hours treated differently? An analysis of the Saudi Project for Assessment of Acute Coronary Syndrome (SPACE) study.

BACKGROUND AND OBJECTIVES: It is often suggested that acute coronary syndrome (ACS) patients admitted during off-duty hours (OH) have a worse clinical outcome than those admitted during regular working hours (RH). Our objective was to compare the management and hospital outcomes of ACS patients admitted during OH with those admitted during RH. DESIGN AND SETTING: Prospective observational study of ACS patients enrolled in the Saudi Project for Assessment of Acute Coronary Syndrome study from December 2005 to December 2007. PATIENTS AND METHODS: ACS patients with available date and admission times were included. RH were defined as weekdays, 8 AM-5 PM, and OH was defined as weekdays 5 PM-8 AM, weekends, during Eid (a period of several days marking the end of two major Islamic holidays), and national days. RESULTS: Of the 2825 patients qualifying for this analysis, 1016 (36%) were admitted during RH and 1809 (64%) during OH. OH patients were more likely to present with heart failure and ST elevation myocardial infarction (STEMI) and to receive fibrinolytic therapy, but were less likely to undergo primary percutaneous coronary interventions (PCI). The median door to balloon time was significantly longer (P<.01) in OH patients (122 min) than in RH patients. No differences were observed in hospital outcomes including mortality between the two groups, except for higher heart failure rates in OH patients (11.1% vs 7.2%, P<.001). CONCLUSIONS: STEMI patients admitted during OH were disadvantaged with respect to use and speed of delivery of primary PCI but not fibrinolytic therapy. Hospitals providing primary PCI during OH should aim to deliver it in a timely manner throughout the day.

Influences of twist phenomenon of partially coherent field with uniform-intensity diffractive axicons.

The effects of twist phenomenon (beam rotation) of a partially coherent field are studied on the operation of two classes of uniform-intensity diffractive axicons. A general theory of axicon image formation is developed, discussed, and examined. We show that the intensity of the diffracted field is a multiple Bessel field, and only the energy of the zero-order Bessel field diffracts along the propagation axes. We also show that, at any twist strength in all correlation levels, the images can be evaluated by using the stationary-phase method. The three-dimensional stationary-phase formula of axicon images is derived. Such formula may be used in fast image evaluation, for designing diffractive axicons that perform a uniform axial intensity in a twisted partially coherent field.

Age and its relationship to acute coronary syndromes in the Saudi Project for Assessment of Coronary Events (SPACE) registry: The SPACE age study.

OBJECTIVE: To characterize risk profile of acute coronary syndrome (ACS) patients in different age groups and compare management provided to in-hospital outcome. DESIGN: Prospective multi-hospital registry. SETTING: Seventeen secondary and tertiary care hospitals in Saudi Arabia. PATIENTS: Five thousand and fifty-five patients with ACS. They were divided into four groups: ⩽40 years, 41-55 years, 56-70 years and ⩾70 years. MAIN OUTCOME MEASURES: prevalence, utilization and mortality. RESULTS: Ninety-four percent of patients <40 years compared to 68% of patients >70 years were men. Diabetes was present in 70% of patients aged 56-70 years. Smoking was present in 66% of those <40 years compared to 7% of patients >70 years. Fifty-three percent of the patients >70 years and 25% of those <40 years had history of ischemic heart disease. Sixty percent of patients <40 years presented with ST elevation myocardial infarction (STEMI) while non-ST elevation myocardial infarction was the presentation in 49% of patients >70 years. Thirty-four percent of patients >70 years compared to 10% of patients <40 years presented >12 h from symptom onset with STEMI. Fifty-four percent of patients >70 compared to 64-71% of those <70 years had coronary angiography. Twenty-four percent of patients >70 compared to 34-40% of those <70 years had percutaneous coronary intervention. Reperfusion shortfall for STEMI was 16-18% in patients >56 years compared to 11% in patients <40 years. Mortality was 7% in patients >70 years compared to 1.6-3% in patients <70 years. For all comparisons (p < 0.001). CONCLUSIONS: Young and old ACS patients have unique risk factors and present differently. Older patients have higher in-hospital mortality as they are treated less aggressively. There is an urgent need for a national prevention program as well as a systematic improvement in the care for patients with ACS including a system of care for STEMI patients. For older patients there is a need to identify medical as well as social factors that influence the therapeutic management plans.

In-hospital adverse clinical outcomes of ST elevation myocardial infarction patients with renal dysfunction. Insights from the Saudi Project for Assessment of Coronary Events.

OBJECTIVE: To explore the prognostic value of baseline estimated glomerular filtration rate (eGFR) in Saudi patients presenting with ST elevation myocardial infarction (STEMI), and its impact on hospital therapies. METHODS: The STEMI patients with a baseline serum Creatinine enrolled in the SPACE (Saudi Project for Assessment of Coronary Events) registry were analyzed. This study was performed in several regions in Saudi Arabia between December 2005 to December 2007. Based on eGFR levels, patients were classified into: more than 90.1 ml/min (normal renal function), 90-60.1 (borderline/mildly impaired renal function), 60-30 (moderate renal dysfunction), and less than 30 ml/min/1.73 m2 (severe renal dysfunction). RESULTS: Two thousand and fifty-eight patients qualified for this study. Of these, 1058 patients had renal dysfunction. Patients with renal dysfunction were older, and had a higher prevalence of risk factors for atherosclerosis. Patients with moderate or severe renal dysfunction were less likely to be treated with beta blockers, angiotensin converting enzymes inhibitors, statins, or reperfusion therapies. Significantly worse outcomes were seen with lower eGFR in a stepwise fashion. The adjusted odds ratio of in-hospital death in patients with eGFR less than 30 ml/min was 5.3 (95% CI, 1.15-25.51, p=0.0383). CONCLUSION: A low baseline eGFR in STEMI patients is an independent predictor of all major adverse cardiovascular outcomes, and a marker for less aggressive in-hospital therapy.

[Etiological and prognostic aspects of renal failure in patients with prostatic adenoma].

The aim of our study was to assess the causes of renal failure in patients with prostatic adenoma (PA) and outcomes after draining of the urinary bladder. A retrospective study comprised 239 PA patients with a serum creatinine level over 120 mcmol/l. Outcomes were assessed after 3-5 day and 2.5 month bladder draining. The Spearman test was used for statistical analysis. We found that age, prostate volume, PA growth pattern, urinary tract infection, concomitant pathology (arterial hypertension, diabetes mellitus, atherosclerosis) do not correlate with a serum creatinine level. The presence of bilateral retention of the upper urinary tract was associated with a higher serum creatinine level. There is a significant correlation between lowering of a serum creatinine concentration after bladder draining and the level of upper urinary tract retention.

Cytotoxic effects of the root extracts of Eurycoma longifolia Jack.

The methanol, n-butanol, chloroform and water extracts obtained from the root of Eurycoma longifolia Jack were assayed using methylene blue assay to evaluate its cytotoxic effect against KB, DU-145, RD, MCF-7, CaOV-3, MDBK cell lines. The results showed that all the root extracts except the water extract of E. longifolia produced significant cytotoxic effect on these cell lines. However, no significant cytotoxic effect was detected on MDBK (kidney) normal cell line. 9-methoxycanthin-6-one, an alkaloid, was detected in each extract with different intensities by reversed-phase high performance liquid chromatography.

Long-term clinical outcome after implantation of medium Palmaz (biliary) stents in very large native coronary arteries.

Intracoronary stenting has been shown to improve acute and long-term clinical results compared with coronary angioplasty. However, clinical outcome after medium Palmaz biliary (PB) stent implantation in very large native coronary arteries (> 4 mm in diameter) is unknown. This study evaluated restenosis and long-term clinical outcome after PB stenting in large native coronary arteries. Between June 1993 and December 1998, 55 patients with 56 lesions were treated with PB stents. Intracoronary stent deployment was successful in all 56 vessels attempted (100%). The mean stenosis was reduced from 65% +/- 10% to 4% +/- 14%. In 48 of the 56 vessels (86%), vessel size was greater than 4.0 mm in diameter and the mean reference vessel diameter was 4.73 +/- 0.7 mm after stenting. Angiographic success was achieved in 100%. Five patients had postprocedural cardiac enzyme elevation. There was no periprocedural death, emergency coronary artery bypass surgery, repeat target lesion revascularization, or acute stent thrombosis. Long-term clinical follow-up at mean of 28 +/- 15 months was obtained in 96% of the patients. Clinical restenosis rate occurred in 18% of ostial (6/34) and 0% of nonostial (0/22) lesions (P < 0.0001) with an overall clinical restenosis rate of 11%. Repeat angioplasty were performed in these six patients. There were three cardiac and three noncardiac deaths. The overall event-free survival at 1 and 3 years was 92% +/- 4% and 80% +/- 6%, respectively. PB stent implantation in very large native coronary arteries can be performed with a high degree of procedural success and low in-hospital complications. The long-term clinical outcome of patients undergoing PB stenting is associated with excellent event-free survival. However, stenting of ostial lesions remains as an important factor for restenosis even in very large coronary artery stenting.

Serum sodium changes during and after transuretheral prostatectomy.

OBJECTIVE: This prospective study aims at determining the effect of transurethral resection of the prostate on serum sodium levels during and after the procedure. METHODS: One hundred consecutive unselected patients with prostatic obstructive symptoms over a period of 11 months underwent transurethral resection of the prostate using continuous flow irrigation with 1.5% glycine running from a height of 70 cm above the table level under epidural anesthesia and were given 1L of intravenous normal saline/hour during the procedure. Resection time ranged between 25 and 90 minutes (mean 32) and was less than 45 minutes in 91 patients (91%). No postoperative irrigation or diuretics were given and the patients were given food and liberal fluids immediately after the operation. RESULTS: Fifty-four patients (54%) had intraoperative reduction of serum sodium ranging between 2 and 7 mmol/L (mean 3.5), 18 of whom showed further drop of 2-10 mmol/L after 24 hours (mean 3.4). Twenty-five patients (25%) did not have any intraoperative change in their serum sodium level, 6 of whom dropped their serum sodium 24 hours later. After 24 hours, 41 patients (41%) ended with serum sodium lower than their preoperative level by 2-12 mmol/L (mean 4%), 3 of whom had a drop of 10-12 mmol/L. The reduction was manifested 24 hours after the procedure in 27 patients (27%). None of the patients had transurethral resection syndrome nor its prodromal manifestations. CONCLUSION: After transurethral resection of the prostate, hyponatremia can occur as late as 24 hours postoperatively. Short operative time, giving intravenous sodium supplement intraoperatively and avoiding postoperative irrigation were perhaps factors in avoiding drastic hyponatremia and transurethral resection syndrome in this prospective series of unselected patients.

Role of Ser(289) in RARgamma and its homologous amino acid residue of RARalpha and RARbeta in the binding of retinoic acid.

The biological actions of retinoic acid (RA) are mediated by retinoic acid receptors (RARalpha, -beta, and -gamma) and retinoid X receptors (RXRalpha, -beta, and -gamma). Although the ligand-binding domains of RARs and RXRs have been suggested to share the same novel folding pattern, the ligand-binding pockets of each of the retinoid receptors must have unique structural features since it has been possible to develop RAR subtype-selective and RXR-selective retinoids. We have previously demonstrated the importance for RA binding and RA-dependent transactivation of Arg(276) in RARalpha and Arg(278) in RARgamma; however, in RARbeta Arg(269) functions in conjunction with Lys(220). Here we have examined the role of the hydroxyl group of RARgamma Ser(289) and its homologous amino acid residues in RARalpha (Ser(287)) and RARbeta (Ser(280)) alone and in conjunction with their respective RARgamma Arg(278) homologs for RA binding and RA-dependent transactivation activity. The hydroxyl group of this Ser in all three RARs was found by itself not to be important for RA binding and RA-dependent transactivation activity. However, in RARalpha and RARgamma this Ser appears to play a small role in conjunction with Arg(276) and Arg(278), respectively, for these activities. Alternatively, strong synergism was observed in RARbeta between Ser(280) and Arg(269) for RA-binding and RA-dependent transactivation activity. This provides further evidence that the mechanism of interaction between the carboxylate group of retinoids and the amino acid residues in the ligand binding pocket of RARbeta is different from that of RARalpha and RARgamma.