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.

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.

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.

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.

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.

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.

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.

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.

Post-exposure temperature influence on the toxicity of conventional and new chemistry insecticides to green lacewing Chrysoperla carnea (Stephens) (Neuroptera: Chrysopidae).

Chrysoperla carnea (Stephens) is an important biological control agent currently being used in many integrated pest management (IPM) programs to control insect pests. The effect of post-treatment temperature on insecticide toxicity of a spinosyn (spinosad), pyrethroid (lambda cyhalothrin), organophosphate (chlorpyrifos) and new chemistry (acetamiprid) to C. carnea larvae was investigated under laboratory conditions. Temperature coefficients of each insecticide tested were evaluated. From 20 to 40 °C, toxicity of lambda cyhalothrin and spinosad decreased by 2.15- and 1.87-fold while toxicity of acetamiprid and chlorpyrifos increased by 2.00 and 1.79-fold, respectively. The study demonstrates that pesticide effectiveness may vary according to environmental conditions. In cropping systems where multiple insecticide products are used, attention should be given to temperature variation as a key factor in making pest management strategies safer for biological control agents. Insecticides with a negative temperature coefficient may play a constructive role to conserve C. carnea populations.

Room temperature ammonia sensing using tapered multimode fiber coated with polyaniline nanofibers.

We demonstrate an ammonia sensor composed of a tapered multimode fiber coated with polyaniline nanofibers that operates at room temperature (26°C). The optical properties of the polyaniline layer changes when it is exposed to ammonia, leading to a change in the absorption of evanescent field. The fiber sensor was tested by exposing it to ammonia at different concentrations and the absorbance is measured using a spectrophotometer system. Measured response and recovery times are about 2.27 minutes and 9.73 minutes, respectively. The sensor sensitivity can be controlled by adjusting the tapered fiber diameter and the highest sensitivity is achieved when the diameter is reduced to 20 µm.

Tritrophic interactions between parasitoids and cereal aphids are mediated by nitrogen fertilizer.

Host plant nutritional quality can directly and indirectly affect the third trophic levels. The aphid-parasitoid relationship provides an ideal system to investigate tritrophic interactions (as the parasitoids are completely dependent for their development upon their hosts) and assess the bottom up forces operating at different concentrations of nitrogen applications. The effects of varying nitrogen fertilizer on the performance of Aphidius colemani (V.) reared on Sitobion avenae (F.) and Aphidius rhopalosiphi (D.) reared on Rhopalosiphum padi (L.) were measured. Parasitism and percent emergence of parasitoids were positively affected by nitrogen fertilizer treatments while developmental duration (egg, larval, and pupal stages) was not affected by increasing nitrogen inputs. In males and females of both parasitoid species, adult longevity increased with the increasing nitrogen fertilizer. Hind tibia length and mummy weight of both parasitoid species increased with nitrogen fertilizer concentrations, as a result of larger aphids. This study showed that nitrogen application to the soil can have important consequences for aboveground multitrophic interactions.

Extended nonlinear parametric process in anomalously pumped linear cavity oscillator.

We demonstrate a linear cavity fiber optical parametric oscillator with extended pump-signal separation of 14.3 THz (116 nm). The signal laser is provided by a pair of 1675nm fiber Bragg gratings and a tunable idler from 1456.12 nm to 1462.48 nm is generated by detuning the pump wavelength in the anomalous dispersion regime of a highly nonlinear fiber. At such large pump-signal separation, we are still able to record a parametric conversion efficiency of more than -35 dB and idler optical signal-to-noise-ratio of 50 dB on average. The stability of the lasing signal and idler is examined and result shows both signal and idler peak power fluctuation is less than 1 dB over a period of 30 minutes.

Single mode tapered fiber-optic interferometer based refractive index sensor and its application to protein sensing.

We demonstrate refractive index sensors based on single mode tapered fiber and its application as a biosensor. We utilize this tapered fiber optic biosensor, operating at 1550 nm, for the detection of protein (gelatin) concentration in water. The sensor is based on the spectroscopy of mode coupling based on core modes-fiber cladding modes excited by the fundamental core mode of an optical fiber when it transitions into tapered regions from untapered regions. The changes are determined from the wavelength shift of the transmission spectrum. The proposed fiber sensor has sensitivity of refractive index around 1500 nm/RIU and for protein concentration detection, its highest sensitivity is 2.42141 nm/%W/V.

Effect of plant nutrition on aphid size, prey consumption, and life history characteristics of green lacewing.

Plant quality can directly and indirectly affect the third trophic level. The predation by all the instars of green lacewing, Chrysoperla carnea (S.) (Neuroptera: Chrysopidae) on the cereal aphids, Rhopalosiphum padi (L.), and Sitobion avenae (F.) at varying nitrogen fertilizer levels was calculated under laboratory conditions. Wheat plants were grown on four nitrogen fertilizer levels and aphids were fed on these plants and subsequently offered as food to the C. carnea. Aphid densities of 10, 30, and 90 were offered to first, second, and third instar larvae of green lacewing. Increased nitrogen application improved nitrogen contents of the plants and also the body weight of cereal aphids feeding on them. Aphid consumption by green lacewings was reduced with the increase in nitrogen content in the host plants of aphids. Predation of both aphid species by first, second, and third instars larvae of C. carnea was highest on aphids reared on plants with the lowest rate of fertilization, suggesting a compensatory consumption to overcome reduced biomass (lower aphid size). Total biomass devoured by C. carnea on all nitrogen fertilizer treatments was not statistically different. Additionally, the heavier host prey influenced by the plant nutrition had an effect on the life history characteristics of green lacewings. The larval duration, pupal weight, pupal duration, fecundity, and male and female longevity were significantly affected by the level of nitrogen fertilization to the aphid's host plants, except for pupal duration when fed on S. avenae. This study showed that quantity of prey supplied to the larvae affects the prey consumption and thereafter the life history characteristics of green lacewings.