Search

Background Many different conventional approaches such as the frontal and pterional approaches are used to access anterior circulation aneurysms. Recently, the supraorbital approach has been widely applied to the treatment of anterior circulation aneurysms. This study was done to evaluate which approach (pterional or supraorbital) has better outcomes in terms of residual neck post-clipping, cosmetic satisfaction, scar tenderness, complications and functional outcomes. Methodology A total of 123 patients were recruited into this study, comprising 82 patients who underwent a pterional approach and 41 patients who underwent a supraorbital approach. Computed tomography angiograms, the modified Rankin Scale, and the visual analogue scale were administered at 6 months to look for residual aneurysm, functional outcomes, scar tenderness, and cosmetic satisfaction. Complication data were collected from patients' case notes. Results The mean operating time for the pterional group was 226 min, compared to supraorbital group, which was 192 min (P = 0.07). Cosmetic satisfaction was significantly higher (P = 0.001) in the supraorbital group. There was no significant difference between the supraorbital and pterional groups' scar tenderness (P = 0.719), residual aneurysm (P = 0.719), or functional outcomes (P = 0.137), and there was no significant difference between the groups in terms of intra-operative and post-operative complications. Conclusions The supraorbital group had better cosmetic outcomes and shorter operating times compared to the pterional group.

Background Meningioma is the commonest primary intracranial tumour in adults. Excision is curative for low grade meningioma, whereas high-grade meningioma requires adjuvant therapy following surgery. Several studies have examined the association between peritumoural brain Edema - a common feature in meningioma - and histological grading with mixed results. The present study attempted to elucidate this association and if peritumoural brain Edema affects the intra-operative judgement of surgeons on the completeness of resection. Methods An observational study was conducted among those who underwent surgery for meningioma. Eighteen subjects were recruited each for low- and high-grades, respectively. Magnetic resonance imaging (MRI) prior to surgery was employed for interpreting the Edema index and MRI after surgery was used to determine residual tumour. Results Median age was 50 years, male to female ratio was 1:3.5, 69.4% had peritumoural brain Edema and 75% had reported gross resection. Among the reported gross total resection cases, 40.7% had residual tumour. Analysis showed statistically significant association between peritumoural brain Edema (P = 0.027) and tumour volume (P = 0.001) with high-grade meningioma, however multivariate analysis did not present any association. No association was noted between judgement of tumour resection by surgeons and peritumoural brain Edema. Conclusion Odds ratio for peritumoural brain Edema remained high and the tumour volume exhibited marginal P-value marginal significance for prediction of high grade meningioma. These two factors may still contribute to the tumour grade and should be included in further studies on the prognosis of meningioma.

The aims of the present study were to undertake gene expression profiling of the blood of glioma patients to determine key genetic components of signaling pathways and to develop a panel of genes that could be used as a potential blood-based biomarker to differentiate between high and low grade gliomas, non-gliomas and control samples. In this study, blood samples were obtained from glioma patients, non-glioma and control subjects. Ten samples each were obtained from patients with high and low grade tumours, respectively, ten samples from non-glioma patients and twenty samples from control subjects. Total RNA was isolated from each sample after which first and second strand synthesis was performed. The resulting cRNA was then hybridized with the Agilent Whole Human Genome (4x44K) microarray chip according to the manufacturer's instructions. Universal Human Reference RNA and samples were labeled with Cy3 CTP and Cy5 CTP, respectively. Microarray data were analyzed by the Agilent Gene Spring 12.1V software using stringent criteria which included at least a 2-fold difference in gene expression between samples. Statistical analysis was performed using the unpaired Student's t-test with a p

BACKGROUND Intraventricular haemorrhage (IVH) causes blockage of ventricular conduits leading to hydrocephalus, increased intracranial pressure (ICP), and a reduced level of consciousness. The current standard management of IVH is insertion of an external ventricular drainage (EVD) catheter. However, this procedure addresses only the problems of acute hydrocephalus and raised ICP. Endoscopic washout allows for a more complete removal of the intraventricular clot. This study compared these two types of treatment in terms of shunt dependency and relevant clinical outcomes. METHODS Patients who were 10-80 years old and presented with a Graeb score of more than six were randomised into endoscopic washout and EVD treatment groups. A CT brain was repeated on each patient within 24 hours after surgery, and if a patient's Graeb score was still more than six, a repeat endoscopic washout was performed to clear the remaining clots. All patients were monitored for shunt dependency at two weeks and three months, and clinical outcomes were measured at six months after the procedure. RESULTS A total of 39 patients were recruited; 19 patients were randomised into the endoscopic washout group, and 20 were randomised into the EVD group. However, three patients in the endoscopic group refused that treatment and opted for EVD insertion. Patients treated with endoscopic washout had significantly less drainage dependency at two weeks (P < 0.005) and at three months (P < 0.004) as compared to patients in the external ventricular drainage group. The reduction in Graeb scores was also significantly greater in the endoscopic washout group (P < 0.001). However, the functional outcome at six months measured via a modified Rankin scale score was no different in the two groups of patients. The difference in the functional outcome of the patients was mainly dependent on the initial pathology, with those presenting with a thalamic bleed with IVH showing a poor functional outcome. This parameter was also influenced by the Glasgow Coma Scale (GCS) score on admission, with those patients with a score of 12 or less having a poor functional outcome (MRS 5-6) at three and six months after the surgery. CONCLUSIONS The use of neuroendoscopy in patients with a massive IVH significantly reduced drainage dependency. However, it did not alter the final functional outcome.

ObjectiveTo conducted a spatial analysis for stratification of priority malaria control areas in Kahnuj County, as part of field exercise.MethodsInformation of Health Centers of Kahnuj County has been used for stratification retrospectively. A knowledge, attitudes and practices (KAP) study was arranged to provide preliminary information about the knowledge, attitude and practice related to malaria in the area.ResultsNumbers of malaria cases has been decreased in year 2008. There were five important vectors of malaria in this region including: Anopheles stephensi (An. stephensi), Anopheles dthali (An. dthali), Anopheles superpictus (An. superpictus), Anophels culicifacies (An. culicifacies), and Anopheles fluviatilis (An. fluviatilis), but majority of malaria cases in this county was related to Plasmodium vivax (P. vivax). Educational levels of community were 38%, 20%, 10% and 32% for illiterate, primary, secondary and university levels, respectively. KAP study revealed that about 37% of people have got malaria at least once and only 27% of people knew that mosquito is the vector of malaria.ConclusionsMalaria in Kahnuj represents a real threat. Transmission occurs in city center. An. stephensi can be suspected for the first peak of malaria cases in late spring in Kahnuj city. An. fluviatilis has a relatively high density in autumn while two malaria cases due to P. falciparum were reported in 2008. Based on KAP study, the knowledge of respondents seems good but the attitude and practice is low. According to the data such as API, main malaria vector, transmission rate, and foreign migrants, the Kahnuj County has been spatially divided into three strata based on various characteristics. The authorities should implement all the interventions based on stratification.

We performed a prospective observational study in a clinical setting to test the hypothesis that prior colonization by a Staphylococcus aureus strain would protect, by colonization interference or other processes, against de novo colonization and, hence, possible endo-infections by newly acquired S. aureus strains. Three hundred and six patients hospitalized for >7 days were enrolled. For every patient, four nasal swabs (days 1, 3, 5, and 7) were taken, and patients were identified as carriers when a positive nasal culture for S. aureus was obtained on day 1 of hospitalization. For all patients who acquired methicillin-resistant S. aureus (MRSA) or methicillin-susceptible S. aureus via colonization and/or infection during hospitalization, strains were collected. We note that our study may suffer from false-negative cultures, local problems with infection control and hospital hygiene, or staphylococcal carriage at alternative anatomical sites. Among all patients, 22% were prior carriers of S. aureus, including 1.9% whom carried MRSA upon admission. The overall nasal staphylococcal carriage rate among dermatology patients was significantly higher than that among neurosurgery patients (n = 25 (55.5%) vs. n = 42 (16.1%), p 0.005). This conclusion held when the carriage definition included individuals who were nasal culture positive on day 1 and day 3 of hospitalization (p 0.0001). All MRSA carriers were dermatology patients. There was significantly less S. aureus acquisition among non-carriers than among carriers during hospitalization (p 0.005). The mean number of days spent in the hospital before experiencing MRSA acquisition in nasal carriers was 5.1, which was significantly lower than the score among non-carriers (22 days, p 0.012). In conclusion, we found that nasal carriage of S. aureus predisposes to rather than protects against staphylococcal acquisition in the nose, thereby refuting our null hypothesis. Clinical Microbiology and Infection (C) 2015 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Background: Malignant middle cerebral artery (MCA) infarction is a devastating clinical entity affecting about 10% of stroke patients. Decompressive craniectomy has been found to reduce mortality rates and improve outcome in patients. Methods: A retrospective case review study was conducted to compare patients treated with medical therapy and decompressive surgery for malignant MCA infarction in Hospital Kuala Lumpur over a period of 5 years (from January 2007 to December 2012). A total of 125 patients were included in this study; 90 (72%) patients were treated with surgery, while 35 (28%) patients were treated with medical therapy. Outcome was assessed in terms of mortality rate at 30 days, Glasgow Outcome Score (GOS) on discharge, and modified Rankin scale (mRS) at 3 and 6 months. Results: Decompressive craniectomy resulted in a significant reduction in mortality rate at 30 days (P < 0.05) and favorable GOS outcome at discharge (P < 0.05). Good functional outcome based on mRS was seen in 48.9% of patients at 3 months and in 64.4% of patients at 6 months (P < 0.05). Factors associated with good outcome include infarct volume of less than 250 ml, midline shift of less than 10 mm, absence of additional vascular territory involvement, good preoperative Glasgow Coma Scale (GCS) score, and early surgical intervention (within 24 h) (P < 0.05). Age and dominant hemisphere infarction had no significant association with functional outcome. Conclusion: Decompressive craniectomy achieves good functional outcome in, young patients with good preoperative GCS score and favorable radiological findings treated with surgery within 24 h of ictus.

Peak electricity demand has become a global concern. It causes grid transmission constraints and congestion, and also increases the cost of electricity for all users, specifically industrial consumers with high peak demands. Time-of-use demand side management coupled with thermal energy storage and off-grid solar PV can be an alternative to increase the flexibility and security of the whole energy system. The aim of the current paper is to study the potential of implementing time-of-use demand side management coupled with thermal energy storage and solar PV technologies using optimization techniques for shifting electricity peak loads of cooling processes in an industrial unit. It was found that considerable reductions can be achieved in electricity power demands in different tariff periods using optimization-based demand side management (DSM) together with thermal energy storage and off-grid solar PV. In addition, it was seen that coupling cold thermal energy storage and solar photovoltaic technologies is more energy-beneficial than using them separately Refereed/Peer-reviewed

Cooling in the industry sector contributes significantly to the peak demand placed on an electrical utility grid. New electricity tariff structures include high charges for electricity consumption in peak hours which leads to elevated annual electricity costs for high-demanding consumers. Demand side management (DSM) is a promising solution to increase the energy efficiency among customers by reducing their electricity peak demand and consumption. In recent years, researchers have shown an increased interest in utilizing DSM techniques with thermal energy storage (TES) and solar PV technologies for peak demand reduction in industrial and commercial sectors. The main objective of the present study is to address the potential for applying optimization-based time-of-use DSM in the industry sector by using cold thermal energy storage and off-grid solar PV to decrease and shift peak electricity demands and to reduce the annual electricity consumption costs. The results show that when cold thermal energy storage and solar PV are coupled together higher annual electricity cost savings can be achieved compared to using these two technologies independently. Additionally, considerable reductions can be seen in electricity power demands in different tariff periods by coupling thermal energy storage with off-grid solar PV. The work partially funded by the Spanish government (ENE2015-64117-C5-1-R (MINECO/FEDER), ENE2015-64117-C5-3-R (MINECO/FEDER), and TIN2015-71799-C2-2-P). The authors would like to thank the Catalan Government for the quality accreditation given to their research group (2014 SGR 123) and the city hall of Puigverd de Lleida. This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 657466 (INPATH-TES). Alvaro de Gracia would like to thank Ministerio de Economia y Competitividad de España for Grant Juan de la Cierva, FJCI-2014-19940.