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juniperpublishersoceanography · 3 years

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Conservation of Marine Environment - Only Way of Sustaining the Very Existence of Human Civilization on our Planet- Juniper Publishers

Abstract

In order to find out the solution of various problems prevailing in the marine and offshore ecosystems in India, the present authors, as regular routine practice of versatile research work respectively, have been concentrating their respective scientific research on marine pollution, ocean acidification, coastal resource management and its social impact study and have presented their respective papers in various national and international conferences and obtained interactions. In order to ponder the real time solution, the present paper deals with the observation and experience obtained by the respective authors which are the derivatives of scientific and societal thought presented in this paper as a product of intermittent and cumulative manners and opined suggestive issues on the present and future significance of marine and coastal research activities, apprehensions and its various hindrances. Issues of marine conservation, threats to securities of marine & coastal ecosystem including the direct impacts for not taking appropriate measures of marine conservation, and the suggestive remedial measures have been categorically discussed from new dimensions.

Keywords: Marine conservation; Offshore environment; Coastal ecosystem; Criminal laws; Civilization support system; Oil spill; Ocean acidification; Over fishing; Biodiversity; Disaster management

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Introduction

'Conservation of marine environment' or 'marine conservation' broadly is a development program through scientific management of natural coastal and offshore ecosystems of marine environment which:

I. Has been generated as perception from the study of marine & coastal ecosystems.

II. Is comprising of various activities within the ambit of estuarine, coastal, onshore and offshore areas.

III. On techno-scientific application, marine & coastal resources are more beneficially effective in their ecosystem services; and finally.

IV. Requires a good and moral coordination in the management of such resources and their respective ecosystem services with and/or without requirement of development law and policy both for the development of human society and natural ecosystem without pollution and/or degradation.

The marine environment is the specific environment significantly differs from the land or terrestrial environment and influenced by ocean, sea, gulf, bay and estuarine ecosystems. The marine ecosystem therefore is a continuing interactive process induced by-and prevail in between all the living beings and their respective ambient physical environment. By land-water ratio of occupancy, the marine environment shelters largest ecosystem known as marine ecosystem on our planet earth. From various research findings, it is established by scientific evidence that different but unique marine and related ecosystems provide at least one common phenomenon of continuous release of oxygen (O2) by all green pigment plant and plankton by taking Carbon-di-Oxide (CO2) from atmosphere. This is that Carbon-diOxide (CO2) which is released and/or coming out of utilization of energy- be it the respiration of living being, or be it the consumption of energy primarily in our industry to the bedroom air conditioner to refrigerator for our 'civilization support system".

This is that Carbon-di-Oxide (CO2) which is released and/ or coming out of activities of the world-wide sale of arms and using of that arms by one person against the other, by one nation against the other. This is that Carbon-di-Oxide (CO2) which is released and/or coming out from the illegal release/spillage of huge quantity of petroleum oil into the sea by one tanker, lifting that oil to different tanker, and the rest oil spillage onto the surface sea water by incineration in order to the procurement of insurance money. This is that Carbon-di-Oxide (CO2) that could not have been utilized by the plant and plankton of the marine and coastal ecosystems because of such plant and plankton were died because of toxicity of such spilled petroleum oil or its chemical fractions mostly soluble/miscible in the sea water.

This is that Carbon-di-Oxide (CO2) not being used by the plant and plankton of the marine ecosystem released into atmosphere by the human activities, and now said to be the 'most notorious culprit' causing the global warming at local and regional levels, and manifested/inflicted upon human natural social life as local and regional 'weather anomaly' in the form of disasters like hurricane and cyclone (both are same weather phenomenon but called differently because of its geographical positions) caused damage of properties, civilization system and thus huge monetary loss pushing our social economy backward.

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What are the issues in Marine Conservation?

In order to conserve the marine ecosystem prevailing in any part of the world are:

Prevention/ mitigation of

a. Marine and coastal pollution (oil spill & land-based waste disposal).

b. Ocean acidification and local climate change.

c. Overfishing and subsequent un-employment/under employment of fisher-persons.

d. Loss of biodiversity and coral bleaching.

e. Coastal erosion and un-scientific coastal development.

Development and management of

i. Coastal habitat conservation in island and mainland coast.

ii. Coastal Tourism.

iii. Disaster management and preparedness team with intra-national and international coordination;

iv. Appropriate policy not only for the threatened and endangered species protection but also for further development of coastal resources and their appropriate management.

v. Criminal/penal laws at local and national levels of any maritime nations, Small Islands Developing States (SIDS) for committing Item 1 to 5 above and acting directly and/or indirectly against Item 6 to 9 including practice of espionage activities relating to prevention of marine environment/ ecosystem development research and policy(s).

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What are the Threats to Marine Environment/Ecosystem?

Although the overall threat to global marine ecosystem security is 'warming' or 'temperature increase' in the atmosphere at various local/regional/national levels even though it would be wise to visualize such threat from different angles primarily finding out or determining the sources of threat in order to appropriate management of such threat to cope with.

There are categories of sources of threat to security of surviving marine ecosystem. Maritime countries appears to have such sources of threats at varying magnitude to their respective marine environment/ecosystems. Such sources of threats are varying country to country, region to region, but globally there are commonalities in nature. These are:

1. Lack of knowledge of the fisher-people's about the surviving marine & coastal ecosystems and their greed to earn more money by overfishing.

2. Lack of political willingness of local/national government to deploy regulatory authority with the honest and knowledgeable people armed by the appropriate law making and introduction of appropriate training.

3. Not deployment of specific type of appropriately educated & trained 'Watch-Guard' both at coast land, and offshore water.

4. Inducing misrepresentation and wrong explanation in presentation of usage of terms and knowledge by various means of social application.

5. Ignoring & screening appropriate people/organization by:

(i) Not paying heed apparently to their suggestions relating to marine & coastal conservation but copying the idea from them for other personal purpose including forms of monetary gain.

(ii) Not paying heed to their timely suggestions relating to marine & coastal conservation if it is 'politically thought to be deferred and/or not to be taken action’ silently.

(iii) Inducing process of destruction by:

(a) Bribing key fellows through their personal career and gain as an outcome - apparently invisible.

(b) Secretly taken decision making for such organization to deprive them for being granted financial assistance compelling them to stop their research activities relating to marine & coastal development which include 'conservation' as the first and foremost step (Our Asian Marine Conservation is a rarest exceptional education and research organization that has never been granted any financial assistance from any government/ corporate/ intergovernmental bodies at local/ national/ international levels but continue to excel in its research globally for more than 25 years).

6. National Intelligence Bureau including military intelligence have not been appropriately taught/trained so that all illicit/illegal money including bribe could be earned by the person having vested interest at the cost of primary national security which includes military security and natural ecosystem security.

7. Lack of appropriate legislation.

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What are the Direct Impacts for Not Taking Appropriate Measures of Marine Conservation?

Of various dimensions and all are negative in nature. Amongst those the most important and primary ones are:

a. Deficit in national natural resource base (NRB).

b. Overall delay in sustainability in the national growth & development.

c. Resource conflict amongst people at the local levels and instability in the national socio-political system.

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What is/are the Remedial Measure(s)?

Reversing the modes of indirect 'threat perception’, as stated before, by systematically adopting special political willingness and incorporate such programme in the national planning commission or national planning board.

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Conclusion

In order to reversing the trend of global climate degradation due to pollution of marine environment E that lead to degradation of natural quality of marine & coastal ecosystem services, national and global leaders must be ethically honest to:

i. Become humane.

ii. Perceive quick decision making in scientifically fighting global warming and preventing marine & coastal pollution.

iii. For the act of increase global coordination at regional levels forgetting enmity to each other nations which will create a huge job creation and that in turn boost up global economy at national and regional levels.

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juniperpublishers-orthopedics · 3 years

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Assessment of Knowledge about the BARC Centre and Satisfaction with the Educational Services Available

Abstract

The aim if this proposal is to determine knowledge in the general population about arthritis and immunology disorders ; to ascertain if this has improved in the decade since our Needs Assessment; and the satisfaction with the educational material now available to support communities and arthritis sufferers.

Background

BARC (Birmingham Arthritis Resource Centre) was set up to provide education and support to people with arthritis and their carers, based on a formal Needs Assessment. BARC aims to promote self-coping to help people to deal with the physical and social disabilities caused by their disease. It is cited in the city centre public library and works alongside the regular medical NHS service provision. Services for Rheumatology have always had lower priority and funding than those for acute services such as Cancer and Heart disease. In addition they have historically been somewhat restricted in the West Midlands (the UK region where Birmingham is the central city) compared to the rest of the UK. The picture is also complicated by the high percentage of ethnic minority groups locally (generally referred to as BME groups- Black and Minority Ethnic). Birmingham is set to become the first major UK city where BME groups will become the majority within the next ten years. There is evidence that “excluded groups” - such as immigrants, the poor and the less-well educated have poorer health but do not access the NHS in the same way as the white middle-class population for a variety of reasons, including cultural, language and poverty barriers. This is clearly relevant to the wider European scene where there is increasing pressure from immigration while currently both health and social programs are threatened by the financial recession.

The BARC project was started a decade ago with a formal research process to determine the extent of current services and what people wanted. This “Needs Assessment” showed that both medical profession and public perceived a need for more information provided in an informal setting (ie a non-medical setting) - and wanted it in a range of languages Adab et al. [1]. There was also a widespread desire for more support services for patients. The BARC centre was set up on the basis of this in space provided by the City in the Central Library and is manned by volunteers. These have been selected and trained by the Centre manager, Chan Gordhan, who has a long background in social and voluntary work. The volunteers come from a range of ethnic backgrounds and importantly they have all had some personal rheumatic problem. Thus they fit what the UK government is now calling “expert patients” - and promoting the idea that they are best placed to help others since they have learnt how to cope. Interestingly our experience shows that volunteering to help others also empowers them to deal with their own lives, so they should also be the best placed group to teach us how to empower our clients. Our data also shows that the BARC service is wanted as well as needed locally.

The key point in developing any new service is to provide an evidence base for it. BARC set out to do this from the outset. Following the initial “Needs Assessment” We carried out a focus group study to determine what patients from BME groups were looking for from the local health services Bacon et al. [2]. A key factor expressed by the participants was the desire to be listened too. They were dissatisfied with their doctors who were seen to lack time to take in the patients broader complaints. This echoes wider concerns about poor doctor patient communications an area which the Royal College of Physicians is holding an enquiry into at present.

BARC has set up sympathetic listening as one of the basic parts of the service Gordhan [3,4]. This is provided by trained volunteers. They are themselves patients and come from a range of ethnic and linguistic backgrounds, so that they are able to provide culturally sensitive guidance to clients. We have collected data on who has attended and how satisfied they are with the service provided Treharne [5]. Approximately 40% of attendees come from the BME groups, similar to the general population. Thus we are getting through to target populations - but not in large enough numbers. We have also had high gradings for client satisfaction.

We have also addressed the need for relevant patienteducation material understandable to those for whom English is not their mother tongue. We recently completed a set of educational leaflets, designed as “bottom-up” material that is based on questions people actually ask rather than information doctors think patients ought to know. They are in simple English, avoiding technical terms, so as to be easily understood. The first six have been translated into Urdu and recorded on CD’s in both languages, as well as in print format with a few cartoons to illustrate them. A preliminary piece of market research in the BARC Centre shows that the volunteers think they are what is needed and a small sample of clients listening to the first one agreed. The Urdu translation has also been approved by a range of Indian colleagues as being both true to the English information and understandable by a range of local language speakers. The translation is not strict Urdu but includes phrases used in Bollywood films (watched by all the local S. Asian groups) as well as some English words generally used in the version of “Urdu” widely used around Birmingham.

A questionnaire-based assessment of the first of these CD’s – on Understanding Arthritis – showed that clients gave it high scores for clarity of information and obtaining information that they wanted. In general they found the CD helped them to cope Sharif [6]. We are just completing an assessment of the CD on rheumatoid arthritis and the outcome is very exciting. The challenge was far greater here as the usefulness of the CD was examined in a specialist RA clinic which already had a highly trained specialist nurse providing explanations and support to patients. Despite this the comments made at the focus groups demonstrated that the study participants had found the additional BARC service a major help Kumar et al. [7]. There is now patient pressure to set up such a service on a regular basis in the hospital setting. This would be in line with the recent Report from the influential Kings Fund which noted a lack of understanding on the quality of RA care and the struggle many RA patients have to access quality care Kings Fund [8].

In the same way, we have struggled to reach our target for new attendees at the BARC centre, despite the evidence for the need for and the success of the BARC service. Total numbers accessing the BARC service, including phone calls and web-site hits, have increased year-on year but surprisingly there has been no increase in personal visitors. A number of community centres have asked for the manager to go out to specific groups with promotional and educational talks. This alternative approach has proved very popular but many attendees have said they were not aware of the BARC centre. These outreach sessions are demanding on Chan Gordhan’s time and there is an excellent service available at the library. Thus the next essential step is a study of why people are not coming in the predicted numbers.

Hypothesis

We propose that the population in general tend to downplay the importance of their musculo-skeletal problems. This is reinforced by the poor publicity that arthritic diseases get compared to some others. Analysis of the relative importance given by press or TV showed that heart disease and cancer got far more attention and were treated as serious scientific problems. Rheumatic diseases by contrast were seen as “lifestyle problems” for which there was no real medical treatment. The existence of a ground-breaking local service does not appear to have changed that mould to any major extent. Each time that the BARC Centre has been discussed on local radio there has been a sharp rise in client enquiries – but only for a short period. We intend to analyse the degree of local awareness of the BARC and at the same time look further into the responses of those who do actually come to seek help.

Methods

The first aspect will be carried out by collecting data about knowledge of BARC and satisfaction with current educational support using standardised questionnaires. This will target both a random population (people accessing the Central Library for any purpose) and specific communities such as local Sikh and Somali populations who have already identified a perceived need for an increased service for their groups. A minimum of 200 library people will be sampled at random in each grouping. The second part (analysis of satisfaction with current services) will be completed by analysis of the data collected over the past two years from attendees at the Centre, who are all asked to complete such a form. The data from this project will be compared to that obtained 10 years ago in the original Needs Assessment

Broader aspects of Fellowship

The advantages of taking on this project would be to widen your experience into qualitative research and introduce you to a new but important area of rheumatology, patient education. The latter has many messages for someone practicing in a major city with an immigrant population and you have already reported working with several ethnic minority groups in Kosova. We have been thinking about this project for some time, so there are some things already in place to facilitate your research. We have already trailed a simple questionnaire for these assessments. A sociology student is currently using these to collect some preliminary data from library visitors. That experience will focus the further development of the project. A trained health psychologist is available to help with analysing the questionnaires and the unstructured material coming from the “free comment” section at the end of each form. In the same way, the set of forms collected from clients attending the Centre in its early years have been analysed and will form a useful comparison with the planned analysis of the comments collected from recent clients.

This exercise will definitely lead to at least one published paper. The methodologies used will be of value to you in assessing the worth of conventional treatment options across the field of rheumatology. Our speciality deals with incurable chronic disease and there is increasing evidence that patients have a different perspective on the outcome to their doctors Hewlett [9]. Helping people to cope with chronic disability, improving their life by addressing their real concerns rather than measuring “medical outcomes” like degree of swelling or ESR, is becoming increasingly important. Finding ways of reaching out to the large percentage of the population who have a disability related to a rheumatic problem is also essential to persuade politicians to take the subject seriously and invest in it. Thus the experience gained from this would be advantageous to your career in many ways – and I believe you would find working in BARC both interesting and rewarding. Once in place here you can join in all the usual University Rheumatology Departmental activities, from seminars to clinical meetings. We would also work to get you some exposure to Rheumatoid Arthritis clinics as an observer on an informal basis. That will be easier to do with colleagues on the ground than to set up formally in advance with the current NHS bureaucracy [10].

Conclusion

You will have free time to catch up on your reading, particularly on the fairly large literature on self-coping and on what people expect from health services. You would need this to write a good paper and I would expect you to write up a comprehensive introduction and methods section well before data collection has been completed. Of course we will be available to discuss that with you but it will be your responsibility to produce the first version. I believe that an important part of such a fellowship is learning how to plan and write up your own research projects for the future.

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juniperpublishersophthalmology · 3 years

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Visual Rehabilitation and Tolerability Using Hybrid Contact Lenses of Patients with Moderate to Severe Keratoconus-juniper Publishers Introduction Keratoconus is non inflamatuary and progressive disease of the younger age group in which corneal thinning occurs and cornea assumes a conical shape associated with abnormal curvature. This changes often results in irregular astigmatism and myopia and leads to mild to marked visual impairment [1]. Corneal topography is a non-invasive technique to detect and monitor the progression of keratoconus. Contact lenses were used to improve visual conditions in keratoconus. Rigid gas permeable (RGP) lenses are most used type of contact lenses but in patient with severe disease RGP lens is insufficient for visual impairment and comfort [2]. Irregular astigmatism which developed after ectasia is not corrected with glasses and soft contact lenses. Mini-scleral, semi- scleral and scleral contact lenses are safe options in the management of irregular corneas. Because of heavy costs of scleral lenses, hybrid lenses with the comfort of the soft lenses and the optical quality of the hard lenses are developed [2]. This article reports the efficiency and accuracy of hybrid contact lens known as Clear Kone (Synerg Eyes Inc., Carlsbad, CA) in patients with moderate to severe keratoconus. Methods This study was performed in Medical Park Hospital, Antalya, Turkey. The patients were requested to sign informed consent forms. Patients had been previously diagnosed with keratoconus by corneal topography (Pentacam HR, Oculus, Wetzlar, Germany) and bio microscopic findings of Fleisher ring and Vogt lines. Inclusion criteria were keratoconus patients with severe visual problems and indication of intra corneal ring or transplantation surgery by another eye center. Cross linking was performed for all patients before the study. All patients were not appropriate for rigid gas permeable (RGP) lenses. All eyes were fitted with Clear Kone hybrid keratoconus lenses. The fitting is based on the concept of sagittal depth called as vault in relation to the cornea. Skirt curvature was determined as steep, median or flat according to limbus. Proper fitting was observed with using sodium fluorescein. After fitting, control of lens movement, vision and corneal epitelium were performed, 3 hours later. Corneal topography findings, pachymetry and refraction and vision were determined every 6 months. Results In this study, 19 eyes of 11 patients (6 men and 5 women) with a mean age of 26, 4 (16-43) were evaluated. Keratometry findings are between55-75 (Kmax). Before using contact lens, uncorrected and best corrected visual acuity with glasses were 0, 74±0, 3 LogMAR and 0, 58±0, 22 Log MAR respectively. Visual acuity with hybrid contact lenses was 0, 09±0, 05 LogMAR (Table 1). Mean follow-up was 7, 2 months (4-12 months). One patient didn't tolerate because of corneal edema. Discussion The first treatment choice for a patient with keratoconus is using a RGP lens [3]. Therefore, most of these patients, visions not corrected by glasses or soft contact lenses, have already tried the RGP lenses. The potential challenges associated with fitting rigid lenses are suboptimal initial comfort on non adapted eyes, the potential for lens decentration and the risk of lens ejection. Soft contact lenses have more comfort but less visual correction especially in advanced disease. Aim of hybrid lens is to combine the preferred properties of rigid and soft contact lenses [4]. Hybrid lenses are combines of a center-zone rigid lens and a peripheral zone soft skirt. Clear Kone lens which is used this study requires the determination of two fitting parameters, vault for rigid component and skirt curvature for soft component [5]. Due to design of the hybrid lens, most of the refraction power is provided by the tear layer, which increases the optical quality and oxygen supply of the cornea. Additionally, a little space between cornea and hard part of the lens prevents mechanical abrasion of the cornea [4] (Figure 1). In our study, all patients have moderate to severe keratoconus and discomfort while using RGP lenses. Because of this condition, by other eye centers, corneal ring or keratoplasty were advised. Before the surgical treatment, we wanted to try another non- invasive management, hybrid lens fitting. Disadvantage of using hybrid lens, Clear Kone Synerg Eyes, is that this process is time consuming and requires more patience. Because of this, for appropriate final lens and shortening of process, we used the parameters of RGP lenses. This approach improved patients' compliances. Clear Kone lenses with hard central part and tears between lens and cornea improve vision. In our study, all patients had a good visual outcome. Soft peripheral part provides stability and comfort. Except one patient, 10 of 11 patients had a good comfort. According to findings of this study, using hybrid lens on the keratoconus patients can be good choise for the patients with moderate to severe disease with discomfort of soft or hard lenses before thinking surgical management.

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journalofsportsmedicine · 3 years

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Juniper Publishers- Journal of Physical Fitness, Medicine & Treatment in Sports

Static and Dynamic Balancing and Gait Training in Shooters Leading to a Better Efficacy-A Prospective Study- Juniper Publishers Introduction

The ability to walk upright is a defining characteristic of man. Gait is the way walking is performed and can be normal, antalgic, or unsteady [1]. Gait analysis can be assessed by various techniques but is most commonly performed by clinical evaluation incorporating the individual’s history, physical examination, and functional assessment. Gait abnormalities can be more precisely examined using gait laboratories. These laboratories utilize surface EMG activity of muscles, force plates, and kinematic evaluation of the lower limbs. They are highly specialized units that assess various gait abnormalities from individuals with neuromuscular disorders to high-level athletics. A proper clinical evaluation should always precede any gait lab assessment [2]. The determination of abnormal gait requires one to first understand the basic physiology and biomechanics of normal gait [3]. The gait cycle is a time interval or sequence of motion occurring from heel strike to heel strike of the same foot. The gait cycle has been broadly divided into two phases: stance phase and swing phase. These phases can then be further subdivided and discussed in terms of percentage of each within the gait cycle (Figure 1).

The stance phase is 60 percent of the gait cycle and can be subdivided into double-leg and single-leg stance. In double-leg stance, both feet are in contact with the ground. At an average walking speed, it represents 10percent of the entire gait cycle, but decreases with increased walking speed and ultimately disappears as one begins to run. At slower walking velocities the double-leg support times are greater. Single-leg stance comprises up to 40 percent of the normal gait cycle [4]. The muscles that are active during the stance phase act to prevent buckling of the support limb. These include the tibialis anterior, the quadriceps, the hamstrings, the hip abductors, the gluteus maximus, and erector spinae. The swing phase is described when the limb is not weight bearing and represents 40 percent of a single gait cycle. It is subdivided into three phases: initial swing(acceleration), mid swing, and terminal swing (deceleration). Acceleration occurs as the foot is lifted from the floor and, during this time, the swing leg is rapidly accelerated forward by hip and knee flexion along with ankle dorsi flexion. Midswing occurs when the accelerating limb is aligned with the stance limb. Terminal swing then occurs as the decelerating leg prepares for contact with the floor and is controlled by the hamstring muscles.

Determinants of Gait and Energy Conservation

During gait, three main events occur in which energy is consumed. This includes controlling forward movement during deceleration toward the end of swing phase, shock absorption at heel strike, and propulsion during push off, when the center of gravity is propelled up and forward. A human’s center of mass (COM) is located just anterior to the second sacral vertebra, midway between both hip joints [5]. The least amount of energy is required when a body moves along a straight line, with the COM deviating neither up nor down, nor side to side. Such a straight line would be possible in normal gait if man’s lower limbs terminated in wheels instead of feet. This obviously is not the case, thus, our COM deviates from the straight line in vertical and lateral sinusoidal displacements. With respect to vertical displacement: the COM goes through rhythmic upward and downward motion as it moves forward. The highest point occurs at midstance, the lowest point occurs at time of double support. The average amount of vertical displacement in the adult male is approximately 5cm. With respect to lateral displacements: As weight is transferred from one leg to the other, there is shift of the pelvis to the weight-bearing side. The oscillation of the COM amounts to side-to-side displacement of approximately 5cm. The lateral limits are reached at midstance. Any pathology that increases the vertical distance between the high and low points, increases the energy cost of ambulation (Figures 2 & 3).

Methodology

A total of 32 shooters were examined clinically and gait analysis was performed on them thereafter with a proper consent for participation in the study at ABHINAV BINDRA TARGETING PERFORMANCE, INDIA from a period of January 2019 to May 2019 (Figure 4).

Aims & Objectives

Gait analysis and pelvis muscles assessment for shooters prior to training and comparing the assessment post training, effect of stability and strengthening for improving the efficacy of the shooters.

Discussion

The analysis of pre and post static balance as well as dynamic balance for both groups and the comparison of the post balance test of two groups were analyzed by using independent sample t-test. First, the GAIT assessment scoring of firm surface before the study among the control group was 5.14±1.069 and increased to 5.39±1.704, which did not show significant at 5% level of significance (ρ>0.05). while the scoring of foam surface before study was 7.79±0.851 and increased to 7.53±1.372, therefore it was not significant at 5% level of significance (ρ>0.05). On the other hand, the scoring of GAIT assessment for firm before the intervention among the experimental group was 5.34±1.269 and after the intervention training program, it reduced to 2.90±1.190 which showed significant improvement with ρ<0.05. The dynamic balance results were reported on left and right stance. The higher the score the better the dynamic balance of the individual.

The shooters scores of mean and standard deviation of left stance before the study among the control group before test was 77.36±4.137 and after test score was 74.79±7.156, which the improvement did not show statically significant; whereas in right stance, before test was 76.37±6.785 and after test was 72.58±7.960 after four weeks of study and the improvement did not show statically significant. However, the score for experimental group in left stance was 75.31±5.334 before the intervention and improved to 82.14±5.661 after a month intervention training, and it was significant at 5% level of significance (ρ<0.05). Meanwhile, the scoring of in right stance increased from 77.12±7.015-86.29±5.795 before and after intervention respectively. Thus, this showed that the result of left stance and right stance in SEBT indicated significant improvement (ρ<0.05). Meanwhile, for standing on firm surface, the mean score for the experimental group was 3.20±1.191 and for the control group was 5.79±1.504. The result indicated there was significant difference between the pre training and post training after a month’s study.

Result

The combination of the two exercises components in current study which were the balance exercises and jump landing training, gait training and static and dynamic balancing on firm and foam surface have drastically improved the ability of shooters to balance and aim accurately [6]. Thus, it is crucial that balance training should continue to be studied and promoted to ensure the improvement in static and dynamic balance and thus reducing the risks of injuries such as knee and ankle injuries and ensure the accuracy of shooters.

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juniperpublisherscasestudies · 3 years

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Juniper Publishers- Open Access Journal of Case Studies

Unusual Cause of Dyspnea and Chest Pain in Cardiac Patient

Authored by Ayman Helal

Abstract

Background: Postoperative dyspnea is common after cardiac surgery that may differ in causes. In common, it may be due to the incision, operation site, cardiopulmonary bypass, and internal thoracic artery harvesting, or lung diseases.

Case summary: Fifty-three years old female presents with dyspnea associated with limiting stitching chest pain 1 year after cardiac surgery. She was diagnosed to have bronchial asthma at this time and she was commenced on inhaled bronchodilators and inhaled steroids without any improvement. Echocardiography showed a good cardiac function, well-functioning prosthetic mitral valve, and a 0.3cm sub-aortic ventricular septal defect with left to right shunt which was insignificant. A respiratory function test demonstrated a restrictive lung disease. According to these results a chest x-ray was requested that revealed the presence of fractured sutures with some parts within the upper part of left side of the chest. A CT chest confirmed these findings and some of the fractured sutures even infiltrating the lung tissue. Fractured migrated sutures are the cause of the stitching chest pain that limit this patient’s inspiration.

Discussion: The integration of history taking, echocardiographic findings including shunt quantification, and the result of respiratory function test guide the diagnosis towards a restrictive lung disease which is demonstrated by the chest X-Ray and CT chest to be due to fractured migrated sutures that cause stitching chest pain that limit patient’s inspiration.

Keywords:Fractured suture; Dyspnea; Stitching chest pain; Post-operative

Learning Points

a) The importance of integrating history taking, examination, laboratory and radiological investigation to reach a final diagnosis.

b) Fractured sutures are not un-common after cardiac surgeries and should be suspected especially if there is dyspnea with stitching chest pain.

Introduction

Postoperative dyspnea is common after cardiac surgery, even in low-risk patients. Cardiac surgeons and anesthesiologists are familiar with patients suffering from dyspnea in the early postoperative period, but in some cases, conventional treatment strategies may be ineffective, and a consultation with a pulmonologist may be required. Causes of dyspnea may differ because of the incision, operation site, cardiopulmonary bypass, and internal thoracic artery harvesting, which are unique to cardiac surgery [1] (Table 1).

Case Presentation

Fifty-three years old female presents with gradual onset progressive course of shortness of breath for the last 5 years (since 2014). The dyspnea was associated with limiting stitching chest pain over the upper part of left side of the chest wall that increase with deep inspiration. The patient is known to be hypertensive for the last 5 years that was controlled on Bisoprolol 5mg/d and Candesartan 4mg/d. She has past medical history of mitral valve replacement in 1996 at which she was commenced on oral anticoagulant (Warfarin 5mg/d with a stable mean INR of 2.5). She underwent another operation in 2013 for removal of a missed sub-aortic membrane and thyroidectomy at the same time!!!. She sake medical advice many times during this period and she was told that she has bronchial asthma and she was commenced on inhaled bronchodilators and inhaled steroids without any improvement.

On examination, her vital signs were (Pulse= 90/min, Blood pressure=130/85mmHg, Respiratory rate=30/min, Temperature= 37oC). General examination revealed normal JVP, normal chest examination (vesicular breathing without any additional sounds) apart from sternotomy and thyroidectomy scars, and normal abdominal examination and normal upper and lower limbs without any edema. Local cardiac examination demonstrated normal prosthetic metallic mitral valve sound with a pan-systolic murmur over A2 area associated with thrill.

Routine investigations were unremarkable (Table 2). ECG was normal (Figure 1). Echocardiography was performed that showed a good cardiac function, well-functioning prosthetic mitral valve (PPG=22mmHg, MPG=9, MVA=1.7cm2), and a 0.3cm sub-aortic ventricular septal defect with left to right shunt (Figure 2, video link: https://www.youtube.com/watch?v=73JbbJrSKdI). The shunt is shown to be in-significant as the calculated Qp/Qs were 1.44 (Figure 3). A respiratory function test (Table 3) was requested that demonstrated a restrictive rather than obstructive lung disease. According to these results a chest x-ray was requested that revealed the presence of fractured sutures with some parts within the upper part of left side of the chest (Figure 4). A CT chest was performed and confirmed the site of fractured wires with some of them inside and outside the chest wall and some of them even infiltrating the lung parenchyma. Fractured migrated sutures are the cause of the stitching chest pain that limit this patient’s inspiration (Figure 5).

Discussion

This case presents the importance of integrating history taking, examination, laboratory and radiological investigation to reach a final diagnosis. One can say that the residual ASD after sub-aortic membrane removal is the cause of dyspnea and sent the patient to surgery for the 3rd time but the history, shunt quantification, and the result of respiratory function test guide the diagnosis towards a restrictive lung disease which is demonstrated by the chest X-Ray and CT chest. Fractured migrated sutures are the cause of the stitching chest pain that limit patient’s inspiration.

Moreover, other one may suspect coronary artery disease as it is a disease with high prevalence worldwide especially in Egypt [2]. Mainly, two reasons respond for the sternal wire fracture: the overloading due to the patient’s activity and the wire mechanical fatigue, such as growth of sternum, activities, and the sharp increase of wires’ yield strength. Usually, wire fracture occurs a week or more after surgery [3].

Conclusion

Fractured migrated sutures are the cause of the stitching chest pain that limit patient’s inspiration.

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Juniper Publishers| A Review of Indication and Complications of Extracorporeal Membrane Oxygenation

Journal of Surgery

JuniperPublishers

Abstract

Mechanical circulatory support may be the last life-saving resort in certain circumstances such as life-threatening pulmonary failure, cardiac failure, or both. ECMO has been shown to provide adequate cardiopulmonary support and can be initiated rapidly in an emergent setting by either percutaneous or surgical implantation. It allows bridging of patients with cardio-pulmonary collapse to recovery or long-term mechanical support. Veno-arterial ECMO (VA-ECMO) is used as bridge-to-decision and/or bridge-to-recovery in patients with cardiogenic shock. Long-term mechanical circulatory support devices such as left ventricular assist devices (LVADs) are widely available and play a central role in bridge-to-transplantation in those eligible for heart transplantation (HTX) and as destination therapy (DT) in those not eligible for HTX. LVAD-implantation or HTX in patients with acute cardiogenic shock is associated with dismal outcomes; this illustrates the importance and necessity for short-term support like ECMO. This manuscript provides an overview of indications, outcome, and complications of ECMO.

Keywords: Acute cardiogenic shock; Mechanical circulatory assist device; Extracorporeal membrane oxygenation; Bridging to transplantation; Left ventricular assist device

Abbreviations: VA-ECMO: Veno-Arterial ECMO; LVADs: Left Ventricular Assist Devices; HTX: Heart Transplantation; DT: Destination Therapy; CPB: Cardiopulmonary Bypass; VV: Venovenous; VA: Venoarterial; PCI: Percutaneous Coronary Intervention; VAD: Ventricular Assist Device; IABP: Intra-Aortic Balloon Pump; AFM: Acute Fulminant Myocarditis; AKI: Acute Kidney Injury; CRRT: Continuous Renal Replacement Therapy; ELSO: International Extracorporeal Life Support Organization; APACHE: Acute Physiology and Chronic Health Evaluation

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Historic Background

It is controversial to refer to ECMO as a cardiopulmonary bypass (CPB); however, ECMO is based on the same principle -- in other words, ECMO is a variation of CPB and may be viewed as prolonged cardiopulmonary bypass, allowing for a prolonged cardiopulmonary support [1,2]. The history of ECMO is date back to invention of CPB. Gibbon attempted to create a heart-lung machine and designed an oxygenator, where the anticoagulated blood was exposed directly to oxygen (bubble oxygenators). However, this approach caused severe hemolysis, thrombocytopenia, hemorrhage and multiorgan failure [3]. In 1956, Clowes et al. [4] introduced the membrane oxygenator that separated blood from oxygen by a membrane, securing efficient and safe blood oxygenation and fewer complications compared to film or bubble oxygenators. In 1983, Larm et al. [5] introduced a new ECMO system in which heparin molecules are covalently bonded to the synthetic surfaces of the ECMO circuit. The heparin coating of the ECMO circuit comes into contact with the blood, reducing complications significantly [6]. In a prospective randomized controlled study, Knoch et al. [7] reported that the use of heparin-coated circuits and oxygenators reduces blood loss and the need for blood transfusion. Introduction of heparin-coated ECMO circuit revitalized this technology.

Indication

Fundamentally, ECMO is used as a bridge to an eventual recovery in patients with cardiogenic shock [8-10]. The indication for ECMO has been divided into three major categories: cardiogenic, respiratory, or cardiopulmonary failure. There are two primary forms of ECMO, based on the indication and the type of access: venovenous (VV) and venoarterial (VA). Table 1 demonstrates some of the characteristics of VV- and VA-ECMOs [1]. ECMO management (i.e., how ECMO should be utilized once initiated) is based on consensus guidelines and institutional experience; however, there are not established guidelines regarding the indication and timing for the initiation of ECMO support and the approach should be individualized to each patient’s condition [2,11]. ECMO can also be used as temporary hemodynamic support in order to perform an invasive cardiac treatment (percutaneous coronary intervention (PCI)), or to assess the eligibility of the patient for LVAD placement [1,2].

A. Cardiogenic shock

ECMO is indicated for the management of refractory cardiac or cardiopulmonary failure. While it is used in a variety of clinical scenarios, the outcome often depends on the primary indication [15,19,20]. Postcardiotomy shock, the main indication for ECMO in adult populations (occurs in 0.5% to 1.5% of cases), is defined as the inability to wean the patient from extracorporeal circulation using inotropic and vasoactive drugs as well as an intra-aortic balloon pump (IABP) [20-22]. ECMO may allow the affected organ to recover (bridge to recovery) or provide enough time for the decision (bridge to decision) and prepare the patient for a long-lasting organ substitution either by a ventricular assist device (bridge to bridge, or destination LVAD) or transplantation [23]. ECMO can be used to bridge patients with end-stage heart failure to heart transplant [12,24]. Earlier initiation of ECMO may prevent complications and improve outcomes [25]. It provides temporary assisted circulation, (partial) off-loading of LV, and respiratory support to prevent multisystem organ failure and death [10,21,26].

B. Acute fulminant myocarditis

Acute fulminant myocarditis (AFM) carries high mortality and those affected are candidates for short-term mechanical support. Though highly morbid, most patients with AFM recover and are weaned from ECMO [27]. In a retrospective review of Extracorporeal Life Support Organization Registry database (n=19,348 patients), 260 ECMO patients (1.3%) had AFM. Survival to discharge from the hospital was 61%. The female gender, arrhythmia while on ECMO, and acute renal failure requiring dialysis were predictors of worse outcomes in patients with AFM who received ECMO [28]. In a different series of 75 patients with AFM, the survival to discharge was 64% (n = 48). Pre-ECMO resuscitation did not have a negative impact on survival [27]. In a larger series of patients with acute cardiogenic shock, 11 patients had fulminant myocarditis. Eight patients recovered and one was successfully transplanted. All three deaths were due to neurologic complications [29].

Furthermore, using ECMO during pregnancy was discouraged in the past, with the assumption of increased risk of bleeding as well as increased fetal and maternal mortality. However, a recent metaanaylsis demonstrated the safety of ECMO for severe cardiopulmonary failure during pregnancy. The overall maternal and fetal survival on ECMO has been reported to be about 80% and 70%, respectively. Meticulous anticoagulation at lower therapeutic levels may be required [30].

C. Septic shock

ECMO is a valuable therapeutic option for adults in severe septic shock with refractory cardiac and hemodynamic failure. Brechot et al. [28] reported using ECMO for hemodynamic support of patients with severe septic shock refractory to medical management. All patients had severe myocardial dysfunction (EF10%-30%). Twelve patients (86%) could be weaned off ECMO after 5.5 days of support and 10 patients (71%) recovered to be discharged from hospital and remained alive at a mean follow up of 13 months [28]. However, Huang et al. [31] reported a series of 52 adult patients in refractory septic shock, who received VA-ECMO, with only 15% (n=8) survival. The authors reported that using ECMO in adult patients with refractory septic shock is associated with unsatisfactory outcome [31]. ECMO has also been utilized to stabilize adult trauma patients in the presence of coagulopathy and/or brain injury. The benefits include rapid re-warming, acid base correction, oxygenation, and circulatory support [28].

D. ECMO after Heart Transplant, Acute Graft Failure

Acute graft failure following heart transplant is a serious complication and ECMO support might be beneficial. A retrospective review of 385 consecutive heart transplants revealed that 46 patients suffered acute graft failure requiring ECMO support. The overall success rate, defined as removal of ECMO, was 47.9%; 51.4% for early graft failures and 50% for late graft failure, while the long-term outcome remained similar. Any graft failure requiring mechanical support is associated with high mortality and unfavorable short- and long-term outcome [32].

E. TAVR

Considering the evolving field of enodvascular procedures, and the complexity of procedure performed in multimorbid ever aging patient population, ECMO may provide adequate short term cardiopulmonary support during TAVR on emergency or prophylactic bases. High Euro-score might be an indication for using prophylactic VA-ECMO support during complex endovascular procedures. Life-threatening complications during TAVR can be managed using emergency VA-ECMO but mortality remains high [33].

F. Hypothermia

ECMO has been used to resuscitate patients with severe accidental hypothermia with or without cardiac arrest (n=26). Sawamoto et al. [34] reported a survival rate of 38.5% in a series of 26 patients. While neurological outcome was generally acceptable at discharge; a cardiac rhythm other than asystole, nonasphyxial hypothermia, higher pH, and lower serum lactate were associated with more favorable neurological outcome [34]. Considering these patients’ condition prior to initiation of ECMO, the neurologic injury may not be an immediate complication of ECMO, rather a feature of their condition on presentation.

G. Technical aspects

The cannulation can be done either peripherally or centrally. After gas exchange in vitro, the blood is returned either peripherally or centrally into the patient’s venous or arterial system, depending on type of ECMO [35]. Components utilized for conduction of ECMO include: a pump, an oxygenator, and a circuit. The oxygenation of blood occurs via a membrane, which is a cylindrical rotor comprised of a strong textile support coated by a plastic microporous film [36]. Currently, the most efficient systems utilize a small centrifugal pump and a low-resistance polymethylpentene-oxygenator. Models such as the RotaFlow (Maquet, Jostra Medizintechnik AG, Hirrlingen, Germany) and CentriMag (Levitronix LCC, Waltham, MA, USA) are used for this propose [37]. ECMO flow depends on the available volume in the heart chambers, the speed of the pump, and the vascular resistance. Attention should be paid to avoid hypovolemia, cannula malposition, pneumothorax, and pericardial tamponade.

H. Central vs peripheral cannulation

ECMO can be placed either centrally (Figure 1) through a sternotomy or peripherally, percutaneous (Figure 2), frequently using the femoral artery and vein [38]. Central ECMO cannulationis achieved with direct cannulation of the aorta and provides antegrade flow to the arch vessels, coronaries, and the rest of the body. In contrast, the retrograde aortic flow by peripheral ECMO leads to mixing of the blood in the arch or descending aorta and may not adequately supply the arch vessels with oxygenated blood. In certain patients with cardiac or respiratory failure who have recently undergone cardiac surgery, transthoracic cannulation of the right atrial appendage and the ascending aorta is performed. A disadvantage of central cannulation is that the chest must be left open which is associated with increased risk of infection and bleeding. Newer cannulae are designed to be tunneled percuatneously through the subcostal margin and abdominal wall, allowing the chest to be closed. Transthoracic cannulation may allow better left heart decompression and oxygenation of vital organs.

On the other hand, percutaneous cannulation is less invasive and can be performed at the bed side with the guidance of transthoracic echocardiogram [39]. The major disadvantages of the transthoracic approach are vascular injury during cannulation and ischemia of ipsilateral lower extremity distal to the cannulation site. ECMO through peripheral vessels is associated with early [40] and late vascular complications at the femoral access site [41]. However, some authors advocate peripheral cannulation in selected patients. Using femoral vessels is an established access route for peripherally-inserted ECMO. However, in some patients, alternative cannulation sites should be considered [42]. However, in a retrospective series of 50 ECMO cases, the cannulation was performed either by central or peripheral cannulation. The authors did not report any difference in the incidence of ischemia or compartment syndrome in the lower extremities, while central cannulation was associated with a higher risk of bleeding, need for transfusion, and greater utilization of resources. There was no difference in 30-day mortality [38]. Difficulty during ECMO placement or removal and a history of peripheral vascular disease are predictors of long-term vascular complications [26,41]. Symmetrical peripheral gangrene is an unusual complication of ECMO that may arise in the setting of DIC, sepsis, or other hemostatic and/ or hemodynamic imbalance [40]. Minor vascular complications after ECMO support are not associated with higher mortality rates [43].

I. ECMO via axillary artery

ECMO via axillary cannulation, though still considered peripheral, allows for antegrade perfusion and supplies the aortic arch vessels with adequately oxygenated blood. Axillary artery cannulation is commonly performed through a Dacron graft sutured in an end-to-side fashion to the axillary artery. Direct cannulation of the axillary artery is a reliable option with an acceptable complication rate [44-47]. Exposure of the artery is achieved via the deltoid-pectoral approach. Advantages of axillary artery cannulation are the nearly central cannulation with antegrade perfusion and excellent upper body oxygenation. It also allows for chest closure after postcardiotomy shock or avoids the sterntomy in the first place [45]. Axillary cannulation is a viable option, especially in patients with significant peripheral vascular disease, [45,48] and may avoid many complications inherent to transfemoral ECMO. However, hematoma formation has been reported which may cause injury to the nearby brachial plexus [48].

In a series of 308 adult ECMO patients, axillary artery cannulation was performed in 81 patients (26.3%), 166 patients (53.9%) received femoral arterial cannulation, and 61 (19.8%) underwent ascending aortic cannulation. The most common complication following axillary cannulation was hyperperfusion syndrome of the ipsilateral upper extremity (up to 25%), followed by bleeding from the arterial outflow graft. Lower extremity ischemia and fasciotomy were the most frequent complications after femoral arterial cannulation [49]. Wada et al. [50] compared the efficacy of transfemoral with transaxillary ECMO in a canine model. Percutaneous cardiopulmonary support was initiated via the left femoral artery and then switched to the right axillary artery. Cerebral tissue oxygen saturation was 54.2±3.4% with femoral artery cannulation verses 82.3±4.6% during axillary artery cannulation. LV dP/dt max as a sign of myocardial contractility increased significantly after switching to the axillary perfusion [50].

Comparing central (n=65; 53.7%) vs peripheral (n=55; 46.2%) cannulation for ECMO, Loforte et al. [37] reported overall survival of 64.7% (n=77), weaning from mechanical support (n=51; 42.8%) and bridge to heart transplantation (n=26; 21.8%). Regardless of cannulation site, the overall mortality was 35% (n=42). Serum lactate levels, creatine kinase-MB relative index at 72h after ECMO initiation and number of packed red blood cells (PRBCs) transfused on ECMO were predictors of mortality. The central ECMO cannulation group had a higher rate of bleeding events compared with the peripheral cannulation group [37]. Saeed et al. [51] compared peripheral access (n=25) with the central approach (n=12) in 37 patients. While, 11(44%) of the pECMO patients required exploration for bleeding compared to 100% of patients with cECMO. The same study reported a 30-day mortality in patients with pECMO and cECMO of 60% versus 67%, respectively [51].

J. Complications of ECMO

ECMO complications include those associated with cannulation (pneumothorax, vascular disruptions, bleeding, infection, emboli), systemic anticoagulation (GI bleeding, intracranial bleeding, etc), and exsanguination resulting from circuit disruptions. The majority of complications fall into one of three major categories: bleeding, sepsis with multisystem organ failure, or neurologic sequelae. Bleeding and hemolysis, which are out of proportion to the severity of coagulopathy, may occur while on ECMO support; [25,26,52-54] cardiac tamponade and acute renal insufficiency may also occur [21]. Some of the major complications and contraindications are shown in (Table 2) [9,18,22,27,55-63].

In a meta analysis which included 12 studies (n=1763 patients), the most common complications associated with ECMO were renal failure/dialysis (occurring in 52%), bacterial pneumonia (33%), bleeding (33%), oxygenator dysfunction requiring replacement (29%), and sepsis (26%). Pneumonia, sepsis, arrhythmia, and multisystem organ failure comprise additional complications of prolonged ECMO support [54-57]. In a series of 117 postcardiotomy ECMO patients, the most common complications were re- exploration for bleeding (n = 24), alimentary tract hemorrhage (n = 14), renal failure requiring renal replacement therapy (n = 29), infection (n = 32), limb ischemia (n = 5), oxygenators malfunction (n = 29), and hemolysis (n = 7). Overall, 87 patients (74.4%) were successfully weaned from ECMO and 69 patients survived to discharge [25]. In another series of 129 patients undergoing VA-ECMO 59 patients (38%) were weaned, 7 (5.4%) were bridged to a LVAD, and 6 (5.2%) were listed for heart transplantation [64]. Overall mortality was reported as 54%, with 45% of events during ECMO support and 13% after weaning.

Finally, In a metaanalysis by Cheng et al. [65] including 1,866 patients, major complications were: lower extremity ischemia (16.9%), fasciotomy or compartment syndrome (10.3%), lower extremity amputation (4.7%), stroke (5.9%), neurologic complications (13.3%), acute kidney injury (55.6%), need for hemodialysis (46.0%), major or significant bleeding 40.8%, rethoracotomy for bleeding or tamponade in postcardiotomy patients (41.9%), liver dysfunction, and infection (30.4%). Survival to hospital discharge ranged from 20.8% to 65.4% [65]. Device-related complications include tubing rupture, pump malfunction, oxygenator failure, heat exchanger malfunction, and cannula-related problems [66]. Lewandowski et al. [67] reported a total of 27 device related complications during 27,137 hours of ECMO support. The documented complications included pump malfunction (n=6), tubing rupture (n=6), and cannula placement or removal problems (n=5) [67].

a) Bleeding

Continuous activation of fibrinolytic systems by the circuit and consumption and dilution of coagulation factors may occur. Platelets may adhere to the circuit surface and become activated, resulting in platelet aggregation, clumping, and subsequent thrombocytopenia [68]. A plasma free hemoglobin > 10 mg% may indicate hemolysis [69]. Bleeding seems partly related to intravenous heparinization, [25,26,53,54,70,71] and can be managed in any standard situation by decreasing or stopping heparin and infusing platelets and blood products. However, increased red blood cell transfusion is associated with adverse outcomes in ECMO patients [70]. Smith et al. [70] reported in 484 ECMO runs with a median duration of ECMO support of 4.6 days that patients with post cardiotomy cardiogenic shock required increased RBC transfusion compared to other patients with cardiogenic shock. A higher RBC transfusion rate carried higher in-hospital mortality. A lower baseline hematocrit and increasing duration of ECMO support were risk factors for increased RBC transfusion [71]. Regular monitoring of coagulation profile, platelet count, hemoglobin, and creatinine are the routine, while an early replacement of clotting factors and electrolytes may prevent complications [69]. In addition to bleeding at the surgical site, other bleeding related complications include intracerebral bleeds [9,18,22,27,55-63].

b) AKI

Acute kidney injury (AKI) is a major complication and is associated with high mortality in adult ECMO patients. Oliguria followed by acute tubular necrosis occurs with AKI, which may require hemofiltration and dialysis [56-58]. The impact of fluid status, while on ECMO, was evaluated in 115 patients with acute cardiogenic shock and 57 patients with refractory respiratory failure. Fifty-seven per cent of patients had acute kidney injury (AKI) after ECMO initiation, and 60% (n = 103) of patients received hemodialysis/continuous renal replacement therapy (CRRT) during ECMO course. Overall 90-day mortality was 24%. Acute Physiology and Chronic Health Evaluation (APACHE) III, CRRT during the first 3 days, major bleeding, and positive FB was independent predictors of 90-day mortality [72]. ECMO may alter serum concentration of drugs due to increased volume of distribution, which makes dose adjustments necessary [56,57].

K. Neurologic Complications

Neurologic adverse events range from gross motor delay to spastic quadriparesis and seizures. Intracranial bleeds, and hemorrhagic as well as embolic stroke, remain the main culprits for neurologic adverse events. Intracranial hematoma, while on ECMO, is a serious complication. Neurologic adverse events occur in approximately 7-15% patients [25,73,74]; while, systemic heparinization, thrombocytopenia, coagulopathies, and systolic hypertension are the major risk factors [73]. Although the risk is substantial, surgical evacuation of hemorrhage might be indicated in some patients [73]. Management of intraparenchymal hemorrhage while on ECMO has limited success and carries high rates of re-bleeding and in-hospital mortality (75%). Krenzlin et al. [75] reported such complications in 12 patients; 11 LVAD, and one ECMO. Surgical hematoma evacuation was performed in 11 patients; one patient received decompressive hemicraniectomy [75]. Reversing the anticoagulation may be lifesaving in those patients. Acidosis, renal failure, and cardiopulmonary resuscitation increase the risk of neurologic complications [76].

The survivors of prolonged ECMO may suffer from longterm neurologic sequelae, regardless of manifested neurologic complications during the time of ECMO support as noted [77,78]. Indeed, The intelligence quotient (IQ) scores of patients who received ECMO have been reported to be lower [74]. Moreover, ECMO is associated with an increased prevalence of long-term psychiatric disorders and distress [76,79]. While neurologic complications occur with prolonged ECMO support, in some patients, ECMO can prevent cerebral hypoperfusion and actually improve neurologic outcome after cardiac arrest.

L. Vascular complications

Peripheral vascular complications occur in less than 20% of patients and are more common with peripheral cannulation [80]. Among those patients who develop vascular complications, the most common indication for ECMO is cardiogenic shock [80]. In a series of 100 VA-ECMO patients, the majority of ischemic episodes were resolved or prevented with the insertion of a distal perfusion catheter [81]. An adequate distal limb perfusion via a 6-8 Fr cannula, placed in distal femoral artery, may reduce the risk. In a series of 83 ECMO patients; 45 received peripheral VA-ECMO. Distal limb perfusion was achieved with an introducer sheath (6-8 Fr) in 13 cases and with a distal-perfusion cannula (10-12 Fr) in 32 cases. Nine (20%) patients developed signs of ischemia; five (11.2%) were treated conservatively, while four (8.8%) required surgical intervention. The incidences of limb ischemia and limb ischemia requiring surgical intervention were significantly lower using the introducer sheath compared with the cannula [82]. In 101 patients receiving ECMO, vascular complications were observed more frequently in male patients (78%), in those receiving prolonged ECMO support, and in patients with chronic CHF (72%). Overall mortality was 42% (n=42) [80].

M. Infection on ECMO

Prolonged ECMO support is associated with higher infection rate [83]. In a series of 139 patients undergoing ECMO, 36 patients had a total 30 infectious episodes per 1,000 days of ECMO. Enterobacteriaceae and Candida were the most frequent pathogens. Infection did not significantly increase the risk of mortality, but the length of stay in the ICU and in hospital were prolonged following infection [83].

N. Risk Factors for Adverse Outcome

Wang et al. [84] reported 59% of patients (n=87) were successfully weaned from VA-ECMO and 49% were discharged. Older age (>65 years), postoperative hemodialysis, a peak lactate level (> 12 mmol), LVEF <40%, and prolonged ECMO support (>60 hours) were independent predictors of in-hospital mortality. IABP placement had a favorable impact on survival [84]. Prolonged ECMO support (48 hours) and incomplete sternal closure were significant risk factors for mortality [59]. Slottosch et al. [39] reported an overall 30-d mortality rate of 70% in 77 patients who required ECMO following cardiotomy. Age at ECMO implantation, high lactate levels, prolonged ECMO support, and gastrointestinal complications were independent predictors for 30-day mortality [39].

ECMO-assisted PCI for patients with AMI complicated by profound CS was shown to improve the 30-day and 1-year survival rates [85]. The 6-h pH value at the time of ECMO was an independent risk factor of 30-day mortality. Neither CPR nor implantation under ongoing CPR results in significant differences in outcome [86]. In a series of 129 patients undergoing VAECMO, myocardial function improved significantly. Lower dose of inotropes before ECMO was a positive predictor of weaning from ECMO. Longer ECMO support, transfusion rate, and central cannulation were predictor of unfavorable outcome, even after successful weaning from ECMO; 15 (31%) patients died following weaning from ECMO. Central ECMO, persistent RV failure, need for dialysis, higher inotropic score, lower systolic pressure, or higher leukocyte count at weaning correlated with mortality [64]. In a metaanalysis (12 studies, n=1763 patients), mostly VA-ECMO, for various pathology, the 30 day mortality was 54%; 45% while on ECMO and 13% after weaning. Almost 50% of patients receiving ECMO survived to be discharged.

O. ECMO and IABP

One important pitfall of ECMO is the inappropriate offloading of the LV, leading to pulmonary stasis and inadequate myocardial recovery. Off-loading the LV is crucial for possible myocardial recovery. Barbone et al. [87] used a 7F pigtail to offload the LV. The pigtail catheter was placed in LV through the aortic valve. The authors reported that this approach provided a better off-loading of LV and prevented distension as well as lung congestion [87]. Simultaneous IABP or a left ventricular vent may improve the LV off-loading [88]. Ma et al. [88] reported the benefits of IABP in 54 ECMO patients; 31 patients received IABP followed by ECMO, and the remaining patients had ECMO placement first prompted by LV distention and minimal opening of the aortic valve. The authors reported favorable outcome combining ECMO and IABP [88]. We recommend using a simultaneous IABP to offload the LV and improve the outcome.

P. Age

Survival to hospital discharge is lower in elderly patients (>65 years) who received ECMO support compared to younger adult patients (28.7% vs. 40.0%). In one study, a total of 212 patients received ECMO for cardiac (n = 126) or respiratory (n = 86) failure. The overall survival to discharge was 33%; older age, chronic cardiac related issues, and transfusions were predictors of unfavorable outcome. In another study, age was a significant risk factor in cardiac patients [89]. However, advanced age should not be an absolute contraindication for ECMO. The International Extracorporeal Life Support Organization (ELSO) registry database was used to investigate ECMO support among 99 elderly patients (>65 years of age, median age of 70 years). For survivors, the median time spent on ECMO was 69 hours, and the median time to discharge spent off ECMO was 587 hours. Overall, survival at hospital discharge was 22.2% (22/99). The presence of acute renal failure, which preceded ECMO placement, was found to be the most significant risk factor for mortality [90].

Q. Comment

Despite substantial mortality, ECMO implantation in selected patients might be a life preserving measure that otherwise would not survive. ECMO may result in recovery in 40%-60% of the patients with cardiogenic shock; this survival rate has remained stable over the past decade [9,18,22,27,55-63]. The favorable long-term outcomes of ECMO survivors may justify itsuse; however, the decision to utilize ECMO should be made on case by case bases depending on patient’s individual risk profile [84]. Patients with chronic heart failure may have structural remodeling in the myocardium and increased interstitial fibrosis, which results in a combined systolic and diastolic dysfunction [91]. These patients may not recover on ECMO and a long-term plan should be in place before placement of ECMO in this patient population. A preoperative poor left- ventricular ejection fraction, [92] systolic blood pressure <90 mmHg, poor myocardial systolic function, and severe refractory metabolic acidosis are associated with poor outcomes [93].

Although ECMO is associated with adverse events, the patients underlying condition may contribute significantly to this adverse event profile. Therefore, the terminology “ECMO mortality” most likely reflects the combined mortality of the patient’s already poor condition as well as ECMO itself, not ECMO alone. The efficacy of ECMO would be better evaluated in a prospective randomized clinical trial; however, given the end point of such a study would be death, a study of this kind cannot be ethically justified. Furthermore, only a small number of adult patient populations receive ECMO support, which makes it difficult to study the outcome and management of ECMO [94].

Once patients survive the acute phase of ECMO implementation, they have a reasonable long-term survival, [59] depending on the etiology of their underlying disease. Survival on ECMO depends on multiple factors such as patient’s age and etiology of the disease [55,64]. In a diverse group of 45 patients with cardiogenic shock who required temporary ECMO support, 27 patients could be successfully weaned from support (60%); additionally, five were bridged to heart transplantation. The in-hospital mortality was 42% (19/45). The main cause of death remained multisystem organ failure [26]. In a series of 108 patients with postcardiotomy cardiogenic shock [55], pediatric patients had the best survival (65.7%), followed by patients who suffered primary graft failure following cardiac transplantation (42.9%). The worst survival rates were observed with postcardiotomy shock (15.2%). Older age, high body weight, increased AST/GOT levels, thrombocytopenia, and higher serum creatinine were predictors of mortality [55]. These findings have been confirmed by other authors [60]. In addition, greater lactate levels after 24 h of ECMO therapy, lactate level during ECMO support, urine output, postoperative need for dialysis, serum total bilirubin >6 mg/dL, mean arterial pressure (MAP), duration of ECMO, low serum albumin level, low oxygen pressure of the venous tube of the ECMO, and pre-ECMO EF < 30% seem to be significant predictors of hospital mortality [22,60,62,63,78,93].

In a larger series of 137 ECMO patients, 39% of patients survived to be discharged home. Male gender, a longer duration of mechanical ventilation before initiation of ECMO, and renal or hepatic failure while on ECMO were risk factors for higher mortality [95]. Zangrillo et al. [96] did a meta-analysis including 12 studies (1763 patients) and reported a 30-days mortality of 54%; of which 45% occurred while on ECMO and 13% after weaning and explantation of ECMO [96]. Acute Physiology and Chronic Health Evaluation (APACHE) IV scores have been reported to have a prognostic value in patients who required postcardiotomy ECMO [60].

Patient selection, based on preoperative parameters and underlying condition of patients, though difficult, may be a major determining factor for a favorable outcome [97]. ECMO placement in a report of 517 postcardiotomy cardiogenic shock patients showed high weaning rate of 63%, while 24.8% were discharged from the hospital. Neurologic complications occurred in 17%. Age greater than 70 years, DM, preoperative renal insufficiency, EuroSCORE greater than 20%, and a lactate level greater than 4 mmol/L were significant risk factors of mortality. Isolated coronary artery bypass grafting had a positive impact on outcome [22]. Lan et al. [61] reported in a larger series of 607 adult patients that age, stroke, the need for dialysis during ECMO, pre-ECMO infection/bactermia, hypoglycemia, and alkalosis were independent predictors of mortality [61]. Wang et al. [59] reported a series of 62 patients who required temporary postcardiotomy ECMO support: 40 patients (64.5%) were successfully weaned from ECMO and 34 patients (54.8%) were discharged from hospital. With an in-hospital mortality of 45%, the main cause of death was multisystem organ failure [78]. Early ECMO placement may improve the outcome, i.e. successful weaning as well as shorter hospital stay [98] while, prolonged use of ECMO with refractory cardiac failure, respiratory failure, or both is associated with reduced survival [60].

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Summary

For some patients with acute cardiogenic shock or pulmonary failure, ECMO is the last life preserving option. It may provide partial biventricular off-loading as well as respiratory support. A recovery without the need for long-term extracorporeal circulation may be achieved in selected patients. Early implementation, control of complications, and meticulous management during ECMO and explantation of ECMO in a timely fashion can improve the patient outcome. Early placement may improve outcomes and give clinicians the necessary time for further work-up and bridge the patients to decision.

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juniperpublishers-fashion-b-blog · 5 years

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Application of Chitosan for Peripheral Nerve Repair - Juniper Publishers

Abstract

Regeneration and repair of peripheral nerves, as a prevalent medical problem was not satisfying and complete. This clinical problem is in accompany with loss of innervation in arms or legs, leading to the loss of motor and sensory function. Although, this problem is not lifethreatening, impose socio-economical pressure on individual and society. The worst case of a peripheral nerve trauma is the total disruption of the nerve (neurotmesis), which requires realignment. Chitosan, a natural polysaccharide, synthesized from chitin which is abundant in shrimps and crabs skeleton. Chitosan has excellent biocompatibility and biodegradability can be used as nerve conduit material. The purpose of this work was to study the ability of chitosan and some chitosan-derived materials to promote behavioral, functional and histological assessments in peripheral nerve regeneration and repair. Here, we mentioned the investigations about using chitosan and chitosan derivatives on regeneration and repair of peripheral nervous injuries.

Keywords: Chitosan; Peripheral nervous injury; Regeneration; Repair

Introduction

Chitosan (CS) is a polysaccharide achieved from N-deacetylation of chitin and it is a copolymer of D-glucosamine and N-acetyl-D-glucosamine. Nowadays there is increasing interest in CS in the field of tissue engineering, because it has anti-tumour and antibacterial activities, and also have biodegradabile and biocompatibile properties [1]. There is a similarity between Chitosan and glycosaminoglycans which is found in the basal membrane and extracellular matrix. It has important role in providing interactions between this chitinderivative and extracellular adhesive molecules such as laminin, fibronectin and collagen. So, much attention is focused on CS as a candidate material for neuroregeneration. It is reported that use of chitosan fibers make a similar guide for regenerating axons to Bungner bands in the nervous system by supporting the adhesion, migration and proliferation of Schwann cells (SCs) [1,2]. In this regard, a mixture of hydroxyapatite to provide mechanical support, chitosan derived from crab tendons and laminin to increase the growth of regenerating axons applied for regeneration and repair of a 15mm defect in a rat sciatic model [3].

In this study, histomorphic results showed improvement but functional and behavioral assessments did not improve in comparison with isograft group [4]. In another study, laminin which was conjugated to chitosan membrane used as a scaffold [5]. Laminin gave the membrane a flexible property which leads to better interaction with receptors in comparison with laminin alone [6]. Since progesterone and pregnenolone, the precursor of progesterone has important role in myelination, in a study, investigators used chitosan for delivery of progesterone to the site of injury in a rabbits’ facial nerve injury model [7,8] by significantly increasing the number of myelinated fibres and the regenerated area when compared to chitosan group [9]. At the site of injury, there was no evidence of inflammatory response and infection. The spongy forms of chitosan conduit increase the permeability and have beneficial effects on nerve regeneration. Since the duration of progesterone release was not enough for nerve regeneration, investigators used a crosslinking format of progesterone to chitosan conduit. This form of combination had three properties for chitosan scaffolds including reduction of swelling degree and rate of degradation and also enhancing their hydrophilicity and elasticity. In this regard, hexa methylene di iso cyanate cross linking to chitosan increased fibronectin and laminin adsorption which leads to an increase in the spread and proliferation of Schwann cells [10].

Using chitosan conduits had appropriate mechanical properties and the rate of degradation is low [11]. It is reported that a mixture of chitosan and gelatin improved the elasticity and increase the ability for adhesion of axon regeneration [12]. Chitosan and poly-l-lysin had higher hydrophile surface in comparison with collagen and improves the nerve regeneration [13].

Conclusion

Now a days, one serious health problem is peripheral nerve injury. Tissue engineering as an interdisciplinary field which combined life science and engineering is promising in regeneration and repair of peripheral nerve injuries. Scaffolds are noticeable components of tissue engineering and regenerative medicine which helps proper growth of regenerating axons on its bed. Scaffolds should be biocompatible, biodegradable, nontoxic, anti-inflammatory, anti-bacterial properties. Chitosan has similar molecular structure to components of extracellular matrix and is a promising candidate material for nerve regeneration.

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juniperpublishersoceanography · 4 years

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The Effect of Salinity Acclimation on the Upper Thermal Tolerance Threshold of the European Green Crab

Abstract

Fluctuations in salinity and temperature, among other varying environmental conditions, are stressors in estuaries and may work together to alter the physiological response of organisms that inhabit such environments. Laboratory assessments that investigate how animals respond to multiple environmental stressors can provide an ecological framework for understanding physiological performance across varying conditions. In this study, European green crabs, Carcinus maenas, were collected from Seadrift Lagoon, California, USA (37°54′27.82″N, 122°40′19.56″W) and were lab-acclimated at three different salinity concentrations typical of many estuaries: 15, 25, and 35 PSU at 12 °C (± 1 °C). After acclimation, crabs from each salinity treatment experienced a temperature ramp of 2 °C every 30min until they reached their critical thermal maxima (CTmax). Crabs held at 15 PSU acclimation treatment died at significantly lower temperatures than those acclimated to 25 PSU, demonstrating that the upper thermal tolerance of C. maenas is decreased at lower salinities. Hence, crabs in the northeast Pacific, which are limited to estuarine and brackish waters by marine predators, may be physiologically limited from further expanding their southern range boundary due to the effect of increased temperature on physiological performance. This work took place in March, 2013 and highlights the importance of examining the effect of multiple stressors to understanding what factors may limit or enhance range shifts.

Keywords: Carcinus maenas; Multi-stressor; Salinity acclimation; Thermal tolerance; Abiotic resistance; Invasive species

Introduction

Ecophysiological research has historically focused on altering one abiotic variable at a time to measure the physiological response to that variable. However, examining how multiple stressors affect organisms provides a more holistic view into factors that govern distribution and abundance of species [1-3]. The intersection of fresh and salt water, coupled with thermal fluctuations typical of estuaries can affect physiological performance, leading to geographic distribution limitations of estuarine organisms Sokolova et al. [4]. Additionally, along the west coast of North America, the estuarine distribution of Carcinus maenas has been attributed to predation by a larger, aggressive native crab Hunt & Yamada [5].

Owing to their broad thermal and salinity tolerance, C. maenas has successfully invaded coastal habitats of four continents, including the west coast of North America [6-8]. In addition, C. maenas can survive and reproduce in a wide range of salinity concentrations because they are proficient osmoregulators [9]. Nagaraj [6] found that salinity had little to no effect on developmental rates of C. maenas; however, zoeae kept in high salinity treatments (25 and 35ppt) had the greatest survival rates at the lowest experimental temperature, ~10 °C [6]. While these studies are informative, they do not necessarily reflect the dynamic abiotic environment that C. maenas inhabits.

In the eastern Pacific, C. maenas is preyed upon by native crabs, limiting their habitat use of the open coast, consequently forcing C. maenas to occupy areas with greater temperature and salinity fluctuations [5]. As such, C. maenas populations generally reside in upper estuaries, which are characteristically warmer and less salinated [5]. For C. maenas specifically, exposure to lower salinities leads to increased oxygen demand (i.e. increased anaerobic metabolic rate) as a means to offset the concomitant increase in hemolymph pH, which in turn affects the hemolymph’s O2 affinity [10]. The variable salinity concentration of estuaries in conjunction with their often warmer conditions [5] may combine to limit the ability of C. maenas to mount robust heat stress response, thus lowering the upper thermal tolerance, despite it being a euryhaline hyperosmotic regulator. Ionic stress combined with heat stress has been investigated in larval C. maenas; however, the effect of variations in salinity concentrations on adult crab upper thermal tolerance has yet to be investigated. To better understand how variations in salinity affect the upper thermal tolerance of adult crabs, animals were acclimated to three different salinity concentrations common to estuaries and then were subject to acute heat stress. Given that C. maenas is an osmoregulator, such that decreased salinity increases metabolic demand, we hypothesized that a reduction in salinity would circumvent the ability of C. maenas to mount a robust response to heat stress, thus reducing organismal thermotolerance.

Methods

Sampling, maintenance, and salinity treatments

Male and female Carcinus maenas were collected from Seadrift Lagoon, Stinson Beach, California, USA in August 2012, and transported to Portland State University, Oregon, USA. The crabs were temperature acclimated at 12 °C (± 1 °C) and 30 PSU for approximately 210d prior to the salinity acclimation phase. Three groups were then formed via random selection and acclimated to 15, 25, or 35 PSU, encompassing the salinity conditions where they are typically found (~10-35 PSU) [11] for 56d. Each salinity-controlled treatment group was held in a separate, self-sustaining, recirculating-water, temperaturecontrolled aquarium table system in artificial sea water (Instant Ocean) treated with 20mL of a nitrogen reducer (AmQuel) per approximately 151.42L of water, when nitrogen was high. System salinity was held within ± 1 PSU of the target salinity concentration for each treatment group by thrice weekly salinity measurements and additions of deionized water as needed to maintain the respective salt concentrations. The crabs were fed a medley of squid, fish, and mussels ad libitum, once per week.

Heat ramping

Members of the C. maenas sample population (n = 15 per treatment) were randomly selected from each salinity treatment and placed in recirculating and continually aerated water bath (Lauda RM6 MGW) filled with aquarium water from their acclimation tank. The bath was then ramped up by 2 °C every 30min, beginning from a base temperature of 12 °C ± 1 °C Kelley et al. [7]. The temperature at which each crab expired was monitored with a Vernier thermometer probe (± 0.1 °C) and recorded. Critical thermal maximum (here after CTmax), a standard measure of temperature-related animal death, was determined via a set of criteria verified by physical examination [7]. If the specimen was unresponsive to manipulation and could not right itself, it was held just below the surface of the water and examined for signs of respiration, i.e., water movement via the activity of the scaphognathite Crothers [12]. If cessation of respiration lasted for longer than 30s, the specimen was considered physiologically deceased and was removed from the water bath. Upon each crab’s death, we removed the specimen and recorded its treatment group, sex, temperature at death, and carapace width. Heat ramping continued until all of the experimental animals expired.

Statistics

To determine that the assumptions of normality and homoschedasticity were not violated, the Kolmogorov-Smirnov Goodness-of-Fit Test (P = 0.57) and Bartlett’s test for equal variance (P > 0.1) were used (Graphpad Prism) prior to analysis. Analysis of Covariance (ANCOVA), followed by Tukey’s Multiple Comparison Test were employed to determine whether salinity (fixed) and crab size (continuous covariate) affected the upper thermal tolerance of the crabs (Minitab 17). To further explore the relationship between carapace width (CW) and CTmax, a linear regression was used (Graphpad Prism).

Results

The three salinity treatments differed in their mean CTmax values (Figure 1, Table 1, ANCOVA, F(2,42) = 4.16, P = 0.02). The mean differences in CTmax between 15 PSU and 25 PSU, 15 PSU and 35 PSU, and 25 PSU and 35 PSU were -2.6, -1.3, and 1.3 °C, respectively. Tukey’s Multiple Comparison Test revealed a significant difference between the 15 PSU and the 25 PSU samples: the average CTmax of the 15 PSU sample (32.5 °C ± 0.6 °C) was significantly lower than that of the 25 PSU sample (35.0 °C ± 0.46 °C, Figure 1). The 35 PSU treatment was intermediate, having an average CTmax of 33.7°C ± 0.6, and did not significantly differ from the CTmax values of the other two salinity treatments. CW also significantly affected the upper thermal tolerance threshold, with lower CTmax for larger crabs (Figure 2: r2 = 0.2, y=-0.1*x + 41; ANCOVA. F(2,41); P = 0.008).

Discussion

We found that adult crabs that were acclimated to low salinity concentrations showed greater susceptibility to rising temperature. Crabs acclimated to lower salinity had a significantly lower CTmax than crabs acclimated to 25 PSU, supporting our initial hypothesis that lower salinity environments can negatively affect the upper thermal tolerance of adult Carcinus maenas. This finding was in accordance with a study that examined the effect of salinity acclimation on thermotolerance and larval development distribution of larval C. maenas Nagaraj [6]. Similarly, in another study, temperature interacted with salinity, together affecting larval development duration and attachment of the barnacle Balanus trigonus Thiyagarajan et al. [13]. Variations in salinity and temperature significantly modified the development of Nile tilapia, Oreochromis niloticus, but the interaction of the two variables modified development in unpredictable ways, with growth rates peaking at different temperatures as salinity changed Likongwe et al. [14]. A decrease in salinity concentration was also shown to significantly limit the range of temperatures tolerable by the bivalves Mercenaria mercenaria and Crassostrea virginica, for both survival and larval development Davis and Calabrese [15].

Our CTmax data suggest that after acclimation to a low salinity (15 PSU), temperature tolerance decreased significantly, offering an additional abiotic variable that may further limit their distribution. Hence, a large expansion south to warmer waters along the western North American coast seems unlikely This observed decrease in temperature tolerance implies that although C. maenas is capable of tolerating low salinities, it is metabolically taxing for them and could synergistically alter their ability to physically cope with thermal stress. Southward expansion of east coast C. maenas populations has been documented to be limited by native crab species found in estuaries De Rivera et al. [16], our data suggest that salinity and temperature in concert with predation together limit southward expansion. Together these multiple stressors may determine the potential for future range expansion of C. maenas.

A recent study found a significant relationship between environmental temperature and body size across this population of C. maenas, with larger crabs occupying areas of cooler temperatures, a phenomenon known as the temperaturesize rule for ectotherms Kelley et al. [17]. Here, we have shown that larger crabs tend to have a lower overall thermal tolerance threshold than smaller crabs (Figure 2). This study provides further evidence supporting the temperature-size rule in that large crabs that inhabit warmer, hyposaline water are more susceptible to heat stress, such that temperature acts as a selection force against larger body size.

Our study’s findings add to the body of literature supporting the conclusion that multiple stressors combine synergistically and may affect geographic range expansion and possibly overall success; however, the exact effects and synergistic relationship differ across species Todgham et al. [18], Crain et al. [1], McBryan et al. [19], Todgham and Stillman [3]. Together these studies, and others, suggest that the interaction between salinity concentration and temperature on aquatic life is not purely additive, and that more research is needed on multiple environmental stressors acting in one system, especially to predict the geographic distribution of species as their ranges shift due to climate change or biological invasion. Because of overwhelming evidence of climate change, it is important to consider the implications of inevitable further rise in temperature and changing estuarine salinities on native and non-native marine species in the near future Kelley [20], Sorte et al. [21]. The predicted change in riverine input could alter salinity and temperature along with pH, and could be modeled to understand potential future distributions. Life at low salinity levels and high temperatures becomes increasingly difficult for native and invasive species and can cause northward range expansion of C. maenas Kelley et al. [3], Hunt and Yamada [5]. It is important to understand the many abiotic factors can affect C. maenas distribution in order to predict future range expansions and possible ecological and economic effects of a non-native species on native marine animals and delicately balanced ecosystems.

Conclusion

This study documents that other environmental factors influence the upper thermal tolerance of the invasive Carcinus maenas, the European green crab. Understanding the role that dynamic environments play in regulating the physiological tolerances of invasive organisms is critical to gaining insight regarding the ecology of biological invasions. This research underscores the importance of, and the need to conduct studies that investigate the interplay of multiple environmental stressors on the physiology of non-native species.

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annieboltonworld · 2 years

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Juniper Publishers-Open Access Journal of Environmental Sciences & Natural Resources

Natural Dyeing of Cotton Fabric by Extruded Pelargonidin of Red Onion Skin and Finished it Naturally with Aloe Vera

Authored by Ashish Debnath

Abstract

According to the opinion of the Ecologist, the Textile industry is regarded as the most polluting sectors. Almost every single day, various textile industries mostly Dyeing factories are ejaculating different toxic chemicals, dyes and other agents which are very much harmful to our nature and environment. As a result, the demand for natural dyes has increased abundantly. Natural dyes are environment friendly. In this project, we used onion outer skins as a potential source of natural plant dyes. These dyes, which are known as pelargonidin were applied on cotton fabric by the exhaust method. For proper fixation, drying and curing is carried out in Mini Thermosol Machine. The dyed sample was evaluated for color fastness to washing, light, rubbing and perspiration. The fastness properties were satisfactory. Natural plants that are used as antibacterial finishing agent have a greater market value. As a source of antibacterial finishing agent, Aloe Vera leaf gel applied on Cotton fabric, which has been using as a medium to support the growth of microorganisms, is used. The antibacterial finish has been imparted to cotton by the pad-dry-cure method. The Aloe Vera treated samples have been tested as per Parallel Streak method and found very high inhibition against bacteria.

Keywords:Red Onion Skin; Aloe Vera; Cotton fabric; Antibacterial; Color Fastness

Introduction

Eco-friendly and biodegradable materials caught significant attention all around the globe in recent times[1]. The idea of applying natural dyes on textile materials not only supports the cause but also bears a huge potential in terms of revolutionizing the field of textile. Increased awareness regarding the environmental issues has vastly encouraged the idea as natural dyes are bio-degradable and better compatible with environment[2]. Natural dyes can be extracted from roots, leaves, flowers fruits which are basically parts of plants[3]. It can also be obtained from animals[3]. The dye molecules are pigment molecules having aromatic rings structure coupled with a side chain impart color to the material by resonating and also by virtue of the co-relation between the chemical structure and color plus chromogen- chromophore with auxochrome[4]. Onion skin is an easily available material to extract a particular natural dye from known as pelargonidin. There are four hydroxyl groups in a molecule which act as the auxochrome groups in order for the pelargonidin to impart good dyeing properties with a view to dyeing natural fibers[2].

Textile materials as a substrate can easily be vulnerable to bacterial growth and microbial growth given the right conditions as in moisture, nutrients, temperature etc. [5] Hence, anti-bacterial finishing has been largely focused here as health and hygiene is always the top priority and concern[6] For anti-microbial finishing, an agent is due which is capable of eliminating the growth of micro-organisms as in bacteria, fungi, algae, yeast etc[6]. Natural fibers are comparatively more exposed to the bacterial attack than synthetic fibers because of their porous and hydrophilic nature[5]. And it’s because of their tendency to absorb water and oxygen with nutrients, micro-organisms are favored with environment that can easily support their survival and growth. On top of that, human body acts as a source of warmth, humidity and nutrients which supports the bacteria’s cause even more[6]. The proliferation of micro-organisms can be responsible for the malodors, stains and wreckage of the mechanical properties of the component fibers which may lead to the product being less suitable for the purposed use. This fact has raised the necessity for the textile product which would be bio-functional capable of performing anti-microbial activities. There are herbal compounds, extractable from plants which are not only well recognized for such anti-microbial properties but also available in abundance around us in nature. Along with being cost efficient, these products are non-irritant and non-toxic to human skin[6].

The prime goal of this project is to use Aloe Vera leaves in order for its anti-microbial properties to perform an ecofriendly antibacterial finishing on textile products. The aim of this research is to reduce the uses of synthetic dyes and make people aware about the necessity of using natural dyes and natural finishing agents for the betterment of environment. This research helps people to utilize the natural sources and plants like Aloe Vera and Red onion skins and apply these sources on textile and dyeing industries all over the world.Onion Skin dyes which also called pelargonidin (3,5,7,4-tetrahydroxyanthocyanidin)[3], that can dye the Cotton, protein fibers effectively. The presence of four hydroxy groups (Auxochrome groups) pelargonidin is the main reason of better dyeing abilities for dyeing of natural fibers [2]. Figure 1 Chemical Structure of Pelargonidin[3]Onion outer skin which is contained Flavonoid, Tannin, Cardiac glycoside, Anthraquinone etc[7]. The lower leaves of the plant is the main source for obtaining the Aloe vera inner gel. The gel can be extracted by slicing the leaf open. The gel is clear, odorless, and tasteless and free from the yellow parts of leaf skin[8]. Aloe Vera gel which is contained Vitamins,Sugars,Minerals,Hormones,Anthraquinone (alloin,emodin) etc[9,10].

Materials and Methods

Materials

Source of Dye: Red Onion outer skin which was collected from Nayarhat, Savar, Dhaka.

Natural Antibacterial Source: Fresh Aloe Vera plants were collected from Panchdona, Narsingdi.

Nutrient Agar Source: Nutrient agar was brought from Mitali Chemicals House, Gulisthan, Dhaka.

Bacteria Source: Bacteria was collected from Laboratory.

Instruments:

a) Beaker

b) Thermometer

c) Glass rod

d) Burner

e) Electric Balance

f) Mini Themosol Machine

Methodology

Extraction of the Natural Dye: In aqueous extraction process, the coloring matter was withdrawn from the skins. Required amount of liquor was taken and boil at (65-80)°Cfor 50-70 min. When the mixture was cooled down, the dye extracts were filtered accurately in each process of extraction. The temperature, concentration and time combination were taken as the optimum condition of extraction of dye because they yield maximum absorption[2].

Dyeing of Cotton Fabric with Extruded Pelargonidin Dye

Dyeing Procedure: The dyeing of scoured and bleached cotton fabric was conducted in exhaust method. Fabric was weighted in Electric balance. Then required amount of liquor and other necessary auxiliaries was calculated. A beaker was taken and required amount of liqour taken into beaker. Then the fabric was immersed into the dye solution. Dyeing was carried out at 75°C for 60 min in acidic medium. After dyeing, hot wash was done with hot water at 50°C for 10 min.Then cold wash was done at 30°C at 10 minute.

Drying and Fixation: After dyeing, drying and curing was done in mini thermosol machine. Drying is done at 150°C to dry the fabric. Then curing is done at 200°C to fix the dye into the fabric. The machine speed was 10 rpm.

Extraction of Aloe Vera Gel: Aloe vera leaf is collected from the plant. To remove the dirt from the aloe vera leaf, washing is necessary. With the use of our hands solid gel converts into liquid gel by massaging. Aloe vera gel is extracted from inner parts of the leaf by using spoon[10].

Aloe Vera Gel Solution: 60 gm of aloe vera gel is mixed with 40mL of water (Aloe Vera:Water =60:40)and boiled for 10 min at 50°C to produce aloe vera gel solution. The mixture was cooled down in each process of extraction. The temperature, concentration and time combination were taken as the optimum condition of extraction of dye because they yield maximum absorption.

Microbial Finishing of Cotton Fabric with Aloe Vera Gel by Pad-Dry-Cure Method

a) Padding:M Microbial finishing of cotton fabric with aloe vera gel was done in mini thermosol machine. Aleovera gel solution taken in liqour trough. Then the fabric was passed into liqour trough. Aloe vera gel is coated in fabric which was done by padder. The pressure of padder is 5 bar.

b) Drying: Drying is done at 150°C to dry the fabric.

c) Curing: Then curing is done at 200°C to fix the aloe vera gel into the fabric. The machine speed was 10 rpm.

Method of Color Fastness Test

a) Color Fastness to Wash: For Color fastness to Wash, BSEN ISO 105 C06 method was followed.

b) Color Fastness to Rubbing: For Color Fastness to Rubbing,BSEN ISO 105*12 method was followed.

c) Color Fastness to Perspiration: For Color Fastness to Perspiration,BSEN ISO 105 E04 method was followed.

d) Color Fastness to Light: For Color Fastness to Light,BSEN ISO B02 method was followed.

Antibacterial Test for Finished Sample

For Antibacterial Test,parallel streak method AATCC-147 was used to prove the antibacterial activity of Aloe Vera gel applied on the cotton fabric by assessment the inhibition zone of bacterial culture.

Go toDyed SampleColor Fastness Result of Finished FabricGo to

Result and Discussion

By applying the same process and procedure as well as recipe we got the following results:(Figure 2).

a. Fastness Result OfDyed Sample

b. Color Fastness to Wash: The Rating of color fastness to washing of the dyed sample was evaluated and presented in the below Table 1.

c. Color Fastness to Rubbing: The Rating of color fastness to rubbing of the dyed sample was evaluated and presented in the below Table 2.

d. ColorFastness to Perspiration: The Rating of color fastness to Perspiration of the dyed sample was evaluated and presented in the below Table 3.

e. Color Fastness to Light: The Rating of color fastness to Light of the dyed sample were evaluated and presented in the below Table 4.

f. Finished Sample: By applying the same process and procedure as well as recipe we got the following results: (Figure 3).

a) Color Fastness to Wash: The Rating of color fastness to washing of the dyed sample was evaluated and presented in the below Table 5.

b) Color Fastness to Rubbing: The Rating of color fastness to rubbing of the dyed sample was evaluated and presented in the below Table 6.

c) Color Fastness to Perspiration: The Rating of color fastness to Perspiration of the dyed sample was evaluated and presented in the below Table 7.

d) ColorFastness to Light: The Rating of color fastness to Light of the dyed sample was evaluated and presented in the below Table 8.

e) Antibacterial Test Result: Pad-dry samples are treated with aloe vera gel to check the antibacterial activity. The figures shown that, the antibacterial activity of Aloe Vera exhibits against Staphylococcus aureus and E. coil to reasonable extent when aloe vera advents the fabric samples; it bleeds from the samples and shows inhibition against the bacteria. Bacteria colony are absent in the contact area under the sample. A clear zone of inhibition was observed when the fabric samples are tested by parallel streak method to evaluate the antibacterial activity of Aloe Vera treated cotton fabric(Figure 4).

Conclusion

The environment surrounding us is being polluted daily for using excessive chemicals and other harmful ingredients. Therefore, a global awareness is raised for limiting the use of these ingredients and favoring the use of natural resources. In present research work, it was found that cotton could be dyed with dry Red onion outer skin. The concentration of dye, temperature, time are the parameter which is to be optimized for more effective results. The color fastness test of washing, light, perspiration, rubbing to the samples are shows good fastness property. The onion outer skin can be used as a potential natural source of dyes for the cotton dyeing which was demonstrated by this study. This study gave the chance to change the fashion hues on cotton fabric. Though the gathering of the ingredients is relatively expensive, but the dyes extracted from this type of waste materials can be an attractive alternative. The Aloe Vera leaf gel created a good effect of antibacterial and softness on the cotton fabric. From this work, we came to conclusion that aloe vera extract has the best antibacterial properties which could be achieved by pad dry cure method with the high concentration of aloe vera extract while coated samples with extract could not give such zone of inhibition. It proves that the bacterial inhibition occurred due to the slow release of active substances from the surface of the fabric. From our lab result Aloe Vera gel treated dyed fabric has very high resistance against bacterial habitation.

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juniperpublishers-dentistry · 3 years

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Evaluation of Main Factors Affecting Metal Posts Retention: A Review of Article- Juniper Publishers

Authored by Amirreza Hendi

Abstract

The restoration of endodontically treated teeth should reestablish its form and function. To restore these weakened teeth, reconstruction of lost tooth structure is performed using a single material or a combination of available materials. The retention is the most important single factor that affect the prognosis of a post retained restoration. There are so many factors that affect the retention of metal posts and this study will review the effect of main ones.

Keywords: Cast post, Retention, Post diameter, Luting cement

Introduction

Caries, cavity preparation and root canal instrumentation can cause a huge loss in the structure of endodontically treated teeth. The restoration of endodontically treated teeth should reestablish its form and function. Loss of retention is one of the main reasons of failure in teeth restored with metal posts [1]. Several factors, including:

I. Post length

II. Post diameter

III. Design

IV. Adaptation of the post and

V. Luting agent, can influence the retention of the metal posts [2].The retention is the most important single factor that can affect the prognosis of a post retained restoration. The retention value of various post systems had been investigated in many laboratory studies [3-6]. In the following, we will review the effect of main factors influencing the retention of metal posts.

Post length

The retention of cast post increases as the length of the post increases. A post that is too short will be failed. As Stockton LW [3] and Kurer et al. [4] declared, ideally the post should be as long as possible without influencing the apical seal. There are different guidelines for the ideal length of metal posts:

a. The post should equal the occlusocervical length of the crown.

b. The post should be two thirds or four fifths the length of the root.

c. The post should be one half of the length between crestal bone and apex.

d. Study by Johnson JK et al. [5] showed an increase of 24-30% in posts retention with 2-4mm increase in their length.

Post diameter

It is not recommended to increase the post diameter in order to increase the retention. As showed by Standlee et al. [6], increase in post diameter will not significantly affect the post retention. This can be related to the variations in canal morphology. Therefore, post diameter must be controlled to preserve radicular dentin. Study by Good acre [7] suggests that the long-term prognosis will be achieved when post diameter does not exceed one third of the root diameter and at least 1mm dentinal wall remain.

Design

Nowadays, there are so many different post systems available. Study by Johnson et al [8] declared that a parallel-sided post is the most retentive design, whereas tapered post is the least retentive one. These conclusion is relevant only if the post fits the root canal properly. According to the stress distribution, tapered posts produced the greatest stress at the coronal section, and parallel posts produced the greatest stress at the apex of the canal preparation (1-3).As a result, according to the design of the posts, a parallel-sided posts should be selected.

Adaptation of the post

The adaptation of the posts to root canals has been identified as the main factor associated with the failure threshold of restored teeth [9]. If any rocking or rotation is present, the custom post should be remake and the prefabricated post should be change in diameter and length. The development of impression techniques that may increase the quality of reproduction and hence improve custom posts adaptation to the prepared root canal is necessary [10].

Luting agent

Zinc phosphate cement is considered as the gold standard and other cements mostly compared to zinc phosphate. Zinc phosphate and glass ionomer have comparable retentive properties, however, the retention values of polycarboxylate and composite resin are slightly less than the retention value of zinc phosphate [11,12].

Table 1 summarizes the available articles that studied the effect of these main factors on the retention of metal posts.

Conclusion

Retention is the most important factor that must be achieved with post-and-core retained restorations. The available articles clearly declared that factors including post diameter and length could influence the retention of the metal posts. On the other hand, according to the stress distribution and retention, the most favorable post design is parallel-sided posts. So, it can be concluded that in order to achieve longtime prognosis, clinicians should consider all of these factors together.

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Sero-Prevalence Of Brucellosis In Goats And Community Awareness In Liban District Of Guji Zone, Oromia Regional State, Southern Ethiopia-Juniper Publishers

Juniper Publishers- Juniper Online Journal of Public Health

Abstract

A cross-sectional study was conducted to determine sero prevalence of brucellosis, community awareness about zoonotic importance of the disease and its transmission to goat owners in Liban district of Guji zone Oromia regional state, southern Ethiopia. Study was conducted on 413 goats that are managed under pastoral production system. Sera samples were serially tested using Rose Bengal Plate Test (RBPT). Positive sera samples were retested by complement fixation test (CFT). Questionnaire survey was administered to 153 goat owners to assess community awareness. Collected data was analyzed using SPSS version 15 software. The study showed that goat brucellosis is a moderately distributed with overall sero-prevalence of 6.2% in Liban district. All 153 (100%) respondents in the area recognized abortion but 136 (88.9%) of the respondents have no awareness about zoonotic importance of brucellosis. The current study has determined women and children to be the risky group with higher probability of being infected with brucellosis from goats relative to men as result of close contact they have with goats during parturition, handling of cases like aborted foetus and retained placenta bare handed, milking and caring after goats. Therefore, awareness creation to the community and elimination of positive reactors are recommended to control brucellosis in the area.

Keywords: Brucellosis; Community awareness; Goats; Guji; Risky groups; Sero-prevalence

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Introduction

Brucellosis is a contagious disease caused by bacteria of genus Brucella. In livestock, it is mainly a reproductive disease of the sexually mature animals with predilection site of placenta, fetal fluids and testes of male animals Wadood 2009. It has been recognized as a global problem of wild and domestic animals, especially cattle, sheep and goats Rijpens [1]. The disease is primarily an occupational risk in exposed professions, i.e. veterinarians, farmers, laboratory technicians, abattoir workers, and others who work with animals and their products. The primary source is the animal and infection is contracted either by direct or indirect contact through the skin or mucous membranes or ingestion of contaminated products, especially fresh dairy products. Pastoralists, especially women have direct contact while milking and helping ewes when deliver even with cases like aborted fetus of ewes and retained placenta which could increase the chance of infection with brucellosis Muhammed [2].

Brucellosis is prevalent in all major livestock production systems in sub-Saharan Africa, yet its presence often remains unrecognized through lack of awareness by both veterinarians and health care staff and absence of accessible laboratory diagnostic facilities. As a consequence brucellosis remains a largely neglected disease with little attention to control and prevention except in South Africa where a successful control policy has been instigated McDermott, Arimi [3] Preliminary data suggests that the incidence of brucellosis is highest in pastoral production system where large number of animal mix and lowest for confined farms Muriuki [4], Habtamu [5].

Goat brucellosis has significant economic and zoonotic implication for the pastoral communities in Ethiopia in consequence of their traditional life styles, feeding habits and disease patterns. Hence, knowledge of brucellosis occurrence in pastoral production system has considerable importance in reducing the economic and public health impacts of the disease Rahman and Dabasa [6] In Ethiopia, pastoral area covers sixty percent of the total land mass and holding inhabitants more than 10 million of people in seven regional states and Oromia pastoral area shares the largest percentage of pastoralism in the country PFE, 2004.

Serological studies of brucellosis have been carried out in farm and pastoral areas of the country. However, only few studies have been conducted on small ruminants brucellosis. Reported prevalence include 15% in sheep and 16.5% in goats in Afar Teshale [7] 3.2% in sheep and 5.8% in goats in Afar Ashenafi [8] and 3.2% in goats and 1.6% in sheep Mengistu in Konso; 1.37% Mindaye [2] 9.6% Yohannes [9] The presence of Fraser [10] brucellosis in livestock varies between different regions of the country Hoover and Friedlander [11] Maloney, Furthermore, only few serological studies demonstrated the occurrence of the disease among Borana and Hamer pastoralists PFE 2004.

Pastoralists of Borana area have cultural indigenous range and water ponds management knowledge governing pasture and water ponds and thus settlement is based on some predetermined scenario which allow some group of the community or clan to use these resources Oba [11]. This kind of settlement and livestock mixing, however, can favor disease transmission easily. Study conducted by Dabasa [6] shows that there is history of the disease in the area where sheep and goats are affected by the disease at the prevalence rate of 1.17 and 1.88%, respectively. This indicates that there was no study conducted on separate species of these animals. In particular, there is little information on goat brucellosis across various livestock production systems of southern part of the country, which gave impetus to the initiation of this study. Therefore, this study was designed to undergo serological survey of brucellosis in goats and community awareness about the disease in Liban district of Guji zone.

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Materiel And Method

Study Area

The study was conducted in Liban districts of Guji zone pastoral area, Oromia regional state, southern Ethiopia. Guji zone comprises five pastoral districts namely Liban, Gorodola, Wadara, Girja and Sababoru. Liban district was selected based on presence of high goat population relative to other districts in Borena zone. The major animal species kept in the area include cattle, goat, sheep, camels, poultry, donkeys, mule and horses. Next to cattle, goats are the most important animal species kept in the area for milk production and income generation for small holders. The predominant goats are managed under pastoralism production system (Figure 1).

Study Design and population

A cross-sectional study was conducted on goats kept under pastoral system in Liben district. A total of 413 goats (378 females and 35 males) were tested using RBPT and CFT. All goats that were more than two years old were included in the study. Variables such as sex, age, abortion history, retained placenta and parity number were taken as potential risk factors. Information on each goat was recorded properly while collecting specimen from the goats. Visit to settlements and collection of sample was made early in the morning before the pastoralists start moving in search of pasture. Information related to management system of goats was recorded and responsible household member who care after the goats was also interviewed using semi structured questionnaires.

Sample size and sampling

Selection of animals was based on a stratified sampling method. Five (PAs) namely, Hadesakorat, Malkaguba, Siminto, Bulbul and Karsamale were selected based on their goat population. The five PAs were considered as strata, a total of 75 households were visited where fifteen (15) households were visited from each PAs. Villages and households were selected purposively based on the inclusion criteria (accessibility, willingness of the households to participate in research and security). Taking estimated prevalence of 3% brucellosis in individual animal reported previously by Sintayehu [12] at the area; and taking a confidence interval of 95% and 5% absolute precision, sample size was determined using single proportion formula set by Thrusfield, 2005:

n = 1.962 x Pexp (1-Pexp)

Where: - n = the required sample size,

- Pexp = expected prevalence

- d= desired absolute precision

Therefore, the minimum sample size required was 45 goats. However, to increase the representativeness of the study sample and reduce the design effect, sample size was increased by 9 fold and the total number of goats included was 413. Study animal-related information on each tested goat (such as sex, age, abortion history, retained fetal membrane) was collected and recorded at the time of test.

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Laboratory Techniques

Rose Bengal plate test (RBPT)

All sera sample were initially screened by using Modified Rose Bengal Plate Test (mRBPT) antigen at Yabelo Regional Veterinary Laboratory. Sera and antigen were left at room temperature for half an hour before conducting the test. 75 μl antigen and 25 μl test serum were taken using micropipette and mixed thoroughly on the RBPT plate of the test box using a tooth pick and the box was hand rocked for 4 min. Samples that showed signs of agglutination were recorded as positive while those with no sign of agglutination were recorded negative.

Complement Fixation Test (CFT)

The entire sera tested by RBPT and found to be positive for the test were subjected to CFT for confirmation. The test was conducted at National Animal Health Diagnostic and Investigation Centre (NAHDIC).

Data collection and analysis

All information related to study animal such as age, sex, abortion history and history of retained fetal membrane was recorded in Microsoft excel spread sheet. Recorded information and test result analyzed using SPSS version 15 statistical data analyzing software. Chi-square and P value report was analyzed to compare significance difference of suggestive risk factors.

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Result

Rose Bengal plate test (RBPT)

Out of 413 goat sera screened with RBPT 27 (6.5%), samples were found to be positive for Brucella antibodies. Of these RBPT positive sera, 26 were also found to be positive by CFT giving an overall confirmed brucellosis sero-prevalence of 6.3% in the study area (Table 1) Out of 153 goats owners 136 (88.9%) said they had no awareness about zoonotic importance of brucellosis (Table 2), although almost all of them recognized the existence of abortion locally known, in local language (Afaan Oromo), as”Sallesu” mean abortion. Almost all pastoralists of Liban district assist does during parturition and in removing retained fetal membranes bare handed (Table 2). Drinking of goat milk is common in poor household regularly and it is also consumed in relatively rich family when there is no sufficient milk that they obtain from cows during dry season. However, most of the pastoral community consumes goat milk by boiling the milk with tea known as shayi ananan (shayi adessa) in local language to mean milk with tea (Table 2). Prevalence of Brucellosis is high in Hadesakorat relative in order by Siminto and Malkaguba but has no statistically significant variation between PAs (Table 3).

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Discussion

Brucellosis is bacterial disease of animals with zoonotic and economic implication worldwide Corbel [13]. The overall sero-prevalence of goat’s brucellosis in the current study area, based on RBPT was found to be 6.5% whereas on the basis of CFT, determined to be 6.2%.The Seroprevalence of brucellosis showed that it is moderate relative to previous reports on brucellosis. This is fairly in agreement with the report of Yohaness [9] who reported 11.10% prevalence in goats using RBPT in Yabello district. However, the current finding result is lower than that of Al-Majali [14] where 27.7% (305 of 1100) of goats were seropositive by RBPT and CFT. This result is slightly higher than report of Sintayehu [12] which was 3% in Borena area of souther Ethiopia. But the present study is higher than, finding of Bekele [15] at Jijjiga who detected brucellosis 2.3% (7 of 309) in goats using RBPT and 1.9% (6 of 309) using CFT and Tekelye, Kasali [16] who recorded 1.3% in goats in central highlands of Ethiopia. This difference in sero-prevalence of brucellosis within the same ecosystem could be described as strong clan-based segregation of animals and range lands in the pastoral area Teshale, Bekele [16] Differences in geographical location and livestock management in the central high lands or low lands of the country could be due to mixed farming in the high lands, in which fewer animals are raised separately Ferede [17] However, the higher prevalence rate detected in pastoral area could be due to variations in the management practices in pastoral area, free movement of animals or frequent introduction of new animals without prior serological testing and keeping of animals with high incidence of abortions. This is in agreement with previous reports of Hamidullah [18], Negash [19].

In present study area, goat owners use common grazing range lands and watering points which created relatively higher prevalence rate of brucellosis as reported by different researchers on brucellosis Teshale [7] Negash [19] In the present study, a higher sero-prevalence recorded in males (20.0%) than in females (5.3%) with significance difference occurrence of brucellosis (Table 1); this result is contradictory to report of Negash [19] that serological prevalence was lower in males (8.99%) as compared to females (9.22%). This could be due the method used to collect sera sample and sex composition difference. In the present study, 88.9% of the pastoral community in the study area has no awareness on zoonotic importance of brucellosis. This is in agreement with study conducted in Jima zone by Bashahun [20-24] where they found that 97% of the respondents said they have no awareness on zoonotic importance of Brucellosis. Women and children are risky group among family members mainly exposed to the disease. Furthermore, 150 (98%) of the owners were found to have habit of handling cases like abortion and retained placenta with bare hand which is in agreement with report of Bekele [14], Negash [19] Handling cases could be main way of transmission of disease from human to animals and increase chance of the risky groups to be infected by brucellosis [25-30].

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Conclusion

Brucellosis is transmissible from animals to humans through consumption of contaminated milk, raw milk products, meat or direct contact with infected animals. Women and children’s close contact with goats while milking and keeping flock, unsafe handling of placenta, aborted fetus and assisting births bare handed were common practices among analyzed population. These practices may predispose children and women to acquire brucellosis from goats which are reservoirs of the most pathogenic Brucella species, B.melitesis for human and animals [31]. Therefore, collaborative activity between veterinarians, physicians and other governmental and nongovernmental organizations is needed to take preventive and control action through educating communities and creating awareness on zoonotic importance of brucellosis.

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