Iris Publishers - Open access journal of Otolaryngology and Rhinology | Grisel Syndrome: A Rare Complication of Pediatric Adenotonsillectomy

Authored by Enrico Maria Amadei

We present our casuistry of pediatric adenotonsillectomies carried out during the period 2009-2018. We report our experience about a rare and often not quickly recognized complication the Grisel syndrome. This consists of a non-traumatic atlantoaxial subluxation with inflammation in adjacent soft tissues. We performed 1231 paediatric adenotonsillectomies and we found 4 cases of Grisel syndrome. We discuss the diagnosis and treatment of this complication.

We report our casuistry of 1231 pediatric adenotonsillectomies. All were performed at our Hospital during the period 2009-2018 by the same surgeon. In adult patients adenoidectomy is rarely indicated. The main indication for tonsillectomy is given by recurring inflammations/infections. From international guidelines the indication is given by 5 or more episodes of tonsillitis per year, for at least 2 consecutive years [1]. In pediatric patients, on the other hand, the main indication for adenoidectomy is given by nasal breathing difficulty and by recurrent acute or chronic otitis. The indication for tonsillectomy is essentially represented by obstruction of the upper airways caused by hypertrophic tonsils, with consequent night snoring and sleep apnea. Adenotonsillectomy is a routine surgery for an otolaryngologist, but never trivial. In fact, there are many transient problems after surgery: these are mainly represented by the difficulty in swallowing, halitosis, fever, earache, post-tonsillectomy hemorrhage. This last complication has an incidence in our casuistry of 3% per year, as in the international case studies. In 4 cases we found a persistent torcicollis.

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Iris Publishers - Open access journal of Complimentary & Alternative Medicine | Facilitating Spiritual Care for Whole Person Patient- Centered Care

Authored by Pamela H Cone

Spirituality is at the core of the person. When nurses care for the whole person, all domains of the person need to be addressed, including the spiritual [1,2]. There is a significant amount of research that indicates that addressing the deep inner needs of a patient will enhance healing [2-4]. While many nurses feel unprepared to facilitate spiritual care Cone PH, et al. [5], most recognize the importance in the overall healing process with their patients [3,6,7].
This can result in an ethical dilemma for nurses, which, if left unresolved, can lead to burn-out and compassion fatigue [5,7]. However, when spiritual practices, including religious as well as non-religious approaches are utilized [8]. Nurses find that their connection to and rapport with their patients can be strengthened [3]. So, what are the steps or approaches that can facilitate spiritual care?

The first element is spiritual awareness. Nurses need to keep learning about spirituality and spiritual care competencies in order to become more comfortable and prepared to facilitate patient care in the spiritual domain [5,9]. When nurses are provided with spiritually focused readings and patient scenarios to reflect on, their thinking is expanded and they feel better prepared to face a variety of patient spiritual needs and concerns, and even patient spiritual resources [5]. One approach for increasing nurse preparation is to make spiritualty part of nursing education across the curriculum Mthembu TG & Cone PH [6,10]; this can be done strategically by adding activities and assignments to current courses rather than adding a spirituality course to the overall curriculum [10]. Another approach is to promote nurse learning in the clinical setting among working nurses and students in practical clinical education [4,9,10]; pre- and post-conference meetings at shift change can be utilized if topics succinct and readings are brief.

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Iris Publishers - Academia.edu | Depression from Sadness to Melancolia - Journal of Neurology & Neuroscience- Iris Publishers

Iris Publishers - Academia.edu | Depression from Sadness to Melancolia - Journal of Neurology & Neuroscience- Iris Publishers

 

Depression from Sadness to Melancolia - Journal of Neurology & Neuroscience- Iris Publishers

Sometimes we have felt so sad and so disappointed for afew hours or days, situation that leads us to sleep badly, haveawakenings consists before, decreased appetite, easy crying,tiredness, attention deicit, grumpy, even wanting to “swallow theEarth” which is a small thought to “want to die”; These situations are normIn the mood swings we experience throughout the L day or ina few weeks, and that is recovering with the passage of time, thanksto the adjustment in your brain neurotransmitters experience, wehave already commented that they are chemicals in the brain thatallow to carry out the different phases of thought.

This series of symptoms or sensations We come from a series of external stimuli or characteristic experiences that all, absolutelyeveryone must go through once in our lives, as are the heartbreaks,both marital separation and the various breakups of courtship,The loss of A loved one, an economic bankruptcy, A robbery, ajob dismissal, anyway. The big problem lies in The Times, that is to say, when this series of situations are presented to the passageof a month, and that they become incapacitated for their work, fortheir family, for the life in general, this is when it goes from beinga moment of sadness to the moment of using the word sounding Depression.

And it is that depression does not respect age, sex, religion,social position or other variant of the human being; It has different presentations because in children we can see it with attention deicit, irritability, unsocial personality or avoids meetings, orkicker or let them hit in school; In adolescents with dificulties sleeping, either with lack or excess, sadness, easy crying, loss of daily habits; Or in elderly people with severe forgetfulness thatsimulates Alzheimer’s disease

Read More About This Article  : https://www.academia.edu/38512713/Depression_from_Sadness_to_Melancolia_-_Journal_of_Neurology_and_Neuroscience-_Iris_Publishers

Iris Publishers- Open access Journal of Animal Husbandry & Dairy Science | Agricultural Activity and Chemical Water Pollution 

Authored by Peña BSD

 

This article reviews the water pollution by phosphate and sulfate anions, present in detergents and fertilizers; its consequences for the environment involves public health and food production. Mexican regulation for non- degradable detergents and wastewater must be updated, since in some countries these detergents are prohibited due to their negative impact on the environment.
Agricultural production according to the report of [1], is the main source of chemical contamination of water, due among other causes to the excessive use of fertilizers containing phosphorus, phosphates, nitrates and pesticides; also livestock activity through animal droppings whose runoff to bodies of water are another possible source of contamination with phosphorus and the use of detergents (phosphates and sulphates), within the livestock facilities.
Currently pastures for animal consumption and agricultural crops for human consumption must be produced in a sustainable and environmentally friendly manner. Such is the case of the studies carried out by Mexican researchers, whose results show that higher yields of the crops are produced with the use of bio-fertilizers. The fertilizers used in agricultural production belong to the group of superphosphates, which are a source of contamination of groundwater, being dragged by rain and soil winds; since it is estimated that the crops absorb between 20 to 40% of the fertilizers applied and the rest is discarded causing water pollution, among other environmental phenomena such as acid rain and climate change. However, its use dates back to the 50’s. Mexico imports about 63% of the fertilizers used in agricultural production. So the development of bio-fertilizers for some years, has been a strategy to avoid environmental damage, caused by the excessive use of chemical fertilizers. Biofertilizers contain microorganisms that live in symbiosis with plants that help them feed and protect themselves from predators [2]. The best known are the mycorrhizal fungi that provide phosphorus to the plant and Bacillus bacteria (All-Taweil et al., 2009; Pooja et al, 2007). Phosphate solubilizing microorganisms [3], such as Fusarium oxisporum, Trichoderma aureoviridae, Aspergillus aculeatus, are considered as an alternative to replace synthetic fertilizers in agricultural fields (FAO, 2008).
Cleaning agents or detergents, are chemical products intended for the washing of machinery and inputs in the livestock industry, which are used without any restriction; However, detergents contain chemical substances such as phosphates that reduce the hardness of water, favoring the function of surfactants, which help to modify the surface tension of water and can be: zwitterionic, amphoteric, anionic, cationic and non-ionic [4].
In 1940, detergents were introduced to the world market [5], which improved the cleanliness with respect to the products that contained soap as a base; sodium tripolyphosphate being its main ingredient [6]. which represents a small portion of the phosphate market, while 85% is dedicated to the production of fertilizers [6]. Decades later he was assigned alterations in fauna in lakes with a high content of phosphates, because they are not compounds of easy degradation but remain for long periods of time, so the search for new compounds that are degradable mainly in developed countries, since the impact of their use such as increases in the amount of nutrients in water effluents such as rivers and lakes, the decrease in the amount of oxygen and imbalance in fish or aquatic life [6], an impact that still affects countries in Europe, Japan and the United States [7,8].

To read more...Journal of dairy science

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Iris Publishers-Open access journal of Animal Husbandry & Dairy Science | Survey on Existing Status of the Animals in Rangpur Zoo of Bangladesh 

Authored by M Ashraful Kabir

Rangpur Zoo of Bangladesh is the second government zoo after Dhaka Mirpur Zoo (National Zoo of Bangladesh). Its area is 20.75 acre which was established in the year 1989. This zoo was opened for the people at 14 September 1991. Due to the exhibition of various animals and for increasing animal research, this Zoo and Recreational Park has been established. Here, total animals were 184 including reptiles, aves, and mammals. According to the results of this study, proper manpower and shortages of medical facilities in this zoo is hampered. Animals are suffered by indigestion, catch cold and tuberculosis. Immediately need to provide animals’ hospital, isolation room, and veterinary surgeon in this zoo. Out of 30 animals the reptilian were 3(10%), aves 17(56.67%), and mammals 10(33.33%) respectively. A great problem is continuing here that in case of Lion, Hyena, Hippopotamus, Cassowary, and Ass all were male and Tiger and Bear were female. Same sex fighting and in Monkey, they were suffering sexual problems. Need to maintain male female ratio of Deer 1:6. One Indian Peafowl is male, and another is albino male. Already an application was submitted to the concern authority to collect those animals for their paring. If some rare animals like Zebra, Giraffe, Elephant, Leopard, Ostrich, Chimpanzee, and Gibbon being introduced it would be an excellent zoo of the country. Vitamin deficiency is common in zoo animals especially in Tiger and Lion.

Zoos are primarily such facilities where animals are confined within enclosures, and in which they may also be bred. Such facilities include safari park, aviaries, butterfly park, and reptile center as well as wildlife sanctuaries and nature reserves. In Bangladesh zoos are- Chittagong Zoo, Comilla Zoo, Dhaka Zoo, Dulahazra Safari Park, Bhawal National Park, Bangabandhu Sheikh Mujib Safari Park, Nijhum Dip Park, Rajshahi Zoo, and Rangpur Zoo. Within these only Dhaka and Rangpur is the government zoo and others are private. Safari parks are good for observing the animals with biodiversity in a natural state where animals live freely and can perform natural breeding. Many of today’s zoos hope to stop or slow the decline of many endangered species. Many zoos see their primary purpose as breeding endangered species in captivity and reintroducing them into the wild. However, zoo advocates argue that their efforts make a difference in wildlife conservation and education [1]. Bangladesh zoos are associated to donate or exchange of the animals with Saudi Arabia, Iraq, Kuwait, and Bahrain. In any zoos need an animal museum, vet hospital, investigation and research section [2]. Shortages of manpower, supply of feed, care, enclosure maintenance, various establishments, protection, conservation, guidelines for common visitors, and administration all are not positive in this zoo. There is no vet hospital, isolation room, and vet surgeon so it is being burden to detect the diseases of zoo animals. Immediately need to establish new buildings. Present administrative office of the zoo is under the place of horticulture. There is no vehicle of this zoo. This zoo earns a lot of revenue from various sources- pond lease, canteen, children park, parking, and garden. Sex identification of some animals and exchange male or female is urgent in this zoo. The objective of this study is to solve above adverse situations.

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Iris Publishers- Open access Journal of Agriculture and Soil Science | Role of Stratospheric Temperature and Humidity in Occurrence of 2011 Spring Ozone Anomaly in the Arctic and on the Northern Territory of Russia Using Aura OMI/ MLS Observations

Authored by Oleg E Bazhenov

In March-April 2011, the М-124 ozonometer observations recorded an anomalous decrease in the level of the total ozone (TO) content over Tomsk. The decrease reached 30% as compared to multiyear average. The paper studies the temperature, humidity, and ozone anomalies, recorded in March 2011 by the Aura OMI/MLS instrumentation in the stratosphere of Arctic latitudes and on the northern territory of Russia. Their relation to the decrease in the ozone concentration over Tomsk in April 2011 is analyzed. It is hypothesized that the Arctic phenomena are the result of ozone loss due to heterogeneous reactions on the surfaces of particles in polar stratospheric clouds after a return of sunlight during spring. Supposedly, irreversible growth of water vapor content at heights of ozone maximum in the second half of March had raised the temperature threshold for formation of PSCs that persisted until late March; this probably promoted the chlorine activation and, thereby, delayed the chlorine deactivation, resulting in even greater overall ozone losses during March 2011. The subsequent midlatitude phenomena seem to be due to synoptic-scale export of the ozone-depleted humid Arctic air masses.

Present-day estimates indicate that the total ozone (TO) column has a positive trend since 2000 at most latitudes, but this trend is not statistically different from zero in many regions [1]. The meteorological conditions in 2010-2011 were unusual for the Arctic and resulted in record-low ozone. If analogous conditions were to arise again in the Arctic while stratospheric chlorine loading remains high, similar severe chemical ozone losses would take place again. A stable stratospheric polar vortex was extremely long-lived in the winter-spring of 2010-2011 in Arctic. The transport barrier at the edge of polar vortex in February-March was the strongest in the last 30 years [2]. The temperatures below TNAT~195 K (the temperature threshold for formation of polar stratospheric clouds (PSCs) Ia) persisted until late March in the altitude interval of 15-23 km [2]. The temperature in the Arctic stratosphere in March 2011 was the second least in the period of 1979-2011, and the Arctic polar vortex was the third or fourth longest of the satellite era [3].

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Iris Publishers- Open access Journal of Agriculture and Soil Science | Nutrients Recovered from Organic Residues as Fertilizers: Challenges to Management and Research Methods 

 

 

Authored by Bente Foereid

 

Biofertilizers, fertilizers made from organic residues, could replace some mineral fertilizers, reducing energy consumption and resource mining. The main treatment options are composting, anaerobic digestion, drying, pyrolysis and combustion, they can be used alone or in combination. The quality of biofertilizers depend both on the original residue and on the treatment, but in most cases not all the nutrients are immediately available to plants. It is difficult to predict how available the nutrients are, and when they will become available. The methods to assess and predict nutrient availability are reviewed. Furthermore, the effect of biofertilizers on the environment in the form of nutrient losses and greenhouse gas emissions are reviewed and compared to mineral fertilizers. There is a need to produce biofertilizers with better and more predictable qualities, and also to understand their effects over multiple seasons.
Many organic waste streams have high nutrient content. Recent years have seen increasing restriction on release of such waste to the environment, due to risk of eutrophication and other environmental problems [1-4]. However, current management usually only considers this aspect, and not the recycling of nutrients as resources to replace mineral fertilizers. Production of mineral fertilizers is energy intensive, particularly fixation of nitrogen [5,6] and mine mineral resources in a way that is not sustainable in the long run. Particularly phosphorus that is estimated to run out in the next few centuries [7,8]. Potassium is also only mined in Europe and Canada, making it difficult for developing countries to get it at affordable prices [9]. It is therefore necessary to develop better systems to recycle nutrients in organic waste streams beck to agriculture to replace mineral fertilizers. There are a number of obstacles to this and needs for both research and societal changes [10,11].
Fertilizers based on organic residues are known under many names, e.g. organic fertilizers, biofertilizers. The term “organic fertilizers can be misinterpreted to mean “fertilizers for organic agriculture”, and although organic agriculture may be the most important user (see below) the goal has to be that fertilizers based on organic rest products should be used also outside organic agriculture. Further, current regulations prohibit the use of certain organic rest products (e.g. sewage) in organic agriculture. The term “organic” also excludes ash and precipitates, so “organically based” will be a better term, but maybe too long. However, in this paper I will use the term biofertilizer. It is meant to cover all fertilizers and products used as fertilizers and soil improver of organic origin.

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Iris Publishers- Open access Journal of Ophthalmology & Vision Research | Key Transcription Factors Linking Macular Degeneration and Alzheimer’s Disease

Authored by Joseph W Eichenbaum

Alzheimer’s disease (AD) and age-related macular degeneration (AMD) have certain pathologic features in common. Chronic oxidative stress and neuroinflammation result in aggregate protein deposits, extracellular drusen in AMD, extracellular and intracellular amyloid in AD, and intracellular tau in AD, and mitochondrial proteosomal pathway damage in both. Along with risk factors: aging, smoking, hypertension, hypercholesterolemia, obesity, arteriosclerosis, unhealthy diet, chronic anticholinergic use, and latent herpetic infection, three transcription factors, NRF-2 (nuclear factor-erythroid 2) and NFKB (nuclear factor kappa B) which regulate cellular detoxification from oxidative stress and innate cellular immunity, respectively, and PGC-1α (peroxisome receptor gamma coactivator), which is the master of mitochondrial biogenesis and antioxidant control, seem to play a major role in disease progression of AMD and AD . Neuropathology and protein marker changes related to imbalances in NRF-2, NFKB, and PGC- 1α illustrate neurodegenerative and vision loses commensurate with NRF-2 and PGC-1α deficiencies and NFKB excess. Examining these transcription factors in more detail may provide insights into slowing the progression of AD and AMD. 

The global prevalence of AMD in 2020 is projected to be 196 million people [1] and that of Alzheimer’s disease was 50 million in 2017 [2]. Chronic oxidative stress and neuroinflammation from aging, injury, and individual risk factors (smoking, hypertension, arteriolosclerosis, obesity, dietary indiscretion, chronic anticholinergic use, and latent infection) in AMD and AD contribute to toxic protein deposits, loss of homeostatic protein clearance, and progressive neurodegeneration [3-11].
Neuroinflammation also provokes persistent immune response, which participates in further brain and macular damage. However, studies using anti-inflammatory therapy in AD and in AMD have yielded small, mixed or inconclusive results [12-15].
Toxic protein accumulation: in AMD, drusen, (lipoprotein deposits between the basal lamina and the retinal pigment epithelial layer, RPE) and lipofuscin (from inefficient protein clearance) [3,4,13] and in AD, extracellular and intracellular amyloid and complement and intracellular tau, (because of breakdown of the blood-brain barrier from reactive oxygen species, inflammation, or local or systemic infection), may be slow burners in chronic inflammation and its sequelae [5,6,16] However, cognitive issues, (memory and learning) in AD may precede amyloid plaque and tau fibrillar aggregates by months or longer [5]. For that matter, in AMD despite impaired lysosomal degradation, lipofuscin accumulation, defects in the ubiquitin protein clearance, and mitochondria dysfunction [3], many ophthalmologists can attest to the fact that visual loss may take years to manifest.

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Iris Publishers-Open Access Journal of Ophthalmology & Vision Research| Does your Child have a Vision Problem?

 

Authored by Manal Hassan Abuelela

 

Good vision and eye health are a critical part of child’s learning and development. As vision continues to develop up until the age of 8 or 9 years old, it’s important to have your child’s eyes checked so that any issues can be detected early enough to treat.
There is a difference between a vision screening, which can be done at your child’s primary care provider, and a comprehensive eye exam, which is typically conducted by an optometrist or ophthalmologist. Moreover, it’s important for parents to keep an eye out for warning signs of vision problems that can develop in between those screenings and exams [1]. Many parents and caregivers believe the screening performed by the child’s pediatrician or other primary care physician or school nurse is sufficient to rule out all significant visual disorders. However, these screenings are limited and were not intended to replace a comprehensive eye examination [2]. Health education of parents and guardians on the need for frequent eye examination and necessary treatment is an important WHO strategy in developing countries where a good number of people have poor knowledge of the importance of eye examination and treatment, hence neglecting eye care for their children [3].
Blindness in children can be avoidable with preventive measures and when eye examination and treatment is early and frequent. In the developed world, children are required to undergo eye examination at birth and as early as six months. By six months an average child has attained a number of developmental milestones and so can undergo a full eye examination. Afterwards, a comprehensive eye examination is necessary at the preschool age and frequently during the school age.

About 5% to 10% of preschoolers have vision problems. About 10% of school-aged children have vision problems. Without proper screening, vision problems may not be detected, and permanent loss of vision may occur [5]. Children rarely complain when they have vision problems because they do not know that their vision is not normal. They think that everyone sees the world the way they do. So, parents and teachers have important responsibility to recognize the signs of vision problems in order to identify children who need a complete eye examination [6].

Children Who May be at Risk for Vision Problems

If there were health problems during pregnancy (such as measles, infections, toxemia, drugs or alcohol), they were born prematurely, there were complications at birth( such as long labour, lack of oxygen), they had certain childhood illnesses (such as high fever, viruses), there is a family history of vision problems (such as lazy eye, crossed eyes, or wearing strong glasses) or they have certain health conditions or developmental disabilities (such as cerebral palsy, Down syndrome, hearing loss, developmental delay, Autism)

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Iris Publishers- Open access Journal of  Civil & Structural Engineering | Hybrid Subsea CCS System-CO₂ Storage in Offshore Ultra Deep-Water Salt Caverns

 

 Authored by Alvaro M Costa

Computational geomechanics is the field of computational mechanics where geo-engineering systems are analyzed using the prinCurrently there is a demand for CCS of large quantities of CO₂ associated with CH₄ in the pre-salt offshore oil fields in Brazil. The pre-salt reservoirs have as caprock 2000 meters of continuous rock salt. Rock salt is a special geomaterial. It has negligible permeability and porosity, is able to support very high stresses, develops the self-healing effect, fractures will heal only with time and a good geomechanical project can design very large openings in the salt body. In Brazil the rock mechanics and computing modeling related to underground excavations in salt rock started in the years 1970´s with very complex challenges, starting with the project of an underground mining of sylvinite (potash ore) overlying tachyhydrite, a very weak salt rock, solving the challenges of the solution mining of salt caverns, for brine production, in bedded stratified halite with intercalations of shales, development of special geomechanical projects of oil wells for drilling through very thick stratified salt rock barrier and finally the application of salt caverns opened by solution mining for natural gas storage and CCS of CO₂. Salt caverns onshore, opened by solution mining have been used since the years 1950´s to store hydrocarbons and contaminants. A good example of a very large underground storage is the Strategic Petroleum Reserve in the United States, storing since 1974 around 800 million barrels of crude oil. Today there are more than 4000 caverns opened by solution mining for the storage of oil and gas. This article introduces a new concept called the Hybrid Subsea CCS System, which performs all the offshore CO₂ separation process with subsequent storage in underground salt caverns offshore. Today much is said on the concept of “Subsea Factory” in the global oil industry, which is every day closer to become a reality. Many operators have been applying high R&D investments in bringing down to the sea floor equipment from the deck of the production platforms like: multiphase pumps, oil separators, electrical transformers, gas compressors, among other pieces of equipment, reducing the size of the floating platforms and in some sites, becomes the only solution available due to the water depth, which cause a great limitation in the elevation of the hydrocarbon through conventional and even with non-conventional riser systems. The main challenge of doing a complete Subsea “factory” or develop the “Subsea CCS System” is the storage. Shell, USP (University of São Paulo) and FAPESP (Sao Paulo Research Foundation) are developing a R&D project of a hybrid system using partially the subsea factory technology with the high structural performance of salt rock caverns, opened by solution mining, in ultra-deep water. This hybrid system is expected to do at the same time the separation between the natural gas and CO₂, Carbon Capture and Storage of CO₂ and allowing the monetization of the separated natural gas. This paper describes the conceptual design of this hybrid system showing the steps from the drilling phase of the wells, the process of opening the salt caverns by solution mining, the subsea equipment required, the basic logistic system to servo control this equipment and the geomechanical project of salt caverns to store Natural Gas and CO₂ in salt domes in ultra-deep water.

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Iris Publishers- Open access Journal of  Cardiovascular Research | Prevention and Control of Cardiovascular Diseases by Beneficial Use of Islamic Lifestyle

Authored by Mohammad Rabbani Khorasgani 

In recent decades, the advancement of human researches and public health activities resulted to infectious diseases control, therefore, the morbidity and mortality rates of many important infectious diseases in the world declined. Although, the risk of development and spreading of emerging, re- emerging, and drugresistant infectious diseases are important, but human industrialized life and life style changes have resulted in new challenges for human health specially in the field of non- communicable diseases (NCDs): cardiovascular diseases (CVDs), cancers, obesity and etc. Non-communicable diseases, are the major causes of death in the world, representing 63% of all annual deaths (more than 36 million people). It is estimated that 17.9 million people died from CVDs in 2016, representing 31% of all global deaths [1]. On the other hand, disease development is influenced by different host, environment and microorganisms related factors, therefore, the pay attention to predisposing cultural, social, economic and religious factors is necessary for human health promotion as a multidisciplinary subject. Lifestyle is a way or style used by people in their life in special time and place and includes behaviors and functions of individuals. Lifestyle is formed in specific geographical, economic, political, cultural and religious context and influenced by them [2,3]. Lifestyle is an important and very effective agent in human beings life including the human-human, and human-environment interactions. If human regarded as whole, the thoughts, perspectives and practices affect his body and soul directly or non-directly. Many philosophical, religious documents and excellent scientific findings in psychology, biology and medicine favor it [4]. Therefore, human health is influenced by lifestyle, also. WHO has estimated that 60% of related factors to individual health and quality of life are correlated to lifestyle [3]. Pay attention to complex, but, define networks in neuro immune endocrine communication could be elucidate some aspects of lifestyle effects on human health. Lifestyle management or promotion may be regarded as effective action for health promotion.

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Iris Publishers- Open access Journal of Cardiovascular Research | Systemic Thrombolyis within 24 Hours of Major Cardiac Surgery; When the Risk to Life outweighs the Haemorrhage

Authored by Mahmoud M Abdelaziz

 

Ischaemic stroke after cardiac surgery is well recognised devastating complication. The incidence of stroke usually varies based on patients’ risk factors and peri-operative related factors and can be as high as 6% [1]. Due to the high risk of Intracerebral and systemic haemorrhage, systemic thrombolysis is contraindicated within 14 days after any major surgery including open heart surgery [2]. Given the high risk of bleeding, unsurprisingly there has not been any research articles into the bleeding rate of systemic thrombolysis after major surgery.
We present a case of using systemic thrombolysis within 24 hours post major open-heart surgery for treating acute ischaemic stroke.
An 81-year-old man presented with increasing shortness of breath and previous hospital admission with congestive heart failure and pulmonary oedema. Echocardiography confirmed severe mitral and tricuspid valve regurgitation, moderately elevated pulmonary artery pressures (PASP 56mmHg) and preserved left ventricular function. His risk factors of heart disease included primary hypertension and hypercholesterolaemia. He underwent median sternotomy, cardiopulmonary bypass with systemic cooling to 30⁰C, Mitral valve and Tricuspid valve repair. He was transferred to the intensive care unit as per routine and immediate postoperative recovery was unremarkable. 13 hours after the operation the patient suddenly became unresponsive with poor respiratory effort and Glasgow coma score (GCS) deteriorated from normal to 3 for which he required emergency re-intubation and ventilation. His Pupils were unequal.
Computer Tomography angiography (CTA) scan of the brain did not show any obvious areas of infarcts or bleeding, but clinical assessment by expert neurology physician concluded the likelihood of major brain stem stroke which carried very high risk to life and poor prognosis if left untreated. Targeted cerebral intra-arterial thrombolysis was not feasible based on CT findings and the anatomy of the affected area. Upon discussion with the surgical team, cardiac anaesthetic team and patient’s family, the decision was made to treat the patient with systemic thrombolysis given the likelihood of not surviving this insult if left untreated and accept the risk of major bleeding event.

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Iris Publishers_Good Friday

It’s time to wish on the occasion of Good Friday for everyone on behalf of Iris Publishers.

“The marvel and heaven and earth, of time and eternity, is the atoning death of Jesus Christ. This is mystery that brings more glory to God than all”

He will answer your prayer today, have a holy Good Friday.