bluuebunny/crossref_metadata_2025 huggingface dataset:
Influences of Fabrication Parameters on Natural Fiber Reinforced Polymer Composite (NFRPC) Material: A Review
Authors: Boopathi Sampath , Sureshkumar M. , Jeyakumar M. , Kumar R. Sanjeev , Subbiah Ram
Published: November 2022

In the recent development of modern manufacturing industries, the metallic components have been replaced by natural polymer composite materials due to increasing the strength to weight ratio, developing eco-friendly components, and reducing the overall cost of the product. In this review article, the various research activities on the effects of various single-layer and multi-layer fibers, moisture contents, surface treatments methods, filler materials, and drilling processes on the Natural Fiber Reinforced Polymer Composite (NFRPC) characteristics have been illustrated. The research opportunities for future developments in NFRPC materials have been extracted from the literature.
Wear Behavior and Wear Worn Surface Analysis on Hardox Steel
Authors: Harinarayanan G. , Krishnan V.K. , Natarajan M.P. , Surender V. , Gowthaman J.
Published: November 2022

High quality and behavior of steel is playing an essential role in metal and manufacturing industries. Hardox steel has exceptional properties includes high wear resistant and hardness. The wear behavior of hardox 400 steel was evaluated through pin on disc tribometer using different input constraints such as load, sliding velocity and disc speed. The wear worn surface was investigated through atomic force microscopy. The wear rate of the hardox steel was calculated with different load conditions. The wear factors and wear rate were optimized by taguchi method. Variance analysis was provided the contribution of each factor on mass loss.
Size Reduction of Dolomite into Nano-Size Range through Milling and Tip-Sonication Processes
Authors: Osman Azlin Fazlina , Fauzi Asfa Amalia Ahmad , Amin Muaz Baderul , Halim Khairul Anwar Abdul , Ul-Hamid Anwar
Published: November 2022

Dolomite has great potential to be employed as filler or nanofiller in polymer composite/nanocomposite system. However, the research on dolomite as filler or nanofiller in polymer composite is still immature, requiring further investigations on how to optimize the dispersion of the dolomite in the polymer matrix, thus improving its properties. Particle size reduction of dolomite can be an efficient approach to increase its surface area and facilitate its dispersion and distribution within polymer matrix in order to develop homogeneous composite/nanocomposite system. In this study, the dolomite in pulverized form was obtained from Perlis Dolomite Industry, Malaysia with the average particle size of 150μm. In order to reduce the size of this dolomite, we have initially employed the planetary ball milling method. Results indicate that the particle size of dolomite has been reduced from 150μm to 2μm after subjected to ball milling process. This shows that upon ball milling procedure, the size of dolomite particle is still in micronmeter. Next, the ball milled dolomite was subjected to tip-sonication process to obtain dolomite in nanosize range. Several tip-sonication parameters, which were; amplitude and number of sonication repetition were applied in order to select the best parameters that can produce the finest dolomite powder. SEM and TEM were used to characterize the microstructure of the raw dolomite and the size reduced dolomite. Our results show that when the ball milled dolomite was tip-sonicated, much smaller particle size was obtained. Dolomite with the smallest particle size (~200nm) was obtained when the tip-ultrasonication was performed 3 times at amplitude of 50. These findings indicate that the combination of ball milling and tip-sonication is an efficient method to produce very fine dolomite particles, up to nanosize range. Furthermore, it is a clean, simple method and not involved any toxic and harmful chemicals.
Production of High Carbon Composite from Catalytic Pyrolysis of Pisum sativum Peels for Methylene Blue Dye Decolorization
Authors: Rubangakene Norbert Onen , Elwardany Ahmed , Fujii Manabu , Sekiguchi Hidetoshi , Shokry Hassan
Published: November 2022

Methylene blue (MB), a deleterious dye with consequential environmental implications is used in dyeing processes. Precipitation, electrolysis, coagulation and adsorption are used to counter its effect. In this study, batch adsorption technique was performed to study the decolorization of methylene blue by high carbon composite obtained from catalytic pyrolysis of green pea peels. Characterizations of carbon composite by XRF revealed metal oxides beneficial for adsorption; FTIR clearly distinguished the location of intensity and shape before and after MB uptake. The PHPZC was 7.3. Dosage, pH, and initial concentration were influential in removal performances of MB. Equilibrium data fitted the Langmuir model with an uptake capacity of 526.32 mg/g and RL of 0.4814, exhibiting a monolayer and favorable adsorption process.
Study of the Effect on Friction Welded Surface on Copper Aluminium Juncture
Authors: Senthilkumar M. , Singh Lavish Kumar , Lakshmanan S. , Shanawaz A.M. , Selwin M.
Published: November 2022

The economical and highly productive method of welding is used to join a dissimilar material. The quality of welded joint with high efficiency is obtained from friction welding process. The intention of the current work is to assess the progress of solid state juncture of dissimilar materials of aluminum 6082 and copper. The strong joints were developed using frictional heat and external pressure. The friction welded joints were tested under welding strength and surface analysis using scanning force microscopy (SFM). Rotational speed, friction pressure and forging pressure were used to evaluate the performance of the welded joints. Optimize the welding strength and hardness was attained through taguchi method.
Insights into Drug-Loading Capacity of Bio-Zirconium Metal-Organic Frameworks Nanoparticles for Tetracycline Hydrochloride
Authors: Hanafi Asmaa Ashraf , El-Kady Marwa , Ayad Mohamad
Published: November 2022

The discovery of a highly efficient drug delivery system with high biocompatibility and good loading/release properties is a key challenging issue. In the past decade, metal-organic frameworks (MOFs) have shown great interest as drug delivery systems (DDSs), due to their high porosity, tunable functionality, and large drug loading capacities. Herein, we report the potential use of a new family of biocompatible MOFs called bio-MOFs synthesized from bio-based ligands and water-based synthesis for drug delivery. We propose a facile method to synthesize MIP-202 (bio-based Zr-MOF) built from Zr metal nodes and aspartic acid as an amino acid ligand. The efficiency of loading tetracycline hydrochloride drug onto MIP-202 and UiO-66-NH2 has been carefully studied. Characterization techniques such as powder X-ray diffraction, and transmission electron microscopy have been used for structural and morphological confirmation. The loading capacity of tetracycline hydrochloride on UiO-66-NH2 was determined to be higher than MIP-202 reaching up to 50.3%. The results provide an investigated insight into the utilization of bio-based MOFs as drug carriers for tetracycline hydrochloride.
Analysis of the Effect of Time on Tensile Strength and Hardness of Electroplating Method Using Nickel on Aluminum 7075
Authors: Setiawan Ferry , Walikram Dzulkifli , Sehono Sehono , Ariebowo T. , Putra I. Rizki
Published: November 2022

The purpose of this research of aluminum electroplating with nickel is to improve the value of its tensile strength and hardness. This test was conducted to determine the effect of time towards the tensile strength and hardness of nickel on aluminum 7075 electroplating and the time required to achieve optimum conditions. The materials used in this study are aluminum 7075 and nickel plating. The finishing treatment process used was electroplating method. Fixed variables utilized in this study comprised the voltage (25 V), gap between electrodes (15 cm), amount of water (2400 ml), salt (four spoons), vinegar (1600 ml), aluminum, and nickel for plating. The variations used in immersion time were 30, 40, and 60 minutes for further tensile test and hardness test. The result of this research shows that the highest tensile strength value obtained was 546,155 MPa with 60 minutes coating time. While the value of hardness from time to time varied with the highest rate in of 30-minute coating time was 188.266 kgf/mm. According to the test results, it can be inferred that the longer coating time it takes, the higher the tensile strength rate the material obtains.
Hydroxyapatite Effect on the Corrosion Rate of AMC Al-Zn by Powder Metallurgy
Authors: Zuliantoni Zuliantoni , Suprapto Wahyono , Setyarini Putu Hadi , Gapsari Femiana
Published: November 2022

Al-Zn-based AMC is a light metal, with low density, excellent mechanical and mechanical properties, suitable for use in automotive, electrical, general-purpose electronics, machinery and equipment. However, the development of this alloy is limited by its low hardness and low corrosion resistance, which limits its use in many applications. This corrosion process can cause fitting corrosion and can damage the passive oxide layer that protects the metal from corrosion. This study aimed to increase the corrosion resistance of AMC Al-Zn by adding hydroxyapatite ceramic reinforcement from snail shells in a corrosive medium of 3.5% NaCl solution. The HAp is used as an AMC amplifier. AMC uses Al-Zn alloys with a ratio of 90% to 10% by mass. The variation of HAp enhancer used was 10, 15, 20, 30 and 40% by weight. This AMC was produced by powder metallurgy using 250 KPa compression for 20 min with sintering at 550°C for 2 h followed by slow cooling. The characterization of Al-Zn-based AMCs was performed by electrodynamic polarization testing in 3.5% NaCl solution. From the experimental results, the addition of HAp snail waste at a concentration of 20% by weight with matrix composition Al90-Zn10 is an AMC preparation with optimal corrosion resistance. The corrosion rate of Al90-Zn10/20HAp is 0.01 mmpy, while the corrosion rate of Al90-Zn10/0HAp is 1.15 mmpy. The addition of HAp up to 20% by weight showed the highest micro-hardness (117.90 Hv) while the smallest micro-hardness occurred at AMC Al90-Zn10/0HAp (87.57 Hv). The HAp material could very well be used as an AMC-reinforced biomaterial for biomedical applications.
Study of the Mechanical Properties of the Copper Matrix Composites (CMCs): A Review
Authors: Poulose Nixon , Selvakumar P. , Philip Jibin T. , Ananthi A. , Kavitha S.
Published: November 2022

Copper matrix composites (CMCs) are known to be lightweight and possess competent mechanical properties, hence is highly suitable for a broad range of advanced applications. Its significance in aerospace, marine, and structural domains make it worthwhile to be investigatedfor low-cost manufacturing and selection of appropriate reinforcements. A comprehensive understanding of CMCs in terms of its fabrication methodologies and the diverse properties achievable through the incorporation of discrete reinforcement materials are essential to beexplored. Given, this manuscript evaluates the distinct methodologies for the preparation of CMCs through various fabrication routes. Besides, the substantial improvement/variation in properties such as mechanical (strength, toughness, hardness and creep), metallurgical (microstructure, grain size and grain boundaries), thermal properties (thermal conductivity, coefficient of thermal expansion) and tribological properties (friction, wear) through the incorporation of reinforcements (additives/filler materials/adhesives) of CMCs also is brought under detailed discussion.
Aluminum Oyster Mushroom Frying Surface Quality Improvement through Anodizing
Authors: Rachmawati Achadiah , Setyarini Putu Hadi , Mahendra Vicky Ihza , Wati Anif Mukaromah , Fajriani Sisca , Ambayoen Mas Ayu , Azizah Siti
Published: November 2022

Aluminum is the most often used metal in modern industry and has a long history of use. This material has several advantages and downsides. Among the drawbacks are some aluminum alloys that cannot survive the corrosion rate produced by the environment. To address these problems, numerous procedures are used, one of which being anodizing. The goal of this procedure is to oxidize the metal surface, forming a coating of aluminum oxide that will protect it from the damaging impacts of the environment. As a result, the coating method is used. Stearic acid and lauric acid were employed in the coating procedure in this investigation. Stearic acid and lauric acid were employed in the coating procedure in this investigation. By performing the anodizing process first, then the coating process, the hydrophobicity properties of the many variations employed may be determined by examining the contact angle generated by the droplet outcomes. Untreated sample with a contact angle of 65° were found to have hydrophilic qualities, while the anodizing treatment had a contact angle close to 0°, and the anodizing process with stearic acid and lauric acid coating had contact angles of 117° and 130°, respectively. A sliding angle was also achieved for each treatment applied to the test sample, with the anodizing process obtaining a sliding angle of 59°, the anodizing process with stearic acid coating obtaining a sliding angle of 38°, and the coating with lauric acid obtaining a sliding angle of 28°. The coating utilizing stearic acid and lauric acid has strong hydrophobicity due to its superhydrophobic nature, which may resist the entry of water on the aluminum basis, according to the various treatments performed.
Flexible Graphene-Copper Nanocomposite for Potential Wearable Electronics Applications
Authors: Nugba Betty Edem , El-Moneim Ahmed Abd , Osman Ahmed
Published: November 2022

The demand for flexible and wearable electrochemical sensors has surged due to their low cost and portability. This study produces and characterizes low-cost and environmentally friendly flexible laser engraved graphene/Cu nanoparticles composite materials as a potential electrode for electronic applications. The electrode is fabricated by directly engraving Polyimide substrate using a CO2 laser machine to produce Laser Engraved Graphene (LEG). The electrode is then modified with copper nanoparticles via a one-step pulse electrodeposition technique to be characterized structurally, mechanically, and electrochemically using SEM, XRD, bending test, electrochemical impedance spectroscopy, and cyclic voltammetry to assess their stability and electrocatalytic activity. The laser irradiation of PI results in 3D porous graphene structure formation that increases electron transfer rate and the electrochemically active surface area. Copper deposition improves the sensitivity of LEG by its high conductivity.
Secondary Material Casting of Al-Si for Making Handle Brake in Variation of Duct
Authors: Partono Patna , Hidayat Narendra , Masyrukan Masyrukan , Pangaribawa Muttaqin Rahmat
Published: November 2022

This study aims to determine the effect of the mold casting duct variations on shrinkage, porosity defects, density, hardness, and chemical composition of materials. The primary raw material uses melting secondary aluminium through a small-scale smelting furnace. Research study about three kinds of ducts: triangular duct, rectangular duct, and circular duct. The testing chemical composition uses an emission spectrometer. Research founds defects by comparing the dimensions of the original object with the specimen results of each duct variation. The density value calculates porosity defects. ASTM E10 standard Brinell test measures the hardness. Besides, ASTM E3 standard test quantifies the microstructure of the product. The highest average shrinkage is the triangular ducts at 3.68%. The least significant numbers of porosity were in rectangular ducts of 2.964 gr/ml. Higher the density value, the denser the material, and the more negligible the porosity. The density of the material affects the hardness material obtained from the results of the Brinell test. The hardness of the Brinell test brought that the rectangular duct with 102.5 BHN was the most enormous. In addition, the results showed that the chemical composition mainly contained mostly chemical elements (Al) 87.1% as the main chemical ingredient and (Si) 9.51%.
Investigation of Cryogenic Thermal Conductivity of AA7115 Subjected to Various Heat Treatments
Authors: Arunprasath K. , Muthumalai M. , Kavitha S. , Vijayaram T.R.
Published: November 2022

Thermal conductivity measurements of high-strength AA 7115 cryogenic thermal conductivity under various circumstances of solution and ageing were made using a one-dimensional steady state method. Structural analysis is also used to examine the heat conductivity of the alloy. Aluminum alloy's thermal conductivity decreased linearly as the temperature lowered. The thermal conductivity at various temperatures was reduced by a considerable 35 percent after the solution was applied. The thermal conductivity of the fluid was dramatically lowered after deep cryogenic treatment. In contrast, the ageing process improved the thermal conductivity succeeding solution-deep cryogenic therapy or solution. There were many point flaws in the lattice that increased electrical scattering, which resulted in a decrease in heat conductivity. After severe cryogenic treatment, thermal conductivity dropped even further because of the larger in size of Aluminum - Copper precipitates and raised dislocation density. Raise in thermal conductivity cause by increase in number of fine secondary phase particles precipitating with time. Thermal conductivity of aluminium alloy can be employed to study deep cryogenic treatment methods at low temperatures.
Microstructure Refinement by Austenizing and Tempering in Low Alloy Carbon Steel Casting
Authors: Chamim Moch , Haikal Haikal , Vendy Muh , Fatimah Nur Hidayah
Published: November 2022

Requirements for high service life and mechanical strength of components undergoing cyclic deformation and abrasive resistant, identification of quantitative relationships between material properties and its microstructure very important. In the previous study, Hardness and toughness properties are usually obtained by combining quenching and tempering. The other studies, to increase the hardness by adding Cr on the material. The application of heat treatment in austenizing can provide a microstructure change with refining carbides. In this study, 2.085Cr 2.418Ni low carbon steel casting were heat treated with a reheated in various temperature without quenching. The changes in the microstructure in the last step after passing through the temperature experienced respectively 750 ° C, 650 ° C and 350 ° C were very significant. The phase that appears is tempered martensit surrounding refinement fine tempered martensite and decreasing hardness from 496 HvN to 257 HvN.
The Effect of Finishing Allowance and Milling Methode on Surface Roughness in the Finishing Process of Al5052 and Al7075
Authors: Burhanudin Burhanudin , Margono Margono , Suryono Edy , Atmoko Nugroho Tri , Zainuddin Zainuddin
Published: November 2022

Experiments with variations in the finishing allowance and different milling cutting methods (climb milling, conventional milling) were carried out on aluminum series 5052 and 7075 to investigate the effect of thickness finishing allowance and milling method on the surface roughness of the finishing process. The finishing process with variations in the finishing allowance of 0.05/ 0.1/ 0.15/ 0.2/ 0.25 and 0.3 mm is carried out with a feed rate of 150 mm/minute, fpt 0.0187 mm, spindle speed 2000 rpm, cutting speed 62.8 meters/minute and depth of cut 25 mm using conventional milling and climb milling methods. The experimental results show that the surface roughness with the climb milling method is smaller than the conventional milling method in all variations of the finishing allowance thickness and on the type of material (Al5052, Al7075). While the effect of variations in the thickness of the finishing allowance shows that at a thickness of 0.3 mm, it produces the smallest surface roughness compared to surface roughness at the finishing allowance thickness of 0.05 0.1 0.15 0.2 and 0.25 both on Al5052 and Al7075 .
Variations in Thrust Sharing for Torque-balanced Lift-offset Coaxial Rotors
Authors: Ho Jimmy C. , Yeo Hyeonsoo
Published: November 2022

This paper presents numerical calculations, on coaxial rotor systems, that show the variations of rotor thrust share with lift offset, system thrust, and advance ratio. The calculations are based on a coupled analysis between the U. S. Army's Rotorcraft Comprehensive Analysis System
(RCAS) and a viscous vortex particle method. The level of agreement between calculations and experimental data is good in hover and mixed in edgewise flight. In hover and zero lift offset–a condition in which the upper rotor typically produces more thrust than the lower rotor–changing
system thrust does not significantly alter the rotor thrust share. For advance ratios up to approximately 0.25, independently increasing lift offset increases the lower rotor thrust; this is an aeroelastic phenomenon that is eliminated with rigid blades. Independently increasing advance ratio
leads to three distinct regions with different thrust sharing behaviors; these behaviors are governed by changes to the longitudinal skew of the upper rotor wake and its proximity to the lower rotor.
Reasons for diabetes patients attending Bishop Lavis Community Health Centre being non-adherent to diabetes care
Authors: Booysen Bernice L , Schlemmer Arina C
Published: November 2022

Background: Non-adherence to diabetes care is a concern at Bishop Lavis Community Health Centre (BLCHC) as it results in many diabetes complications that could have been avoided. The aim was to explore the reasons for people with diabetes in the Bishop Lavis area being non-adherent to diabetes care.Methods: A qualitative study was undertaken. Focus groups and in-depth interviews were conducted with patients who had uncontrolled blood sugar and non-compliance. The framework method was used to analyse the data.Results: The main findings in this study were that the following had a negative impact on compliance with diabetes care: (1) poor knowledge of diabetes mellitus; (2) drug treatment barriers such as shift work and not knowing the importance of taking medication regularly; (3) lifestyle adjustment barriers: dietary barriers and lack of exercise; (4) staff and clinic visit problems, for example over-burdened public health-care facilities; and (5) poor support structures including support from family, the community and financially as well as poor infrastructure.Conclusion: The main findings in this study were consistent with many of the previous studies done on adherence, i.e. patient barriers, disease and drug-regime barriers and doctor–patient relationship barriers. However, in this poverty-stricken area these participants also face other constraints that influence their compliance behaviour. These include (1) over-burdened public health care facilities, (2) insufficient education, (3) poor support structures, (4) infrastructure that is not wheelchair-friendly, (5) unsafe communities, (6) low income and unemployment.
A survey of risk factors associated with hypertension in the adult population of Kang, Kgalagadi North, Botswana
Authors: Tshitenge S. , Mabuza L. H.
Published: November 2022

Background: Sustainable and aggressive population-based programmes on hypertension awareness, prevention, treatment and control are key to the successful control of this epidemic. The objective of the study was to determine to what extent hypertension and risk factors for its development were prevalent in the Kang village community in Botswana, and specifically to assess its prevalence in the adult population and its relationship with high blood pressure, anthropometric measures and lifestyle factors, i.e. diet and the use of tobacco products and alcohol.Method: A population-based cross-sectional study was conducted on 161 adult residents of Kang aged 18 years and older from November to December 2008. A questionnaire adapted from the World Health Organization stepwise approach to the surveillance of chronic disease was used for the data collection. Results: The prevalence of hypertension in the adult population of Kang was found to be 32% (95% confidence interval: 25-40). There was no significant sex difference in the prevalence rate in men (28%) versus women (34%), (p  = 0.59). Hypertension was more prevalent in the overweight group than in the normal-weight group (p  = 0.3), in the obese group than in the normal-weight group (p  = 0.002), and in the obese group than in the overweight group (p  = 0.04). Conclusion: This study showed that hypertension affected almost a third of the adult population of Kang, and was significantly associated with overweight and obesity.
A review of the radiological imaging modalities of non-traumatic small bowel obstruction
Authors: Maharaj Narisha , Singh Bhugwan
Published: November 2022

Small bowel obstruction is a common clinical presentation that presents a diagnostic conundrum. Over the last 2 decades, there has been a paradigm shift in the radiological investigation of small bowel obstruction (SBO) and in the indication for and timing of surgical intervention. Cross-sectional imaging (predominantly computed tomography) has largely replaced the widespread use of radiographic small bowel follow-through studies as the imaging modality of choice for SBO. This article illustrates the current imaging modalities available for diagnosis of small bowel obstruction.
Delayed onset muscle soreness: No pain, no gain? The truth behind this adage
Authors: Zondi Phathokuhle C. , Janse van Rensburg D. C. , Grant C. C. , Jansen van Rensburg A.
Published: November 2022

The purpose of this article is to provide brief insight into delayed onset muscle soreness (DOMS), a phenomenon that is often experienced by recreational and elite athletes. The negative implications of DOMS include pain, decreased motivation to continue training, and decreased performance. While performance issues may be more relevant to the elite athlete, pain and decreased motivation are particularly relevant to recreational athletes wishing to sustain a regular level of physical activity. The article is aimed at general practitioners (GPs) who may encounter athletes presenting with DOMS, and who will benefit from understanding the proposed mechanisms, signs and symptoms of the condition. Numerous researchers have hypothesised that certain interventions may prevent or minimise the symptoms thereof, and all GPs could benefit from understanding the available options for athletes, and the scientific evidence that supports these options.
What creates good experiences for EmOC clients in public health facilities in Ethiopia?
Authors: Helelo A. Z. , Zungu L. I. , Chiegil R. J.
Published: November 2022

Objective: To describe aspects that create positive experiences for emergency obstetric care (EmOC) clients in public health facilities in Ethiopia.Design: A qualitative contextual descriptive phenomenological design was used in this study.Subjects and setting: In-depth interviews were conducted with women who had complications during childbirth and received EmOC in three hospitals in Addis Ababa.Outcome measures: Content analysis was used to analyse data as it complies with the phenomenological data analysis. The data were analysed using the Atlas ti version 6.2 qualitative data analysis software.Results: Care that is life-saving, safe, timely, responsive and given in a clean environment, where the service carers show humility, respect, equal treatment and encouragement in an effort to meet the clients’ needs and expectations, creates a good experience.Conclusion: Clients’ experiences during the provision of EmOC influence their future decisions on whether to seek care or not. The findings of the study along with the developed guidelines will assist in the improvement of the provision and utilisation of EmOC at public health facilities in Ethiopia.
The prepared patient
Authors: Ellis Chris
Published: November 2022

No abstract available.
Predictors of complicated dengue infections in endemic region of Pakistan
Authors: Waheed Ikram , Khalid Samreen , Jamil Zubia
Published: November 2022

Objective:

To predict the factors associated with progression to severe dengue infection to prevent potentially fatal complications and to identify the determinants of severe complicated dengue.

Methods:

The study was conducted in a tertiary care hospitaldengue ward from September to November 2021 including confirmed dengue infected patients (positive NS1 antigen or anti-dengue-antibodies IgM). Secondary dengue infection was labelled by positive anti-dengue-antibodies IgG in active dengue infected patients. Detailed history, physical examination, laboratory and radiological parameters, hospital stay (days) and mortality percentages were noted. Patients were classified into three groups according to disease severity: dengue fever (DF), dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). The predictors of complicated dengue infection were determined by regression analysis.

Results:

The most common symptom was fever (96.9%). Among 129 patients, 62.8% had DF, 31.0% had DHF and only 6.2% developed DSS. History of previous symptomatic dengue and positive anti-dengue-antibodies IgG were present in 100% DSS patients and nearly 75.0% DHF patients (P<0.05). The moratlity rate in patients with DSS, DHF and DF was 50.0%, 2.5% and none respectively (P<0.05). Clinical parameters (body aches, bleeding, conjunctival hemorrhage, maculopapular rash, right hypochondrial tenderness, ascites, pleural effusion) and laboratory parameters (thrombocytopenia, raised alanine aminotransferase and secondary dengue infection) were determinants that complicate the dengue infection.

Conclusions:

Thrombocytopenia, raised alanine aminotransferase and secondary dengue infection are important laboratory parameters to complicate the disease process of dengue infection.
Tension Fecopneumothorax
Authors: Abdullatheef Linu , Anil Manes , Athmaram Arjun , Krishnan Vishnu R. , Roy J Stalin , Namboothiry MN Yoganathan
Published: November 2022

Fecopneumothorax causing tension (hemodynamic compromise) is an extremely rare situation, mostly as a result of blunt trauma. Here, we present an 86-year-old gentleman who presented with tension fecopneumothorax, with an interesting backstory as to the development of fecopneumothorax.
Military Marking Round Injury to the Globe
Authors: Donegan Patrick James , De Niear Matthew Allen , Law Janice C. , Barahimi Behin
Published: November 2022

Marking cartridges are an increasingly popular form of nonlethal training munitions used primarily for military live-fire simulations. We report a case of ocular trauma due to such a projectile, resulting in the complete loss of vision and placement of a scleral shell. A 20-year-old man presented with decreased visual acuity in his right eye after being struck at close range by a marking cartridge during military training. Computed tomography imaging revealed a retained metallic foreign body within a deflated right globe, prompting emergent exploration and repair of the right globe. Postoperative course was complicated by pain and pruritis which resolved over a period of months. Nonlethal weapons, such as marking cartridges, are increasingly used for civilian crowd control as well as military and law enforcement training. Despite guidelines mandating the use of personal protective equipment with marking cartridges, eye protection may not be consistently used during simulated combat exercises. To the best of our knowledge, this is the first formal report of ocular injury due to this type of ammunition. Based on this case, we discuss other similar types of nonlethal munition used by military and law enforcement, their risks to the eye and orbit, and what steps may be undertaken to reduce future injury.
Congenital Cryptorchidism Masquerading as Traumatic Dislocation of Testis
Authors: Agrawal Mayank , Gite Venkat Arjun , Sankapal Prakash
Published: November 2022

Traumatic dislocation of testis (TDT) is an uncommon event. During trauma, the cremasteric reflex can forcefully retract the testis out of the scrotal sac saving the testis from the injury. However, associated injuries in the form of skin degloving, penile avulsion, and amputation can be present. Early surgical intervention to locate and deposit the displaced testis to the scrotal sac is essential. We present a case of a 33-year-old man with bilateral congenital cryptorchidism who suffered blunt trauma to his genitalia following a road traffic injury. On presentation, based on a well-developed scrotum, it looked like a case of TDT. However, good history along with detailed physical and radiological evaluation helped us reach the correct diagnosis. TDT must be suspected in a case of blunt trauma to the genitalia when the scrotal sac (well-developed) is empty. This case report highlights the importance of detailed clinical and radiological evaluation in such cases.
Opioid-Related Overdose Fatality Cases in Two Florida Counties
Authors: Powell Anne T. , Bourgeois Marie M. , Lichterman Julie , Johnson Giffe T. , Galwankar Sagar , Harbison Raymond D.
Published: November 2022

Introduction:

This study evaluates trends in drug-related death cases within both Pasco and Pinellas County, Florida, from the calendar years 2011 to 2016. Specifically, it focuses on opioids and the role of fentanyl in overdose-related mortality in rural versus suburban populations.

Methods:

Two sets of data from each calendar year were obtained from a Medical Examiner's Office. These data were compared by year to assess differences using the nonparametric ANOVA test with the statistical software SAS, University Edition. Binary logistic regression was performed to assess which drugs occurred most frequently in the presence or absence of fentanyl.

Results:

There was not a significant difference in the month of the year or the day of the week that drug-related fatalities occurred. More drug-related mortalities occurred during daylight hours (e.g., 8:00 AM–4:00 PM) and more fentanyl-related mortalities occurred in Pinellas County compared to Pasco County. Fentanyl and heroin tended to co-occur in mortalities, while ethanol, hydrocodone, morphine, oxycodone, and methadone were negatively associated with fentanyl-related overdose cases.

Conclusion:

The characteristics of drug-related mortalities identified here may be used to better target interventions against drug abuse and overdose.
How Many Ultrasound Examinations Are Necessary to Gain Proficiency in Accurately Identifying the Nerves of the Brachial Plexus at the Level of the Interscalene Space?
Authors: Shteyman Alan , Jackson Saundra A. , Campbell Tabitha Anne , Derr Charlotte
Published: November 2022

Introduction:

There has been a trend toward the use of alternative treatments to opioids for adequate pain management. This has paralleled a growing interest in the utilization of bedside point-of-care ultrasonography to guide placement of regional anesthesia in the emergency department. The purpose of this study was to establish the number of supervised examinations required for an emergency medicine resident to gain proficiency in accurately locating and identifying the nerves of the brachial plexus at the level of the interscalene space.

Methods:

Proficiency was defined as the number of attempts a resident required to accurately locate and identify the nerves of the brachial plexus on 10 separate, consecutive examinations. Didactic education was provided prior to the study and residents also participated in two instructional hands-on ultrasound examinations prior to the commencement of initial data collection. Count data are summarized using medians, means, and ranges. Random effects negative binomial regression was used for modeling panel count data where negative coefficients indicate increase in proficiency.

Results:

A total of 24 emergency medicine residents were enrolled in the study. Fourteen males and ten females participated. There were nine PGY-1 residents (37.5%), nine PGY-2 residents (37.5%), and six PGY-3 residents (25%). The median number of required supervised attempts and range for correctly performing both steps in the identification of the nerves of the brachial plexus was 2 (range 2–12). The median starting confidence level was 2 (range 1–4), and the median ending confidence level was 4 (range 1–5). Increases in confidence from start to finish were found to be statistically significant (P < 0.001).

Conclusion:

Emergency medicine residents are easily adept in the identification of the nerves of the brachial plexus at the level of the interscalene space following two supervised examinations. Residents made steady gains in confidence and proficiency throughout the study; statistical analysis found a significant association between the two.
The Alpha-bent and Tunneling
Authors: Gunaseelan R. , Sasikumar M. , Nithya B. , Ezhilkugan G. , Anuusha S. S. , Balamurugan N. , Vivekanadan M.
Published: November 2022

The last step in the management of symptomatic bradycardia according to the advanced cardiac life support algorithm is temporary transvenous pacemaker insertion (TPI). TPI done by an emergency physician in the emergency department (ED) is on the rise particularly in South India owing to the increased incidence of yellow oleander poisoning. As in ED, we use passive fixation leads, fixation of a transvenous pacer lead is very important. In the following case series, we describe two novel techniques namely, “the alpha-bent” and “tunneling” for fixing the transvenous pacer lead. This technique of fixing the lead reduces lead displacement thus minimizing the potential complications.
Stroke Incidence and Outcome Disparity in Rural Regions of Southern West Virginia
Authors: Annie Frank Harrison , Bates Mark C. , Khan Muhammad , Zahid Salman , Shah Syed Imran , Nanjundappa Aravinda , Wyner Joshua R. , Anderson Elise , Farooq Ali , Wood Megan , Challa Abhiram
Published: November 2022

Introduction:

West Virginia has the highest incidence of obesity, smoking, and diabetes within the United States, placing its population at higher risk of stroke. In addition to these endemic risk factors, Appalachia faces various socioeconomic and health care access challenges that could negatively impact stroke incidence and outcomes. At present, there are limited data regarding geographic variables on stroke outcomes in rural Appalachia. We set out to quantify Appalachian geographic patterns of stroke incidence and outcomes.

Methods:

This is a retrospective analysis of all patients hospitalized with a diagnosis of stroke in West Virginia's largest tertiary hospital. During the study (2000–2018), 14,488 patients were analyzed, with an emphasis on those who died from stroke (n = 1022). We first used institutional ICD-9/10 data alongside demographics information and chart reviews to evaluate disease patterns while also exploring emerging hot spot pattern changes over time; we then exploited an emerging time series analysis using temporal trends to assess differing instances of stroke occurrence regionally with hot spots defined as higher than expected incidences of stroke and stroke death.

Results:

Data analysis revealed several hot spots of increasing stroke and mortality rates, many of which achieved statistically significant variance compared to expected norms (P = 0.001). Moreover, this study revealed high-risk zones in rural West Virginia wherein the incidence and mortality rates of stroke are suggestively higher and less resistance to economic change than urban centers.

Conclusions:

Stroke incidence and mortality were found to be higher than expected in many areas of rural West Virginia. The higher stroke risk populations correlate with area that may be impacted by socioeconomic factors and limited access to primary care. These high-risk areas may therefore benefit from investments in infrastructure, patient education, and unrestricted primary care.
Approach to Suspected Physeal Fractures in the Emergency Department
Authors: Singh Ajai , Mahajan Prashant , Ruffin John , Galwankar Sagar , Kirkland Courtney
Published: November 2022

Growth plate (physeal) fractures are defined as a disruption in the cartilaginous physis of bone with or without the involvement of epiphysis or metaphysis. These represent around 15-18% of all pediatric fractures. It is important to diagnose physeal injury as early as possible, as misdiagnosis or delay in diagnosis may result in long term complications. Physeal injuries may not be initially obvious in children who present with periarticular trauma, and a high index of suspicion is important for diagnosis. Differential diagnosis for a Salter-Harris fracture includes a ligamentous sprain, acute osteomyelitis, or an extraphyseal fracture such as a Torus fracture. Salter-Harris I & Salter-Harris II growth plate fractures commonly are commonly managed by closed manipulation, reduction & immobilization. These are relatively stable injuries and can be retained by adequate plaster. Salter-Harris III & Salter-Harris IV fractures require anatomical reduction with the maintenance of congruity of joint. Physeal fractures can have many complications such as malunion, bar formation, acceleration of growth of physis, posttraumatic arthritis, ligament laxity and shortening of the bone. The key to well-healing fractures is successful anatomic reduction and patients must have regular follow-up for these injuries.
Protocol Failure Detection
Authors: Lynn Lawrence A. , Wheeler Emily , Woda Russel , Levitov Alexander B. , Stawicki Stanislaw P. , Bahner David P.
Published: November 2022

In medicine, protocols are applied to assure the provision of the treatment with the greatest probability of success. However, the development of protocols is based on the determination of the best intervention for the group. If the group is heterogeneous, there will always be a subset of patients for which the protocol will fail. Furthermore, over time, heterogeneity of the group may not be stable, so the percentage of patients for which a given protocol may fail may change depending on the dynamic patient mix in the group. This was thrown into stark focus during the severe acute respiratory syndrome-2 coronavirus (SARS-CoV-2) pandemic. When a COVID-19 patient presented meeting SIRS or the Berlin Criteria, these patients met the criteria for entry into the sepsis protocol and/or acute respiratory distress syndrome (ARDS) protocol, respectively and were treated accordingly. This was perceived to be the correct response because these patients met the criteria for the “group” definitions of sepsis and/or ARDS. However, the application of these protocols to patients with SARS-CoV-2 infection had never been studied. Initially, poor outcomes were blamed on protocol noncompliance or some unknown patient factor. This initial perception is not surprising as these protocols are standards and were perceived as comprising the best possible evidence-based care. While the academic response to the pandemic was robust, recognition that existing protocols were failing might have been detected sooner if protocol failure detection had been integrated with the protocols themselves. In this review, we propose that, while protocols are necessary to ensure that minimum standards of care are met, protocols need an additional feature, integrated protocol failure detection, which provides an output responsive to protocol failure in real time so other treatment options can be considered and research efforts rapidly focused.
Patterns and Predictors of Emergency Medical Services Utilisation by Patients Attending the Emergency Medicine Department of a Tertiary Care Hospital in India
Authors: Ravindra Prithvishree , Bhat Rachana , Karanth Nisarg , Wilson William , Lavanya B. N. , Umra Simran , Mahesh Shweta
Published: November 2022

Introduction:

Establishment of strong emergency medical services (EMS) systems plays a pivotal role in reducing morbidity and mortality, especially in low and middle-income countries. We aimed to study the EMS utilization and resources available in the ambulances to deliver prehospital care among patients presenting to the Emergency Medicine Department in a tertiary care hospital in south India.

Methods:

Data regarding prehospital transport practices such as mode of arrival, utilization of EMS, resources available in the ambulance, presenting complaints, triage category, and demographic details were collected and analyzed. Subgroup analysis for time-sensitive complaints was done. Variables were subjected to univariate and multivariate analysis to find the predictors of ambulance usage.

Results:

The study included 3935 patients. The most common time-sensitive complaints were trauma (17%) and chest pain (11.5%). The most preferred mode of transport was the personal vehicle (45.6%). 29.8% of patients arrived in the ambulance. 97.7% of ambulances were not Advanced Cardiac Life Support equipped and 87.1% did not have an accompanying health care provider. 64.5% inter-hospital patient transfers were through ambulance, 83.8% transfers were unaccompanied. Among patients with time-sensitive complaints, EMS utilization was inadequate (46.8% in acute coronary syndrome, 34% in trauma, and 56.5% in early acute ischemic stroke).

Conclusion:

There was underutilization of the EMS services. Majority of the ambulances were not adequately equipped/staffed to deliver prehospital interventions. Policies at national level are required to encourage EMS utilization by the public and urgent measures are needed to improve services provided by them.
Dermatopathia pigmentosa reticularis
Authors: Varghese Nidhin , Prathibha J. P.
Published: November 2022

Dermatopathia pigmentosa reticularis (DPR) is a rare ectodermal dysplasia with a triad of generalized reticulate hyperpigmentation, noncicatricial alopecia, and onychodystrophy. We report a case of a 21-year-old man who had generalized reticulate pigmentation, diffuse noncicatricial alopecia, and onychodystrophy of finger and toe nails. Along with this triad, he also had mild atrophy of skin over hands and feet, palms and soles, and loss of dermatoglyphics. There was no evidence of involvement of other organs with ectodermal origin.