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Butt F.,Sialkot Medical College | Aslam M.N.,Services Institute of Medical science | Nadeem N.,LMDC
Pakistan Journal of Medical and Health Sciences | Year: 2017

Background: Anal fissure is quite a common and painful condition which occurs in all age groups and in both genders. The treatment options are numerous; however, broadly it may be surgical and non-surgical. Among surgical, most commonly performed procedure is Lateral Internal Sphincterotomy (LIS), while among non-surgical most common in use of Glycerin Trinitrate gel (GTN) Aim: To compare the successfulness of treatment with GTN and LIS in patient with chronic anal fissure. Methods: This randomized controlled trial was conducted at AllamaIqbal memorial Trust Hospital Gt Road, Gujranwala Medicare International Hospital Gill Road Gujranwala and Services Institute of Medical Sciences Lahore over a period of 3 years, from 2014 to 2016. All the patients presenting with chronic anal fissure with the age of 18-60 years were included in this study. They were randomly divided into two groups by computer generated numbers: group A (LIS) and group B (GTN). Patients in group A underwent LIS by consultant surgeons on elective list in a standard fashion. Patients in group B received 2% GTN gel. All patients in both groups were assessed after 8 weeks of start of treatment or intervention. All the data were analyzed using SPSS version 20. Results: A total of 60 patients (30 in each group) were included in this study. All the demographic details were almost comparable in both groups. Regarding the position of fissure, most common position was posterior in both groups. Treatment was successful in all patients (100%) in patients in group A while it was successful in 22 patients (73.33%) in group B (P <0.05). One patient in group A had incontinence for flatus, while in group B, headache was reported by all and 6 patients discontinued the treatment with GTN due to severe headache. Conclusion: We conclude that LIS is better than GTN and it may be considered as gold standard treatment for anal fissure particularly in chronic cases. However, the importance of conservative and non-surgical management regimens can't be negated.


Gulnaz H.,The University of Lahore | Majeed N.,Shalamar Medical and Dental College | Ijaz S.,LMDC
Pakistan Journal of Medical and Health Sciences | Year: 2017

Background: Orofacial clefts are very common congenital anomalies and include cleft lip, cleft lip and palate and cleft palate alone. The development of congenital anomalies is multifactorial which include environmental and genetic factors and consanguinity. As consanguineous marriages are commonly practiced, the present study is designedto evaluate the patterns of orofacial clefts in patients with consanguineous parents in local population. Methods: Data was collected from Shalamar Hospital, Children Hospital and Arif Memorial Hospital, Lahore and observed retrospectively. Data was analyzed by using SPSS. Results: Out of 126 patients with facial clefts 103 had positive family history of consanguinity. 25 patientswith consanguineous parents were suffering from cleft lip and 35 from cleft lip and palate. Cleft palate alone was observed in 31 patients and one of the patients was found to have cleft lip and nasal deformity in concert. 11 patients with consanguineous parents were suffering from cleft lip, palate and nasal deformity. Gender disparity among patients with consanguineous parents wasobservable as well; an overall higher frequency of isolated cleft lip (CL) was seen in males than in females with a higher incidence of unilateral cleft lip in males in contrast to a higher incidence of bilateral cleft lip in females. Incidence of cleft palate (CP) and cleft lip and palate (CL+P) showed preponderance in females than in males.Results of the current study elucidate a close association between consanguinity and the development of cleft anomalies. Conclusion: The impact of this practice should be addressed by premarital or at least prior to conception screening with the provision of appropriate counseling to prevent this disorder well-timed.


Linger L.,VINCI Construction Grands Projets | Carcasses M.,LMDC | Cassagnabere F.,LMDC | Cussigh F.,VINCI Construction France | And 3 more authors.
High Tech Concrete: Where Technology and Engineering Meet - Proceedings of the 2017 fib Symposium | Year: 2017

Recent projects specifications are definitively much more focused on the fact that concrete mix designs must be designed to achieve the expected structures durability rather than typical compressive strength classes. European standard EN 206 is allowing the implementation of performance-based approach for concrete mixes design even if its implementation still need to be further detailed. For example, the French relevant specific code for bridges and major civil works structures, (Fascicule 65), is proposing to implement a performancebased-approach by assessing concrete performances accelerated ageing tests or durability indicators with associated threshold values linked to concerned exposure classes. Major worldwide Project's concrete specifications are more and more often setting up threshold values regarding durability indicators aiming to assess concrete transfer properties (porosity, permeability, diffusivity) to prevent aggressive matters (chlorides and sulfate ions, CO2, O2, H2O) to migrate through steel rebar cover. This is the case of a currently ongoing major project in La Réunion Island in the Indian Ocean dealing with the construction of a New Coastal Road consisting in France's longest offshore viaduct, a dike and two interchanges. At the starting up of concrete mixes design process, it has been realized that the intrinsic quality of locally available aggregates (which are exhibiting a high vacuolar interconnected porosity) will definitively be subject to concern to achieve the specified hardened concrete porosity. On the other hand, it was definitively not worth considering the importation of more than one million tons of aggregates for concrete production. It was, then, a major issue to globally investigate the influence of the aggregates intrinsic properties on all the transfer properties in order to propose alternative durability threshold values allowing the achievement of the expected durability of the concrete structures. Considering that concrete overall porosity results from a coupling of cementitious material matrix porosity (where liquid and gas species are migrating) and aggregates intrinsic porosity, it has been investigated if an increased porosity measured on a given concrete mix design was systematically associated with lower transfer properties which would jeopardize concrete overall durability. This study, associated with the selection of adequate steel rebar covers determined by implementing numerical simulation following fib Model Code 2010 modeling tools, allowed to agree on alternative durability indicators threshold values to those initially envisaged for the project. It also leads to the conclusion that it would be worth to carry on further research to better understand the influence of aggregates porosity on concrete overall durability in the course of a starting French national project (PERFDUB 2016) aiming to optimize and rationalize methods of the performance-based approach coupled with the research program MODEVIE (French acronym of Concrete structures ageing modeling) (Modevie 2016). © Springer International Publishing AG 2018.


Shahbaz T.,Lahore Medical and Dental College | Raza S.M.,LMDC | Manzoor Z.,LMDC | Jamshid A.,LMDC
Pakistan Journal of Medical and Health Sciences | Year: 2014

Results: Total 280 medical students were interviewed. Among them 25.7% (60) were from first year, 21.4 %(60) from second year, 24.3% (68) from third year and 28.6%(80) were fourth year medical students. The age ranged from 18-25 years with 41.4% (116) of male students and 58.6%(164) were females. About 80-90% (224-250) showed a good knowledge about transmission and prevention of these infections. 63.6% (178) believe that hepatitis B and C can be transmitted as nosocomial infections and 72.5(203) know that these infections are widely transmitted like HIV/AIDS. 85% (238) were of the opinion that they are at greater risk of having them due to their profession. Among 270 students, 200(71.4%) were fully vaccinated against hepatitis B and 32(11.9%) were partially vaccinated.48 (17.1%) were the students who were not vaccinated at all.Background and Aims: Medical students like other health workers are being part of the health care delivery system are exposed to the same size of risk as other health care workers when they come in contact with patients and contaminated instruments. They are the first level of contact between patients and medical care. They are expected to undertake activities related to patient care with the beginning of their clinical years. They are involved in blood transfusion, injections and surgical operations in their practices. They should have awareness about the risk factors and appropriate precautionary measures to avoid these infections in handling these patients.Study Settings: Descriptive cross sectional study.Methods: A closed ended questionnaire consisting of questions to evaluate the knowledge regarding hepatitis B and C infection, attitude and perception of the medical students was duly filled by 280 students including First, Second, third and Fourth year. The data were entered and analyzed using Statistical Package for Social Sciences (SPSS) software version 20.Conclusion: Level of knowledge was associated with academic grade of the students. Overall knowledge was found to be high but vaccination status was low for this particular group. © 2014 Pakistan Journal of Medical and Health Sciences. All Rights Reserved.


Fatima A.,Lahore Medical and Dental College | Shad M.N.,Islam Medical and Dental College | Asrar A.,LMDC | Murad S.,IMandDC
Pakistan Journal of Medical and Health Sciences | Year: 2014

Hyperlipidemia with increased body weight are main cause of consideration on CAD. These pathological states eventually leading to development of metabolic syndrome are leading cause of morbidity and mortality throughout the world. Various drug groups and regimen are being used to handle these problems but none is absolute satisfactory due to their widespread side effects and low compliance. Conventional use of nigella sativa for many diseases are now emerging in allopathic discipline of healthcare to cure various diseases with good compliance with least side effects. This study was conducted in Lipid Research Centre, Pakistan Institute of Cardiology, Lahore, Pakistan, from October to December 2013. Study period was one month. Sixty male and female hyperlipidemic patients age range from 20 to 70 years were included in the research with written explained and approved consent. All patients were divided in two equal groups. In Group-A, 30 patients were advised to take two spoons of kalonji after breakfast for the period of four weeks. In group-II, 30 hyperlipidemic patients were advised to take placebo capsules after breakfast everyday for the period of four weeks. At the end of research work, mean values of all parameters with ±SD were analyzed statistically using paired 't' test. These results were compared with placebo therapy and observed that both parameters showed highly significant change, with p-value <0.001. We concluded from these results that kalonji is very effective herbal drug to increase HDL-c and decrease body weight.


Tufail S.,S Z Medical College | Fatima A.,LMDC | Niaz K.,IM and DC | Qusoos A.,FM and DC | Murad S.,IMDC
Pakistan Journal of Medical and Health Sciences | Year: 2015

Back ground: Hyperlipidemia is one of the important risk factor to develop coronary artery disease (CAD) leading to main cause of morbidity and mortality due to heart attack and cardiac arrhythmias. Decreased level of plasma HDL-cholesterol independently can cause CAD. Recent studies have proved that walnuts can increase plasma HDL-cholesterol if taken in specific amount per day regularly Place and duration of study: Lahore General Hospital, Lahore from January 2014 to April 2014. Methodology: The baseline values of HDL-cholesterol were measured at day-0 and day-60 by separating other lipoprotein fractions using chemical precipitation with Mg2+, then coupling the products of a cholesterol oxidase reaction. Forty hyperlipidemic patients were selected from Lahore General Hospital for the study. Age of patients ranged from 20 to 65 years. Both gender male and female patients were enrolled. They were advised to discontinue any hypolipidemic medications and foods. Patients suffering from any metabolic disease, renal impairment, liver disease, and already having any cardiac problems were excluded from the research study. Forty patients were divided in two groups, twenty individuals in each group. Group-1 was advised to take 30 grams of walnuts (without shell) per day for the period of eight weeks. Group-II was considered as control group and was advised not to take any dry fruit including walnuts. Results: In twenty hyperlipidemic patients, two months therapy with 30 grams of walnuts per day increase in HDL-cholesterol was 6.3 mg/dl which was significant change when analyzed biostatistically, showing p-value <0.01. Statistical analysis: Mean values with SD and SEM were analysed statistically by using SPSS version 16.1. P-value of <0.001 was considered as significant and p-value of >0.05 was considered as non-significant change. Conclusion: It was concluded that regular intake of specific amount of walnuts without shell can increase good cholesterol (HDL-cholesterol) in male and female patients of age range from 18-65 yrs.


News Article | November 6, 2016
Site: www.theguardian.com

As the world gathers in Morocco for the historic first meeting under the Paris agreement – called “COP22” but now also “CMA1” – it does so with the unprecedented involvement of corporate interests who have fought climate action around the world, funded climate change denial and whose fundamental interest is in extracting and burning as much fossil fuel as possible. Earlier this year, desperate moves from countries representing the majority of the world’s population to examine how the UN might identify and minimise conflicts of interest were swept under the carpet by rich countries – especially the US, EU and Australia – who argued they wanted to be as “inclusive” as possible and that the concept of “conflict of interest” was too hard to define. As a result, representatives of companies such as ExxonMobil, Chevron, Peabody, BP, Shell and RioTinto will have unquestioned access to most discussions in Marrakech, will be called upon for advice and will be walking the corridors and holding private discussions with countries that are trying to move the world to stop consuming the products those companies have based their businesses on. The bodies through which those companies access the COP22 meetings have been detailed in a chart created by Corporate Accountability International. Groups such as the World Coal Association, the Business Council of Australia, Business Europe and Business Roundtable will represent the world’s biggest fossil fuel companies in the meetings through their “observer status”. Jesse Bragg from Corporate Accountability International says it is clear those groups are driven by a profit motive and not by the desire to curb carbon emissions, and so have a conflict of interest. “It’s hard to believe the World Coal Association is having conversations with delegates, encouraging them to more strictly regulate the coal industry,” Bragg says. “That’s completely against their interests. So what is their purpose in that space other than to continue to extract and burn coal?” Bragg says those groups have a role to play in the implementation of the rules set by nations but no legitimate role to play in the setting of the rules themselves. The role many fossil fuel companies play in policy debates as the world attempts to curb carbon emissions has been clear: In a striking irony, the climate change COP at which these corporate interests will be welcome will happen at exactly the same time as another UN COP, where the exclusion of corporate interests has been hailed as a fundamental ingredient to its success: COP7 of the Framework Convention on Tobacco Control, starting today in Delhi, India. At that meeting, a report will be presented analysing the impact of the tobacco control treaty. It concludes the FCTC “has contributed to significant and rapid progress” in tobacco control action. Part of the FCTC – article 5.3 – says that “parties shall act to protect these policies from commercial and other vested interests of the tobacco industry in accordance with national law”. The treaty recognises that “there is a fundamental and irreconcilable conflict between the tobacco industry’s interests and public health policy interests.” It then goes on to recommend almost no contact with the tobacco industry, except when necessary to implement regulation of their products. “It’s pretty much the most important aspect of implementation,” says Mike Daube from Curtin University in Australia, of article 5.3. Daube was the deputy chairman of the committee that wrote the report on the impact of the tobacco control treaty. “It essentially says that governments should only speak with the tobacco industry when they absolutely have to and do so holding their nose and washing their hands afterwards,” Daube says. Despite the strong acknowledgement of corporate conflicts of interest in that UN treaty, rich countries have argued strongly against any measure to limit corporate involvement in the implementation of the Paris agreement. In May, the Like Minded Group of Developing Countries (LMDC) – a collection of more than 20 countries representing most of the world’s population – pushed for an report to be prepared examining how “the United Nations system and other intergovernmental forums … identify and minimise the risk of conflicts of interest”. Far from a radical call for governments to distance themselves from the fossil fuel lobby, it merely asked for a report on how conflicts of interest have been dealt with in other forums. But that request was deleted from the final report from the meeting and a “technical glitch” meant an objection raised by Ecuador on behalf of the majority of the world’s population was ignored. The Venezuelan delegation spoke strongly about the issue: But the EU, Australia and the US rose to speak against any exclusion of fossil fuel lobbyists. The Australian delegation framed the issue as one where developing countries were trying to make the process less “open”, despite supporting measures in the tobacco control treaty to lock out the tobacco industry: Australia also argued the concept of “conflict of interest” itself was too hard to define, despite the issue being grappled with in many other forums: The US delegation also framed the issue as one where they were trying to be as inclusive as possible. “We oppose constraining NGO participation in the UNFCCC process,” the US delegation said. Besides having access to meetings as observers, with no conflict of interest screening, the unprecedented level of corporate influence on the implementation of the Paris agreement was formalised in the global climate action agenda, through which corporations who make carbon-cutting pledges get high-level access to the meetings, can organise side events in the “civil society village”, promote their products in a “gallery” and sponsor the conference. Kingsley Faulkner is the deputy president of the Australian Council of Smoking and Health as well as the national chair of Doctors for the Environment Australia. Faulkner says the exclusion of the smoking lobby from tobacco control forums was essential and that there are clear parallels to the fossil fuel lobby. “Bodies that make these decisions should be looking very seriously at who they allow into the policy-making groups and see in whose interests they are talking,” Faulkner says. “And if you do that, of course, you clamp down on the fossil fuel lobby. “There are a number of real examples where industries have huge influence on public policy, to the detriment of the health of the community. “If politicians are serious about saying their first priority is the security and the wellbeing of the community then they’re going about it in a bad way if they allow the fossil fuel lobby to put that at risk.”


Sellier A.,LMDC | Vidal T.,LMDC | Cagnon H.,LMDC | Buffo-Lacarriere L.,LMDC | Multon S.,LMDC
Key Engineering Materials | Year: 2016

The objective of this research is to understand the behavior of concrete subjected to temperatures up to 180°C and to gas absolute pressures up to 5 bars applied during the two weeks envisioned in the "loss of coolant accident" (LOCA) scenario. Previous studies about delayed mechanical behavior of concrete have pointed out an increase of delayed strains with the temperature rise: the basic creep can be multiplied by a factor 10 at 80°C, and coupling between creep and heating can lead to damage and to transient thermal creep. These phenomena could be predominant if the LOCA induced conditions are maintained several days and more probably several weeks. So, a model able to predict the cracking and the gas leakages has to be developed. It has to consider these phenomena and their coupling with other possible causes of concrete damage previous to the LOCA. In fact, if the LOCA occurs on structure already damaged by early age cracking or endogenous chemical reactions, such as AAR or ettringite, the leakage risk could be increased. The paper will focus on some important aspects of these phenomena (creep rate dependency on temperature, scale effects at early age, damage induced by swelling reactions), and on their coupling in a finite element model. © 2016 Trans Tech Publications, Switzerland.


This article presents the application of a thermo-hydro-chemo-mechanical (THCM) model to a real complex structure of reactor confinement (mock-up VERCORS from EDF) by taking into account the specificities of the construction (construction consequences), the distributed reinforcements and the material heterogeneity of massive structure. The experimental campaigns were conducted during and after the construction of VERCORS. The early-age behavior of concrete is first modelled based on a multiphasic hydration model to ensure the thermal evolution. Then a 3D mechanical model is used to predict the consequences of hydration, temperature and water variations on mechanical behavior. An alternative approach to consider the structural effect of distributed reinforcement without explicit meshing of reinforcements is implemented and is able to reproduce the influence of reinforcement on the crack patterns. Moreover, the "Weakest link localization" method is also adapted to deal with a probabilistic scale effect due to the material heterogeneity of massive structure. It permits to assess directly the most likely tensile strength which can treat the first crack in softening part of the loaded volume of structures. © 2016 Trans Tech Publications, Switzerland.


Bucher R.,LMDC | Cyr M.,LMDC | Escadeillas G.,LMDC
RILEM Bookseries | Year: 2015

The pozzolanic materials are often recommended for their very good durability in aggressive environment. Unfortunately, this is not always true and particularly in the case of carbonation by the atmospheric CO2. Although cement replacement by pozzolanic materials causes a decrease in pore size, the pozzolanic reaction consumes portlandite and decreases the protection potential against CO2 ingress. This is the case for most pozzolanic materials, including metakaolin. The aim of this study is first to confirm the literature results of carbonation by using flash metakaolin in partial replacement of cements (CEM I, CEM II A-LL and CEM II A-V). Then the concretes with a metakaolin are compared with concretes based on standardized cement in order to assess the carbonation depth of metakaolinbased concretes and concretes used today in the building construction. Even though the cement replacement of CEM I and CEM II A-V by metakaolin increases the carbonation depth, results are not the same with the CEM II A-LL cement. The interaction of metakaolin with the cement limestone filler can explain this better performance, certainly because the hemicarboaluminate allows slowing down the CO2 propagation through the matrix. © RILEM 2015.

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