Phenytoin versus Leviteracetam for seizure prophylaxis after brain injury - A meta analysis

Background: Current standard therapy for seizure prophylaxis in Neuro-surgical patients involves the use of Phenytoin (PHY). However, a new drug Levetiracetam (LEV) is emerging as an alternate treatment choice. We aimed to conduct a meta-analysis to compare these two drugs in patients with brain injury.Methods: An electronic search was performed in using Pubmed, Embase, and CENTRAL. We included studies that compared the use of LEV vs. PHY for seizure prophylaxis for brain injured patients (Traumatic brain injury, intracranial hemorrhage, intracranial neoplasms, and craniotomy). Data of all eligible studies was extracted on to a standardized abstraction sheet. Data about baseline population characteristics, type of intervention, study design and outcome was extracted. Our primary outcome was seizures.Results: The literature search identified 2489 unduplicated papers. Of these 2456 papers were excluded by reading the abstracts and titles. Another 25 papers were excluded after reading their complete text. We selected 8 papers which comprised of 2 RCTs and 6 observational studies. The pooled estimate\u27s Odds Ratio 1.12 (95% CI = 0.34, 3.64) demonstrated no superiority of either drug at preventing the occurrence of early seizures. In a subset analysis of studies in which follow up for seizures lasted either 3 or 7 days, the effect estimate remained insignificant with an odds ratio of 0.96 (95% CI = 0.34, 2.76). Similarly, 2 trials reporting seizure incidence at 6 months also had insignificant pooled results while comparing drug efficacy. The pooled odds ratio was 0.96 (95% CI = 0.24, 3.79).Conclusions: Levetiracetam and Phenytoin demonstrate equal efficacy in seizure prevention after brain injury. However, very few randomized controlled trials (RCTs) on the subject were found. Further evidence through a high quality RCT is highly recommended

Co-combustion of blends of coal and underutilised biomass residues for environmental friendly electrical energy production

This study investigated the co-combustion of the blends of coal and biomass residues from poplar sawdust, rice husk, pine nut shells, and sunflower residues for ecofriendly energy production. Proximate and ultimate analyses and calorific values of the coal and biomass residues were also carried out to evaluate the properties of the coal and biomass residues. The volatile matter in coal was reported as 43.38 wt% and ranged from 56.76 wt% to 80.95 wt% in the biomass residues. The ultimate analysis reported the carbon and sulfur content of coal as 68.7 wt% and 5.5 wt%, respectively. The coal and biomass blends were prepared using different ratios on the thermal basis of coal and biomass given as 100:0, 90:10, 80:20, 70:30, 60:40, and 50:50 by weight percentage. The consequent stoichiometric air requirements for all the blends were also calculated. The results revealed that the combustion of 60:40 of coal and sunflower residue blend was the most efficient blend, resulting in less emission of NOx, SOx, and CO2 in the flue gas compared to the combustion of pure coal. The study revealed a great perspective of the selected biomass residues to blend with coal for environmentally friendly and sustainable energy production

Knowledge-based network ties in early rapidly internationalising small firms: a missing link?

This paper sets out to establish the sources of the relationships underpinning Early Rapidly Internationalising Small Firm (ERISF) cross border activities, the main characteristics and specific functions of these relationships, and their process of development. Using interview data from ten South African firms, the findings show that the founder's pre-firm knowledge pools are important in establishing the source of the initial hierarchical knowledge-based interpersonal ties. ERISF internationalisation is enabled by an initial prior interpersonal network tie set, which is composed of predominantly strong knowledge-based contacts. The ERISF acts as the source that provides the technical information and knowledge, which is then adopted by their network partners. This means that the ERISF's product and technological capabilities drive the international knowledge creation process. The findings provide a holistic characterisation of the concept of knowledge in ERISF internationalisation. Within their interorganisational relationships, ERISFs are involved in knowledge creation, knowledge transfer and knowledge adoption activities. Network ties developed in existing knowledge pools are extended to new knowledge pools enabling the leveraging of limited resources