Extra Precautions Research Articles

Histopathologcal Effects of Methotrexate on Rat Kidney –An Experimental Study on Wistar Albino Rats.

Introduction: Methotrexate, a folic acid antagonist is used as a first line drug for the treatment of a number of malignancies and immune disorders like rheumatoid arthritis. Due to hepatoxicity its dose needs to be monitored and sometimes it has to be stopped. In the present study we intend to do a detailed histopathological investigation after methotrexate toxicity on the relatively neglected organ i.e. kidney of rat. Subjects and Methods: Albino rats were divided into four groups (1, 2, 3, and 4) of six animals each. Control group 1 was given distilled water whereas experimental groups 2, 3, and 4 were given low, therapeutic and high doses of methotrexate orally for 28 days. Results: The results showed congestion and infiltration of the glomeruli and interstitial edema and tubular degeneration which were dose dependent. Conclusion: The degenerative changes necessitate extra precautions to be taken while using drug for prolonged period. The study merits due to great social impact.

The Effect of Cyclic Load Characteristics on Unbound Granular Materials

Vertical load characteristics used in laboratory repeated load triaxial tests (RLTT) have a significant impact on evaluating unbound granular materials (UGMs) for the flexible road pavements. Many studies and standard testing protocols suggest a diverse range of these characteristics (i.e. stress magnitude, pulse shape type, loading period and rest period). Several studies have been conducted to identify the factors that affect the permanent deformation (PD) and resilient modulus (Mr) of UGMs. However, the effect of the pulse shape types has not yet been investigated. The aim of this study is to experimentally investigate the effect of vertical stress pulse shape type on the PD and Mr behaviour of the UGMs using RLTT. For further assessment, a parametric analysis was also conducted using eight existing PD and Mr constitutive models. Three typical vertical stress pulse shape types were investigated, namely trapezoidal, haversine and triangular, as suggested by several international testing protocols. The results show that tested UGMs, using trapezoidal stress pulse, produced higher PD and lower Mr than haversine and triangular pulses under controlled experimental conditions. As the loading span of the pulse increased, the amount of PD also increased, and Mr decreased. Some of the regression parameters of the investigated constitutive models for both PD and Mr showed correlations with the type of applied stress pulses. Moreover, it was found that the PD and Mr models were material dependent, as a better statistical fit was achieved for the granite than the basalt samples. It is recommended to take extra precautions while adopting a particular type of vertical stress pulse shape as the results may vary widely.

Partial thickness temporalis rotation for alloplastic temporomandibular joint – how I do it

With increasing clinical evidence, the replacement of the temporomandibular joint with alloplastic joints is being increasingly accepted in severe degenerative diseases. There remains a risk of infection and a possibility of a failure of not just these prostheses but any alloplastic joint prosthesis post-operatively. Therefore, an extra precaution and additional coverage to the joint using partial thickness myo-temporalis rotation flap could be a useful option to minimize post-operative joint failure.

Investigation of undesired ripple voltage across power source side and solutions in military low-frequency immunity tests

The MIL-STD-461 CS101 test is one of the essential low-frequency conducted immunity tests for military and aerospace equipment, however it includes some challenges in application. The major challenge is the necessity for the measurement of injected CS101 ripples under the power frequency of the EUT. The measurement of CS101 ripples on the power frequency is almost impossible without taking some extra precautions. In addition to the hard necessity of measuring the CS101 ripple voltage induced across the EUT power input, the other challenge of measuring the ripple voltage that drops across the power source side under the AC power frequency of the EUT is now required by MIL-STD-461G, which aggravates the severe CS101 test conditions of AC devices. In this paper, we propose a FFT-based time domain solution and a method to instantly check the ripple voltage that drops across the power source side, in other words across the 10 μF test capacitor, during the test under the AC EUT power frequency and to verify that it is low enough and not affecting the reliability of the test. The method proposed in this paper significantly overcomes the CS101 test challenges and makes CS101 test results more accurate. In this paper, we also extensively focused on effective solutions to reduce the ripple voltage induced across the power source side along with measurement uncertainty analysis.

Anatomical variations of anterior ethmoidal artery and their significance in endoscopic sinus surgery: a systematic review.

Anterior ethmoidal artery (AEA) is at risk of injury in endoscopic sinus surgery due to its location. The aim of this review was to assess the anatomical variations of AEA and their significance. A literature search was performed on PUBMED, SCOPUS AND EMBASE. The following keywords were used: ethmoidal artery; anterior ethmoidal artery; anterior ethmoidal canal; ethmoid sinus; ethmoid roof; skull base. The search was conducted over a period of 6 months between October 2016 and April 2017. 105 articles were retrieved. 76 articles which were either case reports or unrelated topics were excluded. Out of the 29 full text articles retrieved, 16 articles were selected; 3 were cadaveric dissection, 5 combined cadaveric dissection and computed tomography (CT) and the rest were of CT studies. All studies were of level III evidence and a total of 1985 arteries were studied. Its position at the skull base was influenced by the presence of supraorbital ethmoid cell (SOEC) and length of the lateral lamella of cribriform plate (LLCP). Inter population morphological variations contribute to the anatomical variations. The average diameter of AEA was 0.80mm and the intranasal length was 5.82mm. 79.2% was found between the second and third lamellae, 12.0% in the third lamella, 6% posterior to third lamella and 1.2% in the second lamella. Extra precaution should be taken in the presence of a well-pneumatized SOEC and a long LLCP as AEA tends to run freely below skull base.

Surgical treatment of pediatric supracondylar humerus fracture could be safely performed by general orthopedists.

Displaced pediatric supracondylar humerus fracture (SCHF) requires a reduction and instrumentation. The trend is to send the cases to a fellowship-trained pediatric orthopedist. This study reviewed the outcomes and complications of SCHF surgically managed by orthopedic surgeons with different backgrounds of subspecialty training. The medical records of 87 children (87 elbows) with an average age of 5.9 ± 3.1 (range 1.3-14.1) years with SCHF Gartland 2 and 3 who underwent operative fixation were reviewed. The demographics data and operative details were obtained. Radiographically, the Baumann and humerocapitella angles were measured. The lateral rotational percentage of Gordon was calculated. The Griffet index 1 and 2 were retrieved. The parameters were compared among groups of surgeons with a pediatric fellowship-trained background and surgeons with other subspecialty training. A univariate analysis was calculated for the risk of postoperative complications. The demographics data were comparable between the two groups. Children who were treated by non-pediatric fellowship-trained orthopedists showed higher but not significant degrees of postoperative Baumann angles; however, the proportion of children with an acceptable range of Baumann angle were similar. The overall complications rate was 17.5% and comparable between the two groups. Only SCHF Gartland 3 was associated with complications (P = 0.01). Pediatric SCHF could be efficiently managed by a general orthopedic surgeon because the radiographic outcomes and complications were comparable to pediatric fellowship-trained orthopedists. Extra precautions need to be exercised in SCHF Gartland type 3 because the chance of complications is higher among these types of injuries. Level III.

15 OF evaluation for the Cyberknife M6: Comparison between two measurement correction methods for different detectors

Introduction For small beams used in stereotactic radiotherapy, extra precautions need to be taken into account when determining dosimetric data used in the modelling of dose calculation algorithms [1] . In this work, we focused on the output factors determination of the Cyberknife M6 (Accuray Inc., Sunnyvale, USA). Measurements were performed with active and passive detectors and with fix collimation. We compared two new sets of corrective factors published by the IAEA (TRS 483) and by Francescon et al., recommended by Accuray [2] and we compared theses corrected results with radiochromic films. Methods OF were measured with three punctual PTW detectors: 60018 (SRS) and 60008 diodes, 60019 microdiamond and EBT3 Gafchromic films (Ashland Inc., USA) for all the fixed collimators in the reference conditions (SAD = 80 cm, depth = 1.5 cm), 200 MU for each beam. Five measurements were performed for each punctual detector and three for the films. Films were analyzed with the Epson V750 Pro (Epson, Japan) and the ImageJ software (NIH, USA). Results Application of these two sets of corrective factors enable the reduction of discrepancies (related to small beams measurements challenges) between detectors for collimators greater than or equal to 7.5 mm diameter (see Fig. 1). For the 5 mm fixed collimator, the maximal discrepancy between two detectors is 9.6% without corrections and is reduced to 4.4% and 8% with the Francescon’s corrections and with the IAEA respectively. In average, corrected measurements are closer to films measurements with a maximal discrepancy varying from 3.8% to 2% and 2.1% for Francescon and for the IAEA respectively. Download : Download high-res image (502KB) Download : Download full-size image Conclusions The two sets of corrective factors give similar OF results with a good agreement between detectors, allowing a better precision for OF modelling in the TPS. Those factors could be extended for the Iris collimator [3] .

Guidelines for exercise during normal pregnancy and gestational diabetes: a review of international recommendations.

Τo summarize and present the main guidelines for exercise during normal pregnancy and pregnancy complicated by gestational diabetes mellitus (GDM). Relevant guidelines were retrieved through the electronic databases PubMed (MEDLINE), CENTRAL (Cochrane), and Embase; reference sections of the retrieved publications; proceedings of the main congresses in the field; and websites of relevant organizations published during the years 2000-2018. All guidelines recommend aerobic training from 60 to 150min/week, with an upper limit of 30min/day. Exercise is safe, even on a daily basis. Resistance exercise is suggested by five national guidelines (Australia, Canada, Denmark, Norway, and the UK). Discrepancies exist regarding the recommended intensity of exercise. Canada, Japan, Spain, and the UK use both objective (heart rate and maximum oxygen consumption) and subjective criteria (Borg's Scale and talk test) to determine the effectiveness and safety of exercise. Only Canada provides specific recommendations, according to the woman's age and level of physical condition. Women with GDM on no insulin treatment do not need to take extra precautions during exercise. However, due to their condition of hyperglycemia, they must comply with the recommendation issued for type 2 diabetes. The prescription and supervision of exercise should be carried out in a similar way as for uncomplicated pregnancies. Finally, women with GDM on insulin treatment need to follow the same recommendations as for those for pregnant women with type 1 diabetes. Health professionals must be informed about the correct planning and execution of physical exercise programs so as to safely achieve the maximum effectiveness of exercise-induced health-related benefits in pregnant women.

Influence of age, gender, smoking, diabetes, thyroid and cardiac dysfunctions on cystatin C biomarker

BackgroundCreatinine is the most widely used renal failure biomarker; however, it has a lot of drawbacks. One of the major drawbacks is the blind range (does not increase until 50% of the kidney deteriorates). On the other hand, cystatin C has gained more attention as a promising biomarker due to several advantages over creatinine. Cystatin C levels are elevated as soon as any mild defect in the kidney occurs. Furthermore, cystatin C is influenced by several non-renal diseases which provide an additional prognostic value for this promising biomarker. Objectives1. Study the effects of age, gender and smoking on cystatin C levels to. 2. Challenge the adoption of glomerular filtration rate equations for healthy population. 3. Compare the values generated from different glomerular filtration rate equations. 4. Evaluate the prognostic value of cystatin C for selected non-renal diseases. MethodsUsing cross sectional analyses, we established the relationship between cystatin C levels and non-renal predictors. The quantification of cystatin C was performed by high performance liquid chromatographic method, while for creatinine by a colorimetric enzymatic method. ResultsIn the healthy volunteers the levels of cystatin C were slightly higher in men than in women and in individuals older than 50 years old than those under 50 years old and in smokers than non-smokers, however, statistical data confirmed a non-significant relationship with respect to the aforementioned factors. For the recruited patients suffering from (diabetes, hyper- and hypothyroidism and cardiac dysfunctions) a clear increase in cystatin C levels were observed with the exception of hypothyroidism patients in which a decrease in their cystatin C levels were observed. ConclusionDiabetes, thyroid and cardiac dysfunctions have a clear impact on the levels of cystatin C in human blood, whereas age, gender and smoking habit have no effect. Therefore, cystatin C could be considered as a useful biomarker of the aforementioned diseases, in turn, this requires extra precautions including the evaluation of several clinical conditions by physicians should CC is considered as a renal failure biomarker.

Effect of vertical stress rest period on deformation behaviour of unbound granular materials: Experimental and numerical investigations

Repeated load triaxial test is used to assess the deformation behaviour of unbound granular materials (UGMs) in flexible road pavements. Repeated load pulse characteristics (i.e. shape, loading period and rest period) are the stress configurations used in the experimental set-up to simulate the passing axle loads. Some researchers and standard testing protocols suggest a rest period of varying durations after a loading phase. A thorough review of existing literature and practises has revealed that there is no agreement about the effect of the rest period of vertical stress pulse on the deformation behaviour of the UGMs. Therefore, the main objective of this study is to investigate the effect of repeated stress rest period on the deformation behaviour of UGMs experimentally. Experiments are conducted, both with and without rest period, using basalt and granite crushed rocks from Victoria, Australia. Furthermore, in order to gain insight into the effect of the rest period, finite element modelling is also developed. Both the experimental and modelling results show that the rest period has a noticeable effect on both resilient and permanent deformation behaviours of UGMs. It is, therefore, recommended to take extra precautions while adopting a particular standard testing protocol and to supplement the results by additional tests with different loading configurations.

Seismic design of Xiluodu ultra-high arch dam

The 285.5 m-high Xiluodu Arch Dam is located in a seismic region along the Jinsha River in China, where the horizontal components of peak ground accelerations for design and checking earthquakes have been estimated to be 0.355g and 0.423g, respectively (g is the gravitational acceleration). The ground motion parameters of design and checking earthquakes are defined by exceedance probabilities of 2% over 100 years and 1% over 100 years, respectively. The dam shape was first selected and optimized through static analysis of the basic load combinations, and then adjusted after taking into account the seismic loads. The dam should be operational during and after the design earthquake with or without minor repairs, and maintain local and global stabilities during an extreme earthquake. Both linear elastic dynamic analysis and nonlinear dynamic analysis considering radiation damping, contraction joints, and material nonlinearity were conducted to assess the stress in the arch dam. The dynamic analysis shows that the maximum dynamic compressive stresses are less than the allowable levels, while the area with tensile stress over the limit is less than 15% of the dam surface and the maximum contraction openings range from 10 mm to 25 mm. The arch dam has sufficient earthquake-resistance capacity and meets the safety requirements. Nevertheless, steel reinforcement has been provided at the dam toe and in the zones of high tensile stress on the dam surface out of extra precaution.

Impact of anthropogenic CO2 emissions on global human nutrition

Atmospheric CO2 is on pace to surpass 550 ppm in the next 30–80 years. Many food crops grown under 550 ppm have protein, iron and zinc contents that are reduced by 3–17% compared with current conditions. We analysed the impact of elevated CO2 concentrations on the sufficiency of dietary intake of iron, zinc and protein for the populations of 151 countries using a model of per-capita food availability stratified by age and sex, assuming constant diets and excluding other climate impacts on food production. We estimate that elevated CO2 could cause an additional 175 million people to be zinc deficient and an additional 122 million people to be protein deficient (assuming 2050 population and CO2 projections). For iron, 1.4 billion women of childbearing age and children under 5 are in countries with greater than 20% anaemia prevalence and would lose >4% of dietary iron. Regions at highest risk—South and Southeast Asia, Africa, and the Middle East—require extra precautions to sustain an already tenuous advance towards improved public health.

Veterinary-Prescribed Buprenorphine Ingestion in a 2-Year-Old Girl

Ingestion of buprenorphine by young children is on the rise and can lead to life-threatening consequences and death. Exposure most often occurs when a child acquires the medication intended for adult use. However, buprenorphine is also prescribed by veterinarians and may be sent home, typically in non-child-resistant packaging, to be administered to the family pet. A previously healthy 2-year-old girl weighing 11.36 kg was found with a 1-mL syringe containing 0.6 mg/mL of buprenorphine in her mouth. The syringe had been in a plastic bag provided to the family by their veterinarian for the family dog. She was hospitalized for 24 hours but remained asymptomatic and was discharged healthy. This type of exposure to buprenorphine has not previously been described in the literature. Having this unsecured medication in the home increases the potential risk of exposure for young children and associated health consequences. Pediatricians should be aware of the potential dangers that veterinary pharmaceuticals can pose and educate parents about proper storage of medications. In addition, veterinarians should take extra precautions when dispensing these medications to pet owners with children.

House dust mite population in the bedrooms of people with dust mite allergy in the city of Ordu, Turkey

House dust mites are a major source of allergens that are responsible for allergic symptoms such as asthma and atopic diseases. The warm and humid climate of Ordu, which is situated on the Black Sea coast of Turkey is highly suitable for the growth of house dust mites. Seasonal changes in the populations of the house dust mites were studied in five houses of dust-mite sensitive people with asthma between 2013 and 2015. Dust samples were obtained once a month to assess the monthly distribution of dust mites. House dust mites were isolated from samples by a wet-sieving method. Permanent slides were prepared for morphologically based species determination. The most abundant species were Dermatophagoides pteronyssinus (Trouessart, 1897) and Dermatophagoides farinae (Hughes, 1961) (Astigmata: Pyroglyphidae), 65.4 and 31.0% of the total count of mites, respectively. Dust mites can survive all year round and are widely distributed in different types of houses in the city of Ordu. The mite abundance reached its peak in all houses during August (26-28ºC and 64-78% RH). The discomfort for people who have a dust mite allergy may reach a peak specifically during this time and they need to take extra precautions to reduce exposure to dust mites as much as possible during this period.

Post Operative Systolic Pressure Ratio between Right and Left Ventricle Predicts Early Outcome after Total Correction of Tetralogy of Fallot

PRV/LV can be easily measured in the operating room by which we can assess the adequacy of relief of pulmonary stenosis. A number of studies carried out where PRV/LV ratio 0.7 was taken as cut off point however in this study post repair ratio 0.5 was taken as cut off value because a recent study has shown better outcome after total correction of tetralogy of Fallot when the post repair PRV/LV was below .05. When the ratio is above 0.5, some extra precaution may be needed in the post operative period to reduce the morbidity and mortality.University Heart Journal Vol. 13, No. 2, July 2017; 59-61

Pediatricians' vaccine attitudes and practices before and after a major measles outbreak.

The objective of this study was to describe how a sample of pediatricians were impacted by and responded to the Disneyland measles outbreak in the United States. We conducted three repeated cross-sectional, online surveys in 2014 (before the outbreak), 2015, and 2016 (after the outbreak) among members of three state chapters of the American Academy of Pediatrics. We assessed pediatricians' level of willingness and length of time comfortable delaying the measles-mumps-rubella (MMR) vaccine before and after the outbreak. Frequency of alternative immunization schedule requests and creation of office immunization policies due to the outbreak were measured. The sample included 304 pediatricians in 2014, 270 in 2015, and 221 in 2016. We found no significant changes in willingness or comfort delaying the MMR vaccine before and after the outbreak. In 2015, 38% of pediatricians reported fewer requests for alternative immunization schedules and 20% created stricter office immunization policies. A subsample of pediatricians reported administering the MMR vaccine earlier in the recommended time frame and taking extra precautions in waiting rooms due to the outbreak. Our results suggest that this measles outbreak did not lead to significant changes in attitudes or practices among this sample, but did modestly affect office immunization policies and practices.

Increased Rates of Readmission, Reoperation, and Mortality Following Open Reduction and Internal Fixation of Ankle Fractures Are Associated with Diabetes Mellitus

Category: Ankle Introduction/Purpose: Ankle fractures are amongst the most common type of fracture injury in adults with an annual incidence of 187 fractures per 100,000 people in the United States. Previous groups have shown that diabetes mellitus (DM) is associated with a myriad of complications – including infection, malunion, and impaired wound healing – following open reduction internal fixation (ORIF) surgery for ankle fractures. However, to our knowledge there has not been a large-scale nationwide study on the rate of readmission, reoperation, and mortality associated with DM. The purpose of this study was to calculate the increased risk and odds ratios for 30-day postoperative readmission, reoperation, and mortality after ankle fracture ORIF. Methods: Patients who underwent ORIF for ankle fractures from 2006 to 2015 were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database using Current Procedural Terminology codes. Median values along with 25th to 75th interquartile ranges (IQRs) were used to describe continuous variables and frequency (%) was used to describe categorical variables. Patient demographic factors along with 30-day postoperative outcomes were compared between those who had DM and those who did not have DM using the Mann-Whitney test or?2 test. 30-day postoperative unplanned readmission, unplanned reoperation, and mortality rates were compared in 2,044 patients with DM and 15,420 patients without DM. Crude odds ratios (OR) and adjusted ORs controlling for age differences were calculated for each parameter with a 95% confidence interval (CI). All statistical analyses were performed with a significance level of 0.05. Results: Patient factors and pre-operative laboratory statistics are summarized in Figure 1D, and the distribution of ankle fractures types are shown in Figure1A&B. Comparing patients with DM vs without DM, the rate of readmission was 4.35% vs 1.50%, rate of reoperation was 2.30% vs 0.75%, and rate of mortality was 0.73% vs 0.21%. As shown in Figure 1C, we found that patients with DM had a 2.66 times increased risk of readmission (CI: 1.99-3.52, p = 0.0001), 2.76 increased risk of reoperation (CI: 1.91-3.92, p = 0.0001), and a 2.34 increased risk of mortality (CI: 1.19-4.44, p = 0.0377). Interestingly, we also found a 22.06 increased risk of amputation (CI: 3.29-344.8, p = 0.0063) though the rate of amputation in both groups was very small. Conclusion: In this large-scale retrospective study we showed that the presence of diabetes mellitus significantly increases the risk of unplanned readmission, unplanned reoperation, and mortality within 30 days after ankle fracture ORIF surgery. Thus, patients with diabetes that require ORIF ankle surgery should be informed of their increased risk of complications and extra precautions should be taken to minimize risk. Further research in optimization of perioperative care for diabetic patients is crucial to reducing rates of complication. Large clinical databases such as ACS-NSQIP should endeavor to collect more parameters on diabetic patients to facilitate these studies.

Energy and exergy analysis of an integrated organic Rankine cycle-vapor compression refrigeration system

In the present study, the performance of an integrated organic Rankine cycle-vapor compression refrigeration (ORC-VCR) system is investigated from the viewpoint of energy and exergy analysis. The system performance was represented by system coefficient of performance (COPS), system exergy efficiency (ηe,sys), turbine pressure ratio (TPR), and total mass flow rate of the working fluid for each kW cooling capacity (ṁtotal). Many common and new hydrocarbons, hydrofluorocarbons, fluorocarbons, hydrofluoroethers, and hydrofluoroolefins were suggested as working fluids. The influences of various parameters such as the boiler, condenser, and evaporator temperatures, along with compressor and turbine isentropic efficiencies, on the system performance were also investigated. The results revealed that the best system performance was attained with the uppermost critical temperature dry working fluid. Among all suggested candidates, R602 is shown to be the most suitable working fluid for the ORC-VCR system from system performance and environmental issues viewpoints. However, due to its flammability, extra precautions should be taken. The highest COPS, ηe,sys, TPR, and the corresponding ṁtotal using R602 are 0.99, 53.8%, 12.2, and 0.005 kg s−1 kW−1, respectively at a condenser temperature of 25 °C and the typical values for the rest parameters.

The Power of a Toothbrush

The Power of a Toothbrush

Approaches of Improving Food Allergy Knowledge: Children with food allergy’s quality of life

The food allergy commonly affected many people regardless of their age, especially among children. Their life could be dangerous if they are exposed to the food allergen because it will lead to life-threatening. Therefore, the nursery employees need to take extra precaution when dealing with children with food allergy as compared to ordinary children. Thus, this paper warrants to assess the knowledge of the person handling the food allergy children and determination of several approaches is needed to improve their understanding of managing this susceptible population.