Permanent Harm Research Articles

Patient and quality characteristics in the treatment with disulfiram (Antabus) in the German "Network for Alcohol Aversive Pharmacotherapy"

More than adecade ago disulfiram lost its approval for use in Germany. Nonetheless, aconsiderable number of psychiatric hospital outpatient departments as well as practicing physicians continue to prescribe it. These professionals have formed the "Network for Alcohol Aversive Pharmacotherapy" (NAP) to maintain a high quality of this treatment approach. To describe the current use of disulfiram with respect to patient numbers and characteristics, side effects, and use of concomitant multimodal treatment forms. Since 2019 the NAP has conducted an annual retrospective survey among its members regarding the aforementioned parameters. From 2019 to 2023 atotal of 1579 treatment cases were described by 33centers, 152 patients reported atotal of 241 drinking events, 26of them resulting in hospitalization but none causing complications or permanent harm. The most frequent side effects, in descending order, were unpleasant body odor (2.5%), fatigue, male sexual dysfunction, mildly elevated liver enzymes, allergic skin reactions and polyneuropathy (0.8%). More than one quarter of the patients suffered from comorbid depression, and approximately 5% from ADHD, borderline or other personality disorders, trauma-related disorders and anxiety disorders, respectively. Of the patients 33% were treated with antidepressants and 12% with sedating antipsychotics. Various forms of concomitant group therapy were offered to 66% of the patients. Treatment with disulfiram is legally possible, generally well-tolerated and safe. It is offered in most treatment centers as part of acomprehensive treatment plan that includes multimodal treatment of comorbid psychiatric disorders.

Physical and mechanical response of large-diameter shield tunnel lining structure under non-uniform fire: A full-scale fire test-based study

When a fire occurs in an underground shield tunnel, it can result in substantial property damage and cause permanent harm to the tunnel lining structure. This is especially true for large-diameter shield tunnels that have numerous segments and joints, and are exposed to specific fire conditions in certain areas. This paper constructs a full-scale shield tunnel fire test platform and conducts a non-uniform fire test using the lining system of a three-ring large-diameter shield tunnel with an inner diameter of 10.5 m. Based on the tests, the temperature field distribution, high-temperature bursting, cracking phenomena, and deformation under fire conditions are observed. Furthermore, the post-fire damage forms of tunnel lining structures are obtained through the post-fire ultimate loading test, and the corresponding mechanism is explained. The test results illustrate that the radial and circumferential distribution of internal temperature within the tunnel lining, as well as the radial temperature gradient distribution on the inner surface of the lining, have non-uniform distribution characteristics. As a result, the macroscopic phenomena of lining concrete bursting and crack development during the fire test mainly occur near the fire source, where the temperature rise gradient is the highest. In addition, the lining structure has a deformation characteristic of local outward expansion and cannot recover after the fire load is removed. The ultimate form of damage after the fire is dominated by crush damage from the inside out of the lining joints in the fire-exposed area. The above results serve as a foundation for future tunnel fire safety design and evaluation.

Ecosystem risk from human use of ocean space and resources: A case study from the Norwegian coast

Coastal and adjacent shelf waters are generally highly productive ecosystems harboring important ecological processes and exposed to a range of anthropogenic pressures from land-based and marine sectors. Ensuring that the cumulative pressures from human activities do not cause unacceptable, permanent harm to the ecosystem is challenging but crucial for sustainable management of these regions. Linkage frameworks and ecological risk assessments have proven to be useful tools for holistic evaluations of cumulative human pressures as a guide to managers and policy makers for prioritization of risk factors. Here, we present the first holistic assessment of ecosystem risk from human activities along the Norwegian coast. Pressures from coastal sectors are identified and weighted by the exposure to and potential impact on ecosystem components following the ODEMM (Options for Delivering Ecosystem-based Marine Management) framework. We focus on four coastal regions with contrasting scales of human activities. Two southern regions with multiple anthropogenic activities are associated with higher cumulative risk of negative impacts compared to northern areas where less extensive activities have a lower potential of harming the coastal ecosystems. Despite latitudinal differences in human use of the coastline, the pressures and ecosystem components associated with the greatest risk of cumulative impacts are relatively similar between the regions. Contaminants and underwater noise stand out as high-risk pressures, associated with multiple sectors with a high spatiotemporal footprint and with the potential to negatively impact a range of ecosystem components. Nevertheless, a confidence assessment also highlights the need for more in-depth analysis on the input, spread and effect of these pressures on coastal ecosystems. We discuss strengths and weaknesses of the risk assessment framework and suggest new directions which may enhance the utility and uptake of such assessments for sustainable management of coastal ecosystems.

Complications and complaints in craniofacial fractures - Finnish national data for 20years.

Research on reasons for malpractice claims in oral and maxillofacial surgery is scarce. The aim of this study was to investigate the causes and prevalence of permanent harm among craniofacial fracture related malpractice claims. A retrospective register study was designed and implemented. All patients with a complaint and a diagnosis of facial or cranial fracture were included. The main outcome was the presence of permanent harm, and the predictor variable was the cause of complaint. Chi-square test was used for estimation of statistical significance. Delay in correct diagnosis was the leading cause of malpractice claims (63.2%), and permanent harm was found in 23.1% of the population. 82.4% of injuries were facial fractures in total population. 65.3% (n = 98) of facial trauma were related with delayed diagnostics (p < 0.001). Permanent harm was more frequent in patients with delayed diagnosis (71.4%) than those without (60.7%, p = 0.299). Claims of craniofacial trauma are related with under-diagnostics, and un-diagnosed facial fracture can lead to a high rate of permanent harm. Systematic clinical evaluation and facial trauma specialist consultation is recommended to set early correct diagnosis for and improve treatment of craniofacial trauma patients.

Medication-related incidents in acute care hospitals among different age groups: An analysis of national patient safety report data.

This study aimed to perform a nationwide analysis of medication errors (MEs) from hospitals using national reporting system data and to compare the ME patterns among different age groups. We analyzed medication-related incidents in acute care hospitals reported to the Korean Patient Safety Reporting and Learning System (KOPS), which is a patient safety reporting system, from July 2016 to December 2020. The stages of the medication use process, type of errors, medication class involved in MEs, and degree of harm were analyzed. Among a total of 5071 medication-related incidents, 37.7% (1911 cases) were incidents that caused patient harm and 1.2% caused long-term, permanent, and fatal harm. The proportion of medication-related incidents that resulted in harm was the highest among the <1-year-old age group (67 cases, 51.5%), followed by the elderly (≥ 65 years) (828 cases, 40.9%). The cases leading to patient death were most frequently reported in patients aged ≥65 years. Medication-related incidents occurred mainly in the administration stage (2954 cases, 58.3%), and wrong dose was the most frequently reported ME type. The most prevalent medication class occurring in the 20-64-year age group (256 cases, 11.7%) was 'antibacterials for systemic use', whereas 'contrast media' (236 cases, 11.6%) and 'blood substitutes and perfusion solutions' (98 cases, 19.3%) were the most prevalent drug classes in the ≥65- and <20-year-old age groups, respectively. It is necessary to establish guidelines for the prevention of medication-related incidents according to the medication use process and patient age group.

Patient experiences and perspectives of health service access for carpal tunnel syndrome in Aotearoa New Zealand: a normalisation process theory-informed qualitative study

BackgroundEarly access to care for carpal tunnel syndrome (CTS) can avoid higher rates of surgery and permanent harm yet is often delayed, particularly for populations more likely to underutilise care.ObjectiveWe sought to explore patient experiences and perspectives of health service access for CTS to inform an equity-focussed co-design of a health service for improving early care access.MethodsIn this Normalisation Process Theory (NPT)-informed qualitative study we conducted semistructured in-depth interviews with 19 adults with experience of CTS. Recruitment prioritised New Zealand Māori, Pasifika, low-income, and rural populations. Data were analysed using deductive then inductive thematic analysis.ResultsWe identified five major themes: (1) the ‘Significant Impact of CTS’ of the sense-making and relational work to understand the condition, deciding when to get care, compelling clinicians to provide care, and garnering help from others; (2) ‘Waiting and Paying for Care’– the enacting, relational, and appraising work to avoid long wait times unless paying privately, particularly where quality of care was low, employment relations poor, or injury compensation processes faltered; (3) circumstances of ‘Occupation and CTS Onset’ whereby the burden of proof to relate onset of CT symptoms to occupation created excessive relational and enacting work; (4) the ‘Information Scarcity’ of good information about CTS and the high relational and appraising work associated with using online resources; (5) ‘Negotiating Telehealth Perspectives’ where telehealth was valued if it meant earlier access for all despite the challenges it held for many.ConclusionQuality, culturally and linguistically responsive information and communication from clinicians and health services will improve equitable early access to CTS care including realising the potential of telehealth modes of care. Policy changes that reduce individual burden of proof in injury compensation claims processes, enable time off work to attend health appointments, and increase public funding for surgical resources would improve early access to CTS care particularly for Māori and Pacific populations and those in small and rural workplaces. NPT is valuable for understanding where opportunities lie to reduce inequitable delays to accessing care including the impact of racism, particularly for populations more likely to underutilise care.

Understanding Vatavyadhi as a Sequelaeae of Metabolic Syndrome And Its Management - A Review

The increasing occurrence of metabolic syndrome in children and teenagers is alarming due to the potential for significant long-term health issues. Recognizing and addressing this condition early are essential to avoid permanent harm. Traditional Ayurvedic perspectives offer valuable insights into this issue. Conditions such as Sthaulya (Obesity), Prameha (Diabetes), Shonita Dusti (Blood Impurity), and Dhamani Pratichaya (Vascular Diseases) share similarities with metabolic syndrome. These arise from excessive intake and accumulation (Santarpana nidana), leading to a build-up of Kapha (one of three senses of humor having unctuous property) and Medha (fat), eventually affecting other Doshas (humor) and multiple tissues. Ayurvedic treatments aim to manage these conditions, as they tend to be chronic and prone to complications, potentially progressing to Vatavyadhi (neurological disorders) over time. The interplay of kapha and medha in blocking channels (Margavarana) is a crucial consequence of these conditions, contributing to the development of vatavyadhi. This review article highlights the importance of early intervention and traditional Ayurvedic approaches in managing metabolic syndrome-like conditions in children and adolescents to prevent long-term complications.

Diagnostic Errors in Hospitalized Adults Who Died or Were Transferred to Intensive Care

Diagnostic errors contribute to patient harm, though few data exist to describe their prevalence or underlying causes among medical inpatients. To determine the prevalence, underlying cause, and harms of diagnostic errors among hospitalized adults transferred to an intensive care unit (ICU) or who died. Retrospective cohort study conducted at 29 academic medical centers in the US in a random sample of adults hospitalized with general medical conditions and who were transferred to an ICU, died, or both from January 1 to December 31, 2019. Each record was reviewed by 2 trained clinicians to determine whether a diagnostic error occurred (ie, missed or delayed diagnosis), identify diagnostic process faults, and classify harms. Multivariable models estimated association between process faults and diagnostic error. Opportunity for diagnostic error reduction associated with each fault was estimated using the adjusted proportion attributable fraction (aPAF). Data analysis was performed from April through September 2023. Whether or not a diagnostic error took place, the frequency of underlying causes of errors, and harms associated with those errors. Of 2428 patient records at 29 hospitals that underwent review (mean [SD] patient age, 63.9 [17.0] years; 1107 [45.6%] female and 1321 male individuals [54.4%]), 550 patients (23.0%; 95% CI, 20.9%-25.3%) had experienced a diagnostic error. Errors were judged to have contributed to temporary harm, permanent harm, or death in 436 patients (17.8%; 95% CI, 15.9%-19.8%); among the 1863 patients who died, diagnostic error was judged to have contributed to death in 121 (6.6%; 95% CI, 5.3%-8.2%). In multivariable models examining process faults associated with any diagnostic error, patient assessment problems (aPAF, 21.4%; 95% CI, 16.4%-26.4%) and problems with test ordering and interpretation (aPAF, 19.9%; 95% CI, 14.7%-25.1%) had the highest opportunity to reduce diagnostic errors; similar ranking was seen in multivariable models examining harmful diagnostic errors. In this cohort study, diagnostic errors in hospitalized adults who died or were transferred to the ICU were common and associated with patient harm. Problems with choosing and interpreting tests and the processes involved with clinician assessment are high-priority areas for improvement efforts.

A Comprehensive Survey of Animal Identification: Exploring Data Sources, AI Advances, Classification Obstacles and the Role of Taxonomy

With the rapid development of entity recognition technology, animal recognition has gradually become essential in modern society, supporting labour‐intensive agriculture and animal husbandry tasks. Severe problems such as maintaining biodiversity can also benefit from animal identification technology. However, certain invasive recognition systems have resulted in permanent harm to animals, while noninvasive identification methods also exhibit certain drawbacks. This paper conducts a systematic literature review (SLR), presenting a comprehensive overview of various animal recognition technologies and their applications. Specifically, it examines methodologies such as deep learning, image processing and acoustic analysis used for different animal characteristics and identification purposes. The contribution of machine learning to animal feature extraction is highlighted, emphasising its significance for animal taxonomy and wild species monitoring. Additionally, this review addresses the challenges and limitations of current technologies, including data scarcity, model accuracy and computational requirements, and suggests opportunities for future research to overcome these obstacles.

BRAK NASTĘPSTW INFEKCJI COVID-19 W ODNIESIENIU DO STANDARDOWYCH TESTÓW AUDIOLOGICZNYCH

IntroductionCoronavirus disease (COVID-19), considered to be caused by a novel coronavirus (SARS-CoV-2), is an acute respiratory disease which was declared a pandemic by the World Health Organization. Previously published reports have shown contradictory findings on the involvement of the auditory system in individuals infected with COVID-19. The present study aims to assess auditory system functioning in individuals post-COVID-19 infection and compare the results with individuals without COVID-19 infection.Material and methodsParticipants in this study were 30 individuals who had experienced mild COVID-19 infection and 30 individuals who never had COVID-19. Participants were aged between 18 and 40 years. Testing was done 1 to 6 months after infection, and involved conventional and extended high-frequency audiometry, speech perception in quiet and at different signal-to-noise ratios (SPIN), transient evoked otoacoustic emissions (TEOAEs) in quiet and in the presence of contralateral noise, and auditory brainstem response (ABR) in the ipsilateral and contralateral mode.ResultsNone of the tests – pure-tone thresholds, speech perception in quiet and in noise, TEOAE with and without contralateral noise, and ABR – showed any significant difference between individuals who never had COVID-19 infection and those who had recovered from the infection. Both afferent and efferent auditory pathways showed normal findings in individuals post-COVID-19 infection.ConclusionsIndividuals who have been infected with mild COVID-19 did not show any significant deficit in any of the audiological tests, suggesting that the disease does not cause any permanent harm to the auditory system after the infection has subsided.

Parenteral nutrition insecurity: ASPEN survey to assess the extent and severity of parenteral nutrition access and reimbursement issues.

Parenteral nutrition (PN) shortages and lack of qualified professional staff to manage PN impact safe, efficacious care and costs of PN. This American Society for Parenteral and Enteral Nutrition (ASPEN)-sponsored survey assessed the frequency and extent to which PN access affects PNdelivery to patients. Healthcare professionals involved with PN were surveyed. Questions were developed to characterize the respondent population and determine the extent and severity of PN access issues to components, devices, and healthcare professionals, as well as their effects on discharge and transfer issues. Reimbursement issues included cost, adequacy of therapy, and healthcare professional reimbursement. Burdens were types and frequency of errors, adverse events, and nutrition problems resulting from PN access issues. Impact on professionals and organizations was determined. Respondents (N = 350) worked in hospitals (75%) and home infusion (25%). Per day, clinicians cared for <15 patients receiving PN. All age populations were represented. Respondents reported shortages of macronutrients (72%, 233 of 324) and micronutrients (91%, 297 of 324). Issues with access to healthcare workers were observed. PN access issues contribute to increased costs of PN, and knowledge regarding the current rate of PN reimbursement is limited. Respondents (75%, 197 of 261) observed an error due to PN access issues. Adverse events (57%, 149 of 259) were observed leading to temporary or permanent harm (24%, 61 of 259) as well as near death (4%, 9 of 259) and death (1%, 2 of 259). Providers reported time away from other job responsibilities and workplace stress. PN access issues result in "PN insecurity" that negatively impacts patients and healthcare providers and leads to adverse events including death in patients receiving PN.

THE BRONZE HARVESTER: RAVAGING AND PLUNDERING IN GREEK WARFARE

AbstractThis article argues that the purpose of ravaging in Greek warfare was not to goad the enemy into fighting or to cause systematic economic harm but to facilitate plundering. The cereal harvest was commonly chosen as a time for invasion, because it maximized the amount of plunder an invading force could expect to find in the enemy countryside. While ravagers were unlikely to cause permanent economic harm to a community as a whole, they could imperil the livelihoods of individual farmers, both directly through theft and destruction and indirectly by preventing farmers from processing the harvest in a timely fashion. This explains the consistent fear of plundering and ravaging present in our sources.

Assessment of Potential Adverse Drug Reactions Associated with Cardiovascular Medicines

Background: Every drug has the potential to cause ADRs. Cardiovascular medications are a major problem in drug therapy as they can result in several consequences, ranging from allergic reactions to permanent harm. We have undertaken a meta-analytic review of various types of studies performed in different hospital settings to understand the importance of ADRs in CVD patients and how ADRs might be better detected, evaluated, and avoided. Objectives: To study various factors and assess the incidence, causality, severity, and preventability of ADRs associated with cardiovascular drugs. Methods: Meta-analytic study conducted over 6 months by reviewing 24 articles finalized from 58 articles collected from various data sources like Clin Med, Pubmed, and Medline. Information related to ADRs was analyzed by using demographic data through various questionnaires and scales in articles. Results: A total of 4421 ADRs were reported among 9759 patients. 8/24 of the studies performed causality assessment by using the Naranjo scale and 12/24 used the WHO-UMC scale. 9/24 studies assessed severity and 5/24 studies performed preventability assessments. The incidence of ADRs was high in the 40-80 age range (94.69%). Commonly prescribed drugs were calcium-channel blockers and beta-blockers in CVD patients. Organ systems like the cardiovascular, central nervous and respiratory systems were commonly affected. Most ADRs were mild and possible. Females experienced more ADRs compared to males. Conclusion: Although this study provides estimates of the incidence, severity, and preventability of ADRs in different settings, further studies are needed for monitoring ADRs in patients using CVD drugs to address how such ADRs will be prevented.

Safety and Efficacy Report for the Use of Poly-4-Hydroxybutyrate as a Retropubic Mid-Urethral Sling (MUS) for Stress Urinary Incontinence: A Prospective 24 Months Follow-Up of New Poly-4-Hydroxybutyrate TephaFlex SUI Bioresorbable MUS

To investigate the feasibility and safety of the retropubic mid-urethral sling (MUS) procedure with a resorbable mesh implant made of poly-4-hydroxybutyrate (P4HB). A prospective clinical cohort study with 24 months follow-up. A tertiary academic hospital. Seventeen women with moderate to severe stress urinary incontinence (SUI). A retropubic MUS procedure with P4HB sling. Seventeen women underwent an uncomplicated MUS procedure with a new sling made of resorbable P4HB. Following safety criteria, there has been no need to stop the study before 24 months' end point. Three serious adverse events were reported during follow-up: (1) inability to void urine after 1 week postsurgery, (2) a hysterectomy and bilateral oophorectomy performed due to a precancerous endometrial lesion at 16 months after initial MUS procedure and (3) exposed mesh with a part of device sheath left behind. These participants underwent an uncomplicated reintervention with no additional and/or permanent harm. Reinterventions because of failure of cure contained 3 second MUS procedures and one admission of urethral bulking agent. Seventy-six percent and 47 percent of patients were objectively cured of SUI at 12 and 24 months, respectively. Preliminary evidence suggests that a sling made of P4HB can be safely used for MUS procedures and could be an alternative for permanent polypropylene slings in patients that prefer the use of nonpermanent material.

Incidents relating to paediatric regional anaesthesia in the first 8000 cases reported to webAIRS.

Regional anaesthesia is an essential tool in the armamentarium for paediatric anaesthesia. While largely safe and effective, a range of serious yet preventable adverse events can occur. Incidence and risk factors have been described, but few detailed case series exist relating to paediatric regional anaesthesia. Across Australia and New Zealand, a web-based anaesthesia incident reporting system enables voluntary reporting of detailed anaesthesia-related events in adults and children. From this database, all reports involving paediatric regional anaesthesia (age less than 17 years) were retrieved. Perioperative events and their outcomes were reviewed and analysed. When offered, the reported contributing or alleviating factors relating to the case and its management were noted. This paper provides a summary of these reports alongside an evidence review to support safe practice. Of 8000 reported incidents, 26 related to paediatric regional anaesthesia were identified. There were no deaths or reports of permanent harm. Nine reports of local anaesthetic systemic toxicity were included, seven equipment and technical issues, six errors in which regional anaesthesia made an indirect contribution and four logistical and communication issues. Most incidents involved single-shot techniques or a neuraxial approach. Common themes included variable local anaesthetic dosing, cognitive overload, inadequate preparation and communication breakdown. Neonates, infants and medically complex children were disproportionately represented, highlighting their inherent risk profile. A range of preventable incidents are reported relating to patient, systems and human factors, demonstrating several areas for improvement. Risk stratification, application of existing dosing and administration guidelines, and effective teamwork and communication are encouraged to ensure safe regional anaesthesia in the paediatric population.

ROLE OF THERAPEUTIC HYPOTHERMIA IN IMPROVING OUTCOME AFTER TRAUMATIC BRAIN INJURY : A SYSTEMATIC REVIEW

Introduction: A nondegenerative and noncongenital brain injury caused by external mechanical forces can cause permanent or temporary harm to cognitive, physical, and psychosocial functions and change or diminish awareness. Traumatic brain injury can cause cerebral edema and ICP increase, worsening the lesion. Cellular death can occur minutes to hours after an injury, although negative effects can last 72 hours or more. Therapeutic hypothermia (HT) can lower ICP and protect neurons, improving patient prognosis and lowering mortality.&#x0D; The aim: This article showed role of therapeutic hypothermia in improving outcome after traumatic brain injury.&#x0D; Methods: This study demonstrated compliance with all requirements by comparing itself to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 standards. Therefore, the experts were able to ensure that the study was as current as feasible. For this search strategy, publications published between 2013 and 2023 were considered. Several online reference sources, including Pubmed and SagePub, were utilized for this purpose. It was determined not to consider review pieces, previously published works, or works that were only partially completed.&#x0D; Result: In the PubMed database, the results of our search brought up 112 articles, whereas the results of our search on SagePub brought up 107 articles. The results of the search conducted for the last year of 2013 yielded a total 59 articles for PubMed and 38 articles for SagePub. In the end, we compiled a total of 28 papers, 19 of which came from PubMed and nine of which came from SagePub. We included seven study that met the criteria.&#x0D; Conclusion: HT has not reduced, but may have increased, mortality in TBI patients in some high-quality studies. However, TBI patients with elevated ICP may benefit from hypothermia as therapy rather than as prophylaxis when initiated within 24 hours.&#x0D;

Improving Safety in Living Liver Donation: Lessons From Intraoperative Adverse Events in 438 Donors Undergoing a Left Liver Resection.

Donor safety is paramount in living organ donation. Left liver resections are considered safer than right lobe hepatectomies. However, unexpected intraoperative adverse events (iAEs), defined as any deviation from the ideal intraoperative course, can also occur during left liver resections and may be life threatening or lead to postoperative complication or permanent harm to the donor and recipient. Records of 438 liver living donors (LDs) who underwent 393 left lateral sectionectomies (LLSs) and 45 left hepatectomies (LHs) between July 1993 and December 2018 in a pediatric living-donor liver transplantation center were reviewed for the appearance of iAEs that could have influenced the donor morbidity and mortality and that could have contributed to the improvement of the LD surgical protocol. Clinical characteristics of LLS and LH groups were comparable. Nine iAEs were identified, an incidence of 2%, all of them occurring in the LLS group. Seven of them were related to a surgical maneuver (5 associated with vascular management and 2 with the biliary tree approach). One iAE was associated with an incomplete donor workup and the last with drug administration. Each iAE resulted in subsequent changes in the surgical protocol. Donor outcome was at risk by 5 iAEs classed as type a, recipient outcome by 2 iAEs (type b) and both by 2 iAEs (type c). Postoperative complications occurred in 87 LDs (19.9%), with no differences between the LLS and LH groups (P = 0.227). No Clavien-Dindo class IVa or b complications or donor mortality (Clavien-Dindo class V) were observed. iAEs debriefings induced changes in our LD protocol and may have contributed to reduced morbidity and zero mortality. iAEs analysis can be used as a quality and safety improvement tool in the context of LD procedures, which may include right liver donation, laparoscopic, and robotic living liver graft procurement.

A Study On Stabilization of Soils by Using Egg Shell Powder

Using alternative materials, which have better engineering quality than traditional materials and are more cost-effective, has received a lot of attention recently. One of the most crucial components in many building projects, such as earth canals and earth dams, is soil. The fact that soil might offer all the resistant qualities required for a project highlights the value of several techniques used to enhance soil quality. The vast majority of construction projects employ clay soil. Because clay soils, especially soft clay soils, have good plastic qualities, their shear strength, compressive strength, and volume changes decrease as moisture content rises. Structures generally suffer permanent harm as a result of these issues, which emphasises how crucial soil improvement is. The use of such refuse and industrial wastes and their subsidiary products as alternatives to construction materials may effectively contribute to environmental preservation and minimize their negative effects on the Environment, especially in light of the millions of tonnes of waste produced annually across the nation, which not only poses the problem of disposal but also adds to environmental contamination and health risks. In the current study, eggshell powder was utilized as a waste to mix with soil in order to examine clay soil's index characteristics, compaction, and shear strength at various mixed proportions. The shear strength of soils that had already been tested was then contrasted with experimental specimens that had been combined with various ratios of eggshell powder.

Tranexamic acid-associated intrathecal toxicity during spinal anaesthesia: A narrative review of 22 recent reports.

Therapeutic use of tranexamic acid (TXA) to minimise blood loss is common during a wide range of surgical procedures. This review aims to explore the clinical features of the accidental intrathecal administration of TXA and to identify contributory factors that might prevent future incidents. The author searched published reports of accidental intrathecal administration of TXA using Medline and Google Scholar databases from July 2018 to September 2022, including error reports in any language but excluding errors via nonintrathecal routes. The human factors analysis classification system (HFACS) framework was used to examine and classify the human and systemic factors that contributed to the errors. Twenty-two errors of accidental intrathecal administration were reported during the search period. The analysis showed that the outcome was death in eight patients (36%) and permanent harm in four (19%). The fatality rate was higher among female individuals (6/13 versus 2/8 male individuals). Two-thirds of errors (15/22) occurred during orthopaedic surgery (10) and lower segment caesarean sections (5). Nineteen of 21 patients developed refractory or super refractory status epilepticus, requiring mechanical ventilation and intensive care for 3 days to 3 weeks for those who survived the initial few hours. Severe sympathetic stimulation resulting in refractory ventricular arrhythmias was the final event in some patients, with death within a few hours. Lack of familiarity with clinical characteristics caused delayed diagnosis or confusion with other clinical conditions. A proposed plan to manage intrathecal TXA toxicity is presented, including immediate cerebrospinal fluid lavage; however, there is no specific approach. The HFACS suggested mistaking look-alike TXA ampoules for local anaesthetic was the predominant cause. The author concludes that inadvertent intrathecal TXA is associated with mortality or permanent harm in more than 50% of patients. The HFACS demonstrates that all errors are preventable.

Personal recording devices for arrhythmia detection.

Persistent cardiac arrhythmias are readily amenable to detection by performing a standard electrocardiogram (ECG), but detection of transient (paroxysmal) arrhythmias has long been a significant cause of frustration to both doctors and patients. Often a significantly symptomatic arrhythmia is experienced by the patient but terminates before an ECG can be recorded to allow diagnosis. Prognostically important treatment is often delayed, and recurrent symptomatic attacks represent a high morbidity in patients' lives and result in a burden on emergency services, who often arrive after the arrhythmia has terminated with no resultant progress in making a diagnosis. Another area of concern has been the presence of asymptomatic, but clinically important, arrhythmias that can go unnoticed by people experiencing them and may result in permanent harm; asymptomatic paroxysmal atrial fibrillation in patients with high CHA 2 DS 2-VASc scores being the most common example. Both these issues are now being importantly addressed by the widespread availability of portable ECG recording devices, which patients can either manually activate themselves or program to automatically detect abnormal arrhythmias. Information on the range of devices available and their strengths and weaknesses is limited. This article aims to provide a helpful overview for patients and doctors advising them.