Risky Cases Research Articles

Hadith-Based Guidance Techniques to Raise the Psychological Intelligence of At-Risk Adolescents


 
 
 
 Some youths are more likely to become involved in delinquent situations because of strain and stress during the development process as well as the difficulties of the modern world. The poor level of intelligence among teenagers is among the elements that are certain to contribute to this occurrence of delinquency. Islamic psychology therefore places a strong emphasis on ways of approach that celebrate the psychological milieu of adolescents and foster the development of intellect so that the adopted approach influences good behavior changes and rational thought. Thus, the purpose of this essay is to explain the idea of the Prophet's instruction in dealing with criminals, particularly teens, psychologically using the scriptural technique of Hadith. This study employs a qualitative design with the help of the method of document analysis. Primary sources like books, articles, proceedings, and scientific studies related to the concept of guidance and the psychology of intelligence are also analyzed and studied. Secondary sources include Hadith books and related Hadith lectures. The study discovered that the Hadiths truly contain the element of intelligence used in the practice of guiding and counselling when dealing with problematic instances. The Prophet S.A.W strategy is a source of growing psychological well-being since it combines intellectual, emotional, moral, and spiritual wisdom. The outcomes of this study are anticipated to contribute to the development of the scriptural approach to Islamic psychology (Nabawi) as a preventative and recuperative strategy for adolescents with risky cases and to the development of the concept of Nabawi psychology as a model or module for future research.
 
 
 

The State of Risk and Optimum Decision According to Neutrosophic Rules

In light of the current circumstances and the momentary fluctuations that we live in all domains of life, which have transformed most decision-making cases into risky cases, this study was necessary. In this research, we present a new study for decision-making in the event of risk, by formulating some rules according to the neutrosophic logic starting from the data of the problem, where we replaced the classical values in the matrix of profit and probabilities with neutrosophic values that have a margin of freedom thanks to the indeterminacy provided by the neutrosophic logic, and we got more accurate solutions than the solutions that we obtained when using the classical rules which reduces the occurrence of losses, especially if the decisions are fateful and the decision issues are huge and complex and helps us to achieve the greatest profits by adopting a rational decision based on modern quantitative ways and methods.

The compliance of our practice of hepatitis B virus screening with the current guidelines in patients undergoing chemotherapy for hematological malignancies

Background/Aim: The reactivation of Hepatitis B virus (HBV) among cancer patients is a critical issue which is preventable by precise detection of risky cases prior to the administration of chemotherapy drugs. This study aimed to investigate whether the evaluated serological tests for HBV screening before chemotherapy in adults with newly diagnosed hematological malignancies follow the guidelines. Methods: In this retrospective cohort study, all patients with hematological malignancies who visited our hematology clinic between January 01, 2018-January 01, 2020, were examined and adult patients referred to the outpatient clinic for combined chemotherapy were included. All clinical data and laboratory results were obtained from the electronic hospital information system. Serological tests performed for HBV screening and their results were noted. The compliance of our clinical practice with the current guidelines was analyzed assuming that there are three mandatory serological tests for screening, HBsAg, anti-HBs and anti-HBc, recommended in the guidelines. Results: A total of 91 newly diagnosed cases were included for analysis. HBV screening completely lacked in 10% of the patients and it did not follow the current guidelines in 30%. The most neglected serological test was anti-HBc. Regarding different hematological malignancies, the results were best in lymphoma patients (76% compliance with guidelines) and worst in MM (only 40% compliance with guidelines). The serological test results of eighty-two cases were also examined and the seropositivity rates for HBsAg and anti-HBc were 2%, and 41%, respectively. Conclusion: We observed that the risk of reactivation was not adequately evaluated by serological screenings for HBV in adult patients receiving chemotherapy for hematological malignancy. To protect patients from this mostly preventable complication, it is necessary to increase the awareness on the subject and encourage more compliance with the related guidelines.

Neonatal pneumothorax from the perspective of a pediatric surgeon: classification and management protocol: a preliminary algorithm

Background/aimCurrent neonatal pneumothorax classifications based on air volume escaping in pleural space have no contribution on the treatment. Therefore, our aim was to classify neonatal pneumothorax to guide treatment management based on our experiences.Material and methodsThe records of all neonates admitted to our clinics from March 2017 to August 2020 were reviewed. The patients with pneumothorax were identified through the neonatology department patient database search. The study only included the patients with symptomatic pneumothorax and these patients were evaluated into 3 groups based on the changes in peripheral oxygen saturation (SpO2) and clinical features immediately after the tube thoracostomy (TT) procedure. Accordingly, neonatal pneumothorax was divided into 3 types: patients with SpO2 increasing immediately after TT were included in type I, patients whose SpO2 did not change after TT were included in type II, and patients with SpO2 decreasing immediately after TT were included in type III pneumothorax.Results A total of 82 patients were included in the study. Sixty-one percent of these patients had type I, 24% had type II, and 15% had type III pneumothorax. None of the neonates died in type I and II pneumothoraces while 9 of 12 neonates (75%) died within the neonatal period in type III pneumothorax. Although we applied treatments such as high-frequency oscillatory ventilation, selective intubation, continuous negative aspiration, and surgical treatment to our patients that were lost due to type III pneumothorax, we were not successful. We successfully managed our surviving type III pneumothorax patients with a simple pressure cycle ventilator, using a combination of high rates, modest peak airway pressures [18 to 22 cm H2O and no positive end-expiratory pressure (PEEP)], and an autologous blood patch.Conclusion Classification of pneumothoraces into different types significantly contributes to patient treatment planning through a predetermined strategy, not through trial-and-error. High frequency and zero PEEP ventilation can provide significant improvement in risky cases.

Prognostic Value of Diffuse Cancer Inflammation Index (ALI), Serum Neutrophil/Lymphocyte Ratio (NLR) and Platelet/lymphocyte Ratio (PLR) in Advanced Stage Lung Cancer

Objective: Lung cancer (Ca) is the most common type of cancer that causes death worldwide. Systemic inflammation has been shown to play a role in cancer etiopathogenesis and can be activated from oncogenic changes in cancer cells. In lung cancer, although there are studies showing that systemic inflammatory parameters may have a role in determining prognosis and risky cases, the results are still controversial. In our study, the prognostic effects of inflammatory parameters calculated from serum were investigated in lung Ca. Method: One hundred fifteen patients with locally advanced and advanced lung cancer who were diagnosed in our chest diseases clinic between 2013 and 2015 were retrospectively analyzed. The relationship between advanced lung cancer inflammation index (ALI index), serum neutrophil/ lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) levels at the time of diagnosis were calculated, and their relationship with overall survival (OS), disease-free survival (PFS) and the treatment response and their effect on predicting prognosis were investigated. Results: In our study, when advanced lung cancer cases were examined regarding OS; ALI, and NLR were statistically significant (p <0.05), non-small cell lung cancer cases were similar to general statistics, and ALI and NLR values were statistically significant. Conclusion: In our study, it was concluded that NLR and ALI values at the time of diagnosis were associated with prognosis, and those values may be useful in predicting prognosis when the cut off values was used. These parameters can be useful in routine use since they can be easily calculated without additional costs.

A Forensic Aspect of Fetal Shoulder Dystocia.

Fetal shoulder dystocia (FSD) is an unpredictable and critical obstetric intrapartum emergency, where an objective problem is the relationship between the mother's pelvis and the child, i. e., an anthropometric disorder of delivery mechanics and dynamics. It is evident that the need to perform other maneuvers indicates the severity of FSD, which in turn correlates with the consequent iatrogenic injury of the fetus and/or mother. FSD is certainly the most controversial forensic obstetric problem, with the most disputes, compensation for damages due to peripartum injury to the child and/or mother, pain suffered, the need for someone else's care, and permanent disability. Suboptimal procedures and inadequate documentation are factors of forensic risk and subsequent litigations. Prevention of FSD is generally not possible, although good antenatal care can sometimes exclude risky cases of FSD, and some rare, chronic intrauterine disorders can result in orthopedic and neurological sequelae, which is especially important in forensic analysis. Because FSD is largely impossible to predict, it must be viewed as an intrapartum acceptable risk. During childbirth, FSD may compromise the safety of the mother and unborn child, therefore education and skills acquisition are necessary for obstetric work. Risk control, proper procedures, and proper documentation, along with good communication with the pregnant women and their families, significantly reduce litigation procedures.

Pharmacokinetic evaluation of MFF in combinations with tacrolimus and cyclosporine. Findings of C0 and AUC.

We hypothesized that area under the concentration time curve (AUC(0-12)) is more accurate pharmacokinetic predictor vs trough level of mycophenolic acid (C0).Study was performed at the University Hospital of Limoges (France) and included 238 renal recipients aged 22 to 82 years. Risk of nephropathy was evaluated by analyzing data of protocol biopsies according to the Banff 97 classification.Assessment of immunosuppressants’ exposures was based on the calculation of the mean of AUC(0-12). The AUC(0-12) was estimated using a Bayesian estimator and a 3-point limited sampling strategy. Cyclosporine and tacrolimus analyses were performed using liquid chromatography–mass spectrometry method. The measurement of total mycophenolic acid was performed using a validated high-performance liquid chromatography method with ultraviolet detection. IBM SPSS 20.0 was used for statistical analysis.The most accurate dosing of mycophenolate mofetil (MMF) was observed in patients receiving MMF with tacrolimus, 70.6% of patients’ AUC(0-12) exposures were within the therapeutic range. The highest rates of low dosing were observed in patients receiving MMF with cyclosporine, 30.9% of patients had AUC(0-12) exposures below the therapeutic range. The assessment of AUC(0-12) revealed 38% of chronic nephropathy cases, while C0 enables to identify only 20% of chronic nephropathy cases.Probability test results showed that more likely AUC(0-12) and C0 will be maintained within the therapeutic width if patients receive MMF with tacrolimus vs MMF with cyclosporine: 0.6320 vs 0.6410 for AUC(0-12) determination and 0.8415 vs 0.4827 for C0 determination.Combination of MMF with tacrolimus is dosed more precisely vs dosing of MMF with cyclosporine. 72 (70.6%) patients AUC(0-12) and 79 (77.5%) patients C0 out of 102 patients were within the therapeutic range. The AUC(0-12) monitoring of mycophenolic acid in patients receiving MMF with tacrolimus or in patients receiving MMF with cyclosporine enabled to identify more overdosing and possible risky cases.Study results show that standard MMF dosing without monitoring and with mycophenolic acid level within the therapeutic width is possible and demonstrates less risky cases in patients receiving MMF with tacrolimus, while patients receiving MMF with cyclosporine should be intensively monitored to achieve the highest safety. However, AUC(0-12) monitoring is advised showing better compliance vs C0 monitoring.

Health Problems and Complementary Medicine in the First Trimester Pregnancy

Gestation is a term which physiological, psychological and social changes are experienced in life and it is necessary to adapt to these changes. However, in every pregnancy, risky situations may occur which may have negative consequences for fetüs and mother. Among these risky cases, in the first trimester are spontaneous abortion, ectopic pregnancy, gestational trophoblastic disease, hyperemesis gravidarum. There were no studies on ectopic pregnancy and gestational trophoblastic disease when the literature was searched. It has been observed that most of your work was about nausea and vomiting seen in this period. However, it is observed that the results of these studies do not contain conclusive evidence. Bed rest, Chinese herbal medicines, acupuncture have been used in the prevention of miscarriages. In hyperemesis gravidarum, it has been observed that many complementary medical methods such as ginger, vitamin B1, vitamin B6, lemon oil inhalation, mint oil, chamomile, moxibustion, tactile massage, hypnosis, acupuncture, acupressure and social support are used. Many complementary methods are similar to nursing in that they centre on the concept of holism. Therefore, information on complementary therapies and their ares of use should be included in nursing curriculums, nurses should be updated on these therapies through in-service trainings. Keyword : Complementary Medicine, First Trimester, Hyperemesis Gravidarum, Nursing. DOI : 10.7176/JSTR/5-4-23

Risk Management in Students Using the FMEA Method (Prospective Approach) to identify ‎risky cases in term of Suicide and its prevention

Background: Risk management refers to the process of adopting policies to accept, identify, evaluate, control, minimize or reduce the assessed risks. Risk management is described in five activities: communicating and counseling, creating background, risk assessment, Monitoring and review. Among these five activities, risk assessment is the most complex one and it includes identifying, analyzing and evaluating risk. Risk Assessment Method, FMEA (Failure Mode and Effects Analysis) was first presented by the US Army for the aerospace industry in 1960s; it was also considered as the basis for managing pre-incident crisis management issues in healthcare systems. Its benefits include anticipating and preventing problems, reducing costs, shortening the time to improve quality, and achieving secure and highly reliable processes. Considering the increasing rate of suicide and its adverse effects on family and society, a prospective approach can be employed for psychological improvement, and evaluate risky cases before the event, and take the necessary interventions to reduce the risk and the likelihood of committing suicide. Methods: This is a research project in the form of safety prospective approach on vulnerable groups. In this project, it is recommended to clinic psychologists at health centers to use a standard questionnaire on probability of suicide in a scheduled program for all high schools in Marand city and assess the students psychologically and evaluate the probability of having suicidal thoughts and finally identify risky students. In the next step, counseling and psychology sessions will be held for identified students; then involved, predisposing factors and inhibitors will be identified in these students. Then, according to the score gained from assessment, students will be prioritized and individual psychology sessions will be held in order to accurately assess the problems of these students and enhance their defense mechanisms. Also, in order to improve the ability to cope with the stress and crisis, some educational sessions will be held for the families of these students and appropriate psychological strategies for proper communication with children, increasing self-esteem, reducing family pressures and ... can be provided for them. Results: In order to implement this plan, a session shouldbe held for all the psychologists of the center, and the objectives of the meeting should be explained to them, and then the action plan must be developed in the form of a Gantt chart. In the next step, the prioritization of schools must be done according to specific areas with high suicide rates. The necessary coordination should also be provided with schools. All data must be used for accurate assessments of managers and teachers. Also, after t identification in improving the mental health of students, teachers can play a very useful role. In this regard, the training teachers seems necessary considering the purposes. Conclusion: Given the importance of a prospective approach in safety, FMEA method is a suitable way for identifying and prioritizing the risks of the society, especially schools. By managing these risks and planning properly, the possible risks can be managed at the time of happening. Also, holding life skills workshops, training adaptive stress skills, training to control stress and anxiety, and using spiritual issues can be helpful to improve the mental health of vulnerable people and to manage possible psychological risks.

Serum amyloid-a may be an early marker in diagnosis of preterm premature rupture of membrane and chorioamnionitis

Aim: To determine the efficiency of serum amyloid-A (SAA) in predicting preterm premature rupture of membrane (PPROM) and chorioamnionitis in risky cases. Study Design: The study consists of 20 women 26-37 weeks of pregnancy who had PPROM and 20 pregnant women without water breaks. Levels of SAA were determined in maternal venous and umbilical cord blood. Results: SAA values in cord blood and venous blood of mothers with PPROM were higher than in the control group (p0,05). SAA values in the patients with clinical chorioamnionitis (n=9) were significantly higher (p0,05) than both PPROM patients without chorioamnionitis (n=11) and the control group (n=20). Conclusion: In women at risk for PPROM in whom diagnosis cannot be established, blood SSA levels can be used as a marker. Increased SAA values in pregnant women with PPROM who were conservatively treated were considered a marker for chorioamnionitis.

Evaluation of rabies risky contact cases admitted to emergency department last year

Evaluation of rabies risky contact cases admitted to emergency department last year

Relationship of Ferritin Levels of Pregnant Women Who Had Fe Deficiency Anemia with Ferritin Levels and APGAR of the Neonates

Iron deficiency anemia in pregnant women can have a negative impact on the baby, such as placental development, low birth weight, prematurity, baby health, hypoxia, decreased immune status, possibility of having physiological disorders and infant growth. The aim of this study was to determine the relationship of ferritin levels of pregnant women who had Fe deficiency anemia with ferritin levels and Apgarof the neonates.This was a cross sectional study in the population of pregnant women who had Fe deficiency anemia and neonates who met the inclusion criteria taken by consecutive sampling technique in the working area of Lubuk Buaya Health Center, Ambacang Health Center and Ikur Koto Health Center. Examination of ferritin levels was carried out in the Biomedical Laboratory of Faculty of Medicine, Andalas University using ELISA method. Data were analyzed by Pearson Test and Mann-Whitney Test. The results of this study showed there was no significant relationship between maternal ferritin levels on neonatal ferritin r = 0.248, p = 0.204. It also showed that there was no relationship between maternal ferritin levels on APGAR p value = 0.199 and there was a significant relationship between neonatal ferritin levels on APGAR p value = 0.002. The conclusion of this study is that there was a positive relationship between maternal ferritin levels with neonatal ferritin levels, there was no significant relationship between maternal ferritin levels and APGAR score, there is a significant relationship betweenneonatal ferritin levels with APGAR score. By improving nutrition, socioeconomic, qualitative antenatal care, early referral of risky cases and iron supplementation can reduce the incidence of anemia.

Relationship Between Ferritin and Folic Acid Levels In Pregnant Women With Newborn Weight and Head Circumference

Iron deficiency and folic acid anemia cause decrease in ferritin and folic acid levels that can interfere with the intake of oxygen and nutrients to the fetus resulting in LBW and reduced brain growth during pregnancy. The aim of the study was to determine the relationship between ferritin and folic acid levels in pregnant women with newborn weight and head circumference.This study was a cross sectional study conducted on 55 pregnant women at 37-42 weeks who were taken by consecutive sampling technique. The study was carried out in the Working Area of the Puskesmas and the Regional Health Laboratory of the Merangin Regency, and the health laboratory of West Sumatra Province from May 25 to July 13, 2018. Test the normality with the Kolmogorov-smirnov test and the correlation test using Pearson and Spearman.The results showed ferritin mean 23,643±16,682 ng/ml, folic acid 14,093±4,578 ng/ml, newborn weight 3047,27±399,005 gram and head circumference 33,02±1,163 cm. Statistical test results showed no correlation between ferritin levels with body weight (r=0.063, p=0.648) and head circumference (r=0.018, p=0.895) and folic acid levels with body weight (r=-0.036, p=0.795) and head circumference (r=-0.098, p=0.477).The conclusions of the study were that ferritin and folic acid levels of pregnant women had no significant correlation with newborn weight and head circumference. By improving nutrition, socioeconomic, qualitative antenatal care, initial referral of risky cases and supplementation of iron and folic acid can reduce the incidence of anemia.

Egalitarianism under Severe Uncertainty

In the spring of 2009, a novel strain of the H1N1 influenza virus, containing a never before witnessed combination of gene segments from human influenza, two forms of swine influenza, and avian influenza, 1 was declared a global pandemic. The UK Government had to decide whether to undertake, at a cost of £1.2 billion (USD 1.9 billion at the time, equivalent to 1 percent of that year’s health budget), an extensive set of preparatory measures, including the purchase of both antiviral medication and a novel vaccine in quantities sufficient to cover the entire UK population, or whether instead to take substantially less costly measures, which would involve having only a limited supply of these medicines and vaccines at hand.2 The possible.

V07-11 ROBOT-ASSISTED LEFT RADICAL NEPHRECTOMY WITH LATERAL CLAMPING OF THE VENA CAVA AND LYMPH NODE DISSECTION

You have accessJournal of UrologyRenal Oncology I1 Apr 2018V07-11 ROBOT-ASSISTED LEFT RADICAL NEPHRECTOMY WITH LATERAL CLAMPING OF THE VENA CAVA AND LYMPH NODE DISSECTION Clément Michiels, Laure Dupitout, Clément Allenet, Jean Rouffilange, Adeline Guillaume, Josselyn Susperregui, Grégoire Robert, Gilles Pasticier, Henri Bensadoun, Nicolas Grenier, Jean-Marie Ferrière, and Jean-Christophe Bernhard Clément MichielsClément Michiels More articles by this author , Laure DupitoutLaure Dupitout More articles by this author , Clément AllenetClément Allenet More articles by this author , Jean RouffilangeJean Rouffilange More articles by this author , Adeline GuillaumeAdeline Guillaume More articles by this author , Josselyn SusperreguiJosselyn Susperregui More articles by this author , Grégoire RobertGrégoire Robert More articles by this author , Gilles PasticierGilles Pasticier More articles by this author , Henri BensadounHenri Bensadoun More articles by this author , Nicolas GrenierNicolas Grenier More articles by this author , Jean-Marie FerrièreJean-Marie Ferrière More articles by this author , and Jean-Christophe BernhardJean-Christophe Bernhard More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1770AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Show the feasibility of a robot-assisted left radical nephrectomy, with a caval thrombectomy. This approach is seldom used in these risky cases, for security reasons when the patient, often fragile at this stage of the disease, could benefit significantly from this minimally invasive approach compared to the open route. With the necessary precautions, the minimally invasive approach gains meaning. METHODS The key steps of the procedure, done with the Da Vinci surgical robot, with 3 operative arms, a 30-degree endoscope and two ports for the assistant are shown. A preoperative surgical planning with an MRI the day before surgery to check the extension of the thrombus into the vena cava is a compulsory prerequisite. Clinical data from this case were extracted from the French national database on kidney cancer UroCCR and were collected after patient consent. RESULTS The 79-year-old patient, presenting with general symptoms and hematuria, was diagnosed with a left renal 11cm-tumor. The tumor infiltrated the kidney entirely, with local lymph node involvement and a thrombus extension into the renal vein, reaching the vena cava. The first step was accessing, through the mesentery, the mid-line retroperitoneal space to allow the dissection of the vena cava, the aorta, to undertake the lymph node dissection and to clip the renal artery. The rest of the nephrectomy was done after the left colon was lowered. The extent of the thrombus into the renal vein allowed a lateral clamping of the vena cava with a laparoscopic clamp inserted through the abdominal wall. The vena cava was sutured under lateral clamping. The pathology report showed a poorly differentiated collecting duct carcinoma, pT3bN1 with capsular rupture. The patient was discharged on post-operative-day-4, without any complication, any transfusion. Follow-up showed a metastatic progression treated by antiangiogenic therapy. CONCLUSIONS A minimally-invasive robot-assisted approach, for this surgery, is feasible and should be considered when possible because such a patient could benefit from it. Crossing the mid-line was possible with this laparoscopic route because the patient was 75 degrees on his right flank. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e745 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Clément Michiels More articles by this author Laure Dupitout More articles by this author Clément Allenet More articles by this author Jean Rouffilange More articles by this author Adeline Guillaume More articles by this author Josselyn Susperregui More articles by this author Grégoire Robert More articles by this author Gilles Pasticier More articles by this author Henri Bensadoun More articles by this author Nicolas Grenier More articles by this author Jean-Marie Ferrière More articles by this author Jean-Christophe Bernhard More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The patho-mechanism of incarceration of the gravid uterus; the pelvic structure and the placental position. A two-case report and review of literature.

Objective: Objective was to use terms and definitions described by the International Endometrial Tumor Analysis group (IETA) in evaluating the endometrium on gray scale ultrasound and Doppler imaging for testing the validity of these ultrasound variables in addition to patient clinical variables and creating a risk scoring model for better prediction of endometrial cancer trying to limit invasive procedures for risky cases only and performing a decision algorithm for their management. Study design: A prospective cross-sectional study, 60 patients with post-menopausal Bleeding (PMB) and endometrial thickness ≥5 mm were enrolled. TVS and color Doppler were done. Patient clinical variables and ultrasound endometrial assessment were compared to histopathology to identify the best predictors of endometrial cancer. Univariate, multivariate, and ROC curve analysis were used to design a risk-scoring model then test its validity. Results: The best predictors for endometrial cancer were endometrial thickness ≥12 mm (OR = 1.9), heterogeneous echogenicity of endometrium (OR = 2.7), irregular endometrial midline (OR = 1.9), ill-defined endometrium-myometrium interface (OR = 3.3), Doppler score > 2 (OR = 2.5). These variables were used to perform a risk-scoring model for the prediction of endometrial malignancy with accuracy about 95% and an area under the curve 0.9. At the best cut-off value (score ≥ 10) sensitivity and specificity were 80%, 97.8%, respectively. Conclusions: Terms used by IETA group were clinically valuable and reasonable in assessment of the endometrium. Applying a malignancy model for women with PMB allowed easy their risk classification, better identification, and management.

An ultrasound risk-scoring model for prediction of endometrial cancer in post-menopausal women (using IETA terminology)

Abstract Objective: Objective was to use terms and definitions described by the International Endometrial Tumor Analysis group (IETA) in evaluating the endometrium on gray scale ultrasound and Doppler imaging for testing the validity of these ultrasound variables in addition to patient clinical variables and creating a risk scoring model for better prediction of endometrial cancer trying to limit invasive procedures for risky cases only and performing a decision algorithm for their management. Study design: A prospective cross-sectional study, 60 patients with post-menopausal Bleeding (PMB) and endometrial thickness ≥5 mm were enrolled. TVS and color Doppler were done. Patient clinical variables and ultrasound endometrial assessment were compared to histopathology to identify the best predictors of endometrial cancer. Univariate, multivariate, and ROC curve analysis were used to design a risk-scoring model then test its validity. Results: The best predictors for endometrial cancer were endometrial thickness ≥12 mm (OR = 1.9), heterogeneous echogenicity of endometrium (OR = 2.7), irregular endometrial midline (OR = 1.9), ill-defined endometrium-myometrium interface (OR = 3.3), Doppler score > 2 (OR = 2.5). These variables were used to perform a risk-scoring model for the prediction of endometrial malignancy with accuracy about 95% and an area under the curve 0.9. At the best cut-off value (score ≥ 10) sensitivity and specificity were 80%, 97.8%, respectively. Conclusions: Terms used by IETA group were clinically valuable and reasonable in assessment of the endometrium. Applying a malignancy model for women with PMB allowed easy their risk classification, better identification, and management.

A Situation-Based Analysis of Flash Flood Fatalities in the United States

Abstract This paper investigates the circumstances of 1,075 fatalities from flash flooding recorded from 1996 to 2014 across the United States. This study provides insights into the situations of the fatality events as determined by the victims’ profile and activity and the spatiotemporal context of the flooding. A reclassification of the individual fatality circumstance (i.e., location and/or activity) is performed to explore statistically the timing, the duration, and location of the flash flood event and the age and gender of the victims. In agreement with other studies, more than 60% of the reported fatalities were related to vehicles involving mainly males. A geospatial analysis indicated these were most common in southern states. Further, 21% of fatalities occurred outdoors, typically in neighborhoods near streams, where the victims were exhibiting high-risk-taking behavior, such as cleaning out drains and even playing in the floodwaters. Human vulnerability varies dynamically on a subdaily basis and depends on social and natural factors of the flash flood. For example, most campsite-related fatalities were associated with very fast-responding flash flood events (less than 5-h duration), occurred more commonly after midnight, and impacted younger females and males alike. On the other hand, fatalities related to inundation of permanent buildings were most commonly associated with longer-duration events and impacted the elderly. Situational rather than generic examination of vulnerability is required to realistically capture risky cases during short-fuse flood events. The circumstances in which people perished in flash floods suggest that situational rather than generic examination of vulnerability is required to realistically capture risky cases during short-fuse flood events.

Anterior Segment Ischemia after Strabismus Surgery.

A 46-year-old male patient was referred to our clinic with complaints of diplopia and esotropia in his right eye that developed after a car accident. The patient had right esotropia in primary position and abduction of the right eye was totally limited. Primary deviation was over 40 prism diopters at near and distance. The patient was diagnosed with sixth nerve palsy and 18 months after trauma, he underwent right medial rectus muscle recession. Ten months after the first operation, full-thickness tendon transposition of the superior and inferior rectus muscles (with Foster suture) was performed. On the first postoperative day, slit-lamp examination revealed corneal edema, 3+ cells in the anterior chamber and an irregular pupil. According to these findings, the diagnosis was anterior segment ischemia. Treatment with 0.1/5 mL topical dexamethasone drops (16 times/day), cyclopentolate hydrochloride drops (3 times/day) and 20 mg oral fluocortolone (3 times/day) was initiated. After 1 week of treatment, corneal edema regressed and the anterior chamber was clean. Topical and systemic steroid treatment was gradually discontinued. At postoperative 1 month, the patient was orthophoric and there were no pathologic symptoms besides the irregular pupil. Anterior segment ischemia is one of the most serious complications of strabismus surgery. Despite the fact that in most cases the only remaining sequel is an irregular pupil, serious circulation deficits could lead to phthisis bulbi. Clinical properties of anterior segment ischemia should be well recognized and in especially risky cases, preventative measures should be taken.

Medical device postapproval safety monitoring: where does the United States stand?

A recent Food and Drug Administration (FDA) proposal aims to speed the evaluation process for new high-risk medical devices that are intended to address unmet medical needs,1 much like existing expedited approval processes, such as the humanitarian device exemption rule for devices intended to treat rare diseases. Such programs are strongly supported by the medical device industry and some patient advocacy groups, which have criticized the FDA for being too stringent in its evidentiary requirements for investigational devices, leading to delays in the approval of potentially helpful products.2–4 For example, in 2011, the FDA approved a transcatheter aortic valve replacement system that demonstrated significant improvements over conventional treatment options for selected patients with severe aortic stenosis.5,6 However, the United States was the 43rd country to approve the device, roughly 4 years after the European Union.7 Yet expedited approval for high-risk medical devices raises the possibility that these devices will not be as effective as predicted in their limited premarket testing or that they could cause unanticipated harms after approval.8 Of course, well-studied devices may present unexpected safety concerns years after approval,9,10 and even the most rigorous conventional premarket approval process will result in some devices later found to be unsafe or ineffective.11–13 Safety of approved medical devices and the proper scope of premarket testing remain contentious issues after recalls of several widely used devices, including popular models of implantable cardioverter defibrillator leads14,15 and metal-on-metal hip implants.16 Inherent limitations in premarket testing, along with the prospect of lowered evidentiary standards for expedited device reviews, place greater pressures on postapproval monitoring of devices to follow clinical performance and to identify emerging public health problems. Medical device manufacturers routinely perform this sort of vigilance, …