Untoward Events Research Articles

Analysis of events reported from industrial radiation facilities

Radiation sources have multifarious societal applications in medical, industrial and research. Prevention of any untoward event is one of the important safety principles to be considered during the handling of radiation sources. However, some unusual events may occur during the handling of radiation sources, which may be attributed to various factors such as equipment malfunction, human error etc. Atomic Energy Regulatory Board (AERB) has a well-established mechanism for event reporting by the stakeholders. An analysis of the events reported by the facilities handling radiation sources for industrial radiography, nucleonic gauges and well-logging applications has been carried out. Analysis shows that the major contributing factors for reported events in industrial radiography are human error and equipment failure, whereas for nucleonic gauges and well logging facilities dominating factors are security-related issues and external (environmental) factors respectively. These reported events have not led to any serious accident, however, reported by the facilities as deviations from standard operating procedures are observed.

Safety evaluations of offspring breastfed by mothers receiving glatiramer acetate for relapsing multiple sclerosis.

Although the relapse risk is increased after birth in women with relapsing multiple sclerosis (RMS), only a very few disease-modifying therapies (DMTs) are approved during breastfeeding. Glatiramer acetate (GA, Copaxone®) is one of three DMTs that can be used in breastfeeding. The real-world safety of Copaxone® in Offsprings of Breastfeeding and treated RMS pAtients (COBRA) study demonstrated that offspring parameters (hospitalisations, antibiotic use, developmental delays, growth parameters) were similar between offspring breastfed by mothers taking GA or no DMT (control) during breastfeeding. COBRA data analyses were extended to provide further safety data on the impact of maternal GA treatment during breastfeeding on offspring. COBRA was a non-interventional, retrospective study using German Multiple Sclerosis and Pregnancy Registry data. Participants had RMS, gave birth and had GA or no DMT during breastfeeding. Offspring total adverse events (AEs), non-serious AEs (NAEs) and serious AEs (SAEs) up to 18 months postpartum were assessed. Reasons for offspring hospitalisations and antibiotic treatments were explored. Baseline maternal demographics and disease characteristics were similar between cohorts. Each cohort had 60 offspring. Numbers of offspring AEs were comparable between cohorts; total AEs: 82 (GA) vs 83 (control); NAEs: 59vs 61; SAEs: 23vs 22. AEs in both cohorts were diverse with no specific patterns. Duration of GA-exposed breastfeeding was 6 to >574 days for offspring with any AE. For all-cause hospitalisations, 11 offspring had 12 hospitalisations (GA cohort) and 12 control offspring had 16 hospitalisations. Most common reason for hospitalisation was infection: 5/12 (41.7%; GA) vs 4/16 (25.0%, control). Two out of 12 (16.7%) hospitalisations due to infection occurred during GA-exposed breastfeeding; the others occurred 70, 192 and 257 days after discontinuation of GA-exposed breastfeeding. Median (range) duration of GA-exposed breastfeeding was 110 (56 to ≥285) days for offspring hospitalised for infections and 137 (88-396) days for those hospitalised for other reasons. Nine offspring had 13 antibiotic treatments (GA cohort) and nine control offspring had 10 treatments. Ten out of 13 (76.9%) antibiotic treatments occurred during GA-exposed breastfeeding, of which four were primarily due to double kidney with reflux. Other antibiotic treatments occurred 193, 229 and 257 days after discontinuation of GA-exposed breastfeeding. GA treatment of mothers with RMS during breastfeeding did not increase AEs, hospitalisations or antibiotic use in their offspring versus control offspring. These data support previous COBRA data that the benefit of maternal RMS treatment with GA during breastfeeding outweighs the potential, apparently low risk of untoward events, in their breastfed offspring.

Electronic Diary Monitoring for Hypertension Post Stroke

Elderly stroke outpatients, without aphasia, hemiplegia, or spatial neglect in their post-acute phase, are typically monitored on a quarterly, physician-visit schedule. Thus, the patient's status goes unreported between visits unless a remarkable untoward event occurs.

Anesthesia in patients with Brugada syndrome: two case reports

BackgroundBrugada syndrome is a rare disease. It causes sudden cardiac arrest, which is a serious life-threatening event. Sudden cardiac death mostly results from coronary artery disease. However, patients with Brugada syndrome show normal cardiac anatomy and no evidence of ischemia or electrolyte imbalance. Anesthesia in patients with Brugada syndrome is challenging due to its unpredictable nature, and is worth our attention.Case presentationWe report two cases of Brugada syndrome during anesthesia. In case one, a 31-year-old Filipino laborer was scheduled for laparoscopic appendectomy. The patient denied any preexisting cardiac disease. The preoperative vital signs were stable, with mild fever of 37.9 °C. The operation was smooth. During the emergence period, the patient suffered from sudden onset of ventricular tachycardia. After resuscitation, the cardiac rhythm returned to normal. Later, he was confirmed to have a genetic trait of Brugada syndrome. In case two, a young Taiwanese patient with pre-diagnosed Brugada syndrome underwent an operation. The perioperative precautions were taken to prevent the occurrence of ventricular arrhythmia. The surgery was uneventful.ConclusionsBrugada syndrome, although rare, has the highest incidence in South East Asian healthy young males. It brings attention to possible fatal cardiac arrhythmia in this population. Careful preoperative evaluation and perioperative management can help reduce the harmful outcome of the disease and prevent any untoward events.

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Topical tranexamic acid reduces postoperative hematomas in reduction mammaplasties

BackgroundPostoperative bleeding requiring reoperation is an untoward event in breast surgery. Topical tranexamic acid (TXA) has been routinely used to reduce the risk of postoperative bleeding in some surgical fields. In breast surgery, it is not routinely used owing to scarce information. We investigated whether the intraoperatively applied topical TXA reduces the incidence of postoperative hematoma in reduction mammaplasty surgeries. MethodsThis retrospective, single-center cohort study comprises of 415 consecutive patients who underwent reduction mammaplasty between 2019 and 2021. The prophylactic use of topically applied TXA (20 mg/ml) was implemented as a part of the hospital protocol in November 2020. The patients who were rinsed with TXA before the wound closure were compared with those who were not rinsed. The results were analyzed using statistical tests, two-sided Pearson’s Chi-Square and Fisher’s exact tests. ResultsTopical TXA significantly reduced the number of postoperative hematomas requiring evacuation (p = 0.008). In the non-TXA control group, 12 (5.8%) hematomas were observed out of 208 patients. In the topical TXA group, only one (0.6%) hematoma occurred among the 168 patients. A tendency towards fewer wound infections, seromas, and other minor wound-healing problems can also be seen in the topical TXA group (ns). No adverse events of topical TXA were detected. ConclusionsThe incidence of postoperative hematomas decreased to a tenth after the introduction of topical TXA in reduction mammaplasty surgeries. This simple procedure may save patients from reoperations owing to bleeding. Randomized controlled trials are warranted.

Development and evaluation of novel artemisinin-isatin hybrids with potential anti-leukemic cytotoxicity.

Twenty-one novel ester tethered artemisinin-isatin hybrids were designed, synthesized and screened against human myeloid leukemia cell lines (K562 and K562/ADR), human acute lymphoblastic leukemia cell line (CCRF-CEM) as well as normal human peripheral blood mononuclear cells (PBMCs) for their cytotoxicity by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. The structure-activity relationships (SARs) were also discussed to facilitate further rational design of more effective candidates. The preliminary results showed that most of the ester tethered artemisinin-isatin hybrids (IC50: 0.32-29.35 µM) exhibited promising activity against CCRF-CEM cells, and some of them (IC50: 1.23-49.84 µM) were also active against K562 and K562/ADR human myeloid leukemia cell lines. Among them, hybrid 7d (IC50: 0.32, 2.67 and 1.23 µM) not only possessed profound activity against the three tested leukemia cell lines and excellent safety and selectivity profiles, but also showed promising pharmacokinetic properties. Accordingly, hybrid 7d could be considered as a potential lead molecule for the development of novel anti-leukemic agents with minimal untoward events to normal human cells.

STUDY ON CLINICO-RADIOLOGICAL FEATURES INDICATIVE OF INTERSTITIAL LUNG DISEASE WITH THE HELP OF SPIROMETRY, CHEST X-RAY AND HIGH RESOLUTION COMPUTED TOMOGRAPHY CHEST

Background: Interstitial lung disease (ILD), is a group of respiratory diseases affecting the interstitium of the lungs and is very common in our country. They exhibit wide variety of symptoms hence their diagnosis is challenging. We aim at studying the clinco-radiological features of ILD using chest x-ray, spirometry and HRCT without surgical and transbronchial lung biopsy. Material and Methods: Patients with clinicradiological features suggestive of ILD that attended the OPD or were admitted to the wards of a tertiary care hospital between 2015 to 2016 were included in the study. The clinical details, demographics, chest x-ray, spirometry and HRCT ndings, were recorded and analysed. Fifty Results: one patients, who were clinic-radiologically suggestive of ILD were included in the study. IPF constitutes the single largest disease accounting for 41.2% among all other ILD followed by connective tissue disorder associated ILD (31.4%). Reticulonodular shadows were the most common chest x-ray ndings present in 36 (70.6%) patients of ILD. Restrictive pattern was found to be present in spirometry in 42 (82.3%) patients of ILD. Honeycombing and reticular opacities (60.8%) were the most common HRCT chest ndings in patients of ILD followed by brosis (35.3%), diffuse ground glass opacities (33.3%), traction bronchiectasis (27.5%) and nodular opacities (5.9%). Surgical and transbronchial Conclusion: lung biopsy are widely used for the diagnosis of ILD but they possess several complications and risk factors like pneumothorax, bleeding in the airways, arrhythmias or untoward events during anaesthesia. Diligent examination of the clinic-radiological features using chest x-ray, spirometry and HRCT can successfully predict ILD thereby avoiding currently used invasive techniques

Design, synthesis, and in vitro cytotoxicity evaluation of novel dihydroartemisinin-isatin hybrids tethered via different length of esters as potential anti-breast cancer agents

In the present work, we reported the design, synthesis, and in vitro cytotoxicity evaluation of novel dihydroartemisinin-isatin hybrids tethered via different length of esters against MCF-7, MDA-MB-231, MCF-7/ADR and MDA-MB-231/ADR breast cancer cell lines. The preliminary results showed that the majority of the hybrids exhibited good anti-breast cancer cell activity. In particular, hybrids 7 g and 7n not only were more potent than ART, DHA and ADR against the four tested breast cancer cell lines, but also were non-toxic towards normal MCF-10A breast cells. The selectivity index values of hybrids 7 g and 7n were > 12.83 and > 25.97 respectively, revealing their excellent safety and selectivity profiles. The drug-resistant index values of hybrids 7 g and 7n were in a range of 0.33 to 1.12, implying that these hybrids had the potential to overcome drug resistance. Accordingly, hybrids 7 g and 7n could be considered as potential lead molecules for the development of novel anti-breast cancer agents with minimal untoward events to normal human cells. The structure-activity relationships indicated that the length of ester likner between DHA and isatin as well as substituents at C-3 and C-5 positions of isatin moiety had great impact on the activity.

NUTRITIONAL SURVEY IN CRITICALLY ILL CHILDREN AND THEIR IMPACT ON ANTHROPOMETRIC INDICES AND OUTCOME.

Malnutrition has a high incidence among patients hospitalized to PICUs. It has a major impact on a child's outcome, including death, morbidity, and length of ICU stay.1, 2, 3 However various studies have found that the actual delivery of enteral nutrition is less as compared to what is needed due to lack of feeding protocols, delay in initiation and stopping enteral nutrition in case of a procedure or an untoward event.4 Covid 19 pandemic has increased both underweight and obesity. Henceforth, our study is conducted in critically ill pediatric patients to evaluate their nutritional needs and the transition of critically ill pediatric patients from partial or total parental nutrition to various forms of enteral nutrition. Along with the nutritional survey, the study also evaluates the change in anthropometric indices of pediatric patients after their PICU stay and co-relation with enteral nutrition. Finally the results were segregated to nd the outcome of these patients in our tertiary level Pediatric Intensive Care Unit based in teaching institute of Western Maharashtra. There is scarcity of literature in nutrition in pediatric critical care in India. This study aims to study the incidence of nutrition in pediatric intensive care units and measures to increase nutrition and their impact on outcome.

NORTH CAROLINA NURSING HOME AND PUBLIC HEALTH RESILIENCE DURING 2021 OF THE COVID-19 PANDEMIC

Abstract Since the onset of the COVID-19 pandemic many healthcare organizations have operated in a climate of uncertainty. Building resilience is one method used to survive and thrive during periods of uncertainty. Measuring an organization’s resilience (ability to prepare for, respond and adapt during time of change) allows the organization to identify its vulnerabilities and set priorities to avert negative outcomes during an untoward event. Through collaboration with four long-term care professional associations, the Benchmark Resilience Tool (BRT-13) resilience survey was disseminated to North Carolina long-term care leaders in April 2021. The BRT-13 survey was also sent to North Carolina public health officials via email during the same timeframe. The BRT-13 contains 13 resilience (RES) items divided into two factors of adaptive capacity (AC) and planning (PL) on a five-point Likert scale of strongly disagree (1) to strongly agree (5). Organizational factors surveyed included type of facility, rural-urban classification area designation, ownership type, level of debt, level of profitability, and employee satisfaction. A total of 142 completed surveys were received, 101 (71%) from long-term care leaders and 41 (28.9%) from Public Health officials. Overall average resilience scores ranged from 3.96 for public health respondents to 4.46 for continuing care retirement communities (CCRC) respondents. Analysis of Variance (ANOVA) was employed to compare the three factors (AC, PL, and RES) to the organizational factors. Resilience was significantly associated with one factor, employee satisfaction. Our findings indicate that organizations can build resilience through processes that contribute to staff satisfaction.

Case Report: Euglycemic diabetic ketoacidosis led by empagliflozin: A case report and literature review

Introduction: Sodium-glucose co-transporter 2 inhibitors (SGLT2i) are a new class of medications that have been approved for the treatment of heart failure (HF) in patients with and without type-2 diabetes mellitus. It is important to be aware of the likely side effects of SGLT2i for their optimal use and enhanced patient safety. One such rare but potential side effect is the development of euglycemic diabetic ketoacidosis (EDKA). Objective: We present a case report of EDKA, in a patient who was started on empagliflozin – one of the SGLT2i – highlighting its presenting signs and symptoms, pertinent laboratory findings, differential diagnosis, treatment and outcome. To strengthen our findings and hypothesis, we conducted a literature review of other cases that used SGLT2i and found similar complications. This case report with review can help recognize the serious, potentially life-threatening complications of the new class of medication SGLT2i that has been incorporated into the current practice, and also help to take appropriate steps to mitigate its adverse effects and improve overall health outcomes in our patients. Conclusions: SGLT2i are increasingly used because of their favorable effects on mortality in the chronic HF patients along with its benefits of weight loss and blood pressure reduction. A potential underdiagnosed adverse effect of SGLT2i use is diabetic ketoacidosis in a setting of normal blood glucose levels. Thus, it is reasonable to be cognizant of its side effects to prevent any untoward events in a timely manner.

A comparative analysis of outcomes of root canal therapy for pediatric medicaid beneficiaries from New York State.

This study investigated differences in the provision of root canal therapy and outcomes in a publicly insured cohort of children and adolescents. New York State Medicaid administrative claims from 2006 to 2018 were analyzed. Enrollees aged 6-18 were included in the study if they had initial non-surgical root canal therapy (NSRCT), in the permanent dentition, that allowed for at least 1 year of post-treatment follow-up. Descriptive analyses, multivariable logistic regression, and multivariable Cox proportional hazard models were used to examine the association between demographic variables (gender, age, race/ethnicity, and area-based factors) and dental treatment provision and outcomes. Male gender was associated with having more than one initial NSRCT (adjusted odds ratio (aOR) = 1.06; 95% confidence interval (CI) = 1.02-1.10), as was rurality (aOR = 1.15; 95% CI = 1.06-1.24). Black/African American (AA) and Hispanic children were less likely than non-Hispanic white children to have multiple NSRCTs (aOR = 0.88; 95% CI = 0.83-0.93 and aOR = 0.78; 95% CI = 0.74-0.83). Being older or female conferred a lower hazard of an untoward event (aHR = 0.93; 95% CI = 0.92-0.94 and aHR = 0.86; 95% CI = 0.81-0.91). Compared to non-Hispanic white children, Hispanic and Black/AA children had a higher risk of untoward event (aHR = 1.31; 95% CI = 1.21-1.41 and aHR = 1.55; 95% CI = 1.43-1.67) while children of Asian descent had a lower incidence after initial NSRCT (aHR = 0.79; 95% CI = 0.71-0.88). Race/ethnicity was the strongest demographic predictor of provision of initial non-surgical root canal therapy, subsequent placement of a permanent restoration and the occurrence of an untoward event after NSRCT in this cohort.

RF09 | PSAT84 Management of Adrenal Insufficiency with Continuous Subcutaneous Hydrocortisone Infusion: Long-Term Experience in 27 Patients

Abstract Background Conventional management of adrenal insufficiency (AI) includes lifelong oral glucocorticoid replacement therapy. Currently, no glucocorticoid regimens adequately mimic the circadian rhythm of cortisol secretion. In some patients, this causes persistence of severe symptoms. Continuous subcutaneous hydrocortisone infusion (CSHI) is an alternative delivery method using an insulin pump. Previous studies have confirmed CSHI's potential to re-establish the diurnal cortisol profile and reduce total daily dose (TDD) of hydrocortisone. To date no reports are available regarding the long-term usage (>2 years) of CSHI in adults. Methods We report the use of CSHI in 27 patients seen at the Scottsdale Endocrinology Institute from 05/2012 to present. CSHI inclusion criteria were persistence of severe symptoms, high steroid dosage, or gastrointestinal intolerance, malabsorption or bleeding in willing and able patients. Individual basal rates were set using a novel method to re-establish patients’ diurnal cortisol profiles. Patients were educated on pump basics including bolusing and temporary basal rates, allowing them to control their dosing during symptomatic and stressful periods and procedures, and using subcutaneous shots during pump failures. Quality of life (QOL) was assessed using the AddiQOL questionnaire periodically. Data was gathered from patient charts and surveys. We report patient preference of CSHI over oral therapy, and changes in QOL, TDD of hydrocortisone, and crises during pump therapy. Results In our patient sample, there were 2 males and 25 females, 9 had primary AI, 15 had secondary AI, and 3 had steroid-induced AI. Ages ranged from 26 to 78 years. 1 patient had 1 year of CSHI, 19 patients had 2-5 years of CSHI, and 7 patients had >5 years of CSHI. After at least 2 years of CSHI, 24/26 patients preferred CSHI over oral therapy, 25/26 patients continued to report improved symptoms and QOL, and average TDD reduction of hydrocortisone was 22 mg (2.5-55.8). 4 patients previously deemed disabled returned to a productive lifestyle. 2 patients underwent successful pregnancies without untoward events. Only 2 patients were hospitalized due to near adrenal crises. 4 chose to discontinue CSHI, 2 for a high out of pocket expense, and 2 for local skin reactions at infusion sites. Conclusion Our method of calculating basal rates and implementing CSHI was associated with improvement in symptoms and QOL and reduced TDD of hydrocortisone and hospitalizations over treatment duration. We expect this to reduce cumulative side effects of steroids and overall cost of treatment of these patients. Autonomy of dose regulation offered by pump therapy improves patient's ability to handle stressful situations and symptoms, including sleep quality and quantity. In summary, we found CSHI to be a safe and effective method to treat patients with AI experiencing problems with oral treatment over an extended period of time. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m., Saturday, June 11, 2022 1:12 p.m. - 1:17 p.m.

Impact of the COVID-19 pandemic on the regular follow-up and outcomes of patients with chronic myeloid leukemia in chronic-phase.

IntroductionCOVID-19 immediately became a major consideration in the management of chronic myeloid leukemia (CML). The influence of such considerations on viral transmission rates and leukemic control remain to be explored. We conducted this study to identify these alterations and to investigate their clinical consequences.MethodsThis was a cross-sectional study, performed at a single institution on CML patients who were interviewed with a survey. We compared variables concerning new attitudes in the pandemic era between the 12-month periods before and after the pandemic onset. Outcome data were attained from the hospital archives.FindingsThe number of patients receiving regular outpatient care for CML in chronic phase was 210, 91% had achieved at least major molecular responses. We assessed survival, progression, number of clinical visits of all, performed the survey on 89% and evaluated molecular responses on 86.6% of these patients. The frequency of clinical and molecular monitoring was significantly reduced during the pandemic deviating significantly from the guidelines. Frequency of death, progression, loss of molecular response was not significantly increased during the pandemic era despite a few cases where the delay in assessment possibly played a role in the unfavorable outcomes. There were no COVID related deaths or disabilities.ConclusionThe case-based untoward events would have probably been better managed with a more efficient communication web between patients, hematologists, and the laboratory. Therefore, it seems reasonable to consider whether such communicative paths are functional before giving up on the set schedule of CML management at times of uncertainty.

Semi-automated mapping of occluded arterial segments in acute large vessel stroke from computed tomography angiography

Catheterisation of occluded artery is the most crucial step in the mechanical thrombectomy of large vessel occlusions. Being a blind procedure, potential major untoward events could be anticipated at this stage. In this study, we evaluated the feasibility of reconstruction of the occluded vascular segment from CT angiography, exploiting the attenuation difference between the clot and adjacent brain parenchyma. Twenty-five patients with large vessel occlusion who achieved TICI2B/3 recanalization were identified. The semi-automated reconstruction was done using an open-source 3D segmentation software by two observers. The generated arterial anatomy was categorized as congruent, if all the major arterial segments namely, internal carotid artery, M1 middle cerebral artery, bifurcation, and major divisions matched with post thrombectomy angiograms. The discrepancy of one or more than one arterial segment was classified as mild or total mismatch respectively. Congruent arterial mapping was possible in 88% and 92 % patients for observer 1 and observer 2 respectively, while mild mismatch was noted in two patients for both the observers. Mismatch mostly occurred in superior division for both observers(100% vs 66.6%). The interrater agreement was good (0.77) and the accuracy was not influenced by the length of the clot. The median time for reconstruction was 4 minutes for both the observers (p - 0.21). Delineation of the anatomy of the occluded major intracranial artery is possible and corresponds with the actual anatomy. It could be used as a guide during thrombectomy procedures.

Why we blame victims, accuse witches, invent taboos, and invoke spirits: a model of strategic responses to misfortune

AbstractExplanations of misfortune are the object of much cultural discourse in most human societies. Recurrent themes include the intervention of superhuman agents (gods, ancestors, etc.), witchcraft, karma, and the violation of specific rules or ‘taboos’. In modern large‐scale societies, people often respond by blaming the victims of, for example, accidents and assault. These responses may seem both disparate and puzzling, in the sense that the proposed accounts of untoward events provide no valuable information about their causes or the best way to prevent them. However, these responses make sense if we see them in an evolutionary context, where accidents, assault, and illness were common occurrences, the only palliative being social support to victims. This would create a context in which all members of a group might be (a) required to offer support, (b) willing to offer such support to maintain a reputation as co‐operators, and (c) desirous to limit that support because of its cost. In this context, recurrent explanations of misfortune would constitute strategic attempts to create and broadcast a specific description of the situation that concentrates responsibility and potential costs on a few individuals. This strategic model accounts for otherwise perplexing features of explanations based on mystical harm (ancestors, witchcraft, etc.), as well as the tendency to denigrate victims, and offers new predictions about those cultural phenomena.

Abstract 132: Reduction Of Bone Quality In A Murine Model Of Essential Hypertension Relative To Age

Autoimmune and inflammatory diseases such as obesity and cancer are highly linked to altered bone growth and osteoporosis. Hypertension (HTN) is an inflammatory condition associated with reduced bone mineral density and increased risk for fragility fractures in adults. As cases of pediatric HTN rise in the United States, HTN may increase bone loss in children and future risk for osteoporosis. We hypothesized that HTN-induced osteoporosis in young mice reduces bone quality like that of aging. To assess this, 3.5- or 16-month-old male C57BL/6J mice received Angiotensin (Ang) II (490 ng/kg/day) or vehicle infusion by subcutaneous osmotic mini-pumps. After 6-weeks of infusion, the lumbar vertebral bodies (VB) were harvested, and analyzed by high-resolution micro-computed tomography and finite element analysis. In young mice, Ang-II induced HTN caused reductions in bone volume fraction (33.4 ± 0.8 vs 25.4 ± 1.1 %, p<0.0001) and trabecular thickness (66.4 ± 1.1 vs 54.3 ± 1.5 μm, p<0.0001). HTN reduced the estimated failure force (24.3 ± 0.7 vs 16.1 ± 1.1 N, p<0.0001) in young mice. In contrast to young mice, in aged mice Ang-II infusion did not induce bone loss; however, at baseline, the old mice exhibited reduced bone quality like that of hypertensive young mice: bone volume fraction (22.5 ± 0.7 vs 25.4 ± 1.1 %, p=0.2928), trabecular thickness (58.0 ± 1.5 vs 54.3 ± 1.1 μm, p=0.3866), and estimated failure force (17.6 ± 0.8 vs 16.1 ± 1.1 N, p=0.6517). To ascertain the impact of inflammation in the bone marrow microenvironment, the bone marrow was analyzed by flow cytometry. The number of CD4 + T cells producing IL-17A was increased in hypertensive vs normotensive young mice (230.0 ± 8.9 vs 167.3 ± 16.6 cells per 1 million events, p=0.0035), as were dendritic cells (408.3 ± 29.1 vs. 229.1 ± 20.5 cells per 1 million events, p<0.0001). CD4 + T cells producing IFN-γ also rose (2845 ± 129 vs 2437 ± 174 cells per 1 million events, p=0.07) in young hypertensive mice. Both normotensive and hypertensive old mice experienced overactive inflammatory responses compared to the young group. Thus, HTN mimics aspects of aging on bone health, causing inflammation in the bone marrow and osteoporosis. Efforts to detect and treat HTN in children may deter untoward events related to bone loss in adulthood.

Perioperative Problems in Infants Having Pulmonary Hypertension Following Ketamine General Anesthesia

Aim: In adolescents, pulmonary arterial hypertension (PAH) is linked through the substantial postoperative danger of serious problems such as pulmonary severe illness and heart attack. The efficacy of ketamine anesthesia inside this patient group is still unknown. Examine the health information about children having PAH in the past to identify the kind and occurrence of peri-procedural issues, as well as whether ketamine medication been connected to peri-procedural difficulties. Methods: Adolescents having PAH who had general anesthesia for operations throughout the one-year interval (May 2020–April 2021) were eligible to participate. Specifics concerning the patient, PAH, surgery, anesthesia, and post-procedural course were recorded, as well as any untoward events that occurred while or inside 48 hours of the operation. Complication rates were reported separately for each surgery. The relationship among ketamine and peri-procedural problems has been investigated. Results: Seventy-five children (median age 8.4 years, average weight 23 kg) had 193 surgeries performed on them. PAH intensity has been classified as mild (26%), medium (37%), or severe (37%). (41 percent). Medical intervention (n = 21), moderate surgery (n = 28), cardiac catheterization (n = 129), and nonsurgical treatments (n = 18) have been performed. During 152 surgeries, ketamine has been given. Thirty mild problems and nine significant problems reported identified. Cardiac arrest occurred in 0.79 percent of cardiac catheterization operations, 11 percent of significant medical procedures, and 2.7 percent of all processes. There has been no death as a result of the surgery. Ketamine administration was not linked to increases in problems. Conclusion: Ketamine looks to be a safe anesthetic alternative for patients. people suffering from PAH We present data on cardiopulmonary resuscitation rates and significant death rates that are higher than that found. Keywords: Pulmonary Arterial Hypertension, Infants, Hypertension, Cardiac Arrest.

Common Accidents in Paediatric Practice; Current Evidence for a 4-Pronged Strategic Framework for Prevention

Accidents are inadvertent untoward events that lead to injuries or diseases. In the healthcare setting, both patients and healthcare workers are at risk of being victims. By virtue of children’s evolving developmental maturity, caring for them puts all parties more at risk. Having a comprehensive framework to prevent accidents in paediatric practice is therefore crucial. This paper aims to utilize the primordial, primary, secondary and tertiary levels of prevention to detail the strategies for preventing needle stick injury, exposure to blood-borne infections, post-injection traumatic neuropathy, post injection abscess, Nicolau syndrome, fluid overload, and drug overdose in paediatric healthcare settings. Preventing the selected injuries and disorders involves a multidisciplinary team of paediatricians, paediatric surgeons, orthopaedic surgeons, burns and plastic surgeons, neurosurgeons, toxicologists, pharmacists, microbiologists, infectious disease physicians, anaesthetists, and public health physicians.