Σφακιανάκης Αλέξανδρος
ΩτοΡινοΛαρυγγολόγος
Αναπαύσεως 5 Άγιος Νικόλαος
Κρήτη 72100
00302841026182
00306932607174
alsfakia@gmail.com

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Δευτέρα 17 Δεκεμβρίου 2018

Panafrican Medical Journal

PAMJ, 3 - 7 Dec 2018

RESEARCH

Menstrual hygiene management practices among primary school girls from a pastoralist community in Kenya: a cross sectional survey
Eleen Korir et al.

Pubescent girls from developing countries are confronted with diverse menstrual hygiene management (MHM) challenges, especially at school. Girls from rural pastoralist communities experience insurmountable MHM barriers. Inadequate coping strategies adopted result in sub-optimal school performance, absenteeism and physical problems.

Outcomes of tunneled internal jugular venous catheters for chronic haemodialysis at the University College Hospital, Ibadan, Nigeria
Yemi Raheem Raji et al. 

Vascular access is an important aspect of haemodialysis treatments and determinant of patient outcomes. Arteriovenous (AV) fistula has been described as the preferred haemodialysis vascular access for patients on chronic dialysis.

IMAGES IN CLINICAL MEDICINE

Une cataracte inhabituelle: régressive à noyau pétaloïde

Ahmed Bennis et al.

Nous rapportons le cas d'une patiente de 38 ans, sans antécédents médico-chirurgicaux, victime d'un traumatisme contusif de l'œil droit par coup de pierre il y a 20 ans, avec baisse de l'acuité visuelle progressive depuis 10 ans.

Formes évolutives postérieures de la persistance de la vascularisation fœtale bilatérale à l'hôpital régional de Gao
Ibrahima Conaré et al. 

La persistance de la vascularisation fœtale (PVF) est une anomalie de la résorption du système vasculaire hyaloïdien. Formes évolutives postérieures bilatérales de la persistance chez un garçon âgé de 2 ans qui a consulté pour une leucocorie de l'œil droit. 

CASE REPORTS

Perforation cæcale néonatale inaugurale du diagnostic d'un mégacôlon congénital

Abdoulaye Diallo Harouna et al.

Les perforations intestinales spontanées sont rares chez un nouveau-né à terme. Nous rapportons le cas d'un nouveau-né issu d'une grossesse de 41 semaines d'aménorrhée, qui avait présenté à trois jours de vie, un pneumopéritoine inaugural d'un mégacôlon congénital.

Corps étranger intra urétral inhabituel chez un adolescent schizophrène: à propos d'un cas

Mustapha Ahsaini et al. 

L'auto insertion d'un corps étranger s'observe généralement chez les patients ayant une psychose chronique dans le but d'automutilation ou érotique. Le diagnostic est parfois difficile s'il est rapporté tardivement ou si le patient est non coopérant, d'où l'intérêt d'un bilan d'imagerie complémentaire.

Indian Journal of Occupational and Environmental Medicine (Indian J Occup Environ Med) 2018 | September-December | Volume 22 | Issue 3

Occupational health surveillance
Damodar Vishnu Lele

Indian Journal of Occupational and Environmental Medicine 2018 22(3):117-120,
Occupational health surveillance
Damodar Vishnu Lele

Indian Journal of Occupational and Environmental Medicine 2018 22(3):117-120



The untold story of fluoridation: Revisiting the changing perspectives
Maitreyee P Unde, Raju Umaji Patil, Persis P Dastoor

Indian Journal of Occupational and Environmental Medicine 2018 22(3):121-127

The discovery of fluoride in dentistry has revolutionized treatment modalities with a new aspect of prevention and conservation of tooth structure coming into foreplay. Since then, there has been a lot of research on both topical and systemic fluoridation in an overzealous attempt to control the most debilitating dental problem of caries. Although topical fluoride is still being widely used as a preventive measure for dental caries, systemic administration of the same has gained major criticism worldwide due to the low margin of safety of fluoride and no control over the amount of individual intake when administered on a community level. This problem is more prevalent in countries with presence of natural fluoride belts that extend from Turkey to China and Japan through Iraq, Iran, and Afghanistan increasing the chances of both dental and skeletal fluorosis and hence increasing the focus toward defluoridation. This historical review highlights the distribution of fluoride worldwide and in India and also discusses about the various claims of the antifluoride lobby. 


Occupational and environmental exposure to lead and reproductive health impairment: An overview
Sunil Kumar

Indian Journal of Occupational and Environmental Medicine 2018 22(3):128-137

Lead is a heavy metal. It is used in lead-acid battery, as a coloring agent, paints, and metal alloyed as shielding materials, smelters, printing press, and so on. It is a toxic metal affecting various organs, and developing fetus and young children are more vulnerable to toxicity of lead. This overview is based on the information of toxic potential of lead to human reproduction and reproductive outcome. Exposure to lead may affect libido, semen quality by declining sperm count, motility, viability, integrity, elevation in morphological abnormalities, and sperm DNA integrity. These alterations led to reducing fertility potential and chances of miscarriages, preterm birth, and so on in a partner. Lead exposure impairs hormonal synthesis and regulations in both sexes. Lead exposure also affects female reproduction by impairing menstruations, reducing fertility potential, delaying conception time, altering the hormonal production, circulation, affecting pregnancy and its outcome, and so on. At present, the safe dose of lead cannot be advocated as more and more data are generated in recent years which indicate the toxic potential of lead to human reproduction at a low level that was previously thought not to have such effect. Hence, use of lead should be stopped/avoided or restricted to safeguard human reproduction. 


Upper extremity muscular strength in push–pull tasks: Model approach towards task design
Joydeep Majumder, Sanjay M Kotadiya, Lokesh Kumar Sharma, Sunil Kumar

Indian Journal of Occupational and Environmental Medicine 2018 22(3):138-143

Background: Pushing and pulling in workplaces are common actions. Repetitive forceful exertions in long-duration works lead to increased risk of musculoskeletal disorders and injuries. Aim: To investigate the upper extremity strength in generic push–pull modes while using hand tools and forecasting the limits of the workers while frequent or continuous operation. Settings and Design: The study was conducted among men workers in Ahmedabad city, India, and the design was cross-sectional study. Materials and Methods: In all, 100 men were recruited (Group 1: 18–39 years and Group 2: 40–60 years). Upper extremity muscular strength (isometric mode) testing of the preferred hand during push–pull type of manual hand-tool operations was carried out for 60 s. Forecasting of strength to generate predictions for future events (120 s) based on known past events (measured 60 s) was carried out using Holt–Winters time-series model. Statistical Analysis: Descriptive statistics was used for analysis. For prediction model evaluation, WEKA 3.8.2 was used. Results: Anthropometric parameters of both groups were similar, having no effect on generated strength. Largely, pull strength was recorded to be higher than push strength, wherein Group 2 men generated slightly higher strength. Seated strength was also higher than standing exertion. Forecasting reveals steady strength values for Group 1 men, whereas steep decline among Group 2 men with increasing duration of trial. Conclusion: The strength data generated would aid in work schedule design. Strength forecasting model would assist in developing engineering guidelines in the design of tools at workplace. 


Effects of occupational heat exposure on traffic police workers in Ahmedabad, Gujarat
Amee Raval, Priya Dutta, Abhiyant Tiwari, PS Ganguly, LM Sathish, Dileep Mavalankar, Jeremy Hess

Indian Journal of Occupational and Environmental Medicine 2018 22(3):144-151

One of the most concerning environmental effects of climate change is rising levels of extreme heat, which already poses serious risks in many parts of the world. In June and July 2015, we collected weekly heat exposure data using area and personal temperature monitoring in Ahmedabad, Gujarat. The study was conducted at four different traffic junctions with a cohort of 16 traffic police. For information on health effects, we administered a baseline survey at the start of the study and prospectively followed up with the officers on prevalence of heat-related symptoms. Wet bulb globe temperature (WBGT) levels ranged from 28.2°C to 36.1°C during the study period. Traffic police workers who participated in this study were exposed to WBGT levels higher than the recommended threshold limit value as per American Conference of Governmental Industrial Hygienists guidelines even beyond the hottest months of the season. Our findings suggest that airport measurements by the Indian Meteorological Department may not accurately capture heat exposures among individuals who work in and alongside high-density traffic junctions. Based on our temperature estimates, traffic police are at risk for heat stress. India is likely to experience warmer temperatures and increased heat waves in the coming decades, fueled by climate change. Therefore, it is important to reduce current and future heat-related risks for traffic police workers and similar occupational risk groups by establishing protection strategies. The protocol established in this study for occupational heat exposure assessment could be applied to a larger cohort. 


The exposure to pollutants of the auto repair workers: Monitoring their oxidative stress
Roberto Menicagli, O Marotta, L Menicagli

Indian Journal of Occupational and Environmental Medicine 2018 22(3):152-155

Background and Aim: Auto repair workers are exposed to multiple pollutants, each of them potentially risks, dangerous for several target organs. The aim of this study is to identify their possible overall effect, by monitoring the concentration of salivary malondialdehyde, index of oxidative stress. Materials and Methods: Malondialdehyde of 25 male workers, smokers and non-smokers, further divided into two subgroups relatively to the amplitude of their working place, was monitored, in the saliva, with the Thiobarbituric acid method. The control group consists of 12 and 13 male smokers, and 13 non-smokers. Univariate (UVA) and Multivariate (MVA) analysis methods were used to analyze the results. Results: No variable is significant (P ≥ 0.05) for the control group using UVA, while age and smoking significantly increase the levels of MDA (P ≤ 0.05) using MVA. For workers group, the age and the place of work increase the MDA (P ≤ 0.05) using UVA analysis, while only the place of work remains significant (≤0.05) using MVA analysis. MVA analysis reveals that, besides the type of work, also the age and smoking significantly increase the level of MDA, as a result of a higher exposure to pollutants. Conclusions: You can check the cumulative effect of pollutants on auto repair workers, by monitoring the salivary malondialdehyde. 


Impact of school air quality on children's respiratory health
Peter Fsadni, Frank Bezzina, Claudia Fsadni, Stephen Montefort

Indian Journal of Occupational and Environmental Medicine 2018 22(3):156-162

Background: Asthma is common in children with indoor pollutants influencing the development of the disease. Since children spend most of their time outside their homes within the school environment, school indoor air quality can directly influence their respiratory health. Aims: This study aims to analyze the indoor and outdoor air quality of Maltese schools and if an association exists between indoor pollutants and respiratory health in children. Settings and Design: Five primary schools were selected with 9- to 11-year-old students participating. Materials and Methods: Standardized health questionnaires and lung function tests were utilized. Indoor and outdoor air sampling together with traffic counts were carried out. Statistical Analysis Used: SPSS version 21 was used and the Chi-squared, logistic regression, and Pearson's correlation were used. Results: The mean indoor PM 2.5 level of 17.78 μg/m3 and CO (9.11 ppm) exceeded World Health Organization thresholds. Indoor ozone levels exceeded the mean European school's indoor ozone concentration of 8 μg/m3. High exposure to formaldehyde, NO2, and ozone was associated with atopy in children. Heavy vehicles passing near the schools were associated with current wheezing (P < 0.001) but not nocturnal cough (P = 0.34). Conclusions: School indoor and outdoor environment has a direct impact on children's respiratory health. This study has identified significant associations between high exposures to indoor air pollutants, school characteristics, and upper and lower airway inflammation. 


Work related musculoskeletal disorders and postural stress of the women cultivators engaged in uprooting job of rice cultivation
Amitava Pal, Prakash C Dhara

Indian Journal of Occupational and Environmental Medicine 2018 22(3):163-169

Aims: A large number of workers including women are involved in the informal sector in India. A majority of them are engaged in agricultural sectors. The agricultural workers have to perform their jobs by putting manual labor and are exposed to different occupational stresses. The present study was aimed to evaluate postural stress and prevalence of musculoskeletal disorder (MSD) of women cultivators engaged in uprooting job of rice cultivation. Settings and Design: This cross-sectional study was conducted on 166 women cultivators from different districts of West Bengal state, India. Materials and Methods: Prevalence and intensity of MSDs of the cultivators were evaluated by Nordic questionnaire and 10-point body part discomfort scale. Work rest pattern and postural pattern were studied by direct observation method. Postural stress was assessed by OVAKO Working Postures Analysis System (OWAS), Rapid Entire Body Assessment (REBA), Rapid Upper Limb Assessment (RULA), and Quick Exposure Checklist (QEC) methods and as well as by measuring center of gravity. Results and Conclusions: MSD was highly prevalent among the study participants. Lower back, hip, wrist, shoulder, and knee were highly affected. Higher prevalence of MSDs among the cultivators may be because of prolonged working hours and awkward postures. The women cultivators had to start their day before dawn to finish off their household chores such as cooking, cleaning, washing clothes and dishes, etc., before they moved off to the fields, which altogether impose them under additional stress. It may be suggested that ergonomic interventions such as modifying work-rest schedules, improving work postures, and introducing new design hand tools should be considered for improving work condition of the women cultivators. 


A comparative study of byssinosis in jute industries
Asim Saha, Anirban Das, Bhaskar Prasad Chattopadhyay, Jane Alam, Tilak Kanti Dasgupta

Indian Journal of Occupational and Environmental Medicine 2018 22(3):170-176

Background: Byssinosis is an acute respiratory difficulty that is caused usually following exposure to cotton and hemp dust. Occurrence of such similar acute symptoms had been reported following exposure to jute dust/fiber also. With passage of time, Jute industries have modernized themselves for increased quality and productivity, which has lessened workforce and thereby provided more working space. However, occupational health benefit due to such changes has rarely been explored. This study was initiated to understand whether this modernization can protect the health of workers. Methodology: This study was carried out in two jute mills manufacturing jute clothes, jute bags, and so on. Interview of the workers for their occupational and morbidity details, medical examinations, as well as pre-shift and post-shift pulmonary function tests was carried out. Results: It was observed that chest tightness was significantly more in the industry with old technologies. Breathlessness was also more in this industry. As far as pulmonary function status is concerned, it was noted that greater than 5% cross-shift change in forced expiratory volume in one second was more common in the industry with old technology. Obstructive feature on lung function test was also observed in workers of both industries. Conclusion: The study concluded that exposure to jute dust has contributed to both acute and chronic respiratory health effects in the jute industry workers. Modernized industry showed lesser prevalence of acute symptoms and changes related to byssinosis. Modernization of processes in jute industries may prove fruitful in lowering the respiratory problems of workers. 


Nipah virus: South India in panic mode
Jasmine Shanthi Kamath, Shruthi Hegde, Vidya Ajila

Indian Journal of Occupational and Environmental Medicine 2018 22(3):177-178






The untold story of fluoridation: Revisiting the changing perspectives
Maitreyee P Unde, Raju Umaji Patil, Persis P Dastoor

Indian Journal of Occupational and Environmental Medicine 2018 22(3):121-127

The discovery of fluoride in dentistry has revolutionized treatment modalities with a new aspect of prevention and conservation of tooth structure coming into foreplay. Since then, there has been a lot of research on both topical and systemic fluoridation in an overzealous attempt to control the most debilitating dental problem of caries. Although topical fluoride is still being widely used as a preventive measure for dental caries, systemic administration of the same has gained major criticism worldwide due to the low margin of safety of fluoride and no control over the amount of individual intake when administered on a community level. This problem is more prevalent in countries with presence of natural fluoride belts that extend from Turkey to China and Japan through Iraq, Iran, and Afghanistan increasing the chances of both dental and skeletal fluorosis and hence increasing the focus toward defluoridation. This historical review highlights the distribution of fluoride worldwide and in India and also discusses about the various claims of the antifluoride lobby. 


Occupational and environmental exposure to lead and reproductive health impairment: An overview
Sunil Kumar

Indian Journal of Occupational and Environmental Medicine 2018 22(3):128-137

Lead is a heavy metal. It is used in lead-acid battery, as a coloring agent, paints, and metal alloyed as shielding materials, smelters, printing press, and so on. It is a toxic metal affecting various organs, and developing fetus and young children are more vulnerable to toxicity of lead. This overview is based on the information of toxic potential of lead to human reproduction and reproductive outcome. Exposure to lead may affect libido, semen quality by declining sperm count, motility, viability, integrity, elevation in morphological abnormalities, and sperm DNA integrity. These alterations led to reducing fertility potential and chances of miscarriages, preterm birth, and so on in a partner. Lead exposure impairs hormonal synthesis and regulations in both sexes. Lead exposure also affects female reproduction by impairing menstruations, reducing fertility potential, delaying conception time, altering the hormonal production, circulation, affecting pregnancy and its outcome, and so on. At present, the safe dose of lead cannot be advocated as more and more data are generated in recent years which indicate the toxic potential of lead to human reproduction at a low level that was previously thought not to have such effect. Hence, use of lead should be stopped/avoided or restricted to safeguard human reproduction. 


Upper extremity muscular strength in push–pull tasks: Model approach towards task design
Joydeep Majumder, Sanjay M Kotadiya, Lokesh Kumar Sharma, Sunil Kumar

Indian Journal of Occupational and Environmental Medicine 2018 22(3):138-143

Background: Pushing and pulling in workplaces are common actions. Repetitive forceful exertions in long-duration works lead to increased risk of musculoskeletal disorders and injuries. Aim: To investigate the upper extremity strength in generic push–pull modes while using hand tools and forecasting the limits of the workers while frequent or continuous operation. Settings and Design: The study was conducted among men workers in Ahmedabad city, India, and the design was cross-sectional study. Materials and Methods: In all, 100 men were recruited (Group 1: 18–39 years and Group 2: 40–60 years). Upper extremity muscular strength (isometric mode) testing of the preferred hand during push–pull type of manual hand-tool operations was carried out for 60 s. Forecasting of strength to generate predictions for future events (120 s) based on known past events (measured 60 s) was carried out using Holt–Winters time-series model. Statistical Analysis: Descriptive statistics was used for analysis. For prediction model evaluation, WEKA 3.8.2 was used. Results: Anthropometric parameters of both groups were similar, having no effect on generated strength. Largely, pull strength was recorded to be higher than push strength, wherein Group 2 men generated slightly higher strength. Seated strength was also higher than standing exertion. Forecasting reveals steady strength values for Group 1 men, whereas steep decline among Group 2 men with increasing duration of trial. Conclusion: The strength data generated would aid in work schedule design. Strength forecasting model would assist in developing engineering guidelines in the design of tools at workplace. 


Effects of occupational heat exposure on traffic police workers in Ahmedabad, Gujarat
Amee Raval, Priya Dutta, Abhiyant Tiwari, PS Ganguly, LM Sathish, Dileep Mavalankar, Jeremy Hess

Indian Journal of Occupational and Environmental Medicine 2018 22(3):144-151

One of the most concerning environmental effects of climate change is rising levels of extreme heat, which already poses serious risks in many parts of the world. In June and July 2015, we collected weekly heat exposure data using area and personal temperature monitoring in Ahmedabad, Gujarat. The study was conducted at four different traffic junctions with a cohort of 16 traffic police. For information on health effects, we administered a baseline survey at the start of the study and prospectively followed up with the officers on prevalence of heat-related symptoms. Wet bulb globe temperature (WBGT) levels ranged from 28.2°C to 36.1°C during the study period. Traffic police workers who participated in this study were exposed to WBGT levels higher than the recommended threshold limit value as per American Conference of Governmental Industrial Hygienists guidelines even beyond the hottest months of the season. Our findings suggest that airport measurements by the Indian Meteorological Department may not accurately capture heat exposures among individuals who work in and alongside high-density traffic junctions. Based on our temperature estimates, traffic police are at risk for heat stress. India is likely to experience warmer temperatures and increased heat waves in the coming decades, fueled by climate change. Therefore, it is important to reduce current and future heat-related risks for traffic police workers and similar occupational risk groups by establishing protection strategies. The protocol established in this study for occupational heat exposure assessment could be applied to a larger cohort. 


The exposure to pollutants of the auto repair workers: Monitoring their oxidative stress
Roberto Menicagli, O Marotta, L Menicagli

Indian Journal of Occupational and Environmental Medicine 2018 22(3):152-155

Background and Aim: Auto repair workers are exposed to multiple pollutants, each of them potentially risks, dangerous for several target organs. The aim of this study is to identify their possible overall effect, by monitoring the concentration of salivary malondialdehyde, index of oxidative stress. Materials and Methods: Malondialdehyde of 25 male workers, smokers and non-smokers, further divided into two subgroups relatively to the amplitude of their working place, was monitored, in the saliva, with the Thiobarbituric acid method. The control group consists of 12 and 13 male smokers, and 13 non-smokers. Univariate (UVA) and Multivariate (MVA) analysis methods were used to analyze the results. Results: No variable is significant (P ≥ 0.05) for the control group using UVA, while age and smoking significantly increase the levels of MDA (P ≤ 0.05) using MVA. For workers group, the age and the place of work increase the MDA (P ≤ 0.05) using UVA analysis, while only the place of work remains significant (≤0.05) using MVA analysis. MVA analysis reveals that, besides the type of work, also the age and smoking significantly increase the level of MDA, as a result of a higher exposure to pollutants. Conclusions: You can check the cumulative effect of pollutants on auto repair workers, by monitoring the salivary malondialdehyde. 


Impact of school air quality on children's respiratory health
Peter Fsadni, Frank Bezzina, Claudia Fsadni, Stephen Montefort

Indian Journal of Occupational and Environmental Medicine 2018 22(3):156-162

Background: Asthma is common in children with indoor pollutants influencing the development of the disease. Since children spend most of their time outside their homes within the school environment, school indoor air quality can directly influence their respiratory health. Aims: This study aims to analyze the indoor and outdoor air quality of Maltese schools and if an association exists between indoor pollutants and respiratory health in children. Settings and Design: Five primary schools were selected with 9- to 11-year-old students participating. Materials and Methods: Standardized health questionnaires and lung function tests were utilized. Indoor and outdoor air sampling together with traffic counts were carried out. Statistical Analysis Used: SPSS version 21 was used and the Chi-squared, logistic regression, and Pearson's correlation were used. Results: The mean indoor PM 2.5 level of 17.78 μg/m3 and CO (9.11 ppm) exceeded World Health Organization thresholds. Indoor ozone levels exceeded the mean European school's indoor ozone concentration of 8 μg/m3. High exposure to formaldehyde, NO2, and ozone was associated with atopy in children. Heavy vehicles passing near the schools were associated with current wheezing (P < 0.001) but not nocturnal cough (P = 0.34). Conclusions: School indoor and outdoor environment has a direct impact on children's respiratory health. This study has identified significant associations between high exposures to indoor air pollutants, school characteristics, and upper and lower airway inflammation. 


Work related musculoskeletal disorders and postural stress of the women cultivators engaged in uprooting job of rice cultivation
Amitava Pal, Prakash C Dhara

Indian Journal of Occupational and Environmental Medicine 2018 22(3):163-169

Aims: A large number of workers including women are involved in the informal sector in India. A majority of them are engaged in agricultural sectors. The agricultural workers have to perform their jobs by putting manual labor and are exposed to different occupational stresses. The present study was aimed to evaluate postural stress and prevalence of musculoskeletal disorder (MSD) of women cultivators engaged in uprooting job of rice cultivation. Settings and Design: This cross-sectional study was conducted on 166 women cultivators from different districts of West Bengal state, India. Materials and Methods: Prevalence and intensity of MSDs of the cultivators were evaluated by Nordic questionnaire and 10-point body part discomfort scale. Work rest pattern and postural pattern were studied by direct observation method. Postural stress was assessed by OVAKO Working Postures Analysis System (OWAS), Rapid Entire Body Assessment (REBA), Rapid Upper Limb Assessment (RULA), and Quick Exposure Checklist (QEC) methods and as well as by measuring center of gravity. Results and Conclusions: MSD was highly prevalent among the study participants. Lower back, hip, wrist, shoulder, and knee were highly affected. Higher prevalence of MSDs among the cultivators may be because of prolonged working hours and awkward postures. The women cultivators had to start their day before dawn to finish off their household chores such as cooking, cleaning, washing clothes and dishes, etc., before they moved off to the fields, which altogether impose them under additional stress. It may be suggested that ergonomic interventions such as modifying work-rest schedules, improving work postures, and introducing new design hand tools should be considered for improving work condition of the women cultivators. 


A comparative study of byssinosis in jute industries
Asim Saha, Anirban Das, Bhaskar Prasad Chattopadhyay, Jane Alam, Tilak Kanti Dasgupta

Indian Journal of Occupational and Environmental Medicine 2018 22(3):170-176

Background: Byssinosis is an acute respiratory difficulty that is caused usually following exposure to cotton and hemp dust. Occurrence of such similar acute symptoms had been reported following exposure to jute dust/fiber also. With passage of time, Jute industries have modernized themselves for increased quality and productivity, which has lessened workforce and thereby provided more working space. However, occupational health benefit due to such changes has rarely been explored. This study was initiated to understand whether this modernization can protect the health of workers. Methodology: This study was carried out in two jute mills manufacturing jute clothes, jute bags, and so on. Interview of the workers for their occupational and morbidity details, medical examinations, as well as pre-shift and post-shift pulmonary function tests was carried out. Results: It was observed that chest tightness was significantly more in the industry with old technologies. Breathlessness was also more in this industry. As far as pulmonary function status is concerned, it was noted that greater than 5% cross-shift change in forced expiratory volume in one second was more common in the industry with old technology. Obstructive feature on lung function test was also observed in workers of both industries. Conclusion: The study concluded that exposure to jute dust has contributed to both acute and chronic respiratory health effects in the jute industry workers. Modernized industry showed lesser prevalence of acute symptoms and changes related to byssinosis. Modernization of processes in jute industries may prove fruitful in lowering the respiratory problems of workers. 


Nipah virus: South India in panic mode
Jasmine Shanthi Kamath, Shruthi Hegde, Vidya Ajila

Indian Journal of Occupational and Environmental Medicine 2018 22(3):177-178



Prescribing Therapy for Hypothyroidism: Influence of Physician Characteristics

Thyroid, Ahead of Print.


https://ift.tt/2GC87Sb

Iodine Status of Pregnant Women and Women of Reproductive Age in the United States

Thyroid, Ahead of Print.


https://ift.tt/2R2joiv

A New Highly Thyrotropin Receptor-Selective Small-Molecule Antagonist with Potential for the Treatment of Graves' Orbitopathy

Thyroid, Ahead of Print.


https://ift.tt/2GmFXu4

An increase of estrogen receptor α protein level regulates BDE-209-mediated blood-testis barrier disruption during spermatogenesis in F1 mice

Abstract

Deca-bromodiphenyl ether (BDE-209) regulates various aspects of spermatogenesis and male fertility through its effect on estrogen receptor α (ERα), but the underlying mechanism remains unclear. Because molecular mechanisms such as remodeling of the blood-testis barrier (BTB) play crucial roles in spermatogenesis, we investigated the disruptive effects of ERα agonists on the BTB in spermatogenesis. In this study, 0, 300, and 500 mg/kg/day of BDE-209 were administered to pregnant adult mice by oral gavage from gestation day 7 to postnatal day 21. SerW3 cells were treated with methylpiperidino pyrazole (MPP) for 30 min before being treated with 50 μg/mL of BDE-209. BDE-209 increases ERα in time- and dose-dependent manners and decreases formin 1 and BTB-associated protein in F1 male mice. Furthermore, BDE-209 impairs the structure and function of the BTB. Activation of ERα signaling could disrupt the BTB, leading to spermatogenesis dysfunction. The results identified the role of ERα in BTB disruption during spermatogenesis and suggested that BTB disruption occurs because of exposure to BDE-209, which could potentially affect spermatogenesis. In conclusion, Sertoli cells seem to be the primary target of BDE-209 in the perinatal period, and this period constitutes a critical window of susceptibility to BDE-209. Also, the SerW3 cell model may not be a particularly useful cell model for studying the function of the cytoskeleton.



https://ift.tt/2A2GHyS

Stabilization and cyclic utilization of chrome leather shavings

Abstract

For the sake of the safe and efficient cyclic utilization of chrome leather shavings (CLS), the temporary stabilization of CLS during the storage and transport processes was optimized. Afterwards, the large-scale stabilized CLS degradation and collagen degradation product (CDP) extraction were completed. In this research, hydroxyapatite (HAP) and calcium hydroxide (Ca(OH)2) were for the first time used as stabilizers in the stabilization of CLS. The results showed that both Ca(OH)2 and HAP displayed resistance to chrome leaching, but HAP provided better stabilization effect than Ca(OH)2. The optimized stabilization conditions giving lower chromium leaching concentration were selected: 2% HAP, temperature 300 °C, reaction time 60 min, and initially added water contents of 50%. The reason for HAP and Ca(OH)2 stabilization was proved by energy dispersive X-ray spectroscopy (EDS). Subsequently, the exploitation value of the stabilized CLS was described by large-scale experiment. The hydrolysis of stabilized CLS could obtain the collagen degradation product (CDP), which had 3.52% of free amino content and a molecular weight of 3.4~30 kDa. The filter residue was treated by 5% sulfuric acid solution extraction and pressure filtration again. The extraction solution and final filter residue were dried separately to obtain chromium-containing organic compounds (COP) and industrial gypsum. The COP, used as a filling for tannery, contains 9.37% Cr2O3 content and 90.6% organic content. The industrial gypsum contains 68.37% CaSO4, 0.13% Cr2O3, and 31.5% residual organic or inorganic compounds, which can be used in building materials. No waste water or solid waste was discharged in this experiment process.



https://ift.tt/2S2JZsN

Kinetic, equilibrium, and thermodynamic studies on the adsorption of ciprofloxacin by activated carbon produced from Jerivá ( Syagrus romanzoffiana )

Abstract

High specific surface area activated carbon prepared from endocarp of Jerivá (Syagrus romanzoffiana) (ACJ) was used for ciprofloxacin (CIP) antibiotic removal from aqueous effluents. The activated carbon (AC) was characterized via scanning electron microscope, Fourier transform infrared spectroscopy, N2 adsorption/desorption, and pH value at the zero-charge point. Avrami kinetic model was the one that best fit the experimental results in comparison to the pseudo-first-order and pseudo-second-order kinetic models. The equilibrium data obeyed the Liu isotherm equation, showing a maximum adsorption capacity of 335.8 mg g−1 at 40 °C. The calculated thermodynamic parameters indicate that the adsorption of CIP was spontaneous and endothermic at all studied temperatures. Also, the free enthalpy changes (∆H° = 3.34 kJ mol−1) suggested physical adsorption between CIP and ACJ. Simulated effluents were utilized to check the potential of the ACJ for wastewater purification. The highly efficient features enable the activated carbon prepared from endocarp of Jerivá, an attractive carbon adsorbent, to remove ciprofloxacin from wastewaters.



https://ift.tt/2A5oPDI

Differential expression of immune markers in the patients with obstructive sleep apnea/hypopnea syndrome

Abstract

Purpose

To evaluate phenotypic changes of various immune cells in the peripheral blood in the patients with sleep apnea/hypopnea syndrome (OSAHS).

Methods

This is a case–control study. The peripheral venous blood was collected. A subset of T cells, B cells, natural killer cells, and dendritic cells was analysed using various markers and flow cytometry. Regression curve analysis was made to examine the correlation between the change of immune cells and aponea hypoxia index (AHI) and oxygen desaturation.

Results

The percentage of CD3+/CD4+ T lymphocytes (P < 0.001) and CD19+ B cells (P < 0.001) and the CD4+/CD8+ ratio (P < 0.001) in the OSAHS patients were significantly increased compared with those in the control group without OSAHS, and CD4+/CD8+ ratio positively correlated with aponea hypoxia index (r = 0.37, P < 0.001) but negatively correlated with the lowest SaO2 (r = − 0.2, P < 0.001), whereas a greater reduction in the percentage of CD3+/CD8+ T cells (P < 0.001). Moreover, the ratios of CD3+/CD16+/CD56+ natural killer (NK)-like T cells (P < 0.05) and CD3/CD16+/CD56+ NKT cells (P < 0.001) were significantly lower in the OSAHS group than those in the control group. However, no significant difference was observed in the percentage of CD3+ total T cells, CD8+/CD28+ T cells, CD8+/CD28 T cells, DC1, DC2, and DC1/DC2 dendritic cells between the OSAHS and control groups.

Conclusion

Our study showed differential responses of various types of immune cells in the peripheral blood in patients with OSAHS and their correlation with severity of oxygen desaturation.



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Exclusively plant, whole-food diet for polypharmacy due to persistent atrial fibrillation, ischaemic cardiomyopathy, hyperlipidaemia and hypertension in an octogenarian

Polypharmacy is common and associated with negative health outcomes in the elderly. We report the case of an 82-year-old man with a history of polypharmacy due to coronary artery disease, myocardial infarction, ischaemic cardiomyopathy, hyperlipidaemia, hypertension and persistent atrial fibrillation who presented with memory loss, cognitive impairment, fatigue and weakness. His treatment plan included an exclusively plant, whole-food diet and moderate physical activity which resulted in a rapid reduction of hyperlipidaemia and high blood pressure and the discontinuation of statin, antihypertensive and beta blocker drug therapy. The patient also reported reversal of impaired cognition and symptoms associated with atrial fibrillation and ischaemic cardiomyopathy, including light-headedness, fatigue and weakness. This case demonstrates that dietary and lifestyle modifications have the potential to improve symptoms of cardiovascular disease and reduce polypharmacy along with associated negative consequences in the elderly.



https://ift.tt/2QFRPfB

Citrobacter freundii sepsis in an immunosuppressed patient with pemphigus vulgaris

Pemphigus vulgaris is an autoimmune bullous disease that involves the skin and mucous membranes. Current therapies aim to decrease antibody production by means of the use of systemic corticosteroids, immunosuppressive agents and, recently, rituximab, an anti-CD20 monoclonal antibody. However, the chronic immune suppression could entail complications, like infections and secondary malignancies. We describe a case of a patient with pemphigus who developed a sepsis due to Citrobacter freundii infection.



https://ift.tt/2BtUkXE

Rare complication of central venous catheter placement: bilateral hydrothorax

Central venous catheters (CVCs) are very useful tools in clinical medicine. It is important not only for the administration of medications or fluids but also the measurement of haemodynamic variables, especially in intensive care patients. CVC placement is a relatively safe procedure but may occasionally be associated with complications, such as pneumothorax, haemothorax, cardiac tamponade, sepsis and thrombosis. We aim to report an extraordinary case of bilateral hydrothorax due to CVC placement.



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Levator palpebrae superioris nuclear palsy in a child with artery of Percheron infarction



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Fungal endocarditis of native valves



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Diffuse large B cell lymphoma: cutaneous presentation



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Misconceptions surrounding pregnancy-associated breast cancer

This case report describes a 31-year-old woman who presented with a right painless breast lump. A mammogram and ultrasound scan showed the lump was suspicious of cancer. Core biopsy and immunohistochemistry of the lump confirmed a triple negative, poorly differentiated, invasive ductal carcinoma of the right breast. One week following her diagnosis, the patient found out she was pregnant. The patient was worried about what the implications this diagnosis would have on both her baby and her own cancer treatment.



https://ift.tt/2QFRzgD

Tilting the balance: hemidiaphragm paralysis leading to right to left cardiac shunt

Patent foramen ovale (PFO) is a congenital abnormality present in 25%–30% of healthy adults and rarely leads to any sequelae.1 2 It is associated with a left-to-right shunt which usually does not lead to any haemodynamic compromise. Occasionally, the shunt can get reversed; that is, right-to-left shunt occurs due to worsening pulmonary hypertension and can lead to persistent hypoxia. It is rare for the shunt reversal to happen in the absence of pulmonary hypertension. Here, we present an exceedingly rare case in a 61-year-old man presenting with hypoxia, was found to have shunt reversal due to unilateral diaphragmatic paralysis. He was successfully treated with PFO closure. The purpose of this report is to consider rare possibilities of PFO shunt reversal when the right-sided heart pressure is normal and to highlight that a simple chest X-ray can be a clue to the diagnosis.



https://ift.tt/2BpT34b

A review of studies on urban energy performance evaluation

Abstract

Energy is a foundation for a city to create economic wealth, satisfy people's desires, and achieve benefits. However, the increasing mismatch between energy supply and demand and the worsening of environmental pollution have highlighted the importance of improving urban energy performance, so the number of studies related to urban energy performance evaluation is increasing. Based on describing the authors, numbers, regional sources, and themes of these studies, this paper reviews and analyzes the conceptions, evaluation indicators, influencing factors, evaluation methods, and evaluation systems related to urban energy performance. Most countries have expressed concern about this topic. Researchers in China, Belgium, and the USA have had the most achievements and collaborations. The concept of urban energy performance further extends to a comprehensive performance. It is measured based on an input-output process. In addition to the original evaluation indicators, new desirable outputs and undesirable outputs are included. Industrial structure, energy price, population density, home car ownership, climate factors, Gini coefficient, health expenditure level, and unemployment rate are regarded as influencing factors. Therefore, a new framework of evaluation indicators and influencing factors is constructed. Stochastic frontier analysis (SFA) and data envelopment analysis (DEA) are commonly used to evaluate. With changes in conceptions, evaluation indicators, and influencing factors, the evaluation method should rather focus on measuring multiple input-output variables, determining the evaluation results and the impacts of factors at the same analysis stage, and highlighting policy orientations. As an important management tool, the evaluation system would continue to be studied and developed.



https://ift.tt/2S5HYfF

Influence of electronic cigarette vaping on the composition of indoor organic pollutants, particles, and exhaled breath of bystanders

Abstract

The changes of particles and organic pollutants in indoor atmospheres as consequence of vaping with electronic cigarettes have been analyzed. Changes in the composition of volatile organic compounds (VOCs) in exhaled breath of non-smoking volunteers present in the vaping environments have also been studied. The exposure experiments involved non-vaping (n = 5) and vaping (n = 5) volunteers staying 12 h together in a room (54 m2) without external ventilation. The same experiment was repeated without vaping for comparison. Changes in the distributions of particles in the 8–400 nm range were observed, involving losses of nucleation-mode particles (below 20 nm) and increases of coagulation processes leading to larger size particles. In quantitative terms, vaping involved doubling the indoor concentrations of particles smaller than 10 μm, 5 μm, and 1 μm observed during no vaping. The increase of particle mass concentrations was probably produced from bulk ingredients of the e-liquid exhaled by the e-cigarette users. Black carbon concentrations in the indoor and outdoor air were similar in the presence and absence of electronic cigarette emissions. Changes in the qualitative composition of PAHs were observed when comparing vaping and non-vaping days. The nicotine concentrations were examined separately in the gas and in the particulate phases showing that most of the differences between both days were recorded in the former. The particulate phase should therefore be included in nicotine monitoring during vaping (and smoking). The concentration increases of nicotine and formaldehyde were small when compared with those described in other studies of indoor atmospheres or health regulatory thresholds. No significant changes were observed when comparing the concentrations of exhaled breath in vaping and no vaping days. Even the exhaled breath nicotine concentrations in both conditions were similar. As expected, toluene, xylenes, benzene, ethylbenzene, and naphthalene did not show increases in the vaping days since combustion was not involved.



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Genotype‐phenotype correlations in Brazilian patients with Hereditary Angioedema due to C1‐ inhibitor deficiency



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Table of contents



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Masthead



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“Five‐point eight‐line” anatomic flap design for precise hemitongue reconstruction

Abstract

Background

Reconstruction of hemiglossectomy defects requires careful flap design to avoid adverse functional and aesthetic outcomes.

Methods

Hemitongue specimens were obtained from minipigs to study the three‐dimensional anatomy and to define anatomic landmarks for precise measurements of flap requirement. The concept developed in animal models was then applied to hemiglossectomy reconstruction in clinical practice. Sixty‐one patients were randomly enrolled into the following two groups: a "five‐point eight‐line segment" (FIPELS) flap design group (28 patients) and a conventional group (33 patients). Functional and aesthetic outcomes were compared between the two groups.

Results

All flaps designed with the FIPELS technique matched the hemiglossectomy defects without the need for flap trimming, thus reducing the operating time (P = .03). Swallowing functions, speech intelligibility, and aesthetic outcomes were superior in the FIPELS group than that in the conventional group (P < .05).

Conclusions

The FIPELS flap design for hemiglossectomy reconstruction yields improved functional and aesthetic outcomes compared to a conventional flap design.



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Apatinib for Advanced Osteosarcoma after Failure of Standard Multimodal Therapy: An Open Label Phase II Clinical Trial

AbstractBackground.Antiangiogenesis tyrosine kinase inhibitors (TKIs) have been shown to prolong progression‐free survival (PFS) in advanced osteosarcoma. Methylsulfonic apatinib is a TKI that specifically inhibits vascular endothelial growth factor receptor‐2. We aim to assess apatinib in patients with advanced high‐grade osteosarcoma progressing upon chemotherapy.Materials and Methods.This phase II trial was conducted at Peking University People's Hospital. We enrolled participants (≥16 years of age) with progressive relapsed or unresectable osteosarcoma. Participants received 750 mg or 500 mg of apatinib according to body surface area once daily until disease progression or unacceptable toxicity. The primary endpoint was objective response rate and PFS at 4 months.Results.A total of 37 participants were finally included into the analysis. Until final follow‐up, the objective response rate (complete response + partial response) was 43.24% (16/37). The 4‐month PFS rate was 56.76% (95% confidence interval [CI], 39.43%–70.84%). Median PFS and overall survival were 4.50 (95% CI, 3.47–6.27) and 9.87 (95% CI 7.97–18.93) months, respectively. Toxic effects led to dose reductions or interruptions in a total of 25 of 37 (67.57%) patients. The most common grade 3–4 adverse events were pneumothorax in six (16.22%) patients, wound dehiscence in four (10.81%), proteinuria in three (8.11%), diarrhea in three (8.11%), and palmar‐plantar erythrodysesthesia syndrome in three (8.11%). No other serious adverse events were reported during the trial. There were no treatment‐related deaths.Conclusion.Apatinib is a sensitive drug for advanced osteosarcoma with a high response rate after failure of chemotherapy, with similar duration of response compared to other TKIs.Implications for Practice.For advanced osteosarcoma progressing upon chemotherapy, antiangiogenesis tyrosine kinase inhibitors (TKIs) have been proved to be effective in prolonging the progression‐free survival in previous multicenter trials and have been included into new National Comprehensive Cancer Network guidelines as second‐line therapy. Apatinib is a TKI that specifically inhibits vascular endothelial growth factor receptor‐2, which is domestically made in China. This phase II trial supports the use of apatinib in patients with advanced osteosarcoma progressing after chemotherapy.

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Neoadjuvant FOLFIRINOX for Patients with Borderline Resectable or Locally Advanced Pancreatic Cancer: Results of a Decision Analysis

AbstractBackground.The effectiveness and cost‐effectiveness of using neoadjuvant FOLFIRINOX (nFOLFIRINOX) for patients with borderline resectable or locally advanced pancreatic ductal adenocarcinoma (BR/LA PDAC) are unknown. Our objective was to determine whether nFOLFIRINOX is more effective or cost‐effective for patients with BR/LA PDAC compared with upfront resection surgery and adjuvant gemcitabine plus capecitabine (GEM/CAPE) or gemcitabine monotherapy (GEM).Materials and Methods.We performed a decision‐analysis to assess the value of nFOLFIRINOX versus GEM/CAPE or GEM using a mathematical simulation model. Model transition probabilities were estimated using published and institutional clinical data. Model outcomes included overall and disease‐free survival, quality‐adjusted life‐years (QALYs), cost in U.S. dollars, and cost‐effectiveness expressed as an incremental cost‐effectiveness ratio. Deterministic and probabilistic sensitivity analyses explored the uncertainty of model assumptions.Results.Model results found median overall survival (34.5/28.0/22.0 months) and disease‐free survival (15.0/14.0/13.0 months) were better for nFOLFIRINOX compared with GEM/CAPE and GEM. nFOLFIRINOX was the optimal strategy on an efficiency frontier, resulting in an additional 0.35 life‐years, or 0.30 QALYs, at a cost of $46,200/QALY gained compared with GEM/CAPE. Sensitivity analysis found that cancer recurrence and complete resection rates most affected model results, but were otherwise robust. Probabilistic sensitivity analyses found that nFOLFIRINOX was cost‐effective 92.4% of the time at a willingness‐to‐pay threshold of $100,000/QALY.Conclusion.Our modeling analysis suggests that nFOLFIRINOX is preferable to upfront surgery for patients with BR/LA PDAC from both an effectiveness and cost‐effectiveness standpoint. Additional clinical data that further define the long‐term effectiveness of nFOLFIRINOX are needed to confirm our results.Implications for Practice.Increasingly, neoadjuvant FOLFIRINOX has been used for borderline resectable and locally advanced pancreatic cancer with the goal of rendering them resectable and decreasing risk of recurrence. Despite many efforts to show the benefits of neoadjuvant over adjuvant therapies, clinical evidence to guide this decision is largely lacking. Decision‐analytic modeling can provide a methodologic platform that integrates the best available data to quantitatively explore clinical decisions by simulating a hypothetical clinical trial. This modeling analysis suggests that neoadjuvant FOLFIRINOX is preferable to upfront surgery and adjuvant therapies by various outcome metrics including quality‐adjusted life years, overall survival, and incremental cost‐effectiveness ratio.

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Clinical Thyroidology® for the Public – Highlighted Article

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From Clinical Thyroidology® for the Public: Higher iodine intake in the mother during pregnancy is associated with higher child IQ. Read More…

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The post Clinical Thyroidology<sup>®</sup> for the Public – Highlighted Article appeared first on American Thyroid Association.



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Clinical Thyroidology® for the Public – Highlighted Article

CTFP-200.png

From Clinical Thyroidology® for the Public: Higher iodine intake in the mother during pregnancy is associated with higher child IQ. Read More…

We welcome your feedback and suggestions. Let us know what you want to see in this publication.

Feedback & Suggestions

The post Clinical Thyroidology<sup>®</sup> for the Public – Highlighted Article appeared first on American Thyroid Association.



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Late onset obesity in mice with targeted deletion of potassium inward rectifier Kir7.1 from cells expressing the melanocortin‐4 receptor

Abstract

Energy stores in fat tissue are determined in part by the activity of hypothalamic neurons expressing the melanocortin‐4 receptor (MC4R). Even partial reduction in MC4R expression levels in mice, rats, or humans produces hyperphagia and morbid obesity. Thus, it is of great interest to understand the molecular basis of neuromodulation by the MC4R. The MC4R is a G protein‐coupled receptor that signals efficiently through GαS, and this signaling pathway is essential for normal MC4R function in vivo. However, previous data from hypothalamic slice preparations indicated that activation of the MC4R depolarized neurons through G protein‐independent regulation of the ion channel Kir7.1. We showed here that deletion of Kcnj13, the gene encoding Kir7.1, specifically from MC4R neurons produced resistance to melanocortin peptide‐induced depolarization of MC4R PVN neurons in brain slices, resistance to the sustained anorexic effect of exogenously administered melanocortin peptides, late onset obesity, increased linear growth, and glucose intolerance. Some MC4R‐mediated phenotypes appeared intact, including AgRP‐induced stimulation of food intake, and MC4R‐mediated induction of PYY release from intestinal L cells. Thus, a subset of the consequences of MC4R signaling in vivo appear dependent on expression of the Kir7.1 channel in MC4R cells.

This article is protected by copyright. All rights reserved.



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Peripheral Insulin Extraction in Non-Diabetic Subjects and Type 2 Diabetes Mellitus Patients

08-2018-0330-dia_10-1055-a-0808-4029-1.j

Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-0808-4029

Background Insulin has to be transported across the capillary endothelium to stimulate muscle glucose uptake. We investigated insulin uptake from the peripheral circulation in non-diabetic (ND) individuals and in type 2 diabetes (T2D) patients. Methods Single-center cross-sectional study involving 40 ND (age 65±11 years) and 30 T2D patients (age 67±8 years). Thirty-six participants were studied in the fasted state (22 ND subjects and 14 T2D patients termed NDF and T2DF) and 34 participants 1-h following a glucose challenge (18 ND subjects and 16 T2D patients indicated as NDG and T2DG). Main outcome measure was fractional extraction (FE) of insulin and glucose using the forearm balance method. Results In NDF, FEins was 18 (10–26)% at lower insulin levels (63 51–80] pmol/l), while in NDG at higher insulin levels (776 [543–1176] pmol/l), FEins was 9 (4–16)% (p=0.01 vs. NDF). In NDF only, a negative correlation was observed between FEins and arterial plasma insulin load (rho=−0.575;p=0.006) and fasting plasma glucose levels (rho=−0.551;p=0.01). In T2DF FEins was 6 (1–19)% and not different from FEins in T2DG (10 2–14)%), and was not associated to fasting glucose. FEins tended to be higher in NDF compared to T2DF (p=0.07). Discussion We propose that in non-diabetic individuals, besides passive diffusion, an active high-affinity pathway with limited capacity around lower physiologic insulin levels exists for insulin transendothelial transport, contributing to glycemic control. In T2D patients, this mechanism of peripheral insulin uptake is diminished or even absent. Modulation of insulin extraction from the circulation may be a novel target to improve glucose metabolism in T2D.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Adherence to Therapeutic Footwear in Type 2 Diabetes in Malta

09-2018-0378-dia_10-1055-a-0808-4111-1.j

Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-0808-4111

Background The literature reports that people living with diabetes do not adhere to their prescribed therapeutic footwear as instructed. The reason for this is still uncertian although certain footwear characteristics seem to reasons reported leading to reduced level of adherence. Objectives To explore the reasons for current adherence or otherwise to prescribed stock footwear amongst patients living with type-2 diabetes. Methods An exploratory qualitative design method using an Interpretative Phenomenological Analysis [IPA] was employed in this research. Employing purposive sampling, twelve participants were recruited and interviewed. Interviews were recorded, transcribed and later analysed. Results Common themes that emerged from this study fell under 2 main categories including 'Adherence' and 'Non – Adherence' to wearing the prescribed stock footwear. A number of themes were identified with regards to the reasons for such adherence or otherwise by respective participants including footwear characteristics, service provision, peer pressure and the patient's knowledge and attitudes. Conclusion This study demonstrated suboptimal adherence to wearing therapeutic footwear among people with type 2 diabetes. Although the literature highlights the importance of adherence to therapeutic footwear in high risk populations for the prevention of diabetic foot complications, this study provides the reasons as to why patients still do not comply in wearing their prescribed therapeutic footwear. In order to improve behavioral changes patients would require on-going care, empowerment and support combined with educational programs to achieve a higher level of adherence. More research is warranted to explore further psychosocial interventions in diabetes care.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Comparison of Polypropylene and Bioabsorbable Mesh for Abdominal Wall Reinforcement following Microsurgical Breast Reconstruction

10-1055-s-0038-1676470_180170-1.jpg

J reconstr Microsurg
DOI: 10.1055/s-0038-1676470

Background Abdominal wall morbidity following microvascular breast reconstruction continues to be an area of interest due to both functional and aesthetic concerns. Donor-site closure technique has been shown to affect bulge and hernia rates and ranges from primary closure to various uses of mesh. Few studies to date have compared types of mesh. The present study compares BARD polypropylene to bioabsorbable GORE Bio-A (polyglycolic acid/trimethylene carbonate) mesh used as a fascial underlay with primary fascial closure. Methods A retrospective review of all consecutive deep inferior epigastric artery-based microvascular breast reconstructions, including perforator and muscle-sparing flaps, performed between September 2014 and February 2017 was performed. All patients underwent primary fascial closure with mesh underlay. Risk factors for the formation of an abdominal bulge or hernia were identified by multivariate logistic regression. Results Eighty-seven patients, with 123 abdominal donor sites, were included. Heavy-weight polypropylene mesh was used for 58 donor sites, while polyglycolic acid/trimethylene carbonate mesh was used in 65 donor sites. The overall incidence of bulge or hernia was 11.4%. The bioabsorbable cohort experienced significantly more bulges/hernias than the polypropylene mesh cohort (20% vs. 1.7% by donor site). Time to diagnosis of bulge was longer for the bioabsorbable group (219 ± 107 vs. 69 days). Flap type and perforator row were not associated with bulge/hernia. The polyglycolic acid/trimethylene carbonate mesh was associated with a 13.3-fold risk of bulge/hernia (p = 0.016). Conclusions Polyglycolic acid/trimethylene carbonate mesh is not appropriate for anterior rectus fascia reinforcement following abdominal tissue transfer.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Tissue Oximetry Monitoring for Free Deep Inferior Epigastric Perforator Flap Viability: Factors to be Considered toward Optimizing Postoperative Outcome

10-1055-s-0038-1676605_180274-1.jpg

J reconstr Microsurg
DOI: 10.1055/s-0038-1676605



Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Tissue Oximetry for Monitoring Free DIEP Flap Viability: Factors to Consider towards Optimizing Postoperative Outcome

10-1055-s-0038-1676493_180221-1.jpg

J reconstr Microsurg
DOI: 10.1055/s-0038-1676493



Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Flow-Through Flaps in the Absence of an Arterial Gap for Extremity Defect Reconstruction: Minimizing the Donor-Site Morbidity

10-1055-s-0038-1676497_180193-1.jpg

J reconstr Microsurg
DOI: 10.1055/s-0038-1676497

Background The use of flow-through flaps was popularized in the early 1990s by Costa, Soutar and Lamberty in cases where an arterial gap was present or a major artery of the limb was damaged. We hypothesized that flow-through flaps can be used in all extremity reconstruction cases, where there is an indication for a free-flap, irrespective of the existence of arterial defect due to its many advantages while not increasing the flap loss significantly. Methods A retrospective study was performed by examining patient status and surgery reports of all patients who underwent extremity reconstruction with a flow-through flap from January 2011 to January 2016. This procedure was applied to all the patients, irrespective of the presence of an arterial gap. Results Forty-seven patients were included. The most frequently used flaps were the anterolateral thigh flap and the latissimus dorsi flap. Reconstructions were either posttraumatic or after oncological resection. Two cases of flap loss were encountered. The mean total operating time was 480 ± 153 minutes. The mean follow-up was 10 ± 3 months. There were no donor-site wound complications. Conclusions Based on our results, the flow-through flap technique can be considered a safe alternative to the end-to-side technique for complex extremity defect reconstruction irrespective of the vascular status. The additional arterial anastomosis, even in the absence of an arterial gap or a vascular compromised extremity, did not increase the complication rate in the hands of experienced microsurgeons.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Is Early Compression Therapy after Perforator Flap Safe and Reliable?

10-1055-s-0038-1676604_180224-1.jpg

J reconstr Microsurg
DOI: 10.1055/s-0038-1676604

Background Due to the concern of circulation compromise, many surgeons hesitate to dangle or challenge the flap in the early postoperative phase. In our experience, early compression may have advantages such as collapse of dead space, evacuation of hematoma, reduction of edema, and stabilization of flap when ambulating. In this study, the effect of early compression of flaps with regard to flap physiology and outcome is evaluated. Methods From postoperative day 3 to 5, a custom-made compression garment was fitted aiming to compress with a pressure of 30 to 35 mmHg. A total of 52 patients (52 flaps) were enrolled for the study and 48 flaps underwent early compression. The compression was applied not only over the flap but also over the extremity or trunk. The flap outcome as well as flow velocity and flow volume of the pedicle before and after compression was measured and evaluated. Results There was no flap complication during the early compression and early ambulation. And, there was no statistical difference either in the flow velocity or in the volume before and after the compression therapy (29.21 vs. 29.42 cm/s and 7.13 vs. 6.56 cm3/s, respectively). Conclusions Early compression with a 30-mmHg pressure customized pressure garment after the flap surgery does not affect the hemodynamics of the perforator and can be safely used after extremity reconstruction before ambulation.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
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“Aesthetic abdominoplasty has a positive impact on quality of life prospectively”

In the previous retrospective study we detected an increased quality of life after aesthetic abdominoplasty. In this survey we analyzed quality of life, self-esteem, emotional stability and mental health before and after aesthetic abdominoplasty prospectively.

https://ift.tt/2Qz2Y1H

Dear Dr. Dermatoethicist: Credit Card on File



https://ift.tt/2ST7tRu

Two cases of Tullio phenomenon in which oval and round window reinforcement surgery was effective

To report the effect of oval and round window reinforcement surgery performed in two patients with the Tullio phenomenon. Case 1: A male with bilateral superior canal dehiscence syndrome. Downbeat nystagmus with leftward horizontal eye movement was recorded in an electronystagmogram using a pure-tone sound of 110dB at 2000 or 4000Hz in the right ear. Case 2: A female who had undergone stapes surgery. Computed tomography revealed an ossicular prosthesis in the vestibule. An audiogram indicated mild to moderate hearing impairment in the right ear.

https://ift.tt/2EoCHff

Influence of the root plaque formation with different species on oxytetracycline accumulation in rice ( Oryza sativa L.) and its elimination in culture solution

Abstract

Hydroponic experiments were conducted to investigate the role of different root plaque formation on oxytetracycline (OTC) uptake/translocation by rice seedlings (Oryza sativa L.) and solution–OTC elimination at two initial OTC concentrations (10 and 30 mg L−1). The results indicated OTC accumulation in rice was always in the order root surface > shoot > inside root whether plaques were formed or not. It demonstrated that Fe–Mn–Mt (montmorillonite) treatment was easier to promote significantly (p < 0.05) OTC accumulation in the underground part (root surface and inside root) and decrease significantly (p < 0.05) OTC translocation from the root to the shoot in rice compared to no plaque treatments (CK), especially for OTC 30 mg L−1 level with the lowest shoot–OTC accumulation in Fe–Mn–Mt treatment. Plaque treatments increased half-life of solution–OTC elimination in the order Fe–Mn–Mt > Fe–Mn > Fe > CK, which was caused mainly by OTC degradation from Fe2+-binding influence in solution, not by the enhancement of OTC accumulation on the root surface and inside root. And solution–OTC elimination increased with decreasing initial OTC concentrations, the drop of Fe2+ and the increment of Fe3+ and pH during the experiment. These findings are useful for reducing OTC accumulation and translocation in rice aboveground parts and eliminating OTC contamination in agricultural environment simultaneously through complicated plaque formation under higher OTC concentration exposure (30 mg L−1) in the future design.



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Scrofuloderma with disseminated tuberculosis in an Ethiopian child: a case report

Cutaneous tuberculosis represents only 1–2% of extrapulmonary forms of tuberculosis. Scrofuloderma is an endogenous form of cutaneous tuberculosis and can present as isolated or coexist with pulmonary and diss...

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Tislelizumab in Combination With Chemotherapy as First-Line Treatment in Adults With Inoperable, Locally Advanced or Metastatic Gastric, or Gastroesophageal Junction Carcinoma

Condition:   Gastric, or Gastroesophageal Junction Adenocarcinoma
Interventions:   Drug: Tislelizumab (BGB-A317) combined with oxaliplatin and capecitabine or Tislelizumab (BGB-A317) combined with Cisplatin and 5-FU;   Drug: Placebo combined with oxaliplatin and capecitabine or Placebo combined with Cisplatin and 5-FU
Sponsor:   BeiGene
Not yet recruiting

https://ift.tt/2QYxOA3

Tislelizumab in Combination With Chemotherapy as First-Line Treatment in Adults With Inoperable, Locally Advanced or Metastatic Gastric, or Gastroesophageal Junction Carcinoma

Condition:   Gastric, or Gastroesophageal Junction Adenocarcinoma
Interventions:   Drug: Tislelizumab (BGB-A317) combined with oxaliplatin and capecitabine or Tislelizumab (BGB-A317) combined with Cisplatin and 5-FU;   Drug: Placebo combined with oxaliplatin and capecitabine or Placebo combined with Cisplatin and 5-FU
Sponsor:   BeiGene
Not yet recruiting

https://ift.tt/2QYxOA3

Biochemical, molecular, and elemental profiling of Withania somnifera L. with response to zinc stress

Abstract

Zn stress seriously induces various toxic responses in Withania somnifera L., when accumulated above the threshold level which was confirmed by investigating the responses of protein, expression of antioxidant enzymes, and elemental profiling on accumulation of Zn. Zn was supplemented in the form of ZnSO4 (0, 25, 50, 100, and 200 μM) through MS liquid medium and allowed to grow the in vitro germinated plants for 7 and 14 days. The study revealed that when the application of Zn increased, a significant reduction of growth characteristics was noticed with alterations of proteins (both disappearance and de novo synthesis). The activity of CAT, SOD, and GPX were increased up to certain concentrations and then declined, which confirmed through in-gel activity under different treatments. RT-PCR was conducted by taking three sets of genes from CAT (RsCat, Catalase1, Cat1) and SOD (SodCp, TaSOD1.2, MnSOD) and found that gene RsCat from CAT and MnSOD from SOD have shown maximum expression of desired genes under Zn stress, which indicate plant's stress tolerance mechanisms. The proton-induced X-ray emission study confirmed an increasing order of uptake of Zn in plants by suppressing and expressing other elemental constituents which cause metal homeostasis. This study provides insights into molecular mechanisms associated with Zn causing toxicity to plants; however, cellular and subcellular studies are essential to explore molecule-molecule interaction during Zn stress in plants.



https://ift.tt/2SWKwNf

Foliar uptake of arsenic nanoparticles by spinach: an assessment of physiological and human health risk implications

Abstract

Atmospheric contamination by heavy metal(loid)–enriched particulate matter (metal-PM) is highly topical these days because of its high persistence, toxic nature, and health risks. Globally, foliar uptake of metal(loid)s occurs for vegetables/crops grown in the vicinity of industrial or urban areas with a metal-PM-contaminated atmosphere. The current study evaluated the foliar uptake of arsenic (As), accumulation of As in different plant organs, its toxicity (in terms of ROS generation, chlorophyll degradation, and lipid peroxidation), and its defensive mechanism (antioxidant enzymes) in spinach (Spinacia oleracea) after foliar application of As in the form of nanoparticles (As-NPs). The As-NPs were prepared using a chemical method. Results indicate that spinach can absorb As via foliar pathways (0.50 to 0.73 mg/kg in leaves) and can translocate it towards root tissues (0.35 to 0.68 mg/kg). However, health risk assessment parameters showed that the As level in the edible parts of spinach was below the critical limit (hazard quotient < 1). Despite low tissue level, As-NP exposure caused phytotoxicity in terms of a decrease in plant dry biomass (up to 84%) and pigment contents (up to 38%). Furthermore, several-fold higher activities of antioxidant enzymes were observed under metal stress than control. However, no significant variation was observed in the level of hydrogen peroxide (H2O2), which can be its possible transformation to other forms of reactive oxygen species (ROS). It is proposed that As can be absorbed by spinach via foliar pathway and then disturbs the plant metabolism. Therefore, air quality needs to be considered and monitored continuously for the human health risk assessment and quality of vegetables cultivated on polluted soils (roadside and industrial vicinity).

Graphical abstract



https://ift.tt/2ChqLui

Temperature sensitivity of different soil carbon pools under biochar addition

Abstract

The objective of this study was to investigate the temperature sensitivity of labile and relatively recalcitrant forest soil carbon (C) pools amended with biochar during short-term incubation. Biochars were prepared using sugar cane residue under pyrolysis temperatures of 300 and 700 °C (i.e., BC300 and BC700), respectively. Coarse particulate organic matter and acid hydrolysis residue were separated from a forest soil and treated as the labile and recalcitrant C pools of the soil, respectively. Temperature sensitivity of the soil C pools was characterized using the Q10 values (i.e., the proportional increase in respiration per 10 °C rise). The increased Q10 values of treatments in the earlier stage were attributable to instantaneously increased aromatic C content. The following decreased Q10 values were related to the consumption of labile C. However, the two types of biochars led to similar Q10 values in the same C pools at the later stage of incubation, which was closely related to the nearly humic-like component content in the dissolved organic matter. The different temporal distributions of Q10 values were attributable to changes of aromatic C content and continuous consumption of labile components.



https://ift.tt/2SUSDtp

Autoimmune pancreatitis in children: The impact of immune system in a challenging disease

Publication date: Available online 17 December 2018

Source: Autoimmunity Reviews

Author(s): Danilo Pagliari, Rossella Cianci, Donato Rigante



https://ift.tt/2rH438D

Autoimmune pancreatitis in children: The impact of immune system in a challenging disease

Publication date: Available online 17 December 2018

Source: Autoimmunity Reviews

Author(s): Danilo Pagliari, Rossella Cianci, Donato Rigante



https://ift.tt/2rH438D

Cell Death and Differentiation

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