Tumoral calcinosis of the foot: An unusual differential diagnosis of calcaneal mass

Introduction Tumoral calcinosis (TC) is a rare disorder characterized by the development of calcified masses within the periarticular soft tissues of large joints. It commonly involves the hip, shoulders, and elbows. TC rarely involves the feet. Case presentation In this report, we describe an unusual case of primary TC of the foot in a 76-year-old female and discuss the pathophysiology, diagnosis, and therapeutic interventions of the condition. Discussion Due to the wide range of conditions mimicking TC, its diagnosis could be challenging. Diagnosis of TC is mainly based on the radiographic findings, the patient's biochemical profile, and the medical history plus differentiating the condition from its mimics. Conclusion TC should be considered in the differential diagnosis of any soft tissue calcification. ©2015 Published by Elsevier Ltd. on behalf of Surgical Associates Ltd

ABCB1-C3435T polymorphism and breast cancer risk: A case-control study and a meta-analysis

Purpose: To investigate the association of ABCB1-C3435T transition with breast cancer risk which was followed by a meta-analysis. Methods: In a case-control study we collected blood samples from 290 women (including 150 breast cancer patients and 140 healthy controls). ABCB1-C3435T genotyping was performed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. A meta-analysis was performed for a total of 13 eligible studies involving 5,835 cases and 8,178 controls. Results: The results of case-control study revealed a significant association between T allele (OR=1.770, 95%CI=1.236-2.535, p=0.002), CT genotype (OR=1.661, 95%CI=1.017-2.713, p=0.042), and TT genotype (OR=3.399, 95%C1=1.409-8.197, p=0.006) with breast cancer risk. Data from meta-analysis revealed a significant association between ABCB1-C3435T polymorphism and breast cancer risk in allelic (OR=1.243, 95%CI=1.079-1.432, p=0.003), co-dominant (OR=1.349, 95%CI=1.042-1.746, p=0.023), dominant (OR=1.204, 95%CI=1.019-1.422, p=0.029), and recessive (OR=1.226, 9S%C1-1.0U-1.488, p=0.039) models. Conclusions: The results suggest that the ABCB1-C3435T gene polymorphism might be a genetic risk factor and a potential biomarker for breast cancer

Etiology and Risk Factors for Infectious Keratitis in South Texas

Purpose: To determine the causative organisms and associated risk factors for infectious keratitis in South Texas. Methods: This retrospective study was performed at a tertiary teaching hospital system in South Texas. Medical records of all patients who presented with infectious keratitis from 2012 to 2018 were reviewed. Only patients with culture-proven bacterial, fungal, and Acanthamoeba keratitis were included. Results: In total, 182 eyes of 181 patients had culture-proven bacterial, fungal, or Acanthamoeba keratitis. The age of patients ranged from 3 to 93 years, with a mean of 48.3 ± 20.8 years. The most common etiologic agent was bacteria, with 173 bacterial cultures (95.1%) recovered, followed by 13 fungal cultures (7.1%), and 3 Acanthamoeba cultures (1.6%). Of the 218 bacterial isolates, coagulase-negative Staphylococcus was the most common (25.7%), followed by Pseudomonas aeruginosa (23.4%), Staphylococcus aureus (11.0%), and Moraxella (7.8%). Fusarium was the most common fungal isolate (46.2%). The most common risk factors for infectious keratitis included contact lens wear (32.4%), underlying corneal disease (17.6%), trauma (14.3%), and ocular surface disease (13.7%). Conclusions: Bacteria are the most common cause of infectious keratitis in this patient population, with coagulase-negative Staphylococcus and Pseudomonas as the most common isolates. The prevalence of culture-positive fungal keratitis is significantly lower than that of bacterial keratitis. Contact lens wear is the most common risk factor associated with infectious keratitis in South Texas

M-machine, no-wait flowshop scheduling with sequence dependent setup times and truncated learning function to minimize the makespan.

Recently, learning effects have been studied as an interesting topic for scheduling problems, however, most researches have considered single or two-machine settings. Moreover, learning factor has been considered for job times instead of setup times and the same learning effect has been used for all machines. This paper studies the m-machine no-wait flowshop scheduling problem considering truncated learning effect in no-wait flowshop environment. In this problem, setup time is a function of job position in the sequence with a learning truncation parameter and each machine has its own learning effect. In this paper, a mixed integer linear programming is proposed for the problem to solve such problem. This problem is NP-hard so an improved genetic algorithm (GA) and a simulated annealing (SA) algorithm are developed to find near optimal solutions. The accuracy and efficiency of the proposed procedures are tested against different criteria on various instances. Numerical experiments approve that SA outperforms in most instances

Numerical simulation of thermal buoyant wall jets

The main focus of this study is on the near field flow and mixing characteristics of the thermal wall jets. A numerical study of the buoyant wall jets discharged from submerged outfalls from cooling systems of power plants has hence been conducted. The effects of different RANS (Reynolds-Averaged Navier-Stokes) turbulence models have been investigated. The standard k-ε, RNG k-ε, realizable k-ε and SST k-ω turbulence models have been applied in this study. A finite volume method with structured grid was used to simulate the flow and temperature fields. The results of temperature and velocity fields are compared to both existing experimental and numerical data. It is found that the realizable k-ε performs the best among the four investigated turbulence models. According to the results from different simulations, relationships and comparative graphs are presented which are helpful for a better understanding of buoyant wall jets.This publication was made possible by NPRP grant # 4-935-2-354 from the Qatar National Research Fund (a member of Qatar Foundation)

Pupil dilation with intracameral lidocaine during phacoemulsification

Purpose: To evaluate pupil dilation by an intracameral injection of nonpreserved lidocaine 1 during phacoemulsification cataract extraction and compare the results with those using conventional topical mydriatics. Setting: Department of Ophthalmology, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran. Methods: A prospective comparative case series study was conducted. The study included 57 patients who were given topical mydriatics (30 eyes) or intracameral lidocaine (27 eyes) to dilate the pupil for phacoemulsification and intraocular lens implantation. The topical group received 3 drops of cyclopentolate 1 and phenylephrine 5 given 5 minutes apart starting 60 minutes before surgery. The intracameral group received preservative-free lidocaine 1 (0.2 to 0.3 mL) injected just before the procedure began. No epinephrine was added to the irrigating solution. In both groups, the horizontal pupil diameter was measured before and after pupil dilation using the same caliper. Total surgical time, need for a mydriatic agent during the procedure, and subjective surgical performance were recorded. Results: The mean age, sex, cataract density, baseline horizontal pupil diameter, and mean duration of the surgery were the same between the topical group and intracameral group. The mean pupil dilation was 4.52 mm ± 0.08 (SD) in the intracameral group and 4.06 ± 0.09 mm in the topical group; the difference between groups was statistically significant (P = .001). There was no significant difference between groups in the overall subjective surgical performance (P = .74). No patient in the intracameral group and 2 patients in the topical group required an intracameral mydriatic injection. Conclusion: During phacoemulsification, intracameral preservative-free lidocaine 1 provided rapid, effective mydriasis comparable that of topical mydriatics. © 2007 ASCRS and ESCRS

Effect of reinforced audit and feedback intervention on physician behaviour: a multifaceted strategy for targeting medical record documentation

We investigated the effects of reinforced audit and feedback on the medical record documentation (MRD) of 35 surgical residents at a tertiary university hospital. In three phases (pre intervention, 3 and 9-month post intervention), 525 medical records were assessed. An educational guideline assisting residents to record more accurate MRD was developed. The MRD rate in the pre-intervention and immediate post-intervention phases had changed significantly. The MRD rate in the pre-intervention and 9 months after cessation of intervention was not statistically significant. Reinforced audit and feedback had only a short term effect on MRD. To achieve long lasting change, we suggest residents’ MRD behaviour must be integrated in their periodic clinical performance evaluation and reinforced through positive feedback including incentive mechanisms

Predictive value of transcutaneous bilirubinometry on third day of birth in diagnosis of hyperbilirubinemia in term and near-term neonates

Introduction: Severe hyperbilirubinemia may cause side effects such as hearing impairment or bilirubin encephalopathy. In this way, transcutaneous bilirubinometry (TCB) is a non-invasive screening method, which is performed using BiliCheck and does not require frequent blood sampling, time and cost. The aim of this study was to determine the predictive value of TCB on third day of birth in neonatal hyperbilirubinemia diagnosis in term and near-term neonates. Materials and Methods: A test assessment method was chosen with continuous sampling in 388 neonates 35 weeks and more at AkabarAbadi hospital in Tehran in 2011. On the third day of birth, cutaneous bilirubin levels (TCB) in the forehead by using BiliCheck and serum bilirubin (TSB) was measured from the heel capillary sample and consequently were compared with each other. Results: In neonatal hyperbilirubinemia diagnosis on the third day of birth, cutaneous bilirubin measurement had the sensitivity of 82 with the confidence interval (78.2, 85.7), specificity of 99.3 with the confidence interval (98.7, 99.9), positive predictive value of 92.9 with the confidence interval (88.0, 96.2) and negative predictive value of 94.8 with the confidence interval (92.8, 96.8). Generally, the third day measurement of cutaneous bilirubin had a predictive value of 94.5 in detecting high-risk neonates for hyperbilirubinemia. Conclusion: Third day TCB, in addition to being non-invasive and convenient use, has a high predictive value to detecting the risk of hyperbilirubinemia in neonate and it is recommended to use hyperbilirubinemia screening. © 2019, Semnan University of Medical Sciences. All rights reserved

Going beyond audit and feedback: towards behaviour-based interventions to change physician laboratory test ordering behaviour

Studies indicate there are a variety of contributing factors affecting physician test ordering behaviour. Identifying these behaviours allows development of behaviour-based interventions. Methods Through a pilot study, the list of contributing factors in laboratory tests ordering, and the most ordered tests, were identified, and given to 50 medical students, interns, residents and paediatricians in questionnaire form. The results showed routine tests and peer or supervisor pressure as the most influential factors affecting physician ordering behaviour. An audit and feedback mechanism was selected as an appropriate intervention to improve physician ordering behaviour. The intervention was carried out at two intervals over a three-month period. Findings There was a large reduction in the number of laboratory tests ordered; from 908 before intervention to 389 and 361 after first and second intervention, respectively. There was a significant relationship between audit and feedback and the meaningful reduction of 7 out of 15 laboratory tests including complete blood count (p = 0.002), erythrocyte sedimentation rate (p = 0.01), C-reactive protein (p = 0.01), venous blood gas (p = 0.016), urine analysis (p = 0.005), blood culture (p = 0.045) and stool examination (p = 0.001). Conclusion The audit and feedback intervention, even in short duration, affects physician ordering behaviour. It should be designed in terms of behaviour-based intervention and diagnosis of the contributing factors in physicians’ behaviour. Further studies are required to substantiate the effectiveness of such behaviour-based intervention strategies in changing physician behaviour