Iatrogenic Cushing's syndrome caused by topical corticosteroid application and its life threatening complications

Introduction: The use of topical corticosteroids in children and adults, especially in covered areas and for a prolonged duration, may result in Cushing's syndrome and suppression of the hypothalamic-pituitary-adrenal axis. Case Presentation: The present report describes the cases of three children and a 25-year-old man who presented with clinical features of Cushing's syndrome and adrenal insufficiency following prolonged use of clobetasol cream. Two of the children continued with hypertension even after discontinuation of clobetasol, and were treated with angiotensin-converting enzyme inhibitors. One of these two children had developed acute renal failure, hypertensive encephalopathy, and permanent visual loss prior to admission. Conclusions: Whenever a cushingoid appearance is accompanied by adrenal insufficiency, the exogenous use of steroids, especially topical creams, should be explored. Hypertension may persist even after cessation of use and may result in life threatening complications. © 2015, Iranian Society of Pediatrics

What if Supersymmetry Breaking Unifies beyond the GUT Scale?

We study models in which soft supersymmetry-breaking parameters of the MSSM become universal at some unification scale, $M_{in}$, above the GUT scale, \mgut. We assume that the scalar masses and gaugino masses have common values, $m_0$ and $m_{1/2}$ respectively, at $M_{in}$. We use the renormalization-group equations of the minimal supersymmetric SU(5) GUT to evaluate their evolutions down to \mgut, studying their dependences on the unknown parameters of the SU(5) superpotential. After displaying some generic examples of the evolutions of the soft supersymmetry-breaking parameters, we discuss the effects on physical sparticle masses in some specific examples. We note, for example, that near-degeneracy between the lightest neutralino and the lighter stau is progressively disfavoured as $M_{in}$ increases. This has the consequence, as we show in $(m_{1/2}, m_0)$ planes for several different values of $\tan \beta$, that the stau coannihilation region shrinks as $M_{in}$ increases, and we delineate the regions of the $(M_{in}, \tan \beta)$ plane where it is absent altogether. Moreover, as $M_{in}$ increases, the focus-point region recedes to larger values of $m_0$ for any fixed $\tan \beta$ and $m_{1/2}$. We conclude that the regions of the $(m_{1/2}, m_0)$ plane that are commonly favoured in phenomenological analyses tend to disappear at large $M_{in}$.Comment: 24 pages with 11 eps figures; references added, some figures corrected, discussion extended and figure added; version to appear in EPJ

Changing trends in mortality among solid organ transplant recipients hospitalized for COVID-19 during the course of the pandemic

Mortality among patients hospitalized for COVID-19 has declined over the course of the pandemic. Mortality trends specifically in solid organ transplant recipients (SOTR) are unknown. Using data from a multicenter registry of SOTR hospitalized for COVID-19, we compared 28-day mortality between early 2020 (March 1, 2020–June 19, 2020) and late 2020 (June 20, 2020–December 31, 2020). Multivariable logistic regression was used to assess comorbidity-adjusted mortality. Time period of diagnosis was available for 1435/1616 (88.8%) SOTR and 971/1435 (67.7%) were hospitalized: 571/753 (75.8%) in early 2020 and 402/682 (58.9%) in late 2020 (p <.001). Crude 28-day mortality decreased between the early and late periods (112/571 [19.6%] vs. 55/402 [13.7%]) and remained lower in the late period even after adjusting for baseline comorbidities (aOR 0.67, 95% CI 0.46–0.98, p =.016). Between the early and late periods, the use of corticosteroids (≥6 mg dexamethasone/day) and remdesivir increased (62/571 [10.9%] vs. 243/402 [61.5%], p <.001 and 50/571 [8.8%] vs. 213/402 [52.2%], p <.001, respectively), and the use of hydroxychloroquine and IL-6/IL-6 receptor inhibitor decreased (329/571 [60.0%] vs. 4/492 [1.0%], p <.001 and 73/571 [12.8%] vs. 5/402 [1.2%], p <.001, respectively). Mortality among SOTR hospitalized for COVID-19 declined between early and late 2020, consistent with trends reported in the general population. The mechanism(s) underlying improved survival require further study

COVID-19 in hospitalized lung and non-lung solid organ transplant recipients: A comparative analysis from a multicenter study

Lung transplant recipients (LTR) with coronavirus disease 2019 (COVID-19) may have higher mortality than non-lung solid organ transplant recipients (SOTR), but direct comparisons are limited. Risk factors for mortality specifically in LTR have not been explored. We performed a multicenter cohort study of adult SOTR with COVID-19 to compare mortality by 28 days between hospitalized LTR and non-lung SOTR. Multivariable logistic regression models were used to assess comorbidity-adjusted mortality among LTR vs. non-lung SOTR and to determine risk factors for death in LTR. Of 1,616 SOTR with COVID-19, 1,081 (66%) were hospitalized including 120/159 (75%) LTR and 961/1457 (66%) non-lung SOTR (p =.02). Mortality was higher among LTR compared to non-lung SOTR (24% vs. 16%, respectively, p =.032), and lung transplant was independently associated with death after adjusting for age and comorbidities (aOR 1.7, 95% CI 1.0–2.6, p =.04). Among LTR, chronic lung allograft dysfunction (aOR 3.3, 95% CI 1.0–11.3, p =.05) was the only independent risk factor for mortality and age >65 years, heart failure and obesity were not independently associated with death. Among SOTR hospitalized for COVID-19, LTR had higher mortality than non-lung SOTR. In LTR, chronic allograft dysfunction was independently associated with mortality

Achieving robust acoustic emission-based damage characterisation of scaled laminated composites under indentation

This paper presents a novel investigation on the robustness of Acoustic Emission (AE) technique on the characterization of indentation-induced Damage Mechanisms (DMs) in scaled laminated composites. AE is used to monitor a comprehensive series of scaled Quasi-Static Indentation (QSI) tests performed on Quasi-Isotropic (QI) S-glass/8552 epoxy composite plates, with in-plane and intra-plane scaling. A detailed assessment of the damage evolution is carried out through clustering of the monitored AE signals. The AE results indicated the existence of different DMs such as delamination, matrix cracking and fiber breakage. Ultrasonic C-scan and visual observations were also used to verify the AE based results. It was observed that both in-plane and intra-plane scaling alter the induced DMs, and the AE analysis was able to accurately identify and quantify the DMs in each case. However, the AE features (frequency, energy and count) were found to be dependent on different variables such as size, geometry and stacking sequence of the investigated samples. This research highlights the potential and challenges to develop AE as a reliable structural health monitoring system for impact/indentation damage monitoring of composite plates over a range of sizes and complexities

Extending a Fuzzy Network Data Envelopment Analysis Model to Measure Maturity Levels of a Performance Based-Budgeting System: A Case Study

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.Performance-based budgeting (PBB) aims to formulate and manage public budgetary resources to improve managerial decisions based on actual performance measures of agencies. Although the PBB system has been overwhelmingly applied by various agencies, the progress and maturity of its implementation process are not satisfactory at large. Therefore, it warrants to find, evaluate and improve the performance of organisations in relation to implementing a PBB system. To do so, the composite indicators (CIs) have been proposed to aggregate multiple indicators associated with the PBB system, but their employment is contentious as they often lean on ad-hoc and troublesome assumptions. Data envelopment analysis (DEA) methods as a powerful and established tool help to contend with key limitations of CIs. Although the original DEA method ignores an internal production process, the knowledge of the internal structure of the PBB systems and indicators is of importance to provide further insights when assessing the performance of PBB systems. In this paper, we present a budget assessment framework by breaking a PBB system into two parallel stages including operations performance (OP) and financial performance enhancement (FPE) to open up the black-box structure of the system and consider the indicator hierarchy configuration of each stage. In situations of the hierarchical configuration of indicators, we develop a multilayer parallel network DEA-based CIs model to measure the PBB maturity levels of the system and its stages. It is shown that the discrimination power of the proposed multilayer model is better than the existing models with one layer and in situations of relatively small number of DMUs the model developed in this paper can be a good solution to the dimension reduction of indicators. Moreover, this research leverages fuzzy logic to surmount the subjective information that is often available in collecting indicators of the PBB systems. The major contribution of this research is to examine a case study of a PBB maturity award in Iran, as a developing country with a myriad of financial challenges, to adopt a PBB maturity model as well as point towards the efficacy and applicability of the proposed framework in practice

Maximizing the minimum load for selfish agents

Abstract. We consider the problem of maximizing the minimum load for machines that are controlled by selfish agents, who are only interested in maximizing their own profit. Unlike the classical load balancing problem, this problem has not been considered for selfish agents until now. For a constant number of machines, m, we show a monotone polynomial time approximation scheme (PTAS) with running time that is linear in the number of jobs. It uses a new technique for reducing the number of jobs while remaining close to the optimal solution. We also present an FPTAS for the classical problem, i.e., where no selfish agents are involved (the previous best result for this case was a PTAS) and use this to give a monotone FPTAS. Additionally, we give a monotone approximation algorithm with approximation ratio min(m, (2 + ε)s1/sm) whereε&gt;0 can be chosen arbitrarily small and si is the (real) speed of machine i. Finally we give improved results for two machines.

Effects of alpha-lipoid acid on serum iron, total iron binding capacity and hematological indices in β-thalassemia major patients: A cross over clinical trial

Background and Objectives: Accumulation of iron is the most common consequences of repeated blood transfusions in β-thalassemia major patients. Iron chelating effects of alpha-lipoic acid have been reported by several studies. The aim of this study was to investigate effects of supplementation with alpha-lipoic acid, as a chelator, on serum iron and hematological indices in these patients. Materials & Methods: Twenty-two β-thalassemia major patients were selected to receive 600 mg alpha-lipoic acid or placebo capsules for 8 w. After a 3-week washout period, order of intervention was replaced as patients who previously received placebo were administered the supplement vise versa for another 8 w. At the end of the study, changes in serum iron, total iron binding capacity and hematological parameters between the treatments were assessed. Results: Serum concentrations of iron and total iron binding capacity and hematological parameters did not change within the supplementation (p > 0.05). Changes in iron, total iron binding capacity and hematological indices were not significantly different between the two interventions (p > 0.05). White blood cell counts in placebo use increased significantly in males (p = 0.04). The mean corpuscular hemoglobin in placebo patients decreased significantly in all patients and males (p = 0.02 for both). Conclusion: Results of this study revealed that alpha-lipoic acid supplementation included no beneficial effects on iron, total iron binding capacity and hematological indices in β-thalassemia major patients. Further studies with more participants and longer times are indispensable. © 2020, National Nutrition and Food Technology Research Institute. All rights reserved