Unusual cause of severe toxic methemoglobinemia in an infant: a case report

Toxic methemoglobinemia is an uncommon blood disorder induced by exposure to certain oxidizing agents and drugs. In severe cases, this condition may rapidly lead to major cardiopulmonary compromise and constitutes an emergency requiring prompt recognition and early management. We report an unusual case of severe toxic methemoglobinemia following wide cutaneous application of a pomade containing benzocaine, resorcin, and oxyquinoline (Nestosyl®) in an infant

Constructing bilayer and volumetric atrial models at scale.

To enable large in silico trials and personalized model predictions on clinical timescales, it is imperative that models can be constructed quickly and reproducibly. First, we aimed to overcome the challenges of constructing cardiac models at scale through developing a robust, open-source pipeline for bilayer and volumetric atrial models. Second, we aimed to investigate the effects of fibres, fibrosis and model representation on fibrillatory dynamics. To construct bilayer and volumetric models, we extended our previously developed coordinate system to incorporate transmurality, atrial regions and fibres (rule-based or data driven diffusion tensor magnetic resonance imaging (MRI)). We created a cohort of 1000 biatrial bilayer and volumetric models derived from computed tomography (CT) data, as well as models from MRI, and electroanatomical mapping. Fibrillatory dynamics diverged between bilayer and volumetric simulations across the CT cohort (correlation coefficient for phase singularity maps: left atrial (LA) 0.27 ± 0.19, right atrial (RA) 0.41 ± 0.14). Adding fibrotic remodelling stabilized re-entries and reduced the impact of model type (LA: 0.52 ± 0.20, RA: 0.36 ± 0.18). The choice of fibre field has a small effect on paced activation data (less than 12 ms), but a larger effect on fibrillatory dynamics. Overall, we developed an open-source user-friendly pipeline for generating atrial models from imaging or electroanatomical mapping data enabling in silico clinical trials at scale (https://github.com/pcmlab/atrialmtk)

A study to derive a clinical decision rule for triage of emergency department patients with chest pain: design and methodology

<p>Abstract</p> <p>Background</p> <p>Chest pain is the second most common chief complaint in North American emergency departments. Data from the U.S. suggest that 2.1% of patients with acute myocardial infarction and 2.3% of patients with unstable angina are misdiagnosed, with slightly higher rates reported in a recent Canadian study (4.6% and 6.4%, respectively). Information obtained from the history, 12-lead ECG, and a single set of cardiac enzymes is unable to identify patients who are safe for early discharge with sufficient sensitivity. The 2007 ACC/AHA guidelines for UA/NSTEMI do not identify patients at low risk for adverse cardiac events who can be safely discharged without provocative testing. As a result large numbers of low risk patients are triaged to chest pain observation units and undergo provocative testing, at significant cost to the healthcare system. Clinical decision rules use clinical findings (history, physical exam, test results) to suggest a diagnostic or therapeutic course of action. Currently no methodologically robust clinical decision rule identifies patients safe for early discharge.</p> <p>Methods/design</p> <p>The goal of this study is to derive a clinical decision rule which will allow emergency physicians to accurately identify patients with chest pain who are safe for early discharge. The study will utilize a prospective cohort design. Standardized clinical variables will be collected on all patients at least 25 years of age complaining of chest pain prior to provocative testing. Variables strongly associated with the composite outcome acute myocardial infarction, revascularization, or death will be further analyzed with multivariable analysis to derive the clinical rule. Specific aims are to: i) apply standardized clinical assessments to patients with chest pain, incorporating results of early cardiac testing; ii) determine the inter-observer reliability of the clinical information; iii) determine the statistical association between the clinical findings and the composite outcome; and iv) use multivariable analysis to derive a highly sensitive clinical decision rule to guide triage decisions.</p> <p>Discussion</p> <p>The study will derive a highly sensitive clinical decision rule to identify low risk patients safe for early discharge. This will improve patient care, lower healthcare costs, and enhance flow in our busy and overcrowded emergency departments.</p

Behaviour of a biocompatible titanium alloy during orthogonal micro-cutting employing green machining techniques

The sustainability of a process is the objective of modern industries aiming to reduce waste in production, since consumers require high quality and efficiency with fair price. Thus, a good understanding of the process should be its starting point. The manufacture of dental implants is an example in which waste reduction is important for the reduction of prices due to the demand for great quality and accuracy. This study observed the behaviour of sustainable micro-cutting applied to the Ti-6Al-7Nb titanium alloy, considering the ploughing effect on minimum quantity lubrication (MQL) and high-speed machining (HSM) conditions. When compared with dry condition and low-speed cutting in orthogonal micro-cutting, the use of HSM in dry cutting was more efficient than using MQL. The dry condition presented lower surface roughness, whilst the cooled/lubricated condition presented lower burr formation.publishe

Photo Documentation In Ocular Trauma

Objective: Aim of the study is to photograph different cases of ocular trauma to ensure the safety of an ophthalmologist in giving prognosis and avoiding problems which are faced in court of law in criminal cases. Study Design: Hospital based, Cross sectional descriptive study Place And Duration: Department of ophthalmology, Abbassi Shaheed Hospital, Karachi. From July 2013 to March 2014 Material And Method: Hundred (100) Patients of ocular trauma were enrolled in the study on basis of nonprobability consective sampling. Their photographs were taken with the help of camera Kowa Fx 50 R. Blunt and penetrating injuries were included. Anterior and posterior segment findings were photographed. Comatose, younger than 6 years, corneal abrasions and corneal foreign bodies were excluded from the study. Data was analyzed on SPSS version 16. Result: Among 100 patients (72) were males with male to female ratio of 3:1. Close globe injuries were (64) and open globe injuries were (36). lid cut 6%, subconjunctival hemorrhages 10%, corneal cut 28%, hyphema 10%, subluxated lens 4%, cataract 10%, traumatic aniridia 2%, Choroidal rupture 4%, Traumatic optic atrophy 2% and Commotio retinae 2%. Conclusion: Ocular photographs are the best evidence to be used in medico legal cases and compensatory purposes. The new aspect to be highlighted is to photograph every case of an ocular trauma to avoid unnecessary aggravation and harassment to the ophthalmologist in different criminal medico legal and compensatory cases

Thigh-length compression stockings and DVT after stroke

Controversy exists as to whether neoadjuvant chemotherapy improves survival in patients with invasive bladder cancer, despite randomised controlled trials of more than 3000 patients. We undertook a systematic review and meta-analysis to assess the effect of such treatment on survival in patients with this disease

Detecting hot spots in photovoltaic panels using low-cost thermal cameras

One of the most important challenges to mitigate global climate change is to move towards replacing petroleum-based energy sources. In this idea, non-conventional renewable energy sources such as photovoltaic (PV) solar and wind power are the most used worldwide. In the case of the massification of PV solar generation systems due to its low cost, it has resulted in the use of large-scale supervision techniques that allow a quick and effective determination of the health status of its main components. This study, performs an analysis of the performance of different low-cost cameras for thermography. The analysis compares the accuracy of the thermal images obtained and the error is quantified by means of an image dispersion analysis in each of them. Three-dimensional meshes and contours figures are also made to determine the temperature of a faulty cell. The study shows that the performance obtained with low-cost cameras presents errors below 10% in costs and less than 0.015 USD/pixel. © Springer Nature Switzerland AG 2020.One of the most important challenges to mitigate global climate change is to move towards replacing petroleum-based energy sources. In this idea, non-conventional renewable energy sources such as photovoltaic (PV) solar and wind power are the most used worldwide. In the case of the massification of PV solar generation systems due to its low cost, it has resulted in the use of large-scale supervision techniques that allow a quick and effective determination of the health status of its main components. This study, performs an analysis of the performance of different low-cost cameras for thermography. The analysis compares the accuracy of the thermal images obtained and the error is quantified by means of an image dispersion analysis in each of them. Three-dimensional meshes and contours figures are also made to determine the temperature of a faulty cell. The study shows that the performance obtained with low-cost cameras presents errors below 10% in costs and less than 0.015 USD/pixel. © Springer Nature Switzerland AG 2020.Sori