Demographics and Outcomes of Pulmonary Hypertension Patients in United States Emergency Departments

Introduction: Pulmonary hypertension (PH) is a common, yet under-diagnosed, contributor to morbidity and mortality. Our objective was to characterize the prevalence of PH among adult patients presenting to United States (US) emergency departments (ED) and to identify demographic patterns and outcomes of PH patients in the ED.Methods: We analyzed the Nationwide Emergency Department Sample (NEDS) database, with a focus on ED patients aged 18 years and older, with any International Classification of Diseases, Clinical Modification (ICD)-9-CM or ICD-10-CM diagnosis code for PH from 2011 to 2015. The primary outcome was inpatient, all-cause mortality. The secondary outcomes were hospital admission rates and hospital length of stay (LOS).Results: From 2011 to 2015, in a sample of 121,503,743 ED visits, representing a weighted estimate of 545,500,486 US ED visits, patients with a diagnosis of PH accounted for 0.78% (95% confidence interval [CI], 0.75- 0.80%) of all US ED visits. Of the PH visits, 86.9% were admitted to the hospital, compared to 16.3% for all other ED visits (P <0.001). Likewise, hospital LOS and hospital-based mortality were higher in the PH group than for other ED patients (e.g., inpatient mortality 4.5% vs 2.6%, P < 0.001) with an adjusted odds ratio (aOR) of 1.34 (95% CI, 1.31–1.37). Age had the strongest association with mortality, with an aOR of 10.6 for PH patients over 80 years (95% CI, 10.06–11.22), compared to a reference of ages 18 to 30 years.Conclusion: In this nationally representative sample, presentations by patients with PH were relatively common, accounting for nearly 0.8% of US ED visits. Patients with PH were significantly more likely to be admitted to the hospital than all other patients, had longer hospital LOS, and increased risk of inpatient mortality

Managing pearly prepuce - Active communication and masterly inaction

Epstein pearls are small inclusion cysts and are found on the hard palate of the newborn infants in the early neonatal age. These may be present on the prepuce and are referred as prepucial Epstein pearl. Epstein pearls need no treatment but parental anxiety needs to be addressed by active communication and counselling

Pain abdomen in a child - An uncommon cause

Diagnosis, identification of underlying etiology and management of pain abdomen, remains difficult. Tumors presenting as abdominal pain are rare in children. We report a case of 11-year old boy presenting with pain abdomen. On examination, he had a lump in left hypochondrium. Gastrointestinal tumors constitute about 12% of abdominal masses, 2% of which are pancreatic tumors. He underwent laparotomy was diagnosed as desmoplastic small round cell tumor in the pancreas. This report presents an uncommon cause of a common pediatric problem

Dean flow-coupled inertial focusing in curved channels

Passive particle focusing based on inertial microfluidics was recently introduced as a high-throughput alternative to active focusing methods that require an external force field to manipulate particles. In inertial microfluidics, dominant inertial forces cause particles to move across streamlines and occupy equilibrium positions along the faces of walls in flows through straight micro channels. In this study, we systematically analyzed the addition of secondary Dean forces by introducing curvature and show how randomly distributed particles entering a simple u-shaped curved channel are focused to a fixed lateral position exiting the curvature. We found the lateral particle focusing position to be fixed and largely independent of radius of curvature and whether particles entering the curvature are pre-focused (at equilibrium) or randomly distributed. Unlike focusing in straight channels, where focusing typically is limited to channel cross-sections in the range of particle size to create single focusing point, we report here particle focusing in a large cross-section area (channel aspect ratio 1: 10). Furthermore, we describe a simple u-shaped curved channel, with single inlet and four outlets, for filtration applications. We demonstrate continuous focusing and filtration of 10 mu m particles (with > 90% filtration efficiency) from a suspension mixture at throughputs several orders of magnitude higher than flow through straight channels (volume flow rate of 4.25ml/min). Finally, as an example of high throughput cell processing application, white blood cells were continuously processed with a filtration efficiency of 78% with maintained high viability. We expect the study will aid in the fundamental understanding of flow through curved channels and open the door for the development of a whole set of bio-analytical applications

Inclusion Ideals Associated to Uniformly Increasing Hypergraphs

In this paper,we introduce the monomial ideals I(H) associated to a special class of non uniform hypergraphs H(X; E; d) namely uniformly increasing hypergraphs. These ideals are named as inclusion ideals. In this paper, we discuss some algebraic properties of these inclusion ideals. In particular, we give an upper bound of the Castlenouvo-Mumford regularity of the special dual ideal I^[*](H) of the inclusion ideal.Comment: 6 pages, 1 figur

The Consumption, Physical Activity, and Nutrition Status to Blood Cholesterol of Participants in Posbindu Anggrek Rosalina, Cibodas Baru, Tangerang

One of the changes with increasing age is the increase in total blood cholesterol levels. The purpose of this research is to know the relationship of  the consumption level of (energy, fat, and cholesterol), physical activity, and nutritional status with total blood cholesterol of the participants of Posbindu Anggrek Rosalina 45-59 years old  in Kelurahan Cibodas Baru Tangerang City 2015.This research use cross sectional design with population of all participants Posbindu Anggrek Rosalina age 45-59 years Kelurahan Cibodas Baru Tangerang City Year 2015. Sampling using purposive sampling technique and obtained 41 respondents. The results showed that average energy consumption was 1806.38 Calories / day, fat consumption level 71.84 gr / day, cholesterol consumption 238.87 mg / day, physical activity 1.49, nutritional status (BMI)  25.70 (overweight), and total blood cholesterol 212.66 mg / dl.Pearson correlation test showed that there was a significant correlation between energy consumption level (p = 0.045 <α = 0.05), fat consumption level (p = 0.039 <α = 0.05), and cholesterol consumption level (p = 0.016 <α = 0.05) with total blood cholesterol levels. There was no significant relationship between physical activity (p = 0.273> α = 0.05), whereas there was no correlation between nutritional status (p = 0.597> α = 0.05) with total blood cholesterol level

Case Report A Case of Hemolytic Disease of the Newborn due to Di a Antibody

Anti-Di a is a clinically significant red cell antibody known to cause hemolytic disease of the newborn. Here, we report on a case of mild hemolytic disease of the newborn caused by Di a antibody. The mother had three prior pregnancies with no history of blood transfusion. She delivered a preterm 35-week-old female newborn by cesarean section. The neonate developed anemia and mild icterus on postnatal day five with hemoglobin of 9500 mg/dL and total bilirubin of 10 mg/dL. The direct antiglobulin test on the neonate's red blood cells was positive. The maternal serum and an eluate from the infant RBCs were negative in routine antibody detection tests but were positive using commercially prepared Di(a+) red cells. The neonate was discharged home in stable condition following treatment with erythropoietin and phototherapy. When a newborn has a positive DAT in the absence of major blood group incompatibility or commonly detected RBC antibodies, an antibody to a low frequency antigen such as Di a must be considered. Further immunohematology tests are required to determine presence of the antibody and the clinician must be alerted to closely monitor the infant for signs of anemia and hemolysis

Ambient air quality standards and policies in eastern mediterranean countries: a review

Objectives: National ambient air quality standards (NAAQS) are critical tools for controlling air pollution and protecting public health. We designed this study to 1) gather the NAAQS for six classical air pollutants: PM(2.5), PM(10), O(3), NO(2), SO(2), and CO in the Eastern Mediterranean Region (EMR) countries, 2) compare those with the updated World Health Organizations Air Quality Guidelines (WHO AQGs 2021), 3) estimate the potential health benefits of achieving annual PM(2.5) NAAQS and WHO AQGs per country, and 4) gather the information on air quality policies and action plans in the EMR countries. Methods: To gather information on the NAAQS, we searched several bibliographic databases, hand-searched the relevant papers and reports, and analysed unpublished data on NAAQS in the EMR countries reported from these countries to the WHO/Regional office of the Eastern Mediterranean/Climate Change, Health and Environment Unit (WHO/EMR/CHE). To estimate the potential health benefits of reaching the NAAQS and AQG levels for PM(2.5), we used the average of ambient PM(2.5) exposures in the 22 EMR countries in 2019 from the Global Burden of Disease (GBD) dataset and AirQ+ software. Results: Almost all of the EMR countries have national ambient air quality standards for the critical air pollutants except Djibouti, Somalia, and Yemen. However, the current standards for PM(2.5) are up to 10 times higher than the current health-based WHO AQGs. The standards for other considered pollutants exceed AQGs as well. We estimated that the reduction of annual mean PM(2.5) exposure level to the AQG level (5 mug m(-3)) would be associated with a decrease of all natural-cause mortality in adults (age 30+) by 16.9%-42.1% in various EMR countries. All countries would even benefit from the achievement of the Interim Target-2 (25 mug m(-3)) for annual mean PM(2.5): it would reduce all-cause mortality by 3%-37.5%. Less than half of the countries in the Region reported having policies relevant to air quality management, in particular addressing pollution related to sand and desert storms (SDS) such as enhancing the implementation of sustainable land management practices, taking measures to prevent and control the main factors of SDS, and developing early warning systems as tools to combat SDS. Few countries conduct studies on the health effects of air pollution or on a contribution of SDS to pollution levels. Information from air quality monitoring is available for 13 out of the 22 EMR countries. Conclusion: Improvement of air quality management, including international collaboration and prioritization of SDS, supported by an update (or establishment) of NAAQSs and enhanced air quality monitoring are essential elements for reduction of air pollution and its health effects in the EMR

Immunogenicity and safety of live attenuated hepatitis A Vaccine: a multicentric study

Objective: To evaluate immunogenicity and tolerability of single dose live attenuated injectable hepatitis A vaccine in four metropolitan cities of India. Methods: Live attenuated hepatitis A vaccine was administered to 505 children aged 18-60 months in four centers across India. Immunogenicity of the vaccine was assessed by estimation of anti-HAV antibody titer at 6 weeks and 6 months following administration of the vaccine. Safety evaluation of the vaccine was also done during the visits. Results: At 6 weeks, 480 subjects (95%) came for the follow-up and 411 (81.4%) subjects reported at the end of 6 months. The geometric mean titer (GMT) of anti-HAV antibody of the subjects who did not have the seroprotective titer at the baseline were assessed at 6 weeks and 6 months which was 81.04 mIU/ml and 150.66 mIU/ml respectively. At 6 weeks, 95.1% seroconverted and at the end of 6 months, 97.9% had seroconverted. Both solicited and unsolicited vaccine-induced local and systemic adverse events were insignificant at all the centers, except swelling and induration in a few. Conclusion: Live attenuated injectable hepatitis A vaccine was immunogenic and tolerable with minimal reactogenecity, in this study of single dose schedule. Safety profile was also satisfactory in the study population