An Atypical Presentation of Raynaud's Disease

Objective: A 57-year-old female with a 33-year history of constant hand discoloration and paronychia had undergone multiple evaluations with a failure to find a diagnosis. She continues to undergo an evolving treatment regimen and diagnostic workup in an effort to find a long-eluded diagnosis. Clinical Presentation: She began to develop superficial ulcerations over the proximal phalanx of her fingers, often pruritic and erythematous, with pain and edema. Intervention: She has since been managed with nifedipine and sildenafil and intermittent stellate ganglion blocks. Conclusion: Despite still lacking a formal diagnosis, her constellation of symptoms is most likely the result of an atypical presentation of Raynaud's disease. (C) 2019 The Author(s) Published by S. Karger AG, Basel.Open access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Synthesis of biomedical Ti-25Ni-15Si-10HA alloy by mechanical alloying and spark plasma sintering

In this research approach, a β-phase titanium alloy was produced successfully employing mechanical alloying and consolidated with spark plasma sintering (SPS) process. Herein, Ni, Si and HA powders with varied weight percentage were used to fabricate the Ti alloy. The influence of HA addition on microstructure of the alloy was assessed using optical microscopy route and further amplified using field emission scanning electron microscopy (FESEM). The elemental composition and phase of Ti-alloy was investigated using x-ray diffractometer. Vicker hardness (HV) tester was employed to estimate the micro hardness of the specimen surface. During the FESEM analysis, it was observed that within the sintering process, alloy exhibits complex reactions with HA, which leads to the progress of bioactive compounds (CaO, TiO2, Ca3 (PO4)2, Ti2Ni, CaTiO3 and CaTiSiO5) enhancing the bioactivity of the Ti alloy. The fabricated Ti alloy (Ti-25Ni-15Si-10HA) exhibited superior microhardness (~458HV) at 900°C, comparative to the other alloys of the native category. Based upon the current investigation, Ti-25Ni-15Si-10HA alloy could find applications as bioimplants in dental and orthopedic areas

Synthesis of biomedical Ti-25Ni-15Si-10HA alloy by mechanical alloying and spark plasma sintering

In this research approach, a β-phase titanium alloy was produced successfully employing mechanical alloying and consolidated with spark plasma sintering (SPS) process. Herein, Ni, Si and HA powders with varied weight percentage were used to fabricate the Ti alloy. The influence of HA addition on microstructure of the alloy was assessed using optical microscopy route and further amplified using field emission scanning electron microscopy (FESEM). The elemental composition and phase of Ti-alloy was investigated using x-ray diffractometer. Vicker hardness (HV) tester was employed to estimate the micro hardness of the specimen surface. During the FESEM analysis, it was observed that within the sintering process, alloy exhibits complex reactions with HA, which leads to the progress of bioactive compounds (CaO, TiO2, Ca3 (PO4)2, Ti2Ni, CaTiO3 and CaTiSiO5) enhancing the bioactivity of the Ti alloy. The fabricated Ti alloy (Ti-25Ni-15Si-10HA) exhibited superior microhardness (~458HV) at 900°C, comparative to the other alloys of the native category. Based upon the current investigation, Ti-25Ni-15Si-10HA alloy could find applications as bioimplants in dental and orthopedic areas

A Brief History of the Opioid Epidemic and Strategies for Pain Medicine

The opioid epidemic has resulted from myriad causes and will not be solved by any simple solution. Consequent to a staggering increase in opioid-related deaths in the USA, various governmental inputs and stakeholder strategies have been proposed and implemented with varying success. This article summarizes the history of opioid use and explores the causes for the present day epidemic. Recent trends in opioid-related data demonstrate an almost fourfold increase in overdose deaths from 1999 to 2008. Tragically, opioids claimed over 64,000 lives just last year. Some solutions have undergone legislation, including the limitation of numbers of opioids postsurgery, as well as growing national prevalence of enhanced recovery after surgery protocols which focus on reduced postoperative opioid consumption and shortened hospital stays. Stricter prescribing practices and prescription monitoring programs have been instituted in the recent past. Improvement in abuse deterrent strategies which is a major focus of the Food and Drug Administration (FDA) for all opioid preparations will likely play an important role by increasing the safety of these medications. Future potential strategies such as additional legislative policies, public awareness, and physician education are also detailed in this review

Photovoltaic performance prediction in Northern Nigeria using generated typical meteorological year dataset

Relevant meteorological files are needed by simulation software to assess the energy performances of buildings or efficiency of renewable energy systems. This paper adopts the Sandia method to generate typical meteorological year (TMY), using a 35-year hourly measured meteorological dataset from four stations in the northern region of Nigeria. The cumulative distribution function (CDF) for each year was compared with that of the long-term composite of all the years in the period for the seven major weather indices made up of relative humidity, wind speed, minimum temperature, global solar radiation, precipitation, mean temperature and maximum temperature. The 12 typical meteorological months (TMMs) selected from the different years were used for formulation of a TMY for the zone. In addition, performance assessment of a 72-cell polycrystalline solar PV module using the generated TMY and long-term (LT) values was also conducted. Two statistical indicators, the mean percentage error and the root mean square error, were adopted to evaluate the performance of each TMY with the LT mean, and also that of the PV energy system. Findings show that the TMMs are evenly spread within the data periods across the sites while closest fit between the long-term mean and TMY are obtained with the global solar radiation followed by the mean temperature in all the sites especially in Bida and Minna. From the energy system analysis carried out, it was found that TMY data are able to predict the performance of the PV system to within 5% of the LT data

Quantitative polymerase chain reaction based quantification of Brucella DNA in serum of pre- and post-therapeutic occupationally exposed infected human population

Background: Brucellosis is one of the neglected zoonotic diseases in humans. The serological methods based on antibody detections are unable to detect the effectiveness of treatment in humans as antibodies persist for long time in humans even after therapy. Therefore, we developed qPCR technique to overcome such discrepancy and device a rapid and efficient test for both diagnosis and follow up of the brucellosis affected individuals. Methods: High risk suspected individuals with positive serology (RBPT, STAT and iELISA) and PCR were mainly analyzed for DNA quantification by qPCR assay. The bcsp-31 gene, a shared gene of Brucella species was amplified by genus specific primers and cloned to pGEMT™ easy vector and the cloned plasmid were used to construct a standard curve (R2 = 0.99, efficiency = 1.98) over 7 orders of magnitude with sensitivity of ≈10 copy number. The assay was found 100% specific. Results: Overall 85 individuals were found positive out of 188. Out of them, 23 serological, PCR and qPCR positive individuals were recommended for 45 days therapy according to WHO regimen (Doxycycline and Rifampin) and each case was further followed by qPCR. The mean threshold cycle (Cq) before treatment was 26.05 ± 0.347 (3940.5 copies/μl), which increased significantly to 32.7 ± 0.66 (259.13 copies/μl) on 4th week during treatment, 35.12 ± 3.12 (38.52 copies/μl) at 6th week on day of treatment completion, 35.6 ± 0.66 (34.21 copies/μl) on 21st day after treatment depicting a significant reduction in DNA load over the course of treatment. Serological follow up showed that only 3 individuals had decreased STAT titre but no change in RBPT results. Out of 17 symptomatic individuals under therapy, 10 improved clinically, 5 improved clinically with persistent weakness and 2 had no effect of therapy. Conclusion: The study suggests that qPCR is more useful and rapid test to follow treated individuals than serology. Keywords: Brucella, qPCR, Cq value, High-risk individuals, Copy numbe

Cost-benefit analysis of intervention policies for prevention and control of brucellosis in India

<div><p>Background</p><p>Brucellosis is endemic in the bovine population in India and causes a loss of US$3·4 billion to the livestock industry besides having a significant human health impact.</p><p>Methods</p><p>We developed a stochastic simulation model to estimate the impact of three alternative vaccination strategies on the prevalence of <i>Brucella</i> infection in the bovine populations in India for the next two decades: (a) annual mass vaccination only for the replacement calves and (b) vaccination of both the adult and young population at the beginning of the program followed by an annual vaccination of the replacement calves and, (c) annual mass vaccination of replacements for a decade followed by a decade of a test and slaughter strategy.</p><p>Findings</p><p>For all interventions, our results indicate that the prevalence of <i>Brucella</i> infection will drop below 2$ 4·16 billion for intervention (a), US $8·31 billion for intervention (b) and, US$ 4·26 for intervention (c). For buffalo, the corresponding NPVs were US $8·77 billion, US$ 13·42 and, US $ 7·66, respectively. The benefit cost ratio (BCR) for the first, second and the third intervention for cattle were 7·98, 10·62 and, 3·16, respectively. Corresponding BCR estimates for buffalo were 17·81, 21·27 and, 3·79, respectively.</p><p>Conclusion</p><p>These results suggest that all interventions will be cost-effective with the intervention (b), i.e. the vaccination of replacements with mass vaccination at the beginning of the program, being the most cost-effective choice. Further, sensitivity analysis revealed that all interventions will be cost-effective even at the 50% of the current prevalence estimates. The results advocate for the implementation of a disease control program for brucellosis in India.</p></div