11 research outputs found
Self-sampling for human papillomavirus testing among rural young women of KwaZulu-Natal, South Africa
Simultaneous determination and validated quantification of human insulin and its synthetic analogues in human blood serum by immunoaffinity purification and liquid chromatography-mass spectrometry
Possible fatal complications of human insulin and its synthetic analogues like hypoglycemia require precise classification and quantitative determination of these drugs both for clinical purposes as well as for forensic toxicologists. A procedure was developed for the identification and quantification of human insulin and different long-acting as well as short-acting synthetic insulins in human blood serum specimens. After an immunoaffinity purification step and separation by liquid chromatography, the insulins were characterized by their five- or sixfold protonated molecule ions and diagnostic product ions. Clinical samples of 207 diabetic and 50 non-diabetic patients after the administration of human insulin or oral antidiabetics and forensic samples were analyzed for human/synthetic insulin concentrations. The method was validated according to international guidelines. Limits of detection of the insulins ranged between 1.3 and 2.8 mu U/ml. Recoveries ranged between 33.2 % and 51.7 %. Precision data was in accordance with international guidelines. Clinical samples showed concentrations of human insulin lower than 301 mu U/ml. Our liquid chromatography tandem mass spectrometry procedure allows unambiguous identification and quantification of the intact human insulin and its intact synthetic analogues HumalogA (R), NovologA (R), ApidraA (R), LantusA (R), and LevemirA (R) in human blood serum in clinical and overdose cases. The assay could be successfully tested in patients with diabetes mellitus on therapy with insulins or oral antidiabetics
Greenhouse conditions induce mineralogical changes and dolomite accumulation in coralline algae on tropical reefs
Inorganic control on original carbonate mineralogy and creation of gas reservoir of the Upper Jurassic carbonates in the Kopet-Dagh Basin, NE, Iran
Head Injuries
Traumatic brain injuries (TBIs) are the leading cause of mortality and morbidity in patients younger than 40 years, affecting 1.7 million people every year in the USA. They are responsible for one-third of all injury-related deaths, whereas patients who survive may develop severe debilitating long-term sequelae.
They consist of a wide spectrum of diseases, defined as a whole as an “alteration in brain function, or other evidence of brain pathology, caused by an external force.” The causes may vary depending on patient’s age: abuse traumas are most commonly observed in infants, while traumatic and sports-related injuries are seen in toddlers and children. Motor vehicle accidents involve most commonly young adults, whereas the elderly population is more prone to accidental falls.
TBIs are clinically divided into minor, mild, moderate, and severe traumas by using the Glasgow Coma Scale (GCS), the most commonly used grading scale to evaluate the entity of head injuries within the first 48 h, which aims to provide a uniform approach to the clinical assessment of patients involved in acute head traumas.
GCS is the sum of three components which are eye opening, motor response, and verbal response; a minor trauma has a GCS = 15; mild, GCS > 13; moderate, GCS 9–12; and severe, GCS < 8.
An additional TBI clinical classification is provided by the Brain Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine, based on the loss of consciousness, loss of memory for events
occurred immediately before or after trauma, changes in mental status, and focal neurologic deficits. According to this classification, a mild trauma is defined as a physiologically disruption of brain functions, evaluated by the presence of
one of the previous described criteria; additional findings are no abnormalities on computed tomography (CT) scan, GCS > 12, no surgical lesions, and length of hospital recovery less than 48 h. Moderate trauma is defined as a GCS of
9–12, hospital recovery of at least 48 h, surgical intracranial lesions, and positive CT scan findings.
Severe traumas are evident at the moment of clinical presentation.
Chronologically, TBIs are divided into primary (injuries occurring at the time of impact) and secondary lesions (lesions occurring after the initial injury, i.e., cerebral herniation, swelling, ischemia, infection, hydrocephalus), resulting from complication of physiological response to injury. Secondary injuries are potentially preventable by stabilizing the patient, by monitoring vital parameters, and, in some cases, by performing decompressive hemicraniectomy.
Other classifications are based on the mechanism of injury (open or blunt trauma) and on the location, dividing them into intra-axial lesions (cortical contusions, diffuse axonal injury, intracerebral hematoma) and extra-axial lesions (subdural, epidural, subarachnoid, and intraventricular hematomas).
Given these data, it is easy to understand the significative role of imaging in this clinical setting, since its goals are to identify treatable lesions, assist to prevent secondary damage, and provide prognostic information.
In this chapter we aim to review the most commonly encountered and severe brain injuries and their complications