Hypovitaminosis D and Systemic Lupus Erythematous Activity and Related Neuropathy: Clinical Correlation

Background: Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease. Vitamin D has a modulating effect on immune responses. Hypovitaminosis D is highly prevalent in SLE patients, and it may lead to SLE activity and SLE-related neuropathy. Aim of the study: To recognize the role of serum vitamin D levels in SLE activity and also to investigate its relation to SLE-related neuropathy. Patients and Methods: the current study was a cross-sectional study performed on 100 SLE patients, who were divided into two groups, Group 1: included 50 patients with disease activity. Group II: included 50 patients without disease activity. They were tested for serum vitamin D levels, serum electrolytes, complement levels and nerve conduction. Results: Vitamin D was significantly low in group1 (median = 9.0 ng/ml) compared to the group 2 (median = 19.3 ng/ml and P-value of<0.001). Hypovitaminosis D was statistically significantly correlated with lower levels of complement (both C3 and C4) in the activity group but not in the non-activity group. Vitamin D levels were significantly associated with delayed nerve conduction in both groups, suggesting that neuropathy was linked to vitamin D level rather than SLE activity Conclusion: Hypovitaminosis D is statistically significantly correlated with SLE activity and SLE-related neuropathy

POLLUTION CONTROL AND WASTE MINIMIZATION OF CHEMICAL PRODUCTS INDUSTRY A Case Study of Polymers Production Industry

A bench scale model and treatability study was developed for chemical product “Polymers ” industry to study the analysis of waste discharge. The main objective of this study is management and control of liquid and solid wastes in the industry in order to protect the environment and to gain benefits as much as possible from the wasted materials and identify opportunities for introducing pollution prevention measures and best method for waste minimization as cleaner production system. The study is taking into account all types of waste production including wastewater and solid waste during the production processes activities. The main raw materials used in the industry are naphthalene, Conc. Sulfuric acid, Formaldehyde, Sodium Hydroxide, Calcium Oxide, Sodium meta Bisulfate, oil. The main product of the industry is sulfated naphthalene formaldehyde which used as a super plasticizer material to achieve improved concrete properties. The chemicals used during the manufacturing processes are very toxic, hazardous and has severe impact on the environment and health of the workers. The liquid waste was found to be extremely soluble in water and very hardly biodegraded

Diagnostic accuracy of the combined use of conventional sonography and sonoelastography in differentiating benign and malignant solitary thyroid nodules

Objective: To assess the diagnostic accuracy of combined use of conventional grayscale US and sono-elastography in differentiating benign and malignant solitary thyroid nodules. Materials and methods: This prospective study included 50 patients with solitary thyroid nodules being evaluated using grayscale US followed with sono-elastography (USE). Suspicious conventional sonographic data for malignancy then evaluated using USE were classified according to Rago criteria with calculation of strain ratio. The diagnostic performances of grayscale US, elastography with Rago criteria, for predicting thyroid malignancy were compared and cutoff value for strain ration was statistically analyzed. Finally all patients with solitary nodule were subjected to US-guided FNAC and 35 patients recommended for surgery in the form of 12 patients underwent total thyroidectomy and 23 patients underwent thyroidectomy with neck dissection. Results: 30 females (60%), and 20 males (40%) were included (Mean age 38) with final diagnosis comprised 29 (58%) pathologically proved benign thyroid nodules and 21 (42%) pathologically proved malignant nodules. US showed significant relation between markedly hypo-echogenicity, oval than tall, margin irregularity, presence of micro-calcification with diagnosis of thyroid malignancies with p value <0.001. Regarding sonoelastography, there was significant relation between elastography scores 4 and 5 and thyroid malignancies showing sensitivity of 80%, a specificity of 100%, and p value <0.001. The most accurate strain ratio cutoff value among studied cases was 2.52. Combination of grayscale US and sono-elastography yielded better results with sensitivity of 92%, specificity of 95%, PPV of 89%, NPV of 92% and diagnostic accuracy or efficacy of 96%. Conclusion: Combined use of USE and grayscale US, showed superior performance in the differentiation of malignant and benign thyroid nodules compared with each technique alone. Suspicious US criteria with elasticity Rago scores 4 and 5 and strain ratio more than 2.52 are the most predictive signs of malignancy

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially