Risk of blood splashes to the eye during surgery

Background. With the advent of a new infectious era involving the HIV and hepatitis B and C viruses, concern has arisen about transmission of these viruses through ocular blood splashes during surgery. The purpose of the study was to determine the risk of ocular blood splashes to surgeons and their assistants during surgery. Method. Surgeons and assistants in several surgical disciplines were requested to wear facemasks with a transparent plastic visor. The visors were collected postoperatively and inspected for macroscopic and microscopic blood splashes. Results. Fifty-nine per cent of the surgeons and assistants refused to wear facemasks with a visor. The incidence of blood splashes in those who participated was 45%. There was a trend for blood splashes to be more common during major surgery and during elective surgery. Surgeons and assistants were subject to similar risk. Conclusion. This study confirms the significant risk of ocular blood splashes during surgery, while also suggesting that both surgeons and assistants lack appreciation of the risk

Game saturation of intersecting families

We consider the following combinatorial game: two players, Fast and Slow, claim $k$-element subsets of $[n]=\{1,2,...,n\}$ alternately, one at each turn, such that both players are allowed to pick sets that intersect all previously claimed subsets. The game ends when there does not exist any unclaimed $k$-subset that meets all already claimed sets. The score of the game is the number of sets claimed by the two players, the aim of Fast is to keep the score as low as possible, while the aim of Slow is to postpone the game's end as long as possible. The game saturation number is the score of the game when both players play according to an optimal strategy. To be precise we have to distinguish two cases depending on which player takes the first move. Let $gsat_F(\mathbb{I}_{n,k})$ and $gsat_S(\mathbb{I}_{n,k})$ denote the score of the saturation game when both players play according to an optimal strategy and the game starts with Fast's or Slow's move, respectively. We prove that $\Omega_k(n^{k/3-5}) \le gsat_F(\mathbb{I}_{n,k}),gsat_S(\mathbb{I}_{n,k}) \le O_k(n^{k-\sqrt{k}/2})$ holds

Eddy Current Measurement of Density During Hot Isostatic Pressing

Hot isostatic pressing (HIPing) is an increasingly used process for consolidating and densifying metal and ceramic powders to near net shape. Powder is encapsulated in a thin walled cannister under vacuum and placed in a pressure vessel where it is subjected to a temperature/pressure cycle, Fig. 1. The cycle used is normally empirically determined and aims to achieve 100 percent theoretical density in the sample

Ischaemic preconditioning of the liver before transplantation

Purpose: Assessment of the effect of a short ischaemic time prior to liver transplantation on the liver graft. Methods: White X Landrace pigs (N=10) were subjected to liver transplantation. Before being removed from the donor animal, the livers were randomised into two groups: group 1 - pre-procurement ischaemia (15 minutes' temporary arrest of portal venous and hepatic arterial inflow to the liver, followed by reperfusion of these vessels for a period of 15 minutes); group 2 - no prior inflow occlusion (control group). In group 1 a spleno-jugular bypass was established to prevent venous congestion, portal venous hypertension, intestinal oedema and bacterial translocation. The livers were perfused with Eurocollins solution (4oC), after which they were stored on ice for a period of 3 hours' cold ischaemic time. Hepatocellular injury was assessed according to liver cell function tests (aspartate aminotransferase, AST), biochemical indicators of reperfusion injury (malondialdehyde) and histopathology. Results: There was a significant rise of AST in both groups 1 hour after transplantation (from 51+27 IU/l to 357+152 IU/l in group 1 and from 29+10 IU/l to 359+198 IU/l in group 2). AST levels were marginally lower in group 1 at 2 and 4 hours after transplantation. There was also a rise in malondialdehyde levels in both groups at 5, 20, 40 and 60 minutes after transplantation. Levels of malondialdehyde were lower in the primed group at 5, 20 and 40 minutes, while the levels at 60 minutes after transplantation were comparable. Histological changes, as measured by vacuolisation, neutrophil infiltration and hepatic cell necrosis, were less in livers transplanted after ischaemic preconditioning, although the difference was not significant. Conclusions: Ischaemic preconditioning of the donor liver seems to decrease hepatocellular damage, reperfusion injury and histological changes in the liver after transplantation. Further studies with larger numbers are indicated

Anaphylactic response to topical fluorescein 2% eye drops: a case report

<p>Abstract</p> <p>Introduction</p> <p>The intravenous use of fluorescein 10% during retinal angiography can cause severe systemic reactions including, on rare occasions, anaphylaxis. Fluorescein 2% eye drops are used extensively for clinical examination and diagnosis, but to the best of our knowledge, they have only been reported as being responsible for a systemic anaphylactic response on two previous occasions.</p> <p>Case presentation</p> <p>We report the case of a 51-year-old woman who developed an anaphylactic reaction when she was administered fluorescein sodium 2% eye drops after cataract surgery. This was the second time she had been exposed to fluorescein. She had brittle asthma and a history of anaphylaxis following exposure to a variety of drug and food allergens. She was successfully resuscitated and recovered completely over a period of two days.</p> <p>Conclusions</p> <p>Fluorescein 2% drops are universally used in general practice, ophthalmology, optometry, and casualty departments. Our case report reveals the potential for this benign eye drop to cause a life-threatening systemic reaction and emphasises the importance of considering this consequence when administering topical fluorescein 2% to a patient with a history of anaphylaxis to other allergens.</p

Rates of glycaemic deterioration in a real-world population with type 2 diabetes

Aims/hypothesis: There is considerable variability in how diabetes progresses after diagnosis. Progression modelling has largely focused on 'time to failure' methods, yet determining a 'coefficient of failure' has many advantages. We derived a rate of glycaemic deterioration in type 2 diabetes, using a large real-world cohort, and aimed to investigate the clinical, biochemical, pharmacological and immunological variables associated with fast and slow rates of glycaemic deterioration. Methods: An observational cohort study was performed using the electronic medical records from participants in the Genetics of Diabetes Audit and Research in Tayside Study (GoDARTS). A model was derived based on an individual's observed HbA(1c) measures from the first eligible HbA(1c) after the diagnosis of diabetes through to the study end (defined as insulin initiation, death, leaving the area or end of follow-up). Each HbA(1c) measure was time-dependently adjusted for the effects of non-insulin glucose-lowering drugs, changes in BMI and corticosteroid use. GAD antibody (GADA) positivity was defined as GAD titres above the 97.5th centile of the population distribution. Results: The mean (95% CI) glycaemic deterioration for type 2 diabetes and GADA-positive individuals was 1.4 (1.3, 1.4) and 2.8 (2.4, 3.3) mmol/mol HbA(1c) per year, respectively. A younger age of diagnosis, lower HDL-cholesterol concentration, higher BMI and earlier calendar year of diabetes diagnosis were independently associated with higher rates of glycaemic deterioration in individuals with type 2 diabetes. The rate of deterioration in those diagnosed at over 70 years of age was very low, with 66% having a rate of deterioration of less than 1.1 mmol/mol HbA(1c) per year, and only 1.5% progressing more rapidly than 4.4 mmol/mol HbA(1c) per year. Conclusions/interpretation: We have developed a novel approach for modelling the progression of diabetes in observational data across multiple drug combinations. This approach highlights how glycaemic deterioration in those diagnosed at over 70 years of age is minimal, supporting a stratified approach to diabetes management

Open Problems on Central Simple Algebras

We provide a survey of past research and a list of open problems regarding central simple algebras and the Brauer group over a field, intended both for experts and for beginners.Comment: v2 has some small revisions to the text. Some items are re-numbered, compared to v

Respecting the deal: how to manage co-opetitive actors in open innovation

Platforms like E-bay allow product seekers and providers to meet and exchange goods. On the same way in open innovation, as defined by Chesbrough, an enterprise can collect ideas from outside the company. But on E-bay, the seeker can return the product if it does not correspond to the expectations, since E-bay is the third-party actor in charge of assuring that the agreement between seekers and providers will be respected. So who does provide the same service for what concerns open innovation, where specifications might not fully defined? In this paper we shall describe the business model of an organizational structure to support the elicitation and respect of agreements between actors, who have conflicting interests but that gain from cooperating together. The concepts of the model will be illustrated to derive a set of propositions and a simple example will illustrate one of its possible instantiations. The description of our first evaluation phase shall find place at the end

"Pseudosarcoma" in a pregnant woman

BACKGROUND: Intravascular fasciitis (IVF) is a rare benign condition characterised by reactive myofibroblastic proliferation arising from the superficial or deep fascia and involving arteries and/or veins. It is a distinct variant of the more common condition of nodular fasciitis, which possesses similar clinical and histological features to IVF, but lacks vascular invasion. A thorough review of the literature revealed 26 reported cases of IVF. CASE PRESENTATION: We report a case of IVF in a 16-week pregnant lady affecting the hypothenar eminence of the hand associated with the ulnar artery. CONCLUSION: The characteristic involvement of muscular arteries and veins by reactive myofibroblastic proliferation in IVF suggests a malignant component and often leads to an inappropriate diagnosis for this benign condition. We propose that hormone-related changes associated with pregnancy may play an important role in the aetiopathogenesis of this myofibroblastic lesion

Access and utilisation of primary health care services comparing urban and rural areas of Riyadh Providence, Kingdom of Saudi Arabia

The Kingdom of Saudi Arabia (KSA) has seen an increase in chronic diseases. International evidence suggests that early intervention is the best approach to reduce the burden of chronic disease. However, the limited research available suggests that health care access remains unequal, with rural populations having the poorest access to and utilisation of primary health care centres and, consequently, the poorest health outcomes. This study aimed to examine the factors influencing the access to and utilisation of primary health care centres in urban and rural areas of Riyadh province of the KSA