Pancytopenia in pregnant patients with COVID-19 infection and vitamin B12 deficiency: a case report study

Background: Folate and vitamin B 12 deficiency can lead to pancytopenia in pregnancy. Some cases of pancytopenia due to COVID-19 infection have also been reported. The two cases that we present are related to the coincidence of pregnancy and deficiency of folic acid and vitamin B12 with COVID-19 infection. Case presentation: A 26-year- woman G3P1L1A1 and 21-year-woman G2P1L1 presented with pancytopenia and mild COVID-19 infection. The antenatal period was uneventful, and both cases also had folate and vitamin B12 deficiency. They received blood products, folic acid, and vitamin B12 supplementation. COVID- 19 infection was managed well with analgesic and vital monitoring. Postpartum hemorrhage occurred in the second case, which was well managed with uterotonics. All laboratory parameters came out to be normal after three months of supplementation of folic acid and vitamin B12. Conclusion: Pancytopenia in pregnancy due to folate and vitamin B12 deficiency and COVID- 19 infection can be easily managed with timely intensive targeted therapy, but we should be extra vigilant while handling such complicated cases, keeping in mind all possible differential diagnoses for pancytopenia

Intraoral Foregut Cystic Developmental Malformations: Three cases with a brief review of literature

Foregut cystic developmental malformations (FCDM) are a type of rare cystic lesion. The occurrence of FCDM is exceedingly uncommon in the intraoral location. We report three cases of FCDM with intraoral location who presented at Chacha Nehru Bal Chikitsalaya, New Delhi, India, in 2016, 2017 and 2018 with symptoms of respiratory distress and feeding difficulties. Two patients were male and one was female with an age range of 29 days to eight years. The clinical differential diagnosis included mucocele, ranula, dermoid, lymphangioma, teratoma, thyroglossal duct cyst, etc. All patients were treated with simple surgical excision and diagnosed, based on histopathology, with FCDM. These should be considered as differential diagnosis of head and neck midline cystic mass lesions. This case report aimed to discuss differential diagnosis and appropriate terminology for these cystic masses as there is varied and ambiguous nomenclature.Keywords: Bronchogenic Cyst; Cyst; Congenital Abnormalities; Oral Cavity; Case Report; India

Trauma Management: Should it be a part of Medical Curriculum?

Trauma management is an approach to assess and treat multiply injured patients. Casualties that present within the first twohours of injury are deaths that can be prevented. Medical professionals need to be trained to appraise and manage these patientsduring this period. A variety of courses are available, designed entirely to teach medical professionals to treat trauma patients.Many counties have adopted these programs and now they are being taught in over 60 countries worldwide. In developingcountries, injuries due to trauma are regrettably neglected, and accounts for more than five million deaths each year. This isnearly equal to combined number of deaths from tuberculosis, malaria and HIV/AIDS. Medical graduates are supposed to beable to handle all types of emergencies, common or traumatic. Lack of ATLS, BCLS and ACLS certified doctors in emergencydepartments lead to improper and un-necessary delay in provision of medical care to patients

How general practitioners and patients discuss type 2 diabetes mellitus and cardiovascular diseases concerns during consultations: Implications for digital health

Objective: To analyse general practitioner–patient consultations about type 2 diabetes mellitus or cardiovascular diseases and describe (i) the nature of self-management discussions; (ii) actions required from patients during and after consultation regarding self-management; and (iii) implications for digital health to support patients during (and after) consultation. Method: This study screened 281 general practitioner consultations conducted in 2017 within the UK general practice setting from an existing dataset containing videos and transcripts of consultations between GPs and patients. Secondary analysis was conducted using a multi-method approach, including descriptive, content, and visualisation analysis, to inform the nature of self-management discussions, what actions are required from patients, and whether digital technology was mentioned during the consultation to support self-management. Results: Analysis of eligible 19 consultations revealed a discord between what self-management actions are required of patients during and after consultations. Lifestyle discussions are often discussed in depth, but these discussions rely heavily on subjective inquiry and recall. Some patients in these cohorts are overwhelmed by self-management, to the detriment of their personal health. Digital support for self-management was not a major topic of discussion, however, we identified a number of emergent gaps where digital technology can support self-management concerns. Conclusion: There is potential for digital technology to reconcile what actions are required of patients during and after consultations. Furthermore, a number of emergent themes around self-management have implications for digitalisation

Surface defects incorporated diamond machining of silicon

Abstract This paper reports the performance enhancement benefits in diamond turning of the silicon wafer by incorporation of the surface defect machining (SDM) method. The hybrid micromachining methods usually require additional hardware to leverage the added advantage of hybrid technologies such as laser heating, cryogenic cooling, electric pulse or ultrasonic elliptical vibration. The SDM method tested in this paper does not require any such additional baggage and is easy to implement in a sequential micro-machining mode. This paper made use of Raman spectroscopy data, average surface roughness data and imaging data of the cutting chips of silicon for drawing a comparison between conventional single-point diamond turning (SPDT) and SDM while incorporating surface defects in the (i) circumferential and (ii) radial directions. Complementary 3D finite element analysis (FEA) was performed to analyse the cutting forces and the evolution of residual stress on the machined wafer. It was found that the surface defects generated in the circumferential direction with an interspacing of 1 mm revealed the lowest average surface roughness (Ra) of 3.2 nm as opposed to 8 nm Ra obtained through conventional SPDT using the same cutting parameters. The observation of the Raman spectroscopy performed on the cutting chips showed remnants of phase transformation during the micromachining process in all cases. FEA was used to extract quantifiable information about the residual stress as well as the sub-surface integrity and it was discovered that the grooves made in the circumferential direction gave the best machining performance. The information being reported here is expected to provide an avalanche of opportunities in the SPDT area for low-cost machining solution for a range of other nominal hard, brittle materials such as SiC, ZnSe and GaAs as well as hard steels.</jats:p

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Optimization of Process Parameters to Achieve Nano Level Surface Quality on Polycarbonate

Optical grade plastics are increasingly being used as magnifiers in Ophthalmic Optical Instrumentation applications. In its effort to develop indigenously aspheric technology-based Ophthalmic Optical aids, the Aspheric Group at CSIO has studied the machining and surface characteristics of optical grade plastics. Generally, PMMA and polycarbonate considered as suitable candidates for aspheric Visual aids. In the study presented, optical grade polycarbonate is explored for its single-point diamond turning (SPDT) features and its profile characteristics. This study focuses on the optimization of SPDT machining parameters viz: tool feed rate, depth of cut, spindle speed for a given tool nose radius. In this study, the machining sensitivity in terms of surface roughness and profile error (Pt) is investigated. It is found that machining parameters play a major role in surface quality optimization in terms of roughness and profile. Based on optimized machining parameters, good quality aspheric lens is developed

Monitoring and Predicting the Surface Generation and Surface Roughness in Ultraprecision Machining: A Critical Review

The aim of manufacturing can be described as achieving the predefined high quality product in a short delivery time and at a competitive cost. However, it is unfortunately quite challenging and often difficult to ensure that certain quality characteristics of the products are met following the contemporary manufacturing paradigm, such as surface roughness, surface texture, and topographical requirements. Ultraprecision machining (UPM) requirements are quite common and essential for products and components with optical finishing, including larger and highly accurate mirrors, infrared optics, laser devices, varifocal lenses, and other freeform optics that can satisfy the technical specifications of precision optical components and devices without further post-polishing. Ultraprecision machining can provide high precision, complex components and devices with a nanometric level of surface finishing. Nevertheless, the process requires an in-depth and comprehensive understanding of the machining system, such as diamond turning with various input parameters, tool features that are able to alter the machining efficiency, the machine working environment and conditions, and even workpiece and tooling materials. The non-linear and complex nature of the UPM process poses a major challenge for the prediction of surface generation and finishing. Recent advances in Industry 4.0 and machine learning are providing an effective means for the optimization of process parameters, particularly through in-process monitoring and prediction while avoiding the conventional trial-and-error approach. This paper attempts to provide a comprehensive and critical review on state-of-the-art in-surfaces monitoring and prediction in UPM processes, as well as a discussion and exploration on the future research in the field through Artificial Intelligence (AI) and digital solutions for harnessing the practical UPM issues in the process, particularly in real-time. In the paper, the implementation and application perspectives are also presented, particularly focusing on future industrial-scale applications with the aid of advanced in-process monitoring and prediction models, algorithms, and digital-enabling technologies

An experimental study on the effect of magneto-rheological finishing on diamond turned surfaces

Magneto-rheological materials are a class of smart materials whose rheological properties can be rapidly varied by applying a magnetic field. Magneto-rheological finishing utilizes magneto-rheological fluid, which consists of magnetic particles, non-magnetic abrasives and some additives in water or other carrier to polish the materials. Single-point diamond turning is able to remove hundreds of microns of material and generate surface with micron accuracies. Residual turning marks are the most important factor limiting the performance in diamond turning process. Magneto-rheological finishing has inherent ability to improve micro-roughness, remove subsurface damage and reduce residual stresses induced during diamond turning process. Combining single-point diamond turning and magneto-rheological finishing creates a deterministic process for manufacturing highly finished surfaces. In this article, an attempt has been made to improve the finish of diamond turned surface with magneto-rheological finishing and to investigate the effects of parameters like current, spacing, wheel speed, feed rate and magnetic field on the final surface finish. Based on the parametric study, an optimum combination of process parameters is identified using analysis of variance. Various image processing techniques have been used for the comparison of the surface analysis of diamond turned surfaces and the magneto-rheological finished surfaces

The New Normal in Urban Pakistan: A Journey of Undergraduate Students Through Photovoice

The COVID-19 global health crisis is an issue of survival for individuals and communities worldwide. With its widespread consequences manifested at every level of the society, concerns about how to adapt to the new normal are rising. This study explores the lived experiences of second-year undergraduate university students located in urban Pakistan amid the early months of the COVID-19 pandemic, in March to May 2020. Drawing on a participatory research approach, students as participants adopted a photovoice methodology to document, share, and analyze their new life realities. The themes that emerged from the data include fear, anxiety, isolation, relationships and hope, among others. Feelings of agency, empathy and a desire for community action were observed in the photo narratives shared by the participants, as they discussed their health, academic, and communication challenges while struggling to conform to the present circumstances