Correction of neglected post-burn severe calcaneo-valgus deformity of foot with Joshi’s external stabilization system: a one stage surgical procedure

Post burn calcaneovalgus is a complex foot deformity and management becomes increasingly difficult especially if deformity is neglected in growing young child resulting in secondary bony deformity. A simple technique of single stage surgical correction with Joshi’s external stabilization system (JESS) is described using principle of distraction osteogenesis or histogenesis without need of extensive plastic surgical procedure. A functional plantigrade foot is achieved after completion of the procedure without need of any bony procedure and least chances of any neurovascular compromise. JESS is a versatile external fixation device for correction of neglected postburn complex calcaneovalgus deformity

Longer Right Colon Withdrawal Time and Retroflexion Duration Significantly Increases Adenoma Detection Rate: A Randomized Controlled Trial at Three Endoscopy Centers

Title from PDF of title page viewed June 18, 2018Thesis advisor: Mary M. GerkovichVitaIncludes bibliographical references (pages 41-47)Thesis (M.S.)--School of Medicine. University of Missouri-- Kansas City, 2018Purpose Detection of adenomas is the foundation of colorectal cancer screening utilizing screening colonoscopies. Adenoma detection rate (ADR) is an increasingly utilized core quality measure for colonoscopies. Colonoscopy is an effective tool to prevent colon cancer but missed lesions can lead to development of interval colon cancer. These missed lesions are particularly in right-side of the colon. Careful examination of the right colon is recommended but the ideal withdrawal time for the right colon is unknown. Design /Method We conducted a prospective, randomized controlled trial in patients undergoing screening or surveillance colonoscopies for colorectal cancer at three hospitals. Adenoma detection rate was defined as the proportion of colonoscopies in which adenomas were detected, compared to all colonoscopies. ADR was compared in patients with < 3mins right colon (up to hepatic flexure) withdrawal time, to patients with ≥ 3mins right colon withdrawal time. Time spent from identifying the appendiceal orifice till the start of withdrawal, which included time spent intubating the terminal ileum and examining the ileum, was excluded as this time is usually not used to identify polyps. A secondary end point was to observe if retroflexion for ≥ 30 seconds compared to < 30 seconds improved ADR in the right colon. Results A total of 250 patients after randomization were included in the analysis. This sample included 135 patients in the < 3 minute right colon withdrawal group (RCWG) and 115 patients included in the ≥3 minute RCWG. Adenoma detection rate in the right colon was 33% if the right colon withdrawal time was ≥3mins compared to 14% if it was < 3 mins; the likelihood of finding right-sided adenomas was 3 times greater in the ≥ 3 min group compared to the < 3 min group, (OR 3, p<0.001, 95% CI 1.62-5.64). The adenoma detection rate in the right colon was also significantly higher when the modified right colon withdrawal time was used in ≥ 3mins group vs. < 3mins group which also showed that the ≥ 3mins group was 3 times more likely to find adenomas in the right colon compared to the < 3 min group (OR 3, p<0.001, 95% CI 1.62-5.64).Adenoma detection rate in the right colon was 45% when retroflexion was performed for≥ 30 seconds compared to 23% in the group where it was performed for < 30 seconds (OR 2.8, p=0.01, 95% CI 1.26 – 6.0). Polyps that were seen only on retroflexion, which could not be seen on forward view, were significantly more likely to be found in the ≥ 30 second group (22%, n =8) compared to the < 30 second group 3%, p<0.001. Conclusion Adenoma detection rate in the right colon was significantly higher when three minutes or more were spent examining the right colon during withdrawal. Significantly higher rates were seen even after taking polypectomy into account and in the average risk screening population. Adenoma detection rate in the right colon was also significantly improved when retroflexion wasperformed for more than 30 seconds.Introduction -- Review of literature -- Methods and materials -- Results -- Discussion -- Conclusions -- Appendix A. Tables -- Appendix B. Illustrations -- Appendix C. Form

High Pressure Study of IrN in Zinc-Blende Structure

The structural phase transition, volume collapse and second order elastic constants of 5d-transition metal mononitride (IrN) have been investigated by using interaction potential model (IPM) which consists of Coulomb interaction, three-body interaction and short range overlap repulsive interactions. The present theoretical approach has predicted pressure-volume relationship curves which shows that IrN exhibits a zinc-blend (ZB) type structure at an ambient pressure and undergoes a structural phase transition from B3 to B1 phase at pressure 72 GPa. The equation of state shows volume collapse of 9.09 %. The phase transition pressure and associated volume collapses obtained from this model show a reasonable agreement with other theoretical results. The second order elastic constants are also investigated for ZB phase. Keywords: High Pressure, Phase Transition, Transition Metal Compound

EARTH OBSERVATION AND CLIMATE SERVICES FOR FOOD SECURITY AND AGRICULTURAL DECISION MAKING IN SOUTH AND SOUTHEAST ASIA

Deliberations on new developments in the use of Earth observation for agriculture and food security in South and Southeast Asia gathered 120 participants to discuss i) agricultural and hydrological drought monitoring and early warning systems, ii) crop mapping and yield estimation, and iii) risk financing and agrometeorological advisory services

Pan-resistant Acinetobacter infection in neonates in Karachi, Pakistan.

Background: Pan-resistant Acinetobacter infection has emerged as an important nosocomial pathogen in our inPatient neonates over the past few years. Methodology: We performed a retrospective chart review during a five-year period (July 2003 - June 2008) of all neonates hospitalized in our neonatal intensive care unit (NICU) who developed Acinetobacter infection to identify mortality-associated risk factors in Acinetobacter neonatal infection. Results: During the five-year study period, 122 cultures from 78 neonates grew Acinetobacter. Source sites of positive culture were in the following descending order: blood (n = 57), trachea (n = 55), tissue/wound/body fluids (n = 4), eye (n = 4), urine (n = 1), and cerebrospinal fluid (n = 1). Twenty-four (31%) Patients had Acinetobacter isolated from more than one site. At the time of admission the mean age was 2.08 +/- 4 days and mean weight was 1.77 +/- 0.88 kg, 75% were premature. Pan-resistance (87/122, sensitive only to Polymyxin) was present in 71% of Acinetobacter isolates. Crude mortality rate of this cohort was 47%, while 70% of Patients died within four days after positive Acinetobacter culture. We identified weight of less than 1 kg on admission (p 0.06, adjusted Odds Ratio (AOR) 1.53), gestational age 28 weeks or less (p 0.011, AOR 2.88), poor perfusion (p 0.007, AOR 2.4), thrombocytopenia (p 0.01, AOR 1.6) and metabolic acidosis (p 0.01, AOR 1.67) as predictors associated with poor outcome. Conclusion: Pan-resistant Acinetobacter infection is exceedingly fatal in newborns, particularly in premature and very low-birth weight neonates. Rational antibiotic use and vigilant infection control in NICUs are key to controlling multi-drug resistant Acinetobacter infection and improving clinical outcome

Titanium Dioxide-Mediated Photcatalysed Degradation of Two Herbicide Derivatives Chloridazon and Metribuzin in Aqueous Suspensions

The aim of this paper is to find out the optimal degradation condition for two potential environmental pollutants, chloridazon and metribuzin (herbicide derivatives), employing advanced oxidation process using TiO2 photocatalyst in aqueous suspensions. The degradation/mineralization of the herbicide was monitored by measuring the change in pollutant concentration and depletion in TOC content as a function of time. A detailed degradation kinetics was studied under different conditions such as types of TiO2 (anatase/anatase-rutile mixture), catalyst concentration, herbicide concentration, initial reaction pH, and in the presence of electron acceptors (hydrogen peroxide, ammonium persulphate, potassium persulphate) in addition to atmospheric oxygen. The photocatalyst, Degussa P25, was found to be more efficient catalyst for the degradation of both herbicides as compared with two other commercially available TiO2 powders like Hombikat UV100 and PC500. Chloridazon (CHL) was found to degrade more efficiently under acidic condition, whereas metribuzin (MET) degraded faster under alkaline medium. All three electron acceptors tested in this study were found to enhance the degradation rate of both herbicides

The mystery of COVID-19 reinfections: A global systematic review and meta-analysis

Background: As the COVID-19 pandemic rages on, reports on disparities in vaccine roll out alongside COVID-19 reinfection have been emerging. We conducted a systematic review to assess the determinants and disease spectrum of COVID-19 reinfection.Materials and methods: A comprehensive search covering relevant databases was conducted for observational studies reporting Polymerase Chain Reaction (PCR) confirmed infection and reinfection cases. A quality assessment tool developed by the National Institute of Health (NIH) for the assessment of case series was utilized. Meta-analyses were performed using RevMan 5.3 for pooled proportions of findings in first infection and reinfection with a 95% confidence interval (CI).Results: Eighty-one studies reporting 577 cases were included from 22 countries. The mean age of patients was 46.2 ± 18.9 years and 179 (31.0%) cases of comorbidities were reported. The average time duration between first infection and reinfection was 63.6 ± 48.9 days. During first infection and reinfection, fever was the most common symptom (41.4% and 36.4%, respectively) whilst anti-viral therapy was the most common treatment regimen administered (44.5% and 43.0%, respectively). Comparable odds of symptomatic presentation and management were reported for the two infections. However, a higher Intensive Care Unit (ICU) admission rate was observed in reinfection compared to first infection (10 vs 3). Ten deaths were reported with respiratory failure being the most common cause of death (7/10 deaths).Conclusion: Our findings support immunization practices given increased ICU admissions and mortality in reinfections. Our cohort serves as a guide for clinicians and authorities in devising an optimal strategy for controlling the pandemic. (249 words)