Acute Coronary Syndrome in a Young Patient with Dual Mechanical Valves and Therapeutic International Normalized Ratio - A Rare Occurrence

Patients of valvular heart disease treated with mechanical valve replacement are required to be on lifelong medication with anticoagulants. Complications may arise when adequate International Normalized Ratio (INR) control is not maintained, leading to thromboembolic events, but very few cases have been reported where these complications arise despite therapeutic INR control. We, here, highlight a case of rare fatal complication of Acute Coronary Syndrome in a one month postoperative patient of Dual Mechanical Valve Replacement with therapeutic INR, which evaded correct diagnosis due to unawareness on the part of the treating team of physicians

Prevalence of hepatitis B and C among patients admitted in respiratory medicine ward of a tertiary care hospital in Mullana, Ambala, Haryana, India

Background: Viral Hepatitis B and C have become a major public health problem. Hepatitis B affects approximately 30% of world population or about 2 billion people have serological evidence of either current or past infection. Hepatitis C virus infects approximately 3% of world population placing about 170 million people at risk of liver disease. In India, HBsAg prevalence rates among general population ranges from 0.1% to 11.7%, being 2% to 8% in most studies and seroprevalence for Hepatitis C ranges from 0.1% to 8% among general population.Methods: The study was conducted in the respiratory medicine Ward, MMIMSR in the month of August 2016. 200 patients were taken up for the study after clinical examination, necessary investigation and proper consent. Patients were tested for HBsAg antigen and HCV Tridot. Patients were put through a carefully designed questionnaire to look for possible cause of infection. Patients who came out to be positive for either Hepatitis B or C were counselled about further investigations and treatment options.Results: The prevalence rate for Hepatitis B came out to be 9% and for Hepatitis C was 5.5%. Hepatitis has become a major public health issue in India particularly in the rural areas. High prevalence rates among patients with respiratory diseases can be attributed to unsafe therapeutic injections and use of shared needles.Conclusions: There is a need to carry out larger studies to better elucidate the epidemiology of Hepatitis B and C and to identify high prevalence areas and simultaneously focus on improving public health measures to prevent disease transmission and decrease the burden of disease

Cephalometric Evaluation of the Effect of Complete Dentures on Retropharyngeal Space and Its Effect on Spirometric Values in Altered Vertical Dimension

Role of complete dentures in reducing apnea-hypoapnea index in edentulous obstructive sleep apnea patient has shown promising results in previous studies. This study was undertaken to ascertain the role of complete denture and complete denture with slight increase in vertical dimension using custom made occlussal jig, on retropharyngeal space, posterior airway space, pharyngeal depth, and spirometric readings in comparison with those in edentulous group. Significant changes were observed in both intervention groups and thus, paving the way for doing further research for the consideration of using complete denture with modifications as an oral appliance in edentulous obstructive sleep apnea patient

Nanoscale Surface Plasmonics Sensor With Nanofluidic Control

Conventional quantitative protein assays of bodily fluids typically involve multiple steps to obtain desired measurements. Such methods are not well suited for fast and accurate assay measurements in austere environments such as spaceflight and in the aftermath of disasters. Consequently, there is a need for a protein assay technology capable of routinely monitoring proteins in austere environments. For example, there is an immediate need for a urine protein assay to assess astronaut renal health during spaceflight. The disclosed nanoscale surface plasmonics sensor provides a core detection method that can be integrated to a lab-on-chip device that satisfies the unmet need for such a protein assay technology. Assays based upon combinations of nanoholes, nanorings, and nanoslits with transmission surface plasmon resonance (SPR) are used for assays requiring extreme sensitivity, and are capable of detecting specific analytes at concentrations as low as picomole to femtomole level in well-controlled environments. The device operates in a transmission mode configuration in which light is directed at one planar surface of the array, which functions as an optical aperture. The incident light induces surface plasmon light transmission from the opposite surface of the array. The presence of a target analyte is detected by changes in the spectrum of light transmitted by the array when a target analyte induces a change in the refractive index of the fluid within the nanochannels. This occurs, for example, when a target analyte binds to a receptor fixed to the walls of the nanochannels in the array. Independent fluid handling capability for individual nanoarrays on a nanofluidic chip containing a plurality of nanochannel arrays allows each array to be used to sense a different target analyte and/or for paired arrays to analyze control and test samples simultaneously in parallel. The present invention incorporates transmission mode nanoplasmonics and nanofluidics into a single, microfluidically controlled device. The device comprises one or more arrays of aligned nanochannels that are in fluid communication with inflowing and outflowing fluid handling manifolds that control the flow of fluid through the arrays. The array acts as an aperture in a plasmonic sensor. Fluid, in the form of a liquid or a gas and comprising a sample for analysis, is moved from an inlet manifold through the nanochannel array, and out through an exit manifold. The fluid may also contain a reagent used to modify the interior surfaces of the nanochannels, and/or a reagent required for the detection of an analyte

Global, regional, and national progress towards Sustainable Development Goal 3.2 for neonatal and child health: all-cause and cause-specific mortality findings from the Global Burden of Disease Study 2019

Background Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000 livebirths, and reduction of death of children younger than 5 years to less than 25 per 1000 livebirths, for each country by 2030. To understand current rates, recent trends, and potential trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 findings for all-cause mortality and cause-specific mortality in children younger than 5 years of age, with multiple scenarios for child mortality in 2030 that include the consideration of potential effects of COVID-19, and a novel framework for quantifying optimal child survival. Methods We completed all-cause mortality and cause-specific mortality analyses from 204 countries and territories for detailed age groups separately, with aggregated mortality probabilities per 1000 livebirths computed for neonatal mortality rate (NMR) and under-5 mortality rate (USMR). Scenarios for 2030 represent different potential trajectories, notably including potential effects of the COVID-19 pandemic and the potential impact of improvements preferentially targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all GBD location-years. The first metric is a global optimum and is based on the lowest observed mortality, and the second is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access and Quality Index. Findings Global U5MR decreased from 71.2 deaths per 1000 livebirths (95% uncertainty interval WI] 68.3-74-0) in 2000 to 37.1 (33.2-41.7) in 2019 while global NMR correspondingly declined more slowly from 28.0 deaths per 1000 live births (26.8-29-5) in 2000 to 17.9 (16.3-19-8) in 2019. In 2019,136 (67%) of 204 countries had a USMR at or below the SDG 3.2 threshold and 133 (65%) had an NMR at or below the SDG 3.2 threshold, and the reference scenario suggests that by 2030,154 (75%) of all countries could meet the U5MR targets, and 139 (68%) could meet the NMR targets. Deaths of children younger than 5 years totalled 9.65 million (95% UI 9.05-10.30) in 2000 and 5.05 million (4.27-6.02) in 2019, with the neonatal fraction of these deaths increasing from 39% (3.76 million 95% UI 3.53-4.021) in 2000 to 48% (2.42 million; 2.06-2.86) in 2019. NMR and U5MR were generally higher in males than in females, although there was no statistically significant difference at the global level. Neonatal disorders remained the leading cause of death in children younger than 5 years in 2019, followed by lower respiratory infections, diarrhoeal diseases, congenital birth defects, and malaria. The global optimum analysis suggests NMR could be reduced to as low as 0.80 (95% UI 0.71-0.86) deaths per 1000 livebirths and U5MR to 1.44 (95% UI 1-27-1.58) deaths per 1000 livebirths, and in 2019, there were as many as 1.87 million (95% UI 1-35-2.58; 37% 95% UI 32-43]) of 5.05 million more deaths of children younger than 5 years than the survival potential frontier. Interpretation Global child mortality declined by almost half between 2000 and 2019, but progress remains slower in neonates and 65 (32%) of 204 countries, mostly in sub-Saharan Africa and south Asia, are not on track to meet either SDG 3.2 target by 2030. Focused improvements in perinatal and newborn care, continued and expanded delivery of essential interventions such as vaccination and infection prevention, an enhanced focus on equity, continued focus on poverty reduction and education, and investment in strengthening health systems across the development spectrum have the potential to substantially improve USMR. Given the widespread effects of COVID-19, considerable effort will be required to maintain and accelerate progress. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd

Haiti Day 4

photographhttps://hsrc.himmelfarb.gwu.edu/artshow_gallery_2017/1087/thumbnail.jp

Haiti Day 4

photographhttps://hsrc.himmelfarb.gwu.edu/artshow_gallery_2017/1088/thumbnail.jp

Haiti Day 2

photographhttps://hsrc.himmelfarb.gwu.edu/artshow_gallery_2017/1086/thumbnail.jp

Haiti Day 6

photographhttps://hsrc.himmelfarb.gwu.edu/artshow_gallery_2017/1090/thumbnail.jp