The readability of online patient information about laser resurfacing therapy

Because there are important distinctions between ablative and non-ablative laser resurfacing, accurate and effective patient education is paramount. However, as more patients use the internet as a resource for medical information, little is known about the content and readability of these sources. Thus, we sought to evaluate the readability of major online resources about laser resurfacing while recognizing the recommendations by the American Medical Association and National Institutes of Health. An internet search for the term "Laser Resurfacing" was performed. The first 9 results were identified, patient information from each of these 9 sites were downloaded, and a total of 25 articles were examined. Readability was analyzed using 7 different established tests. Analysis demonstrated an average grade level of at least 9th grade, with all articles exceeding the recommended 6th grade reading level, emphasizing that these resources are too challenging for many patients to read and comprehend. Such materials may hamper appropriate decision-making in patients considering the use of a laser for their dermatologic conditions. The potential detrimental effect on the opinion, participation, and satisfaction of laser resurfacing should spur dermatologists to be more critical of online patient materials and motivated to produce more appropriate resources

Using simplified blood pressure tables to avoid underdiagnosing childhood hypertension

Background: Recent studies have revealed that hypertension remains underdiagnosed in a significant number of children despite their recorded office blood pressure (OBP) exceeding the recommended fourth report OBP thresholds. Simplified OBP thresholds have been proposed to reduce this underdiagnosis of hypertension in children. In clinical practice, OBP screened as elevated according to the fourth report OBP thresholds are referred for ambulatory blood pressure (ABP) monitoring to rule out \u27white coat\u27 hypertension. Objectives: The present study tested the usefulness of simplified OBP thresholds to screen abnormal OBP for ABP monitoring referral. Methods: A total of 155 subjects were retrospectively analyzed with paired OBP and ABP recordings obtained from an outpatient referral clinic. OBP recordings were classified as abnormal according to the simplified and fourth report OBP thresholds. ABP measurements were classified as abnormal according to the ABP reference tables. Results : Simplified blood pressure (BP) tables correctly identified all OBP classified as abnormal according to fourth report BP thresholds (kappa [κ] 0.72 [95% CI 0.61 to 0.83]) for systolic OBP; κ 0.92 [95% CI 0.86 to 0.99] for diastolic OBP). OBP classified as abnormal by the simplified BP thresholds and by the fourth report BP thresholds performed similarly for correctly identifying abnormal ABP measurements as per ABP references (overlapping 95% CIs of the sensitivity, specificity and predictive values and likelihood ratios). Conclusions: Simplified BP tables, proposed to reduce the underdiagnosis of hypertension in children, can serve as a useful screening tool to decide a referral for ABP monitoring. Future prospective studies are needed to establish these findings

Hyperammonemic encephalopathy as a manifestation of Reye syndrome in a previously-healthy 14-year-old girl: A case report

Reye syndrome is seldom considered in the older child presenting with acute encephalopathy. The paucity of literature on Reye syndrome in the past 30 years highlights the importance of sharing new observations of this less-commonly considered disease. This case details an atypical presentation of Reye syndrome in an adolescent girl whose course was unexpectedly complicated by dialysis disequilibrium syndrome, occurring as a result of rapid metabolic shifts in the setting of urgent hemodialysis. A 14-year-old, previously healthy girl born to non-consanguineous Pakistani parents presented with acute-onset encephalopathy characterized by aggressive behaviour and altered level of consciousness. This was preceded by frequent vomiting and weeks of disordered eating. Laboratory findings included high anion-gap [30 (normal range, \u3c14)] metabolic acidosis [pH 7.23 (normal range, 7.35-7.45), bicarbonate 10 mmol/L (normal range, 22-29 mmol/L)] with markedly elevated peak levels of lactate [13.6 mmol/L (normal range, 0.5-2.2 mmol/L)] and ammonia [573 μmol/L (normal range, 11-48 μmol/L)]. Emergent hemodialysis was undertaken for management of severe hyperammonemia, with subsequent worsening of cerebral edema, elevated intracranial pressure, and consequent uncal and tonsillar herniation, in keeping with the development of dialysis disequilibrium syndrome. The patient was ultimately diagnosed with Reye syndrome after extensive biochemical and molecular testing including exome sequencing were non-contributory. This diagnosis would be consistent with her poor nutritional state, depleted carnitine levels, mild liver dysfunction and hyperammonemia. Two weeks of intensive care were required. The patient was ultimately discharged to a rehabilitation facility with ongoing fatigue and regression in motor and cognitive domains. Hyperammonemic encephalopathy should prompt consideration for Reye syndrome. Hyperammonemia is a medical emergency; the extremely time-sensitive nature of hyperammonemia management mandates that ammonia level testing be undertaken for any unexplained encephalopathy. Severe elevations can result in neurological impairment, cerebral edema, and are acutely life-threatening. Hemodialysis may be indicated for levels \u3e150 μmol/L; the urgency of ammonia clearance must be balanced against the risk of developing dialysis disequilibrium syndrome

Prompt emission polarimetry of Gamma Ray Bursts with ASTROSAT CZT-Imager

X-ray and Gamma-ray polarization measurements of the prompt emission of Gamma-ray bursts (GRBs) are believed to be extremely important for testing various models of GRBs. So far, the available measurements of hard X-ray polarization of GRB prompt emission have not significantly constrained the GRB models, particularly because of the difficulty of measuring polarization in these bands. The CZT Imager (CZTI) onboard {\em AstroSat} is primarily an X-ray spectroscopic instrument that also works as a wide angle GRB monitor due to the transparency of its support structure above 100 keV. It also has experimentally verified polarization measurement capability in the 100 $-$ 300 keV energy range and thus provides a unique opportunity to attempt spectro-polarimetric studies of GRBs. Here we present the polarization data for the brightest 11 GRBs detected by CZTI during its first year of operation. Among these, 5 GRBs show polarization signatures with $\gtrapprox$3$\sigma$, and 1 GRB shows $\>$2$\sigma$ detection significance. We place upper limits for the remaining 5 GRBs. We provide details of the various tests performed to validate our polarization measurements. While it is difficult yet to discriminate between various emission models with the current sample alone, the large number of polarization measurements CZTI expects to gather in its minimum lifetime of five years should help to significantly improve our understanding of the prompt emission.Comment: Accepted for Publication in ApJ ; a figure has been update

Timing Offset Calibration of CZTI instrument aboard ASTROSAT

The radio as well as the high energy emission mechanism in pulsars is yet not understood properly. A multi-wavelength study is likely to help in better understanding of such processes. The first Indian space-based observatory, ASTROSAT, has five instruments aboard, which cover the electromagnetic spectrum from infra-red (1300 $\AA$) to hard X-ray (380 KeV). Cadmium Zinc Telluride Imager (CZTI), one of the five instruments is a hard X-ray telescope functional over an energy range of 20-380 KeV. We aim to estimate the timing offset introduced in the data acquisition pipeline of the instrument, which will help in time alignment of high energy time series with those from two other ground-based observatories, viz. the Giant Meterwave Radio Telescope (GMRT) and the Ooty Radio Telescope (ORT). PSR B0531+21 is a well-studied pulsar with nearly aligned radio and hard X-ray pulse profiles. We use simultaneous observations of this pulsar with the ASTROSAT, the ORT and the GMRT. The pulsar was especially observed using the ORT with almost daily cadence to obtain good timing solutions. We also supplement the ORT data with archival FERMI data for estimation of timing noise. The timing offset of ASTROSAT instruments was estimated from fits to arrival time data at the ASTROSAT and the radio observatories. We estimate the offset between the GMRT and the ASTROSAT-CZTI to be -4716 $\pm$ 50 $\mu s$. The corresponding offset with the ORT was -29639 $\pm$ 50 $\mu s$. The offsets between the GMRT and Fermi-LAT -5368 $\pm$ 56 $\mu s$. (Abridged)Comment: 6 pages, 5 figures, 2 tables, Revised and Updated, accepted for publication in A&

High anorectal malformation in a five-month-old boy: a case report

<p>Abstract</p> <p>Introduction</p> <p>Anorectal malformation, one of the most common congenital defects, may present with a wide spectrum of defects. Almost all male patients present within first few days of life.</p> <p>Case presentation</p> <p>A five-month-old baby boy of Indian origin and nationality presented with anal atresia and associated rectourethral prostatic fistula. The anatomy of the malformation and our patient's good condition permitted a primary definitive repair of the anomaly. A brief review of the relevant literature is included.</p> <p>Conclusion</p> <p>Delayed presentation of a patient with high anorectal malformation is rare. The appropriate treatment can be rewarding.</p

Vitrification and Glass Transition of Water: Insights from Spin Probe ESR

Three long standing problems related to the physics of water viz, the possibility of vitrifying bulk water by rapid quenching, its glass transition, and the supposed impossibility of obtaining supercooled water between 150 and 233 K, the so-called 'no man's land'of its phase diagram, are studied using the highly sensitive technique of spin probe ESR. Our results suggest that water can indeed be vitrified by rapid quenching, it undergoes a glass transition at \~ 135 K, and the relaxation behavior studied using this method between 165 K and 233 K closely follows the predictions of the Adam-Gibbs model.Comment: 13 pages, 3 figures; results on slow cooled water added; four figures compressed in to thre

Effect of post harvest treatments and harvesting stage on vase life and flower quality of cut Oriental lily

An investigation was carried out to study the effect of post harvest treatments and harvesting stage on vase life and flower quality of cut Oriental lily cv. Avocado. The results showed that highest vase life (15.83 days) and vase solution uptake (49.17 ml) was recorded with sucrose (2%) + 5-SSA (200ppm), whereas maximum flower diameter (15.17 cm) was recorded in vase solution containing sucrose (2%) + 5-SSA (100ppm). Earliest opening of florets (4.42 days) reported under sucrose (2%) + 5-SSA (200ppm). Effect of treatments was found non-significant in respect to opening of florets. Harvesting at green bud stage exhibited extended vase life (14.33 days) and higher vase solution uptake (40.43 ml), whereas maximum flower diameter (14.25 cm) recorded at 75% colour development stage. Based on the results it is concluded that 5-SSA could be an inexpensive and potential chemical for delaying senescence and for extending the keeping quality of cut liliums commercially

Triethyl­ammonium N′-(benzyl­sulfanylthio­carbonyl)-2-hydroxy­benzohydrazidate

In the title compound, C6H16N+·C15H13N2O2S2 −, the thione S atom is in a cis configuration with respect to the phenyl and benzene rings, while it adopts a trans configuration with respect to the carbonyl group. The dihedral angle between the benzene and phenyl rings is 78.81 (2)°. The mol­ecular conformation is stabilized by intra­molecular O—H⋯O and N—H⋯S hydrogen bonds, while inter­molecular N—H⋯O, N—H⋯N and weak C—H⋯O inter­actions help to stabilize the crystal structure