Background
Emergency department visits quadrupled with the initial onset and surge during the 2009 H1N1 influenza pandemic in New York City from April to June 2009. This time period was unique in ...that >90% of the circulating virus was surveyed to be the novel 2009 H1N1 influenza A according to the New York City Department of Health. We describe our experience using lung ultrasound in a case series of patients with respiratory symptoms requiring chest X-ray during the initial onset and surge of the 2009 H1N1 influenza pandemic.
Methods
We describe a case series of patients from a prospective observational cohort study of lung ultrasound, enrolling patients requiring chest X-ray for suspected pneumonia that coincided with the onset and surge of the 2009 H1N1 influenza pandemic.
Results
Twenty pandemic 2009 H1N1 influenza patients requiring chest X-ray were enrolled during this time period. Median age was 6.7 years. Lung ultrasound via modified Bedside Lung Ultrasound in Emergency protocol assisted in the identification of viral pneumonia (
n
= 15; 75%), viral pneumonia with superimposed bacterial pneumonia (
n
= 7; 35%), isolated bacterial pneumonia only (
n
= 1; 5%), and no findings of viral or bacterial pneumonia (
n
= 4; 20%) in this cohort of patients. Based on 54 observations, interobserver agreement for distinguishing viral from bacterial pneumonia using lung ultrasound was
ĸ
= 0.82 (0.63 to 0.99).
Conclusions
Lung ultrasound may be used to distinguish viral from bacterial pneumonia. Lung ultrasound may be useful during epidemics or pandemics of acute respiratory illnesses for rapid point-of-care triage and management of patients.
The utility of point-of-care ultrasound is well supported by the medical literature. Consequently, pediatric emergency medicine providers have embraced this technology in everyday practice. Recently, ...the American Academy of Pediatrics published a policy statement endorsing the use of point-of-care ultrasound by pediatric emergency medicine providers. To date, there is no standard guideline for the practice of point-of-care ultrasound for this specialty. This document serves as an initial step in the detailed “how to” and description of individual point-of-care ultrasound examinations. Pediatric emergency medicine providers should refer to this paper as reference for published research, objectives for learners, and standardized reporting guidelines.
Objectives
The objective was to determine the test performance characteristics for point‐of‐care lung ultrasonography (LUS) performed by pediatric emergency medicine (PEM) physicians compared with ...radiographic diagnosis of acute chest syndrome (ACS) in patients with sickle cell disease (SCD) and fever.
Methods
This was a prospective study of patients up to 21 years with SCD and fever requiring chest X‐ray (CXR) evaluation for ACS. Before obtaining CXR, a blinded PEM physician performed LUS using a standardized scanning protocol. Positive LUS for ACS was defined as lung consolidation. All patients received CXR and follow‐up. The criterion standard for ACS was consolidation on CXR as determined by a blinded radiologist. LUS clips were reviewed by a blinded expert PEM sonologist.
Results
A total of 116 febrile events from 91 patients with a median age of 5.7 years were enrolled by 15 PEM sonologists. CXR was positive for ACS in 15 (13%) patients, and LUS was positive for ACS in 19 (16%) patients. Positive LUS had a sensitivity of 87% (95% confidence interval CI = 62% to 96%), specificity of 94% (95% CI = 88% to 97%), positive likelihood ratio of 14.6 (95% CI = 6.5 to 32.5), and negative likelihood ratio of 0.14 (95% CI = 0.04 to 0.52) for ACS. The interobserver agreement (kappa) was 0.77. There were two missed cases of ACS on LUS.
Conclusions
LUS may be sensitive and specific for diagnosis of ACS in pediatric patients with SCD and fever. LUS may reduce the need for routine CXR and associated ionizing radiation exposure in this population.
Gossypiboma: a surgical menace Shah, Nitin H; Joshi, Aditi V; Shah, Vaishali N
International Journal of Reproduction, Contraception, Obstetrics and Gynecology,
11/2019, Letnik:
8, Številka:
11
Journal Article
Gossypiboma is a rare yet devastating complication. It may be a sequela to any kind of surgical procedure, however intra-abdominal surgeries are commonly implicated as the cause for this entity. In ...chronic cases, it may even lead to severe morbidity. We report a case of gossypiboma post vaginal hysterectomy, diagnosed and treated successfully by laparoscopy.
In density functional theory (DFT)-based total energy studies, the van der Waals (vdW) and zero-point vibrational energy (ZPVE) correction terms are included to obtain energy differences between ...polymorphs. We propose and compute a new correction term to the total energy, due to electron–phonon interactions (EPI). We rely on Allen’s general formalism, which goes beyond the quasi-harmonic approximation (QHA), to include the free energy contributions due to quasiparticle interactions. We show that, for semiconductors and insulators, the EPI contributions to the free energies of electrons and phonons are the corresponding zero-point energy contributions. Using an approximate version of Allen’s formalism in combination with the Allen–Heine theory for EPI corrections, we calculate the zero-point EPI corrections to the total energy for cubic and hexagonal polytypes of carbon, silicon and silicon carbide. The EPI corrections alter the energy differences between polytypes. In SiC polytypes, the EPI correction term is more sensitive to crystal structure than the vdW and ZPVE terms and is thus essential in determining their energy differences. It clearly establishes that the cubic SiC-3C is metastable and hexagonal SiC-4H is the stable polytype. Our results are consistent with the experimental results of Kleykamp. Our study enables the inclusion of EPI corrections as a separate term in the free energy expression. This opens the way to go beyond the QHA by including the contribution of EPI on all thermodynamic properties.
Abstract Objective GoPro and Google Glass technology have previously been used to record procedures in ophthalmology and other medical fields. In this manuscript, GoPro’s latest HERO 4 Black edition ...camera (GoPro Inc, San Mateo, Calif.) will be used to record the placement of a scleral buckle during retinal detachment surgery. Methods GoPro HERO 4 Black edition camera, which records 4K-quality video with a resolution of 3840 (pixels) x 2160 (lines), was mounted on a head strap to record placement of a scleral buckle for a retinal detachment. Results Excellent video quality was achieved with the 4K SuperView setting. Bluetooth connection with an Apple iPad (Apple Inc, Cupertino, Calif.) provided live streaming and use of the GoPro App. Zoom, horizontal/vertical alignment, exposure, and contrast adjustments were made with postproduction editing on GoPro Studio software. Conclusions Video recording with the GoPro HERO 4 Black edition camera is an excellent way to document extraocular procedures to improve medical education, self-training, or medicolegal documentation.
Osseous metaplasia of the endometrium is a rare condition with formation of bony tissue inside the uterus, particularly the endometrium. The etiology of this disorder is not completely understood, ...with various hypotheses being put forward to explain its occurrence. It is an important cause of secondary infertility, although it may present with various other gynecological symptoms. It can be suspected on ultrasonography due to its peculiar appearance and can be completely cured following hysteroscopic resection. Here we present a case of a 30 years old female presenting with hypomenorrhoea and secondary infertility following a first trimester abortion. Ultrasonography showed presence of dense linear echogenic band in the uterus suggestive of calcification. Hysteroscopy revealed multiple bony fragments of varying shapes and sizes (0.2-2cm) in the uterine cavity which were removed using a hysteroscopic grasper and the cavity was restored to normal. There were no procedure related complications. Presence of bony tissue was confirmed on histopathology. Patient had a spontaneous conception 3 months after the procedure and delivered a healthy male child at term. Thus, in our case, hysteroscopy was a safe and effective modality for diagnosis as well as treatment of this rare condition. Successful hysteroscopic treatment was followed by a spontaneous conception and a good pregnancy outcome. Keywords: Osseous, Metaplasia, Endometrium, Infertility
Can a material be designed and engineered to use as a replacement for an environmentally unfriendly material? In the specific context of lead titanates, the quest for finding such material ...replacements is ongoing, beginning from lead free alternatives with simple perovskite compositions, extending to hybrid and double perovskite compositions. In this work, we have demonstrated through ab initio density functional theory investigations the tunability of multiple properties of a simple perovskite Ba0.5Sn0.5TiO3 to mimic that of PbTiO3. Our results show that A-site Sn enhances the polarization of Ba0.5Sn0.5TiO3 closer to that of PbTiO3 and tunes its pressure dependent polarization behavior to become similar to that of PbTiO3 and dissimilar to that of BaTiO3 by reorienting the displacements profiles of A, B site and O atoms to become like that of their counterparts in PbTiO3. Compressive pressures facilitate transition from indirect to direct bandgap, increase the mobility of charge carriers and lead to stronger exciton binding in Ba0.5Sn0.5TiO3 opening up its use for optoelectronics. Ba0.5Sn0.5TiO3 has an early onset of absorption and its absorption spectra in UV range is qualitatively similar to PbTiO3 albeit with reduced absorption peak heights and broadening. The absorption spectra of Ba0.5Sn0.5TiO3 can be modified via application of strains and peak absorption heights can be changed to become similar to that of PbTiO3. We also demonstrate that the dielectric constant as well as refractive index of Ba0.5Sn0.5TiO3 can be modulated to increase (decrease) by applying compressive (tensile) strains. The study of mechanical properties demonstrates that Ba0.5Sn0.5TiO3 is more ductile and is mechanically stable even under higher compressive strains making it excitingly attractive for device applications over other lead-free alternatives that are known to display poor stabilities. These comprehensive investigations demonstrate for the first time that all the physical properties of Ba0.5Sn0.5TiO3 can be tuned as desired for a chosen device application making it a competitive and green replacement to lead titanates.
•All properties of Ba0.5Sn0.5TiO3 tunable to resemble PbTiO3.•A-site Sn drives polarization behavior to be akin to PbTiO3 and unlike to BaTiO3.•Compressive strains cause indirect–direct bandgap change and enhance carrier mobility.•Mechanical and thermodynamic stability under compressive strains similar to PbTiO3.•Our study gives a systematic design guideline to replace lead based perovskites.
Objective: Punarnavashtak kwath (PNK) is a classical Ayurvedic formulation, mentioned in Ayurvedic literature Bhaishajya Ratnavali, for hepatic disorders and asthma. This study investigated the ...hepatoprotective activity of PNK to validate the traditional use of this formulation.
Materials and methods: PNK was prepared in the laboratory according to the method given in Ayurvedic literature. Phytochemical screening was performed to determine the presence of phytoconstituents. Hepatoprotective activity was evaluated against CCl4-induced hepatotoxicity in rats and by its effect on the HepG2 cell line.
Results: Preliminary phytochemical screening revealed the presence of alkaloids, tannins, flavonoids, saponins, and a bitter principle in PNK. Administration of PNK produced significant hepatoprotective effect as demonstrated by decreased levels of serum liver marker enzymes such as aspartate transaminase, serum alanine transaminase, serum alkaline phosphatase, and serum bilirubin and an increase in protein level. Thiopentone-induced sleeping time was also decreased in the PNK-treated animals compared with the CCl4-treated group. It also showed antioxidant activity by increase in activity of glutathione, superoxide dismutase, and catalase and by a decrease in thiobarbituric acid reactive substance level compared with the CCl4-treated group. Results of a histopathological study also support the hepatoprotective activity of PNK. Investigation carried out on the HepG2 cell line depicted significant increase in viability of cells exposed to PNK as compared with CCl4-treated cells.
Discussion and Conclusion: It can be concluded that PNK protects hepatocytes from CCl4-induced liver damages due to its antioxidant effect on hepatocytes. An in vitro study on HepG2 cell lines also supports its protective effect.
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