WorldWideScience

Sample records for prevent life-threatening deterioration

  1. Recognizing life-threatening causes of syncope.

    Science.gov (United States)

    Khoo, Clarence; Chakrabarti, Santabhanu; Arbour, Laura; Krahn, Andrew D

    2013-02-01

    While the overall prognosis of syncope is favorable, the identification of individuals with a potentially life-threatening cause is of paramount importance. Cardiac syncope is associated with an elevated risk of mortality, and includes both primary arrhythmic and obstructive etiologies. Identification of these individuals is contingent on careful clinical assessment and judicious use of diagnostic investigations. This article focuses on life-threatening causes of syncope and a diagnostic approach to facilitate their identification. Copyright © 2013 Elsevier Inc. All rights reserved.

  2. [Prevention of soil deterioration during cultivation of medicinal plants].

    Science.gov (United States)

    Guo, Lan-ping; Huang, Lu-qi; Jiang, You-xu; Lv, Dong-mei

    2006-05-01

    This paper summarized the aspects of the soil deterioration due to continuous growth of medicinal plants, such as nutrition insufficient, pH variation, harmful salt accumulating, harmful microbe and allelopathic substance increasing, soil physics and chemistry properties variation. And the ways to prevent and rehabilitate the deteriorated soil was indicated, which included anti-adversity species selecting, scientific management such as whorl cropping, nutrient elements supplement, usage of physical methods, nutrient liquid cultivating and VAM inoculating etc.

  3. Transgender Youth and Life-Threatening Behaviors

    Science.gov (United States)

    Grossman, Arnold H.; D'Augelli, Anthony R.

    2007-01-01

    Sexual minority status is a key risk factor for suicide among lesbian, gay, and bisexual youth; however, it has not been studied among transgender youth. Fifty-five transgender youth reported on their life-threatening behaviors. Nearly half of the sample reported having seriously thought about taking their lives and one quarter reported suicide…

  4. Life-threatening Cerebral Venous Thrombosis: a case report

    Directory of Open Access Journals (Sweden)

    Daniel Agustin Godoy

    2016-06-01

    Full Text Available Cerebral venous sinus thrombosis (CVT can compromise dural sinus, cerebral veins or both. It is an uncommon condition and it is more prevalent in young women. Several prothrombotic states are the principal predisposing factors. Clinical spectrum of presentation is wide, so this entity requires a high suspect index for correct and prompt diagnosis. CVT may develop serious complications that can be life-threatening such as hemorrhagic venous infarctions, cerebral edema, and intracranial hypertension. This report describes the case of a woman who was in treatment for unspecific vaginal bleeding with oral contraceptives. Suddenly she deteriorated to coma with severe respiratory compromise. Neuroimaging showed thrombosis of multiple venous sinus. Physiological neuroprotection, osmotherapy, mechanical ventilation and anticoagulation therapy were the keystones of treatment. In a few months, the patient has recovered a good functional status, while maintaining a motor deficit on the right hand.

  5. Parental spirituality in life-threatening pediatric cancer.

    Science.gov (United States)

    Nicholas, David B; Barrera, Maru; Granek, Leeat; D'Agostino, Norma Mammone; Shaheed, Jenny; Beaune, Laura; Bouffet, Eric; Antle, Beverley

    2017-01-01

    This study addressed parental spirituality in the context of pediatric cancer with a poor prognosis. Drawing upon previous research implementing a longitudinal grounded theory design examining parental hope, 35 parents were interviewed regarding their experiences with an emergent description of the role of spirituality in parents' daily lives. Spirituality included religious beliefs and practices, notions of a higher force or cosmos, relationship with a divine being, as well as elements emerging from meaning-making and relationships. Parental expectations of spirituality remained relatively constant across data collection time points (3-9 months postdiagnosis), although limited variation occurred relative to shifting circumstance (e.g., deterioration of the child's condition). Spirituality appeared to offer: greater acceptance of parents' inability to protect their child from harm related to her/his life-threatening illness, guidance and emotion decompression, and support from one's faith community. Recommendations for integrating spiritual assessment in clinical care practice are offered.

  6. Life-threatening necrotizing myometritis, due to Group A streptococcus - still a life-threatening condition

    DEFF Research Database (Denmark)

    Boie, Sidsel; Krog, Jan; Bor, Isil Pinar

    2015-01-01

    Puerperal infection with Group A streptococcus (GAS) can present with few symptoms and rapidly progress to a life-threatening condition. Often, the infection can be treated with antibiotics. Delay in diagnosis increases risk of sepsis, multiorgan failure, and death. GAS infection is a differential...

  7. Potentialities of embolization of life threatening hemorrhages

    International Nuclear Information System (INIS)

    Moskvichev, V.G.

    1985-01-01

    The author analysed experience in the embolization of the abdominal vessels in 79 patients with diseases and lesions of the peritoneal cavity and retroperitoneal space accompanied by life threatening hemorrhage. In 51 cases embolization was used as an independent method of hemorrhage arrest and in 28 cases for patients' preoperative preparation. A hemostatic sponge combined with a superselective administration of 150-200 ml of aminocaproic acid was used as an emboilizing material. Complications attributed to embolization were noted in 5 patients: pancreatitis, subdiaphragmatic abscess, paranephritis, ischemia of the gluteal soft tissues, sciatic neuritis. An analysis has shown that urgent embolization of the abdominal vessels in diseases and lesions of the organs of the peritoneal cavity and retroperitoneal space accompanied by massive hemorrhage, can be used as an independent method for hemorrhage arrest

  8. Effective Prevention of Oxidative Deterioration of Fish Oil: Focus on Flavor Deterioration.

    Science.gov (United States)

    Miyashita, Kazuo; Uemura, Mariko; Hosokawa, Masashi

    2018-03-25

    Docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), both abundant in fish oil, are known to have significant biochemical and physiological effects primarily linked to the improvement of human health, especially cardiovascular and brain health. However, the incorporation of fish oil into foods and beverages is often challenging, as fish oil is very easily oxidized and can cause undesirable flavors. This review discusses this rapid formation of the fishy and metallic off-flavors, focusing especially on an early stage of fish oil oxidation. Although oxidative stability and quality of commercialized fish oil have improved over the past few years, there is a still a problem with its application: Flavor deterioration can be found even at very low oxidation levels. This review also notes the effective way to inhibit the formation of the volatile compounds responsible for the flavor deterioration.

  9. Pseudohypoaldosteronism in a neonate presenting as life-threatening arrhythmia

    OpenAIRE

    Rajpoot, Sudeep K; Maggi, Carlos; Bhangoo, Amrit

    2014-01-01

    Summary Neonatal hyperkalemia and hyponatremia are medical conditions that require an emergent diagnosis and treatment to avoid morbidity and mortality. Here, we describe the case of a 10-day-old female baby presenting with life-threatening hyperkalemia, hyponatremia, and metabolic acidosis diagnosed as autosomal dominant pseudohypoaldosteronism type 1 (PHA1). This report aims to recognize that PHA1 may present with a life-threatening arrhythmia due to severe hyperkalemia and describes the ma...

  10. Optical illusions and life-threatening traffic crashes: A perspective on aerial perspective.

    Science.gov (United States)

    Redelmeier, Donald A; Raza, Sheharyar

    2018-05-01

    Aerial perspective illusion is a feature of visual perception where landscapes appear relatively close in clear light and distant in dim light. We hypothesized that bright sunlight might cause drivers to perceive distant terrain as relatively close and misinterpret the approach speed of surrounding landscape as unduly slow. This hypothesis would mean, in turn, that drivers in bright sunlight may underestimate their progress on the road, compensate by traveling at a faster baseline speed, and ultimately increase the prevailing risk of a life-threatening traffic crash. We conducted three pilot studies to illustrate how the illusion might contribute to a life- threatening traffic crash. The first illustration used a questionnaire to demonstrate that most respondents were mistaken when judging the distance between simple balls in different positions. The second illustration involved an experimental manipulation to assess whether aerial perspective influenced judgments about the relative positions of vehicles in traffic. The third illustration analyzed a segment of high-volume fast-speed traffic and found an increased frequency of speeding under bright sunlight. Together with past work based on the visual arts, these examples illustrate how an aerial perspective illusion can affect distance perception, may appear in realistic traffic situations, and could potentially contribute to the risk of a life-threatening traffic crash. An awareness of this hypothesis might lead to applications on how optical illusions could extend to everyday traffic and might potentially inform safety warnings to prevent life- threatening crashes. Copyright © 2018 Elsevier Ltd. All rights reserved.

  11. 76 FR 31241 - Prevention of Significant Deterioration (PSD) Program; Massachusetts; Announcing Delegation...

    Science.gov (United States)

    2011-05-31

    ... Deterioration (PSD) Program; Massachusetts; Announcing Delegation Agreement Between EPA and Massachusetts... authority to implement and enforce the Federal Prevention of Significant Deterioration (PSD) program to the... at the Office of Ecosystem Protection, U.S. Environmental Protection Agency, EPA New England Regional...

  12. Final Amendments to Delegation of Authority Provisions in the Prevention of Significant Deterioration Permitting Program

    Science.gov (United States)

    finalized amendments to the New Source Review (NSR) Prevention of Significant Deterioration (PSD) permitting program that will allow the EPA to delegate administration of the program to interested and qualified tribal agencies.

  13. Life threatening arrhythmias: Knowledge and skills among nurses ...

    African Journals Online (AJOL)

    Conclusion: Although the majority of the participants scored highly in their level of knowledge regarding life threatening arrhythmias, they scored poorly in most of the observed skills when identifying and treating this patient group. It is important that hospital administration take into consideration the identified areas of ...

  14. Emotion and Life Threatening Illness: A Typology of Hope Sources.

    Science.gov (United States)

    Klenow, Daniel J.

    1992-01-01

    Presents typology of hope sources for patients with life-threatening illness. Details 10 sources of hope, including 5 major sources of hope: religion, medical science, fallibilism, self-discipline, and renewal and deception by others (false hope). Divides hope sources into cognitive and behavioral dimensions. Examines varying hope orientations…

  15. Clinical risk factors for life-threatening lower respiratory tract infections in children: a retrospective study in an urban city in Malaysia.

    Science.gov (United States)

    Nathan, Anna Marie; Rani, Fairuz; Lee, Rachel Jiun Yi; Zaki, Rafdzah; Westerhout, Caroline; Sam, I-Ching; Lum, Lucy Chai See; de Bruyne, Jessie

    2014-01-01

    Lower respiratory tract infections (LRTIs) are an important cause of morbidity and mortality, especially in low income countries. The aim of this study was to determine risk factors of life-threatening LRTIs in hospitalised children in Malaysia. This retrospective study included children aged less than 18 years admitted for LRTIs over 13 months in a tertiary referral centre in Kuala Lumpur, Malaysia. Neonates, children with asthma and those with either no or a normal chest radiograph were excluded. Life-threatening infection was defined as that needing non-invasive ventilation or admission to the paediatric intensive care unit. Routine blood investigations and nasopharyngeal secretion results (bacterial and viral) were obtained. Chest radiographs were reviewed by a designated radiologist. Environmental data (rainfall, particulate matter ≤ 10 µm [PM10] and air pollution index [API]) was obtained from the respective government departments. Three hundred and ninety-one episodes of LRTIs were included. Viruses were implicated in 48.5% of LRTIs, with respiratory syncytial virus (RSV) being detected in 44% of viral LRTIs. Forty-six (11.8%) children had life-threatening disease and the overall mortality rate was 1.3% (5 children). RSV was detected in 26% of children with life-threatening LRTIs. In multivariate logistic regression, chronic lung disease, presenting history of apnoea and signs of hypoxia, was associated with life threatening LRTIs. Increased LRTI admissions were associated with low rainfall but not PM10 nor API. Of those on follow-up, 39% had persistent respiratory symptoms. One in nine children admitted with LRTI had a life-threatening LRTI. The aetiology was viral in almost half of admitted children. RSV was detected in a quarter of children with life-threatening LRTIs. Children who present with LRTIs and either have chronic lung disease, presenting history of apnoea or signs of hypoxia, should be observed carefully as the risk of deterioration to life-threatening

  16. 76 FR 10894 - Notice of Issuance of Prevention of Significant Deterioration and Federal Operating Permits to...

    Science.gov (United States)

    2011-02-28

    ... FURTHER INFORMATION CONTACT: Kaushal Gupta, Environmental Engineer, EPA, Region 5, 77 West Jackson... ENVIRONMENTAL PROTECTION AGENCY [MN90; FRL-9272-2] Notice of Issuance of Prevention of Significant Deterioration and Federal Operating Permits to Grand Casino Hinckley AGENCY: Environmental Protection Agency...

  17. Can femoral dialysis catheter insertion cause a life threatening complication?

    Directory of Open Access Journals (Sweden)

    Nurkay Katrancıoğlu

    2014-09-01

    Full Text Available Venous catheter (VC insertion may be necessary for the patients with renal failure facing vascular access problem. Femoral VCs are commonly used for their lower complication rates especially in emergency clinics. The incidence of bleeding associated with VC is reported 0.5-1.6%, however, life threatening hemorrhage and complications requiring surgical intervention are very rare. In this manuscript, we aimed to present a case with hemolytic uremic syndrome complicated with retroperitoneal hematoma after femoral VC insertion. J Clin Exp Invest 2014; 5 (3: 472-474

  18. Presentation and Management of Pseudoaneurysmogastric Fistula: A Life Threatening Emergency.

    Science.gov (United States)

    Dash, Nihar Ranjan; Kilambi, Ragini; Singh, Anand Narayan; Pal, Sujoy; Asfan, Mohammed Adil

    2017-10-01

    Pseudoaneurysmogastric fistula is a rare consequence of pseudoaneurysms occurring in the vicinity of stomach. They are the result of pseudoaneurysms eroding into the stomach, and represent a life threatening emergency. Urgent surgical intervention is often necessary to salvage the patient. Data regarding the presentation and management of this condition is sparse. Herein, we present our experience with four cases of pseudoaneurysmogastric fistula, their clinical context, presentation, management and outcomes. We attempt to outline an algorithm for the diagnosis and management of this unusual complication.

  19. Life-threatening gastrointestinal hemorrhage due to juvenile polyposis.

    Science.gov (United States)

    Pashankar, D; Murphy, J J; Ostry, A; Schreiber, R A

    2000-02-01

    A 14-yr-old, previously healthy boy presented with massive lower GI hemorrhage. After the routine endoscopic and radiological evaluation, laparotomy and intraoperative colonoscopy revealed multiple polyps in the colon. A hemicolectomy was performed because of the severity of hemorrhage. A diagnosis of juvenile polyposis was made based upon histological findings and the family history. This is an extremely unusual presentation of juvenile polyposis and has been reported only once before. The clinical features, diagnosis, and therapeutic options for juvenile polyposis are discussed. Juvenile polyposis, although a rare condition in the pediatric population, should be considered in the differential diagnosis of life-threatening GI hemorrhage.

  20. Life-threatening complications after ureteroscopy for urinary stones: survey and systematic literature review.

    Science.gov (United States)

    Cindolo, Luca; Castellan, Pietro; Primiceri, Giulia; Hoznek, Andras; Cracco, Cecilia M; Scoffone, Cesare M; Galfano, Antonio; Petralia, Giovanni; DE Angelis, Michele; Annino, Filippo; Malacasa, Emilio; Cormio, Luigi; Acquati, Pietro; DE Lorenzis, Elisa; Maugeri, Orazio; Arena, Giuseppe; Celia, Antonio; Giusti, Guido; Schips, Luigi

    2017-10-01

    Retrograde ureteroscopy (URS) has become a common procedure for the management of urinary stones. Although its efficacy and safety are well known, the literature about major complications is still poor. This study highlighted some cases of life-threatening complications after semi-rigid ureteroscopy (s-URS) or flexible ureteroscopy (f-URS). Experienced endourologists (more than 75 cases/year in the last 3 years) we enrolled, and a survey was performed asking to review their series and report the cases encumbered by major complications (Clavien-Dindo IIIb-IV grade). A literature search was also conducted in the Medline (PubMed) and Cochrane Libraries databases in July, 2016 to identify all studies reporting the presence of major complications in patients underwent URS procedures. A PubMed search was performed using the following key words in combination: "kidney injury," "ureteroscopy," "nephrectomy," "life-threatening," "urinary stones," "complications." Eleven urologists reported on 12 major complications (4 after s-URS, 8 after f-URS). Eight patients developed a kidney injury, 1 an arteriovenous fistula, 2 a ureter avulsion and 1 acute sepsis. Six patients underwent open nephrectomy, two surgical repair, one open pyeloplasty, one coil artery embolization and two superselective artery embolization. Guidelines and clinical practice give useful recommendations about intraoperative safety and prevention of life-threatening events. The careful postoperative observation and the surgical active treatment of this complications play a key role in reducing morbidity, kidney loss and mortality. This study encourages a strict and active care of patients, supports a routine reporting of complications, and highlights the need for systematic use of standardized classification systems.

  1. Tracheal intubation in the ICU: Life saving or life threatening?

    Directory of Open Access Journals (Sweden)

    Jigeeshu V Divatia

    2011-01-01

    Full Text Available Tracheal intubation (TI is a routine procedure in the intensive care unit (ICU, and is often life saving. However, life-threatening complications occur in a significant proportion of procedures, making TI perhaps one the most common but underappreciated airway emergencies in the ICU. In contrast to the controlled conditions in the operating room (OR, the unstable physiologic state of critically ill patients along with underevaluation of the airways and suboptimal response to pre-oxygenation are the major factors for the high incidence of life-threatening complications like severe hypoxaemia and cardiovascular collapse in the ICU. Studies have shown that strategies planned for TI in the OR can be adapted and extrapolated for use in the ICU. Non-invasive positive-pressure ventilation for pre-oxygenation provides adequate oxygen stores during TI for patients with precarious respiratory pathology. The intubation procedure should include not only airway management but also haemodynamic, gas exchange and neurologic care, which are often crucial in critically ill patients. Hence, there is a necessity for the implementation of an Intubation Bundle during routine airway management in the ICU. Adherence to a plan for difficult airway management incorporating the use of intubation aids and airway rescue devices and strategies is useful.

  2. Paraneoplastic Pemphigus. A Life-Threatening Autoimmune Blistering Disease.

    Science.gov (United States)

    Tirado-Sánchez, A; Bonifaz, A

    2017-12-01

    Paraneoplastic pemphigus (PNP), a subset of pemphigus, is a unique autoimmune blistering condition that can affect multiple organs other than the skin. It is a life-threatening disease associated with an underlying malignancy, most commonly of lymphoproliferative origin. The clinical picture may resemble pemphigus, pemphigoid, erythema multiforme, graft-versus-host disease, or lichen planus. The earliest and most consistent finding is a painful, severe, chronic and often recalcitrant stomatitis. Treatment of PNP is difficult. Immunosuppressive agents are required to decrease blistering, and treating the underlying tumor may control autoantibody production. In this review, we included essential diagnostic aspects of PNP and the most useful treatment options in the dermatologist practice. Copyright © 2017 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. Life-Threatening Thrombocytopenia Following Intravenous Contrast Media Infusion.

    Science.gov (United States)

    Park, Mihwa; Kim, Minjeong; Park, Jisun; Cho, Jinhyun

    2018-01-01

    Radiocontrast media-induced acute severe thrombocytopenia is a very rare complication and potentially life-threatening. Here, we report the case of a 63-year-old male patient with severe acute thrombocytopenia following first exposure to intravenous non-ionic contrast media without immediate allergic reactions. His platelet count dropped from 107000/μL to 2000/μL after six hours of radiocontrast infusion. After administration of corticosteroid and transfusion of platelet concentrates, the platelet count returned gradually to normal within 5 days. To the best of our knowledge, non-ionic contrast media-induced isolated acute severe thrombocytopenia following no signs or symptoms of immediate allergic reaction has never been described. © Copyright: Yonsei University College of Medicine 2018.

  4. Life-threatening complications of deep neck space infections.

    Science.gov (United States)

    Dalla Torre, Daniel; Brunold, Silvia; Kisielewsky, Irene; Kloss, Frank R; Burtscher, Doris

    2013-11-01

    Odontogenic infections represented a challenge for every craniomaxillofacial surgeon in the pre-antibiotic era, not least due to the frequent association with septic complications and lethal consequences. Nowadays, the incidences of serious infection-related complications are less frequent thanks to the medical progress. Nevertheless, the development of severe infections is still hard to foresee. The following analysis provides an overview of four patients with severe, life-threatening odontogenic deep neck space infections treated at the University Clinic for Oral and Maxillofacial Surgery in Innsbruck and describes the etiology, therapy, and outcome for each patient while analyzing differences between the single cases. Crucial aspects in origin, progression, and treatment of DNIs are highlighted, comparing the results with the international literature.

  5. Pumpless extracorporeal carbon dioxide removal for life-threatening asthma.

    Science.gov (United States)

    Elliot, Stuart C; Paramasivam, Kumar; Oram, John; Bodenham, Andrew R; Howell, Simon J; Mallick, Abhiram

    2007-03-01

    To report the use of pumpless extracorporeal carbon dioxide removal in two cases of acute severe asthma. Case reports. Adult general intensive care unit, Leeds General Infirmary, Leeds, UK. A 74-yr-old male and 52-yr-old female with life-threatening asthma developed progressive hypercapnia and severe acidosis that proved nonresponsive to all other therapies. Initiation of extracorporeal arteriovenous carbon dioxide removal using the Novalung device (Novalung GmbH, Lotzenäcker 3, D-72379 Hechingen, Germany). The addition of extracorporeal carbon dioxide removal to mechanical ventilation corrected hypercapnia and acidosis, allowing reduction of other supportive measures. In both cases, adequate gas exchange was maintained until their underlying condition improved sufficiently for device removal. The two patients were subsequently weaned from mechanical ventilation and made a full recovery. Extracorporeal carbon dioxide removal proved to be a valuable adjunct to mechanical ventilation and other medical treatment.

  6. Single-stage Kanban system with deterioration failures and condition-based preventive maintenance

    International Nuclear Information System (INIS)

    Xanthopoulos, A.S.; Koulouriotis, D.E.; Botsaris, P.N.

    2015-01-01

    Despite the fact that the fields of pull type production control policies and condition-based preventive maintenance have much in common contextually, they have evolved independently up to now. In this investigation, an attempt is made to bridge the gap between these two branches of knowledge by introducing the single-stage Kanban system with deterioration failures and condition-based preventive maintenance. The formalism of continuous time Markov chains is used to model the system and expressions for eight performance metrics are derived. Two important, from a managerial perspective, constrained optimization problems for the proposed model are defined where the objective is the simultaneous optimization of the Kanban policy, the preventive maintenance policy and the inspection schedule under conflicting performance criteria. Multiple instances of each optimization problem are solved by means of the augmented Lagrangian genetic algorithm. The results from the optimization trials coupled by the results from extensive numerical examples facilitate the thorough investigation of the system’s behaviour. - Highlights: • Kanban system with deterioration failures and preventive maintenance is introduced. • The system is modeled as a continuous time Markov chain. • Expressions for eight performance metrics are derived. • The behavior of the system is studied through numerical examples. • Optimization results for selected performance metrics are presented

  7. A preventive maintenance policy based on dependent two-stage deterioration and external shocks

    International Nuclear Information System (INIS)

    Yang, Li; Ma, Xiaobing; Peng, Rui; Zhai, Qingqing; Zhao, Yu

    2017-01-01

    This paper proposes a preventive maintenance policy for a single-unit system whose failure has two competing and dependent causes, i.e., internal deterioration and sudden shocks. The internal failure process is divided into two stages, i.e. normal and defective. Shocks arrive according to a non-homogeneous Poisson process (NHPP), leading to the failure of the system immediately. The occurrence rate of a shock is affected by the state of the system. Both an age-based replacement and finite number of periodic inspections are schemed simultaneously to deal with the competing failures. The objective of this study is to determine the optimal preventive replacement interval, inspection interval and number of inspections such that the expected cost per unit time is minimized. A case study on oil pipeline maintenance is presented to illustrate the maintenance policy. - Highlights: • A maintenance model based on two-stage deterioration and sudden shocks is developed. • The impact of internal system state on external shock process is studied. • A new preventive maintenance strategy combining age-based replacements and periodic inspections is proposed. • Postponed replacement of a defective system is provided by restricting the number of inspections.

  8. Ectopic pregnancy: a life-threatening gynecological emergency

    Directory of Open Access Journals (Sweden)

    Lawani OL

    2013-08-01

    Full Text Available Osaheni L Lawani, Okechukwu B Anozie, Paul O Ezeonu Department of Obstetrics and Gynecology, Federal Teaching Hospital, Abakaliki, Nigeria Background: Ectopic pregnancy is a life-threatening gynecological emergency, and a significant cause of maternal morbidity and mortality in Nigeria. Objective: The aim of this work was to determine and evaluate the incidence, clinical presentation, risk factors, and management outcomes of ectopic pregnancies at Ebonyi State University Teaching Hospital (EBSUTH in Abakaliki. Methods: This was a retrospective, descriptive study of ectopic pregnancies managed in EBSUTH during the study period (June 1, 2002 to May 31, 2012. The medical records of the patients managed for ectopic pregnancy as well as the total birth record and gynecological admission records during the period under review were retrieved, and data were collected with the aid of data-entry forms designed for this purpose. There were 4,610 gynecological admissions and 9,828 deliveries, with 215 cases of ectopic pregnancies. A total of 205 cases were suitable for analysis after excluding cases with incomplete records. The relevant data collected were analyzed with SPSS version 15.0 for Windows. Results: Ectopic pregnancy constituted 4.5% of all gynecological admissions, and its incidence was 2.1%. The mean age of the patients was 27 ± 2 years, 196 of 205 (95.6% had ruptured ectopic pregnancies, and the remaining nine (4.4% were unruptured. The commonest (166 of 205, 80.0% clinical presentation was abdominal pain, and the commonest (105 of 205, 51.2% identified risk factor was a previous history of induced abortion. Three deaths were recorded, giving a case-fatality rate of 1.4% (three of 205. Conclusion: Ectopic pregnancy is a recognized cause of maternal morbidity and mortality and has remained a reproductive health challenge to Nigerian women, as well as a threat to efforts in achieving the UN's Millennium Development Goal 5 in sub-Saharan Africa

  9. Performance deterioration modeling and optimal preventive maintenance strategy under scheduled servicing subject to mission time

    Directory of Open Access Journals (Sweden)

    Li Dawei

    2014-08-01

    Full Text Available Servicing is applied periodically in practice with the aim of restoring the system state and prolonging the lifetime. It is generally seen as an imperfect maintenance action which has a chief influence on the maintenance strategy. In order to model the maintenance effect of servicing, this study analyzes the deterioration characteristics of system under scheduled servicing. And then the deterioration model is established from the failure mechanism by compound Poisson process. On the basis of the system damage value and failure mechanism, the failure rate refresh factor is proposed to describe the maintenance effect of servicing. A maintenance strategy is developed which combines the benefits of scheduled servicing and preventive maintenance. Then the optimization model is given to determine the optimal servicing period and preventive maintenance time, with an objective to minimize the system expected life-cycle cost per unit time and a constraint on system survival probability for the duration of mission time. Subject to mission time, it can control the ability of accomplishing the mission at any time so as to ensure the high dependability. An example of water pump rotor relating to scheduled servicing is introduced to illustrate the failure rate refresh factor and the proposed maintenance strategy. Compared with traditional methods, the numerical results show that the failure rate refresh factor can describe the maintenance effect of servicing more intuitively and objectively. It also demonstrates that this maintenance strategy can prolong the lifetime, reduce the total lifetime maintenance cost and guarantee the dependability of system.

  10. Aberrant Right Subclavian Artery: A Life-threatening Anomaly that should be considered during Esophagectomy.

    Science.gov (United States)

    Mahmodlou, Rahim; Sepehrvand, Nariman; Hatami, Sanaz

    2014-01-01

    Aberrant right subclavian artery (ARSA) is a rare anomaly, in which the right subclavian artery arises directly from the aortic arch instead of originating from the brachiocephalic artery. This anomaly should be taken into consideration during surgical procedures around esophagus, such as esophagectomy. Any unintentional injury of this artery during surgical procedures could be extremely life threatening. A 56-year-old woman presented with dysphagia, with concurrent aberrant subclavian artery and esophageal cancer. The transhiatal esophagectomy was performed successfully since the anomaly was preoperatively diagnosed using computed tomography scan. The presence of ARSA during esophagectomy may be challenging, but if diagnosed preoperatively, the precise and diligent dissection of the retroesophageal space during esophagectomy, may prevent any injury to the aberrant artery and consequent complications.

  11. Pseudohypoaldosteronism in a Neonate Presenting as Life-Threatening Hyperkalemia

    Directory of Open Access Journals (Sweden)

    Najya A. Attia

    2016-01-01

    Full Text Available Context. Pseudohypoaldosteronism type 1 (PHA1 is a life-threatening disease that causes severe hyperkalemia and cardiac arrest if not treated appropriately or if diagnosis is missed. Objective. To report a case of a newborn with vomiting and lethargy, ultimately diagnosed with pseudohypoaldosteronism. Patient. This case presented to the ED at an age of 14 days in hypovolemic shock. There was a family history of sudden infant death, her sister who was diagnosed with CAH and passed away at 3 months of age despite regular hormone replacement. Our patient had cardiac arrest in ED, due to hyperkalemia; while receiving fluid boluses, cardiopulmonary resuscitation was initiated. After stabilization, diagnostic workup demonstrated persistently low sodium, acidosis, and high potassium, which required peritoneal dialysis. Based on these findings, the patient was diagnosed with CAH. It turned out later that the patient had PHA1. Two years later, the patient had a new sibling with the same disease diagnosed at birth and started immediately on treatment without any complication. Conclusions and Outcome. This case highlights the significant diagnostic and therapeutic challenges in treating children with PHA1. Adrenal crisis is not always CAH; delayed diagnosis can lead to complication and even death. The presence of high plasma renin activity, aldosterone, and cortisol, along with the presence of hyponatremia and hyperkalemia, established the diagnosis of PHA type 1 and ruled out CAH.

  12. Life-threatening metabolic alkalosis in Pendred syndrome.

    Science.gov (United States)

    Kandasamy, Narayanan; Fugazzola, Laura; Evans, Mark; Chatterjee, Krishna; Karet, Fiona

    2011-07-01

    Pendred syndrome, a combination of sensorineural deafness, impaired organification of iodide in the thyroid and goitre, results from biallelic defects in pendrin (encoded by SLC26A4), which transports chloride and iodide in the inner ear and thyroid respectively. Recently, pendrin has also been identified in the kidneys, where it is found in the apical plasma membrane of non-α-type intercalated cells of the cortical collecting duct. Here, it functions as a chloride-bicarbonate exchanger, capable of secreting bicarbonate into the urine. Despite this function, patients with Pendred syndrome have not been reported to develop any significant acid-base disturbances, except a single previous reported case of metabolic alkalosis in the context of Pendred syndrome in a child started on a diuretic. We describe a 46-year-old female with sensorineural deafness and hypothyroidism, who presented with severe hypokalaemic metabolic alkalosis during inter-current illnesses on two occasions, and who was found to be homozygous for a loss-of-function mutation (V138F) in SLC26A4. Her acid-base status and electrolytes were unremarkable when she was well. This case illustrates that, although pendrin is not usually required to maintain acid-base homeostasis under ambient condition, loss of renal bicarbonate excretion by pendrin during a metabolic alkalotic challenge may contribute to life-threatening acid-base disturbances in patients with Pendred syndrome.

  13. Life-Threatening Hypokalemic Paralysis in a Young Bodybuilder

    Directory of Open Access Journals (Sweden)

    Kitty K. T. Cheung

    2014-01-01

    Full Text Available We report a case of life-threatening hypokalemia in a 28-year-old bodybuilder who presented with sudden onset bilateral lower limbs paralysis few days after his bodybuilding competition. His electrocardiogram (ECG showed typical u-waves due to severe hypokalemia (serum potassium 1.6 mmol/L, reference range (RR 3.5–5.0 mmol/L. He was admitted to the intensive care unit (ICU and was treated with potassium replacement. The patient later admitted that he had exposed himself to weight loss agents of unknown nature, purchased online, and large carbohydrate loads in preparation for the competition. He made a full recovery after a few days and discharged himself from the hospital against medical advice. The severe hypokalemia was thought to be caused by several mechanisms to be discussed in this report. With the ever rising number of new fitness centers recently, the ease of online purchasing of almost any drug, and the increasing numbers of youngsters getting into the bodybuilding arena, clinicians should be able to recognize the possible causes of sudden severe hypokalemia in these patients in order to revert the pathophysiology.

  14. Life-threatening hypokalemic paralysis in a young bodybuilder.

    Science.gov (United States)

    Cheung, Kitty K T; So, Wing-Yee; Kong, Alice P S; Ma, Ronald C W; Chow, Francis C C

    2014-01-01

    We report a case of life-threatening hypokalemia in a 28-year-old bodybuilder who presented with sudden onset bilateral lower limbs paralysis few days after his bodybuilding competition. His electrocardiogram (ECG) showed typical u-waves due to severe hypokalemia (serum potassium 1.6 mmol/L, reference range (RR) 3.5-5.0 mmol/L). He was admitted to the intensive care unit (ICU) and was treated with potassium replacement. The patient later admitted that he had exposed himself to weight loss agents of unknown nature, purchased online, and large carbohydrate loads in preparation for the competition. He made a full recovery after a few days and discharged himself from the hospital against medical advice. The severe hypokalemia was thought to be caused by several mechanisms to be discussed in this report. With the ever rising number of new fitness centers recently, the ease of online purchasing of almost any drug, and the increasing numbers of youngsters getting into the bodybuilding arena, clinicians should be able to recognize the possible causes of sudden severe hypokalemia in these patients in order to revert the pathophysiology.

  15. Life-Threatening Hypokalemic Paralysis in a Young Bodybuilder

    Science.gov (United States)

    Cheung, Kitty K. T.; So, Wing-Yee; Kong, Alice P. S.; Ma, Ronald C. W.; Chow, Francis C. C.

    2014-01-01

    We report a case of life-threatening hypokalemia in a 28-year-old bodybuilder who presented with sudden onset bilateral lower limbs paralysis few days after his bodybuilding competition. His electrocardiogram (ECG) showed typical u-waves due to severe hypokalemia (serum potassium 1.6 mmol/L, reference range (RR) 3.5–5.0 mmol/L). He was admitted to the intensive care unit (ICU) and was treated with potassium replacement. The patient later admitted that he had exposed himself to weight loss agents of unknown nature, purchased online, and large carbohydrate loads in preparation for the competition. He made a full recovery after a few days and discharged himself from the hospital against medical advice. The severe hypokalemia was thought to be caused by several mechanisms to be discussed in this report. With the ever rising number of new fitness centers recently, the ease of online purchasing of almost any drug, and the increasing numbers of youngsters getting into the bodybuilding arena, clinicians should be able to recognize the possible causes of sudden severe hypokalemia in these patients in order to revert the pathophysiology. PMID:24660073

  16. Tension Pneumocephalus with Diplegia and Deterioration of Consciousness

    Directory of Open Access Journals (Sweden)

    Harald Prüss

    2011-02-01

    Full Text Available Tension pneumocephalus results from intracranial air under pressure as a rare complication after head injury or craniofacial surgery. A 58-year-old man underwent ethmoid sinus surgery and subsequently developed rapidly progressive global headache, restlessness, diplegia with sensory loss, and deterioration of the conscious level. A head CT demonstrated extensive pneumocephalus with gross compression of the brain. The frontal retention of air caused widening of the interhemispheric fissure leading to a peaked appearance of the frontal poles, referred to as the ‘Mount Fuji sign’. Surgical revision of a dural air leak resulted in rapid improvement and full clinical resolution. Early diagnosis of tension pneumocephalus and emergent surgical treatment are crucial to prevent life-threatening deterioration.

  17. Tension pneumocephalus with diplegia and deterioration of consciousness.

    Science.gov (United States)

    Prüss, Harald; Klingebiel, Randolf; Endres, Matthias

    2011-02-14

    Tension pneumocephalus results from intracranial air under pressure as a rare complication after head injury or craniofacial surgery. A 58-year-old man underwent ethmoid sinus surgery and subsequently developed rapidly progressive global headache, restlessness, diplegia with sensory loss, and deterioration of the conscious level. A head CT demonstrated extensive pneumocephalus with gross compression of the brain. The frontal retention of air caused widening of the interhemispheric fissure leading to a peaked appearance of the frontal poles, referred to as the 'Mount Fuji sign'. Surgical revision of a dural air leak resulted in rapid improvement and full clinical resolution. Early diagnosis of tension pneumocephalus and emergent surgical treatment are crucial to prevent life-threatening deterioration.

  18. Limitations of Routine Verification of Nasogastric Tube Insertion Using X-Ray and Auscultation: Two Case Reports of Life-Threatening Complications.

    Science.gov (United States)

    Nejo, Takahide; Oya, Soichi; Tsukasa, Tsuchiya; Yamaguchi, Naomi; Matsui, Toru

    2016-12-01

    Several bedside approaches used in combination with thoracoabdominal X-ray are widely used to avoid severe complications that have been reported during nasogastric tube management. Although confirmation by X-ray is considered the gold standard, it is not yet perfect. We present 2 cases of rare complications in which the routine verification methods could not detect all the complications related to the nasogastric tube placement. Case 1 was a 17-year-old male who presented with a brain tumor and repeatedly required nasogastric tube placement. Despite normal auscultatory and X-ray findings, the patient's condition deteriorated rapidly after resuming the enteral nutrition (EN). Computed tomography images showed the presence of hepatic portal venous gas (HPVG). Urgent upper gastrointestinal endoscopy showed esophagogastric submucosal tunneling of the tube that required an emergency open total gastrectomy. Case 2 was a 76-year-old man with long-term EN after stroke. While the last auscultatory verification was normal, he suddenly developed extensive HPVG due to gastric mucosal injury following EN, which resulted in progressive intestinal necrosis, general peritonitis, and death. These 2 cases indicated that routine verification methods consisting of auscultation and X-ray may not be completely reliable, and the awareness of the limitations of these methods should be reaffirmed because expeditious examinations and necessary interventions are critical in preventing life-threatening complications.

  19. A two-stage preventive maintenance policy for a multi-state deterioration system

    International Nuclear Information System (INIS)

    Huang, C.-C.; Yuan, John

    2010-01-01

    This paper is to propose a two-stage preventive maintenance (PM) policy for the multi-state deterioration system under periodic inspection and with multiple candidate actions for PM. Such policy is mainly to schedule PM optimally and also on how to choose the action optimally for each PM. The scheduling includes two tasks: to determine after completing each PM when to make the decision and then at it to schedule the next PM optimally. We assume that: (1) such actions except replacement are imperfect, (2) the inspection and action times can be ignored, (3) the system can be modeled by a multi-state discrete time Markov chain whose transition probabilities will change and be updated only at the instant after completing each PM, and (4) the risks of such imperfect actions will be updated only at the instant after completing each PM. Finally, an example through simulation is presented to illustrate how such policy can be carried out.

  20. Incidence and management of life-threatening adverse events during cardiac catheterization for congenital heart disease.

    Science.gov (United States)

    Lin, C Huie; Hegde, Sanjeet; Marshall, Audrey C; Porras, Diego; Gauvreau, Kimberlee; Balzer, David T; Beekman, Robert H; Torres, Alejandro; Vincent, Julie A; Moore, John W; Holzer, Ralf; Armsby, Laurie; Bergersen, Lisa

    2014-01-01

    Continued advancements in congenital cardiac catheterization and interventions have resulted in increased patient and procedural complexity. Anticipation of life-threatening events and required rescue measures is a critical component to preprocedural preparation. We sought to determine the incidence and nature of life-threatening adverse events in congenital and pediatric cardiac catheterization, risk factors, and resources necessary to anticipate and manage events. Data from 8905 cases performed at the 8 participating institutions of the Congenital Cardiac Catheterization Project on Outcomes were captured between 2007 and 2010 [median 1,095/site (range 133-3,802)]. The incidence of all life-threatening events was 2.1 % [95 % confidence interval (CI) 1.8-2.4 %], whereas mortality was 0.28 % (95 % CI 0.18-0.41 %). Fifty-seven life-threatening events required cardiopulmonary resuscitation, whereas 9 % required extracorporeal membrane oxygenation. Use of a risk adjustment model showed that age events. Using this model, standardized life-threatening event ratios were calculated, thus showing that one institution had a life-threatening event rate greater than expected. Congenital cardiac catheterization and intervention can be performed safely with a low rate of life-threatening events and mortality; preprocedural evaluation of risk may optimize preparation of emergency rescue and bailout procedures. Risk predictors (age < 1, hemodynamic vulnerability, and procedure risk category) can enhance preprocedural patient risk stratification and planning.

  1. Life-threatening Cerebral Edema Caused by Acute Occlusion of a Superior Vena Cava Stent

    Energy Technology Data Exchange (ETDEWEB)

    Sofue, Keitaro, E-mail: keitarosofue@yahoo.co.jp; Takeuchi, Yoshito, E-mail: yotake62@qg8.so-net.ne.jp; Arai, Yasuaki, E-mail: arai-y3111@mvh.biglobe.ne.jp [National Cancer Center Hospital, Department of Diagnostic Radiology (Japan); Sugimura, Kazuro, E-mail: sugimura@med.kobe-u.ac.jp [Kobe University, Department of Radiology, Graduate School of Medicine (Japan)

    2013-02-15

    A71-year-old man with advanced lung cancer developed a life-threatening cerebral edema caused by the acute occlusion of a superior vena cava (SVC) stent and was successfully treated by an additional stent placement. Although stent occlusion is a common early complication, no life-threatening situations have been reported until now. Our experience highlights the fact that acute stent occlusion can potentially lead to the complete venous shutdown of the SVC, resulting in life-threatening cerebral edema, after SVC stent placement. Immediate diagnosis and countermeasures are required.

  2. Life-threatening Cerebral Edema Caused by Acute Occlusion of a Superior Vena Cava Stent

    International Nuclear Information System (INIS)

    Sofue, Keitaro; Takeuchi, Yoshito; Arai, Yasuaki; Sugimura, Kazuro

    2013-01-01

    A71-year-old man with advanced lung cancer developed a life-threatening cerebral edema caused by the acute occlusion of a superior vena cava (SVC) stent and was successfully treated by an additional stent placement. Although stent occlusion is a common early complication, no life-threatening situations have been reported until now. Our experience highlights the fact that acute stent occlusion can potentially lead to the complete venous shutdown of the SVC, resulting in life-threatening cerebral edema, after SVC stent placement. Immediate diagnosis and countermeasures are required.

  3. Recurrent life-threatening reactions to platelet transfusion in an aplastic anaemia patient with a paroxysmal nocturnal haemoglobinuria clone.

    Science.gov (United States)

    Mohamed, M; Bates, G; Richardson, D; Burrows, L

    2014-09-01

    A 60-year-old woman was diagnosed with non-severe aplastic anaemia when she presented with anaemia and thrombocytopenia. She developed recurrent life-threatening hypotensive reactions during transfusion of leukodepleted platelet concentrates, and washed platelet concentrates prevented the development of such reactions subsequently. A paroxysmal nocturnal haemoglobinuria clone was detected on investigating for aplastic anaemia, which has been speculated to play a role in the recurrent hypotensive reactions. © 2014 The Authors; Internal Medicine Journal © 2014 Royal Australasian College of Physicians.

  4. 76 FR 82234 - Amendments to Delegation of Authority Provisions in the Prevention of Significant Deterioration...

    Science.gov (United States)

    2011-12-30

    ...The EPA is taking action to propose amendments to the New Source Review (NSR) Prevention of Significant Deterioration (PSD) program that would correct certain outdated language that currently limits EPA's ability to delegate the Federal PSD program to interested Indian tribes. This action proposes changes that would provide consistency with the current Federal PSD regulatory requirements by allowing the EPA to delegate the PSD program to interested tribes for their attainment areas. The regulations already authorize administrative delegation, and EPA has in the past delegated administration of the PSD program to states and local governments for their attainment areas. The EPA is proposing to delete a restriction on tribes' ability to take delegation of the PSD program and to include tribes, along with state and locals, in another section to make it clear that tribes may voluntarily take direct delegation of the NSR program in areas that are currently attaining the national ambient air quality standards (NAAQS). The rule would not impose any new requirements. The EPA is also proposing to correct a minor typographical error.

  5. Post-traumatic stress disorder associated with life-threatening motor vehicle collisions in the WHO World Mental Health Surveys.

    Science.gov (United States)

    Stein, Dan J; Karam, Elie G; Shahly, Victoria; Hill, Eric D; King, Andrew; Petukhova, Maria; Atwoli, Lukoye; Bromet, Evelyn J; Florescu, Silvia; Haro, Josep Maria; Hinkov, Hristo; Karam, Aimee; Medina-Mora, María Elena; Navarro-Mateu, Fernando; Piazza, Marina; Shalev, Arieh; Torres, Yolanda; Zaslavsky, Alan M; Kessler, Ronald C

    2016-07-22

    Motor vehicle collisions (MVCs) are a substantial contributor to the global burden of disease and lead to subsequent post-traumatic stress disorder (PTSD). However, the relevant literature originates in only a few countries, and much remains unknown about MVC-related PTSD prevalence and predictors. Data come from the World Mental Health Survey Initiative, a coordinated series of community epidemiological surveys of mental disorders throughout the world. The subset of 13 surveys (5 in high income countries, 8 in middle or low income countries) with respondents reporting PTSD after life-threatening MVCs are considered here. Six classes of predictors were assessed: socio-demographics, characteristics of the MVC, childhood family adversities, MVCs, other traumatic experiences, and respondent history of prior mental disorders. Logistic regression was used to examine predictors of PTSD. Mental disorders were assessed with the fully-structured Composite International Diagnostic Interview using DSM-IV criteria. Prevalence of PTSD associated with MVCs perceived to be life-threatening was 2.5 % overall and did not vary significantly across countries. PTSD was significantly associated with low respondent education, someone dying in the MVC, the respondent or someone else being seriously injured, childhood family adversities, prior MVCs (but not other traumatic experiences), and number of prior anxiety disorders. The final model was significantly predictive of PTSD, with 32 % of all PTSD occurring among the 5 % of respondents classified by the model as having highest PTSD risk. Although PTSD is a relatively rare outcome of life-threatening MVCs, a substantial minority of PTSD cases occur among the relatively small proportion of people with highest predicted risk. This raises the question whether MVC-related PTSD could be reduced with preventive interventions targeted to high-risk survivors using models based on predictors assessed in the immediate aftermath of the MVCs.

  6. Concerning the deterioration of furniture: factors in decay and preventive conservation

    Directory of Open Access Journals (Sweden)

    Ordóñez Goded, Cristina

    2011-06-01

    Full Text Available This article outlines some of the principle factors in the deterioration of furniture (lighting, relative humidity, temperature, biodegradation and the human element and presents the type of maintenance work that can be carried out for their preservation denominated “preventive conservation.” These methods, while not eliminating the natural ageing of furniture, at least manage to slow down the decay of their constituent materials. Among the most important are the maintenance of optimal environmental conditions in the place where the works are located, their periodical inspection to check for possible biological infestation and their cleaning at regular intervals.

    Tras una exposición sobre algunos de los principales factores de deterioro del mobiliario (iluminación, humedad relativa, temperatura, biodegradación y elemento humano, este artículo refiere brevemente al conjunto de intervenciones de mantenimiento que pueden llevarse a cabo de cara a su preservación, denominadas “de conservación preventiva”. Se habla de labores que, si bien no evitan el natural envejecimiento de los muebles, sí pueden retardar la degradación de sus materiales constitutivos. Entre ellas podríamos destacar el mantenimiento de unas condiciones ambientales óptimas del lugar en el que se encuentran ubicadas las obras, la revisión periódica de éstas con el fin de comprobar si existe o no infestación biológica, la limpieza regular de las mismas, etc.

  7. Life-threatening necrotizing fasciitis due to 'bath salts' injection.

    Science.gov (United States)

    Russo, Russell; Marks, Noah; Morris, Katy; King, Heather; Gelvin, Angelle; Rooney, Ronald

    2012-01-16

    Necrotizing fasciitis is an orthopedic emergency. The ability to quickly and accurately diagnose this rapidly spreading disease can save a patient's life and limb. However, the diagnosis is complex because necrotizing fasciitis usually manifests as a less severe cellulitis or abscess while the majority of the damages rage beneath the surface of the skin. Although the diagnosis is not new, the potential causes and vectors continually change. This article reports a new source of necrotizing fasciitis in an intramuscular injection of "bath salts," a rapidly emerging street drug that is legal in some states and evades authorities with its innocuous name. The patient presented 2 days after injection of bath salts with extensive cellulitis extending to the mid portion of her upper arm. The cellulitis initially responded to broad-spectrum intravenous antibiotics, but rapidly deteriorated 48 hours later, leading to a forequarter amputation with radical mastectomy and chest wall debridement to obtain healthy tissue margins and control the disease. The patient made a full recovery after further minor debridements, negative pressure dressings, directed antibiotic therapy, and skin grafting. The recent emerging popularity of this highly obtainable, injectable substance may lead to an increase in cases of necrotizing fasciitis. Orthopedic surgeons should be vigilant in diagnosing this process early and should perform an extensive debridement. Copyright 2012, SLACK Incorporated.

  8. Prognostic value of cardiovascular magnetic resonance imaging for life-threatening arrhythmia detected by implantable cardioverter-defibrillator in Japanese patients with hypertrophic cardiomyopathy.

    Science.gov (United States)

    Hen, Yasuki; Tsugu-Yagawa, Mayuko; Iguchi, Nobuo; Utanohara, Yuko; Takada, Kaori; Machida, Haruhiko; Takara, Ayako; Teraoka, Kunihiko; Inoue, Kanki; Takamisawa, Itaru; Takayama, Morimasa; Yoshikawa, Tsutomu

    2018-01-01

    Implantable cardioverter-defibrillator (ICD) is effective to prevent sudden death in HCM patients. We reviewed ICD records to analyze the relation between life-threatening arrhythmia and late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (CMR) in Japanese hypertrophic cardiomyopathy (HCM) patients. In 102 consecutive patients (median age 63 years, 63 males) implanted with an ICD after CMR with gadolinium enhancement (median follow-up 2.8 years), the outcome of life-threatening arrhythmic events (appropriate ICD interventions for ventricular tachycardia or ventricular fibrillation) was examined. Appropriate interventions rate were 10.3% per year for secondary prevention and 7.4% per year for primary prevention. The annualized ICD-related complication rate was 3.7%. 43/91 patients (47%) implanted ICD for primary prevention had maximum wall thickness ≥20 mm plus LGE in ≥4 of 17 left ventricular segments (cut-off value obtained from ROC curve); the appropriate ICD intervention rate was significantly higher in this group than in other patients group (annualized event rate, 11.1 vs. 4.6%; log-rank P = 0.038). A combination of myocardial hypertrophy and LGE is a useful outcome predictive factor for life-threatening ventricular arrhythmia in Japanese HCM patients.

  9. Life threatening medullary injury following adenoidectomy and local anesthetic infiltration of the operative bed.

    Science.gov (United States)

    Hershman, Eli; Halberthal, Michael; Goldsher, Dorit; Golz, Avishai; Bar-Joseph, Gad

    2009-02-01

    To draw attention to a rare, life threatening complication of a rather common procedure, namely medullary injury following adenoidectomy and local anesthetic infiltration of the operative bed. Case report. A tertiary pediatric critical care unit. A healthy 7-year-old girl underwent adenoidectomy and local anesthetic infiltration of the adenoid bed with lidocaine and adrenaline. In the recovery room, nystagmus, dysarthria, dyspnea, inability to cough and right hemiparesis were noticed. Because of her inability to remove secretions tracheal intubation was performed, followed by severe, life threatening respiratory failure. Tracheal intubation, hemodynamic support, prolonged mechanical ventilation, nitric oxide, and tracheostomy. In children, local anesthetic infiltration of the adenoid bed may cause life-threatening medullary injury and its routine use should be re-considered.

  10. Spirituality in the context of life-threatening illness and life-transforming change.

    Science.gov (United States)

    Young, William C; Nadarajah, Sheeba R; Skeath, Perry R; Berger, Ann M

    2015-06-01

    Individuals with life-threatening illness often engage in some form of spirituality to meet increased needs for meaning and purpose. This study aimed to identify the role of spirituality in persons who had reported positive, life-transforming change in relation to life-threatening cancer or cardiac events, and to connect these roles to palliative and supportive care. A purposive sample of 10 cardiac survivors and 9 cancer survivors was recruited. Once the participants had given informed consent and passed screening in relation to life-transforming change and distress, they engaged in a semistructured one-hour qualitative interview on the theme of how their life-transforming change occurred in the context of their life-threatening illness. In the present article, our phenomenological analysis focuses on participants' references to purpose and meaning in their lives, with particular attention to the role and context of participants' spirituality. Participants mentioned spirituality, meaning, and purpose in many contexts, including connecting with family and friends, nature, art, music, and sometimes creating a relationship with God. Participants often accessed spirituality by enhancing connections in their own lives: with a higher power, people, their work, or themselves. These enhanced connections gave participants greater meaning and purpose in their lives, and substantially helped participants to adjust to their life-threatening illnesses. Understanding the roles and contexts of spirituality among patients with a life-threatening illness allows us to develop better palliative and supportive care plans. Spiritually oriented supportive care may include support groups, yoga, meditation, nature, music, prayer, or referral to spiritual or religious counselors. A quantitative scale is needed to help healthcare clinicians assess the spiritual and coping needs of individuals with life-threatening illness.

  11. Life-threatening hyperkalemia following zoledronic acid infusion for Paget's disease: a case report

    Directory of Open Access Journals (Sweden)

    Naysmith Morag

    2011-08-01

    Full Text Available Abstract Introduction Zoledronic acid is a highly effective treatment in Paget's disease for persistent bone pain and prevention of further progression of the disease. The commonest electrolyte abnormality is hypocalcemia. To the best of our knowledge this is the first case of hyperkalemia secondary to zoledronic acid to be published in the world literature. The commonest arrhythmia related to zoledronic acid is atrial fibrillation. Case presentation We describe the case of an 80-year-old Caucasian man, with a history of ischemic heart disease, who had an in-hospital cardiac arrest related to hyperkalemia. Increasing potassium levels were noted following his first zoledronic acid infusion for symptomatic control of bone pain secondary to Paget's disease. Our patient suffered a cardiac arrest 10 days following the zoledronic acid infusion. Our patient's biochemistry and electrocardiogram output were monitored until his death 26 days after his cardiac arrest. Our patient developed paroxysmal atrial fibrillation in the post-resuscitation period and there was persistent hyperkalemia that required prolonged treatment with calcium resonium. All other possible causes of hyperkalemia were excluded. Conclusion In our patient's case persistent hyperkalemia and life-threatening arrhythmias were associated with use of zoledronic acid. These side effects have not been reported before and the causative mechanism is far from clear as there are no obvious systemic effects of zoledronic acid. The combination of zoledronic acid with predisposing factors such as structural heart disease might account for the clinical picture we witnessed. As a result, electrolyte monitoring should be adopted early in zoledronic acid use. Further studies are required to elucidate the underlying mechanism of hyperkalemia and identify the target group of patients where zoledronic acid can be safely administered. Great caution is advised in patients with underlying heart conditions.

  12. An extended family suddenly confronted with a life-threatening hereditary arrhythmia

    NARCIS (Netherlands)

    Hendriks, K. S. W. H.; van Langen, I. M.; van Tintelen, J. P.; Grosfeld, F. J. M.; Wilde, A. A. M.; ten Kroode, H. F. J.

    2005-01-01

    This exploratory study serves to illustrate the psychological impact on an extended family in the process of genetic counselling and testing for a potentially life-threatening arrhythmia, the long-QT syndrome (LQTS). All members of the third generation and their partners (n=11) were interviewed, the

  13. An extended family suddenly confronted with a life-threatening hereditary arrhythmia

    NARCIS (Netherlands)

    Hendriks, K.S.W.H.; Van Langen, I.M.; Van Tintelen, J.P.; Grosfeld, F.J.M.; Wilde, A.A.M.; Ten Kroode, H.F.J.

    2005-01-01

    Objective. This exploratory study serves to illustrate the psychological impact on an extended family in the process of genetic counselling and testing for a potentially life-threatening arrhythmia, the long-QT syndrome (LQTS). Method. All members of the third generation and their partners (n=11)

  14. Sex Differences in Violent versus Non-Violent Life-Threatening Altruism

    Directory of Open Access Journals (Sweden)

    Carey J. Fitzgerald

    2009-07-01

    Full Text Available Many studies on Hamilton's (1964 inclusive fitness theory have used the burning house and kidney donation examples of life-threatening altruism. However, these examples may not be sufficiently exhibiting the risk involved with life-threatening altruism that would have occurred in hunter-gatherer societies, such as fighting off attackers and/or predators. The present study examined participants' estimated likelihood to perform altruistic acts for specific kin members/friends in two violent life-threatening situations (i.e., being mugged and being chased and two non-violent life-threatening situations (i.e., the burning house and kidney donation examples. Participants were 216 undergraduate students who completed a questionnaire on altruism toward an actual kin member/friend. Each questionnaire contained four life-or-death scenarios (two violent and two non-violent in which either the participant's sibling, cousin, or best friend was in danger and needed help. Results indicated that people were more likely to help siblings than cousins and friends in both the violent and non-violent hypothetical scenarios. Participants indicated a greater likelihood to help people in violent situations than in non-violent situations. Women indicated a greater estimated likelihood than men to help people in non-violent situations while men indicated a greater estimated likelihood than women to help people in violent situations. Both male and female participants indicated a greater estimated likelihood to help women than men in violent situations.

  15. Life-threatening Pneumocystis jiroveci pneumonia following treatment of severe Cushing's syndrome

    NARCIS (Netherlands)

    Oosterhuis, J. K.; van den Berg, G.; Monteban-Kooistra, W. E.; Ligtenberg, J. J. M.; Tulleken, J. E.; Zijlstra, J. G.; Meertens, John

    We describe two patients with a severe Cushing's syndrome due to ectopic production of ACTH. Both patients developed a life-threatening Pneumocystis jiroveci pneumonia (PCP) shortly after treatment of the hypercortisolism was started by means of inhibition of production of glucocorticoids and

  16. Collective Efficacy and the Contingent Consequences of Exposure to Life-Threatening Violence

    Science.gov (United States)

    Browning, Christopher R.; Gardner, Margo; Maimon, David; Brooks-Gunn, Jeanne

    2014-01-01

    Neighborhood research has increasingly emphasized the potential for contextual characteristics to moderate the effects of youths' experiences on their outcomes. Drawing on collective efficacy theory, we examine the variable consequences of youths' exposures to life-threatening violence across neighborhoods. We argue that strong community normative…

  17. A life-threatening case of disseminated nocardiosis due to Nocardia brasiliensis.

    Science.gov (United States)

    Paramythiotou, Elisabeth; Papadomichelakis, Evangelos; Vrioni, Georgia; Pappas, Georgios; Pantelaki, Maria; Kontos, Fanourios; Zerva, Loukia; Armaganidis, Apostolos

    2012-10-01

    Nocardiosis is a rare disease caused by infection with Nocardia species, aerobic actinomycetes with a worldwide distribution. A rare life-threatening disseminated Nocardia brasiliensis infection is described in an elderly, immunocompromised patient. Microorganism was recovered from bronchial secretions and dermal lesions, and was identified using molecular assays. Prompt, timely diagnosis and appropriate treatment ensured a favorable outcome.

  18. Candida albicans-associated necrotizing vasculitis producing life-threatening gastrointestinal hemorrhage.

    LENUS (Irish Health Repository)

    Sargent, Jeremy

    2012-02-01

    Patients undergoing treatment of acute lymphoblastic leukemia are at risk for fungal infections including disseminated candidiasis. We describe a case of systemic Candida albicans infection associated with life-threatening gastrointestinal hemorrhage due to unusual necrotizing vasculitis involving the gastrointestinal tract. We explore the association between Candida and such vasculopathy.

  19. Arrhythmogenic right ventricular cardiomyopathy: asymptomatic to life threatening as illustrated by the cases of two sisters

    NARCIS (Netherlands)

    Otterspoor, L. C.; Reichert, C. L. A.; Cramer, M. J. M.; Bhuiyan, Z. A.; Wilde, A. A. M.; Hauer, R. N. W.

    2007-01-01

    Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a heart muscle disorder of unknown cause that is characterised by fibrofatty replacement, primarily of the right ventricular myocardium, which can lead to life-threatening arrhythmias. It is a disease with a very diverse phenotype. In the

  20. Life-threatening necrotizing fasciitis of the neck: an unusual consequence of a sore throat

    NARCIS (Netherlands)

    Persaud, R.; Krahé, D.; Georgalas, C.; Kaniyur, S.; Das, S.; Alusi, G.

    2004-01-01

    BACKGROUND: Necrotizing fasciitis is life-threatening bacterial infection which spreads with frightening speed along the fascial planes resulting in extensive tissue necrosis and often death. The infection is caused by either Group A streptococci or a combination of aerobic and anaerobic bacteria.

  1. Three cases of intentional isoniazid overdose - a life-threatening condition.

    Science.gov (United States)

    Stead, David Francis; Mason, Carolyn Ruth

    2016-08-11

    Currently, isoniazid (INH) overdose seems to be a growing and life-threatening problem, partly due to the recent national roll-out of INHpreventive therapy (IPT) for HIV-positive adults. We present three cases, two of which were fatal, seen at Frere and Cecilia Makiwanehospitals, East London, South Africa over the past 16 months.

  2. Citation Classics in "Suicide and Life Threatening Behavior": A Research Note

    Science.gov (United States)

    Stack, Steven

    2012-01-01

    The number of citations a scholarly work receives is a common measure of its impact on the scientific literature; "citation classics" are the most highly cited works. The content of "Suicide and Life-Threatening Behavior" ("SLTB") citation classics is described here. The impact of "SLTB" citation classics is compared to their counterparts in…

  3. Preparing School Personnel to Assist Students with Life-Threatening Food Allergies.

    Science.gov (United States)

    Hay, Genevieve H.; And Others

    1994-01-01

    Knowledge of and preparation for life-threatening food allergies will enable school personnel to better respond to students who have severe allergic reactions. Given the high incidence of food-related anaphylaxis in public places, teachers and school personnel should be aware of and prepared to handle severe food allergy reactions. (SM)

  4. Guidelines for Managing Life-Threatening Food Allergies in Massachusetts Schools

    Science.gov (United States)

    Sheetz, Anne H.; Goldman, Patricia G.; Millett, Kathleen; Franks, Jane C.; McIntyre, C. Lynne; Carroll, Constance R.; Gorak, Diane; Harrison, Christanne Smith; Carrick, Michele Abu

    2004-01-01

    During the past decade, prevalence of food allergies among children increased. Caring for children with life-threatening food allergies has become a major challenge for school personnel Prior to 2002, Massachusetts did not provide clear guidelines to assist schools in providing a safe environment for these children and preparing for an emergency…

  5. Denosumab Related Osteonecrosis of the Jaw with Spontaneous Necrosis of the Soft Palate: Report of a Life Threatening Case

    Directory of Open Access Journals (Sweden)

    Mohammed Qaisi

    2016-01-01

    Full Text Available Bisphosphonates have been used for years in the treatment of patients with distant bony metastasis and in the prevention of osteoporosis. One of main side effects of these medications is the development of bisphosphonate related osteonecrosis of the jaw (BRONJ in a small subset of patients. A new class of medications with a shorter half-life, known as receptor activator of nuclear factor kappa-B ligand (RANKL inhibitors, was introduced with the hopes of avoiding this side effect. However, reports of osteonecrosis of the jaw after the use of RANKL inhibitors have also been documented. We report on a patient who developed a life threatening osteonecrosis of the jaw with sepsis shortly after switching from a bisphosphonate to a RANKL inhibitor for osteoporosis treatment. This patient developed several soft tissue defects including spontaneous necrosis of the soft palate. To our knowledge this is the first time this presentation has been described.

  6. Life-threatening Duodenal Ulcer Bleeding from a Ruptured Gastroduodenal Artery Aneurysm in a Patient with Neurofibromatosis Type 1.

    Science.gov (United States)

    Im, Kyu Sung; Kim, Sunyong; Lim, Jun Uk; Jeon, Jung Won; Shin, Hyun Phil; Cha, Jae Myung; Joo, Kwang Ro; Lee, Joung Il; Park, Jae Jun

    2015-09-01

    Vasculopathy is rarely reported in neurofibromatosis type 1, but when it occurs it primarily involves the aorta and its main branches. Among vasculopathies, aneurysmal dilatation is the most common form. Although several case reports concerning aneurysms or pseudoaneurysms of visceral arteries in neurofibromatosis type 1 patients have been reported, there are no reports describing gastroduodenal artery aneurysms associated with neurofibromatosis type 1. We experienced a case of life-threatening duodenal ulcer bleeding from a ruptured gastroduodenal artery aneurysm associated with neurofibromatosis type 1. We treated our patient by transarterial embolization after initial endoscopic hemostasis. To our knowledge, this is the first reported case of its type. High levels of suspicion and prompt diagnosis are required to select appropriate treatment options for patients with neurofibromatosis type 1 experiencing upper gastrointestinal bleeding. Embolization of the involved arteries should be considered an essential treatment over endoscopic hemostasis alone to achieve complete hemostasis and to prevent rebleeding.

  7. EPQ model for imperfect production processes with rework and random preventive machine time for deteriorating items and trended demand

    Directory of Open Access Journals (Sweden)

    Shah Nita H.

    2015-01-01

    Full Text Available Economic production quantity (EPQ model has been analyzed for trended demand, and units in inventory are subject to constant rate. The system allows rework of imperfect units, and preventive maintenance time is random. A search method is used to study the model. The proposed methodology is validated by a numerical example. The sensitivity analysis is carried out to determine the critical model parameters. It is observed that the rate of change of demand, and the deterioration rate have a significant impact on the decision variables and the total cost of an inventory system. The model is highly sensitive to the production and demand rate.

  8. Prevention of clinically important deteriorations in COPD with umeclidinium/vilanterol

    Directory of Open Access Journals (Sweden)

    Singh D

    2016-06-01

    Full Text Available Dave Singh,1 M Reza Maleki-Yazdi,2 Lee Tombs,3 Ahmar Iqbal,4 William A Fahy,5 Ian Naya5 1Medicines Evaluation Unit, University of Manchester, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK; 2Division of Respiratory Medicine, Women’s College Hospital, University of Toronto, ON, Canada; 3Precise Approach LTD, London UK; 4Respiratory Medical Franchise, GSK, Research Triangle Park, NC, USA; 5Respiratory Medicines Development Centre, GSK, Stockley Park, Middlesex, UK Background: Minimizing the risk of disease progression and exacerbations is the key goal of COPD management, as these are well-established indicators of poor COPD prognosis. We developed a novel composite end point assessing three important aspects (lung function, health status, and exacerbations of worsening in COPD. The objective was to determine whether dual bronchodilation with umeclidinium/vilanterol (UMEC/VI reduces clinically important deteriorations (CIDs in COPD versus placebo or bronchodilator monotherapy.  Methods: This study is a post hoc analysis of two 24-week trials comparing UMEC/VI 62.5/25 µg with UMEC 62.5 µg, VI 25 µg, or placebo (Study A; NCT01313650, or UMEC/VI 62.5/25 µg with tiotropium (TIO 18 µg (Study B; NCT01777334 in patients with symptomatic COPD, without a history of frequent exacerbations. Deterioration was assessed as the time to a first CID, a composite measure defined as a decrease of ≥100 mL in trough forced expiratory volume in 1 second or ≥4-unit increase in St George’s Respiratory Questionnaire total score or an on-treatment moderate-to-severe COPD exacerbation.  Results: In Study A, fewer patients experienced a first CID with UMEC/VI (44% versus UMEC (50%, VI (56%, and placebo (75%. The risk of a first CID was reduced with UMEC/VI (hazard ratio [HR]: 0.37 [95% confidence interval, CI: 0.30, 0.45], UMEC (HR: 0.46 [95% CI: 0.38, 0.56], and VI (HR: 0.55 [95% CI: 0.45, 0.66]; all P<0.001 versus placebo

  9. Life-threatening allergic vasculitis after clipping an unruptured aneurysm: Case report, weighing the risk of nickel allergy.

    Science.gov (United States)

    Grande, Andrew; Grewal, Sanjeet; Tackla, Ryan; Ringer, Andrew J

    2014-01-01

    This case report represents one of the estimated 17,000 aneurysms clipped annually in the United States, often with nickel-containing clips. The authors highlight the development of life-threatening allergic vasculitis in a 33-year-old woman after aneurysm clipping. After suffering subarachnoid hemorrhage, the patient had coil embolization at another facility for rupture of a right internal carotid artery (ICA) aneurysm. An incidental finding, an unruptured left posterior communicating artery aneurysm unamenable to coiling, was then successfully clipped via a left pterional craniotomy. Arriving in our emergency department 11 days later, she progressively declined during the next weeks, facing deteriorating clinical status (i.e. seizures) and additional infarctions in the left frontal lobe, midline shift, and new infarctions in the bilateral frontal lobe, right sylvian, right insular regions, and posterior cerebral artery distribution. During decompressive surgery, biopsy findings raised the possibility of lymphocytic vasculitis; consultations with rheumatology, allergy, and immunology specialists identified that our patient had a nickel allergy. After reoperation to replace the nickel-containing clip with one of a titanium alloy, the patient had an uncomplicated postoperative course and was discharged 6 days later to a rehabilitation facility. Nickel-related allergies are more common than appreciated, affecting up to 10% of patients. Fortunately, severe reactions are rare; nevertheless, vascular neurosurgeons should be aware of this potential complication when using cobalt alloy aneurysms clips. The use of titanium alloy clips eliminates this risk.

  10. Caring for children with life-threatening illnesses: impact on White, African American, and Latino families.

    Science.gov (United States)

    Hinojosa, Melanie Sberna; Knapp, Caprice A; Madden, Vanessa L; Huang, I-Chan; Sloyer, Phyllis; Shenkman, Elizabeth A

    2012-10-01

    We describe the racial and ethnic variation in family impact resulting from caring for a child with a life-threatening illness. Parents of children aged 2-21 years diagnosed with a potentially life-threatening illness and enrolled in Florida's Medicaid and Children's Medical Services Network programs were surveyed. Two hundred sixty-six telephone surveys were conducted in English and Spanish between November 2007 and April 2008. In adjusted models, compared with Whites, Latinos reported that their child's illness resulted in a greater negative impact on the family. Continued study of this group of parents is critical to developing culturally appropriate interventions to reduce strain and burden and improve the quality of life for families. Copyright © 2012 Elsevier Inc. All rights reserved.

  11. Heparin-Induced Cardiac Tamponade and Life-Threatening Hyperkalemia in a Patient with Chronic Hemodialysis

    Directory of Open Access Journals (Sweden)

    Ho-Ming Su

    2005-03-01

    Full Text Available Heparin, a commonly used anticoagulant agent, is frequently used in patients undergoing hemodialysis. As with most medications, heparin has a significant side effect profile. Two of its most important side effects, major bleeding and hyperkalemia, may be devastating without immediate diagnosis and treatment. Major bleeding such as gastrointestinal, genitourinary or intracranial bleeding is occasionally encountered and rarely neglected. However, heparin-induced cardiac tamponade is rarely encountered and may be easily overlooked. Another side effect, heparin-induced hyperkalemia, an unusual but well-described side effect, is frequently forgotten until life-threatening arrhythmia has occurred. We report a case involving a 40-year-old male patient with uremia, who had received heparin for 10 days for deep vein thrombosis in the left lower extremity. Hemopericardium with cardiac tamponade and life-threatening hyperkalemia were both noted in this patient.

  12. Patterns of decision making by wives of patients with life-threatening cardiac disease.

    Science.gov (United States)

    Hall, Patricia; Sanford, Julie T; Demi, Alice S

    2008-08-01

    Implementation of the Patient Self-Determination Act (PSDA) in the United States has transferred decision making from the responsibility of health care professionals to the responsibility of family members. Dilemmas occurring as a result of this responsibility may cause stress and conflict among family members. The purpose of this study is to describe the patterns of decision making by family members of patients with life-threatening cardiac disease. Purposive sampling is used to select 10 wives of patients with life-threatening cardiovascular disease. Data are gathered through unstructured interviews and are analyzed using grounded theory and theory triangulation. Analysis of the data reveal three patterns of decision making: advocacy, acquiescence, and abdication.

  13. The radiology perspective: needs and tools for management of life-threatening events

    International Nuclear Information System (INIS)

    Gaca, Ana Maria; Lerner, Catherine B.; Frush, Donald P.

    2008-01-01

    Studies have shown that life-threatening contrast agent reactions in adults are very rare, and even less common in children. The rarity of severe allergic reactions to contrast material challenges educators to achieve radiology resident competency in this setting. However, using a simulated anaphylactic contrast reaction paradigm, we have drawn two conclusions: (1) Residents are insufficiently prepared to recognize and manage these life-threatening events and (2) with an interactive, computer-based tool we can significantly improve resident performance in these situations. Simulation is a growing tool in medicine and allows standardized resident exposure to uncommon events in a setting that is conducive to resident education without fear of repercussions (see Ruddy and Patterson in this issue of Pediatric Radiology). More important, simulation provides a cornerstone in patient safety resident education without putting patients at risk. (orig.)

  14. Rivaroxaban-Induced Nontraumatic Spinal Subdural Hematoma: An Uncommon Yet Life-Threatening Complication

    Directory of Open Access Journals (Sweden)

    Mazen Zaarour

    2015-01-01

    Full Text Available In the last decade, the desire for safer oral anticoagulants (OACs led to the emergence of newer drugs. Available clinical trials demonstrated a lower risk of OACs-associated life-threatening bleeding events, including intracranial hemorrhage, compared to warfarin. Nontraumatic spinal hematoma is an uncommon yet life-threatening neurosurgical emergency that can be associated with the use of these agents. Rivaroxaban, one of the newly approved OACs, is a direct factor Xa inhibitor. To the best of our knowledge, to date, only two published cases report the incidence of rivaroxaban-induced nontraumatic spinal subdural hematoma (SSDH. Our case is the third one described and the first one to involve the cervicothoracic spine.

  15. Isoflurane for life-threatening bronchospasm: a 15-year single-center experience.

    Science.gov (United States)

    Turner, David A; Heitz, David; Cooper, Mehrengise K; Smith, P Brian; Arnold, John H; Bateman, Scot T

    2012-11-01

    Children with severe bronchospasm requiring mechanical ventilation may become refractory to conventional therapy. In these critically ill patients, isoflurane is an inhaled anesthetic agent available in some centers to treat bronchospasm. We hypothesized that isoflurane is safe and would lead to improved gas exchange in children with life-threatening bronchospasm refractory to conventional therapy. A retrospective review was conducted and included mechanically ventilated children treated with isoflurane in a quaternary pediatric ICU for life-threatening bronchospasm, from 1993 to 2007. Demographic, blood gas, ventilator, and outcome data were collected. Thirty-one patients, with a mean age of 9.5 years (range 0.4-23 years) were treated with isoflurane, from 1993 to 2007. Mean time to initiation of isoflurane after intubation was 13 hours (0-120 h), and the mean maximum isoflurane dose was 1.1% (0.3-2.5%). Mean duration of isoflurane administration was 54.5 hours (range 1-181 h), with a total mean duration of mechanical ventilation of 252 hours (range 16-1,444 h). Isoflurane led to significant improvement in pH and P(CO(2)) within 4 hours of initiation (P ≤ .001). Complications during isoflurane administration included hypotension requiring vasoactive infusions in 24 (77%), arrhythmia in 3 (10%), neurologic side effects in 3 (10%), and pneumothorax in 1 (3%) patient. Isoflurane led to improvement in pH and P(CO(2)) within 4 hours in this series of mechanically ventilated patients with life-threatening bronchospasm. The majority of patients in this series developed hypotension, but there was a low incidence of other side effects related to isoflurane administration. Isoflurane appears to be an effective therapy in patients with life-threatening bronchospasm refractory to conventional therapy. However, further investigation is warranted, given the uncertain overall impact of isoflurane in this context.

  16. Apparent Life-Threatening Event following Maternal Use of Temazepam during Labour

    Directory of Open Access Journals (Sweden)

    L. Damen

    2014-01-01

    Full Text Available Benzodiazepines are one of the most frequently prescribed psychotropic drugs during pregnancy. Despite the fact that these drugs have been in use for a long time, there is still debate about the safety for the developing fetus and neonate. We present a case of a newborn with an apparent life-threatening event shortly after birth following maternal temazepam use during labour and advise to be reserved in prescribing any dose of any kind of benzodiazepine during labour.

  17. Life-threatening hereditary angio-oedema: Challenges of care in South Africa.

    Science.gov (United States)

    Potter, P; Peter, J

    2018-03-28

    The report and description by Coovadia et al.[1] in this issue of SAMJ of a large cohort of patients in the Western Cape Province of South Africa (SA) suffering from type 1 hereditary angio-oedema (HAE) not only documents for the first time a significant presence of this life-threatening condition on the African continent but highlights the challenges of diagnosis and management in the SA socioeconomic and healthcare context.

  18. Life threatening severe Influenza A Virus (H1N1) infection in ...

    African Journals Online (AJOL)

    ABSTRACT: H1N1 influenza is an emerging threat that is life threatening to pregnant women in the third trimester. Pregnant women are a high-risk group for morbidity and mortality from influenza (H1N1). During the current pandemic of H1N1 influenza, few cases of H1N1 have been reported in pregnancy. We report a case ...

  19. Odontogenic deep neck space infection as life-threatening condition in pregnancy.

    Science.gov (United States)

    Dalla Torre, D; Burtscher, D; Höfer, D; Kloss, F R

    2014-09-01

    Odontogenic deep neck space infections represent a severe disease with possible life-threatening complications. Despite knowledge of these infectious diseases, treatment remains a challenge for every maxillofacial surgeon. Therapy of severe neck infections is even more crucial during pregnancy because of the possible life-threatening situation for both the mother and the foetus. The possible compromise of oral health during pregnancy is well known, however severe odontogenic infections are rarely considered in the literature. The following case report describes the dramatic course of a deep neck space infection in a pregnant patient, commencing with typical symptoms of localized odontogenic infection and ending in a critical, life-threatening condition for the patient and a lethal condition for the foetus. The case represents the first description of intrauterine, foetal death caused by a deep neck space infection. Implications for dental and medical treatment during pregnancy, especially regarding odontogenic infections, are presented and discussed with findings in the international literature. © 2014 Australian Dental Association.

  20. Workplace strength training prevents deterioration of work ability among workers with chronic pain and work disability: a randomized controlled trial

    DEFF Research Database (Denmark)

    Sundstrup, Emil; Jakobsen, Markus D; Brandt, Mikkel

    2014-01-01

    . METHODS: Sixty-six slaughterhouse workers with upper-limb chronic pain and work disability were randomly allocated to 10 weeks of either strength training for the shoulder, arm, and hand muscles (3 times per week, 10 minutes per session) or ergonomic training (usual care control group) from September.......9-3.7] in the strength training group corresponding to a moderate effect size (Cohen's d 0.52). Within-group changes indicated that between-group differences were mainly caused by a reduction in WAI in the ergonomic group. Of the 7 items of WAI, item 2 (work ability in relation to the demands of the job) and item 7...... (mental resources) increased following strength training compared with ergonomic training (Ptraining at the workplace prevents deterioration of work ability among manual workers with chronic pain and disability exposed to forceful and repetitive job tasks...

  1. Aminoguanidine prevents age-related deterioration in left ventricular-arterial coupling in Fisher 344 rats.

    Science.gov (United States)

    Chang, Kuo-Chu; Hsu, Kwan-Lih; Chou, Tsai-Fwu; Lo, Huey-Ming; Tseng, Yung-Zu

    2004-08-01

    In recent studies, aminoguanidine (AG), an inhibitor of advanced glycation endproducts, has been identified as a prominent agent that can prevent the age-related aortic stiffening and cardiac hypertrophy. The aim of this study was to determine whether AG had effects on the left ventricular (LV)-arterial coupling in aged Fisher 344 rats in terms of the ventricular and arterial chamber properties. Normotensive rats were treated from 18 to 24 months with AG (1 g l(-1) in drinking water) and compared with a control group. LV pressure and ascending aortic flow signals were recorded to construct the ventricular and arterial end-systolic pressure-stroke volume relationships to calculate LV end-systolic elastance (Ees) and effective arterial volume elastance (Ea), respectively. The optimal afterload (Qload) determined by the ratio of Ea to Ees was used to measure the efficiency of mechanical energy transferred from the left ventricle to the arterial system. In comparison with the 6-month-old rats, the 24-month-old animals had decreased Ees, at 567.4 +/- 26.7 vs 639.0 +/- 20.7 mmHg ml(-1), decreased Ea, at 411.5 +/- 18.6 vs 577.9 +/- 15.7 mmHg ml(-1), and decreased Q(load), at 0.9428 +/- 0.0024 vs 0.9962 +/- 0.0014. Treatment with AG for 6 months did not significantly affect Ees; however, when normalized to LV weight (i.e., Eesn = Ees/LV weight), Eesn showed a significant rise of 22.8%, suggesting that AG may retard the aging process on the intrinsic contractility of the left ventricle. On the other hand, the decrease in Ea in aging rats was prevented by AG, as reflected in the increase of 19.7% in this variable (P < 0.05). The 24-month-old treated rats also exhibited a significant rise of 21.6% in Ea/Ees, causing an increase of 5.2% in Qload (P < 0.05). We conclude that in healthy older Fisher 344 rats without diabetes, long-term treatment with AG may improve both the arterial and ventricular function and optimize the matching condition for the left ventricular

  2. Nebulised adrenaline to manage a life-threatening complication in a pug with trismus.

    Science.gov (United States)

    Leece, E; Cherubini, G

    2015-07-01

    A 13-month-old pug with severe trismus because of suspected masticatory muscle myositis underwent anaesthesia for magnetic resonance imaging. When regurgitation occurred, the tongue was pulled from the mouth to enable suctioning but could not be repositioned into the oral cavity as it was not possible to open the mouth. Swelling due to venous congestion and a bite wound were treated using nebulised adrenaline and resolved within 2 hours allowing retraction of the tongue. The use of nebulised adrenaline offers a non-invasive method of managing this potentially life-threatening complication. © 2015 British Small Animal Veterinary Association.

  3. Cutaneous Cryptococcosis: a marker of life threatening disseminated cryptococcosis in HIV AIDS

    Directory of Open Access Journals (Sweden)

    Hari Kishan Kumar Yadalla

    2011-10-01

    Full Text Available Cryptococcosis is an opportunistic infection caused by a ubiquitous encapsulated yeast, Cryptococcus neoformans. Affects 5 – 10 % of patients with HIV worldwide. Disseminated cryptococcosis is one of the AIDS defining criteria and the most common cause of life threatening meningitis. Upto 20% of patients with disseminated disease can have skin involvement. Cutaneous lesions in disseminated cryptococcosis are seldom pathognomonic and portent neurological involvement. The significance of skin lesions may provide the first evidence of dissemination and indicate a poor prognosis, however, earlier recognition and treatment would improve survival. Herein we report a case of cryptococcal meningitis with skin lesions in a HIV seropositive patient.

  4. Tension gastrothorax: acute life-threatening manifestation of late onset congenital diaphragmatic hernia (CDH) in children.

    Science.gov (United States)

    Næss, Pål Aksel; Wiborg, Joachim; Kjellevold, Kristin; Gaarder, Christine

    2015-06-24

    Tension gastrothorax in children is a life-threatening condition and presents dramatically with acute and severe respiratory distress. It develops when an intra-thoracic stomach herniated through a diaphragmatic defect is massively distended by trapped air and/or fluid causing mediastinal displacement. Tension gastrothorax is often misinterpreted as tension pneumothorax and managed as such leading to increased morbidity and mortality. We present a child with tension gastrothorax and a literature review of this phenomenon.Immediate clinical and radiographic evaluation should lead to accurate diagnosis followed by emergency decompression of the stomach before laparotomy with reduction of herniated viscera and repair of the diaphragmatic defect.

  5. Maxillary tuberosity fracture: a life-threatening haemorrhage following simple exodontia.

    Science.gov (United States)

    Bertram, A R; Rao, A C A; Akbiyik, K M; Haddad, S; Zoud, K

    2011-06-01

    Maxillary tuberosity fracture is a potential complication of routine exodontia of posterior maxillary teeth. On rare occasions, such a complication can result in torrential haemorrhage due to the close proximity of significant vessels to the area. We present a case of life-threatening haemorrhage complicating a tuberosity fracture during simple extraction of a maxillary posterior tooth. The local anatomy of the region is discussed and we provide guidelines for general dental practitioners for the management of the complication of a tuberosity fracture during routine exodontia. © 2011 Australian Dental Association.

  6. In-hospital heart rate turbulence and microvolt T-wave alternans abnormalities for prediction of early life-threatening ventricular arrhythmia after acute myocardial infarction.

    Science.gov (United States)

    Arisha, Mohamed Moussa; Girerd, Nicolas; Chauveau, Samuel; Bresson, Didier; Scridon, Alina; Bonnefoy, Eric; Chevalier, Philippe

    2013-11-01

    In the setting of primary prevention, most implantable cardiac defibrillators (ICD) are implanted more than 6 months after acute myocardial infarction (AMI). Abnormal heart rate turbulence (HRT) and T-wave alternans (TWA) are predictors of long-term sudden cardiac death (SCD). We intended to assess the predictive value of HRT and TWA for early post-AMI SCD and life-threatening ventricular arrhythmias (VA). One hundred ninety-nine consecutive patients with AMI were prospectively included (age 61.7 years, LV ejection fraction 45%). One hundred eighty-three patients (92%) underwent percutaneous coronary intervention. We assessed HRT using turbulence slope (TS), turbulence onset (TO), and TWA on channels 1 and 2 (TWA1 and TWA2) using the modified moving average method. Predictive performance for SCD/VA was assessed by area under the receiver operating curve characteristic (ROC-AUC). Within 6 months after AMI, 2 patients (1%) developed life-threatening VA and 3 (1.5%) experienced SCD. TO and TWA1 had poor ROC-AUC (both 0.64) whereas TS and TWA2 failed to show any predictive performance (ROC-AUC 0.48 and 0.57, respectively). When combining TO and TWA1, ROC-AUC increased to 0.80. Importantly, when considering the subset of patients with a LV ejection fraction ≤40%, the combined variable of TO and TWA1 remained strongly predictive of a short-term event (ROC-AUC 0.86). Combined assessment of HRT and TWA showed a high predictive performance for SCD or life-threatening VA within 6 months after AMI. This combined Holter ECG index could be useful to identify high-risk patients who might benefit from early ICD implantation. ©2013 Wiley Periodicals, Inc.

  7. Life-threatening interaction between complementary medicines: cyanide toxicity following ingestion of amygdalin and vitamin C.

    Science.gov (United States)

    Bromley, Jonathan; Hughes, Brett G M; Leong, David C S; Buckley, Nicholas A

    2005-09-01

    To describe a case of severe accidental cyanide poisoning following a single ingestion of amygdalin with therapeutic intent. A 68-year-old patient with cancer presented to the emergency department shortly after her first dose (3 g) of amygdalin with a reduced Glasgow Coma Score, seizures, and severe lactic acidosis requiring intubation and ventilation. The patient also ingested 4800 mg of vitamin C per day. She responded rapidly to hydroxocobalamin treatment. The adverse drug reaction was rated probable on the Naranjo probability scale. Amygdalin and laetrile (a synthetic form of amygdalin) are commonly used as complementary or alternative medicine (CAM) for the treatment of cancer. Vitamin C is known to increase the in vitro conversion of amygdalin to cyanide and reduce body stores of cysteine, which is used to detoxify cyanide. Amygdalin has been used for decades by patients with cancer who are seeking alternative therapies, and severe reactions have not been reported with this dose. An interaction with vitamin C is a plausible explanation for this life-threatening response. This case highlights the fact that CAMs can produce life-threatening toxicity. This case also adds a further note of caution, namely, the potential for serious interactions between CAMs, particularly where there is no tradition of concomitant use.

  8. Collective Efficacy and the Contingent Consequences of Exposure to Life-Threatening Violence1

    Science.gov (United States)

    Browning, Christopher R.; Gardner, Margo; Maimon, David; Brooks-Gunn, Jeanne

    2014-01-01

    Neighborhood research has increasingly emphasized the potential for contextual characteristics to moderate the effects of youths’ experiences on their outcomes. Drawing on collective efficacy theory, we examine the variable consequences of youths’ exposures to life threatening violence across neighborhoods. We argue that strong community normative orientations supporting the control of violence diminish the negative effect of exposure to severe violence on subsequent mental health among urban youth. We also consider the extent to which the consequences of exposure to violence vary by gender. Employing data from the Project on Human Development in Chicago Neighborhoods, we estimate a series of multivariate, multilevel linear models of internalizing and externalizing symptoms. Results indicate that, for girls, exposure to life threatening violence (witnessing someone being attacked with a weapon or shot) increases both internalizing and externalizing symptoms. However, this effect achieves statistical significance only for girls who reside in lower collective efficacy neighborhoods. For boys, our analyses offered weaker evidence of violence exposure effects on mental health. Implications for research on the social context of mental health are discussed. PMID:24842460

  9. Gastric Ulcer Hemorrhage - a Potential Life-Threatening Complication of Intragastric Balloon Treatment of Obesity

    Directory of Open Access Journals (Sweden)

    Aleksandra Mojkowska

    2017-04-01

    Full Text Available Background: Some morbidly obese patients do not qualify for bariatric surgery due to general health contraindications. Intragastric balloon treatment might be a therapeutic option in the above-mentioned cases. It can prime super-obese patients with end-stage disease for bariatric surgery. As a neoadjuvant therapy before surgery, it leads to a downstage of the disease by preliminary weight reduction, to an improvement in general health and, in summary, to a reduction of the perioperative risk. It is generally considered to be a safe method. However, due to the wide range of possible complications and unusual symptoms after intragastric balloon treatment, an interdisciplinary, instead of only a surgical or endoscopic, treatment and follow-up might be recommended in these patients. Case Report: We here describe a potential life-threatening complication in the form of gastric bleeding as a consequence of intragastric balloon treatment and simultaneous aspirin taking and Helicobacter pylori infection. Conclusion: There have been reports of some complications of intragastric balloon treatment. However, to the best of our knowledge there were no reports concerning life-threatening hemorrhage from gastric ulcer.

  10. Embolization of Life-Threatening Arterial Rupture in Patients with Vascular Ehlers–Danlos Syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Okada, Takuya, E-mail: okabone@gmail.com [Assistance Publique des Hôpitaux de Paris, Georges Pompidou European Hospital, Interventional Radiology Department (France); Frank, Michael, E-mail: michael.frank@egp.aphp.fr [Assistance Publique des Hôpitaux de Paris, Georges Pompidou European Hospital, Rare Vascular Diseases Reference Center (France); Pellerin, Olivier, E-mail: olivier@pellerin.as; Primio, Massimiliano Di, E-mail: massimiliano.di.primio@gmail.com; Angelopoulos, Georgios, E-mail: giorginos78@msn.com [Assistance Publique des Hôpitaux de Paris, Georges Pompidou European Hospital, Interventional Radiology Department (France); Boughenou, Marie-Fazia, E-mail: marie-fazia.boughenou@egp.aphp.fr [Assistance Publique des Hôpitaux de Paris, Georges Pompidou European Hospital, Anesthesia and Surgical Intensive Care Unit (France); Pagny, Jean-Yves, E-mail: jean-yves.pagny@egp.aphp.fr [Assistance Publique des Hôpitaux de Paris, Georges Pompidou European Hospital, Interventional Radiology Department (France); Messas, Emmanuel, E-mail: emmanuel.messas@egp.aphp.fr [Assistance Publique des Hôpitaux de Paris, Georges Pompidou European Hospital, Rare Vascular Diseases Reference Center (France); Sapoval, Marc, E-mail: marc.sapoval2@egp.aphp.fr [Assistance Publique des Hôpitaux de Paris, Georges Pompidou European Hospital, Interventional Radiology Department (France)

    2013-05-09

    PurposeTo evaluate the safety and efficacy of transarterial embolization of life-threatening arterial rupture in patients with vascular Ehlers–Danlos syndrome (vEDS) in a single tertiary referral center.MethodsWe retrospectively analyzed transarterial embolization for vEDS performed at our institution from 2000 to 2012. The indication of embolization was spontaneous arterial rupture or pseudoaneurysm with acute bleeding. All interventions used a percutaneous approach through a 5F or less introducer sheath. Embolic agents were microcoils and glue in 3 procedures, glue alone in 2, and microcoils alone in 2.ResultsFive consecutive vEDS patients were treated by 7 embolization procedures (4 women, mean age 29.8 years). All procedures were successfully performed. Two patients required a second procedure for newly arterial lesions at a different site from the first procedure. Four of the five patients were still alive after a mean follow-up of 19.4 (range 1–74.7) months. One patient died of multiple organ failure 2 days after procedure. Minor procedural complications were observed in 3 procedures (43 %), all directly managed during the same session. Remote arterial lesions occurred after 3 procedures (43 %); one underwent a second embolization, and the other 2 were observed conservatively. Puncture site complication was observed in only one procedure (14 %).ConclusionEmbolization for vEDS is a safe and effective method to manage life-threatening arterial rupture.

  11. Life-threatening asthma attack during prolonged fingolimod treatment: case report

    Directory of Open Access Journals (Sweden)

    Zecca C

    2014-07-01

    Full Text Available Chiara Zecca,1,* Matteo Caporro,1,* Sandor Györik,2 Claudio Gobbi11Neurocenter of Southern Switzerland, Department of Neurology, Ospedale Regionale di Lugano, Lugano, Switzerland; 2Department of Internal Medicine, Ospedale Regionale di Bellinzona, Bellinzona, Switzerland*These authors contributed equally to this workBackground: Fingolimod (FTY mediates bronchoconstriction by interacting with sphingosine-1-phosphate receptors. The majority of the reported adverse respiratory events occur during the first weeks of treatment.Case presentation: A 49-year-old woman developed a life-threatening asthma attack after 6 months of continuous FTY treatment. The adverse event required prolonged hospitalization, and the patient recovered without sequelae after FTY interruption. A history of previous airway hyperreactivity and a concurrent viral respiratory infection possibly acted as predisposing factors.Conclusion: This first description of a severe, life-threatening asthma attack during prolonged FTY treatment suggests the need for long-term clinical surveillance, especially in patients with known predisposing factors.Keywords: multiple sclerosis, bronchial hyper-reactivity

  12. Life-threatening conditions in pregnant's with cardiovascular pathology: multidisciplinary approach

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    Lazoryshynez V.V.

    2016-03-01

    Full Text Available Purpose — to reduce maternal and infant mortality and morbidity, applying a multidisciplinary approach to the treatment of pregnant women with life-threatening heart disease. Patients and methods. Pregnant women (n=29 with cardiac pathology, which were assisted during 2013–2015 in SI «Amosov National Institute of Cardiovascular Surgery NAMS of Ukraine» and SI «Institute of Pediatrics, Obstetrics and Gynecology of NAMS of Ukraine». Results. All pregnant women were divided into three groups: patients, requiring cardiac emergency care (n=10; patients, who cardiac surgery care is provided in conventionally planed (n=11; patients, potentially not require cardiac care, but require multidisciplinary supervision (n=8. In 5 patients performed cardiac surgery using CAPB. In 7 patients with rheumatic heart disease and mitral stenosis III–IV degree (class III–IV WHO was performed transventricular mitral commissurotomy without the use of cardiopulmonary bypass (CAPB. 8 Cesarean section were performed in women who belonged to Class IV for the modified classification WHO. In two patients with aortic coarctation performed endovascular stenting narrowed region of the aorta, in 6 cases performed surgical treatment of arrhythmias. Conclusions. Pregnant women with cardiac pathology requiring intersectoral cooperation obstetrician, cardiologists and cardiac surgeons. Multidisciplinary care to pregnant women with special needs greatly reduces the risk of death and disability of mothers and children, subject to stratification of cardiovascular risk. Special attention required pregnant women with life-threatening conditions, which are subject to emergency or urgent cardiac surgery.

  13. Protect and enhance: Lowi's juridical democracy and the prevention of significant deterioration of air quality

    Energy Technology Data Exchange (ETDEWEB)

    Meiburg, A.S.

    1986-01-01

    The capture of Federal regulatory agencies by the groups they were supposed to be regulating has been a topic of concern in the traditional literature of public administration. In his influential book The End of Liberalism, Professor Theordore Lowi suggested that capture resulted in part from vauge delegations of authority of Congress to regulatory agencies. Lowi argued that democracy would be better served if Congress were more specific in drafting laws, if agencies made greater use of formal rulemaking in implementing them, and if the courts rejected statutes which contained excessively vague delegations of authority - a remedy which he labeled juridicial democracy. This dissertation examines Lowi's theory in light of the experience of Congress and the Environmental Protection Agency (EPA) with the requirements of the Clean Air Act to prevent the significant deterioration of air quality in areas where air was already relatively clean. The history of the program to develop and carry out these requirements, known as PSD, is described in detail from its inception in the late 1960's through EPA's final regulations in 1980. Special attention is given to the actions taken by EPA after environmental groups successfully used the courts to force EPA to develop a PSD program in 1974, how Congress responded by amending the Clean Air Act in 1977, and the difficulties these amendments and subsequent additional court reviews caused for EPA.

  14. Physical exercise at the workplace prevents deterioration of work ability among healthcare workers: cluster randomized controlled trial.

    Science.gov (United States)

    Jakobsen, Markus D; Sundstrup, Emil; Brandt, Mikkel; Jay, Kenneth; Aagaard, Per; Andersen, Lars L

    2015-11-25

    Imbalance between individual resources and work demands can lead to musculoskeletal disorders and reduced work ability. The purpose of this study was to investigate the effect of workplace- versus home-based physical exercise on work ability among healthcare workers. Two hundred female healthcare workers (Age: 42.0, BMI: 24.1, work ability index [WAI]: 43.1) from 18 departments at three Danish hospitals participated (Copenhagen, Denmark, Aug 2013-Jan 2014). Participants were randomly allocated at the cluster level to 10 weeks of: 1) workplace physical exercise (WORK) performed during working hours for 5x10 min per week and up to 5 group-based coaching sessions on motivation for regular physical exercise, or 2) home-based physical exercise (HOME) performed during leisure time for 5x10 min per week. Both groups received ergonomic counseling on patient handling and use of lifting aides. The main outcome measure was the change from baseline to 10-week follow-up in WAI. Significant group by time interaction was observed for WAI (p workplace prevents deterioration of work ability among female healthcare workers. ClinicalTrials.gov NCT01921764 . Registered 10 August 2013.

  15. Worksite interventions for preventing physical deterioration among employees in job-groups with high physical work demands: background, design and conceptual model of FINALE

    DEFF Research Database (Denmark)

    Holtermann, Andreas; Jørgensen, Marie B; Gram, Bibi

    2010-01-01

    A mismatch between individual physical capacities and physical work demands enhance the risk for musculoskeletal disorders, poor work ability and sickness absence, termed physical deterioration. However, effective intervention strategies for preventing physical deterioration in job groups with high...... physical demands remains to be established. This paper describes the background, design and conceptual model of the FINALE programme, a framework for health promoting interventions at 4 Danish job groups (i.e. cleaners, health-care workers, construction workers and industrial workers) characterized by high...

  16. Cisplatin chemotherapy (without erythropoietin) and risk of life-threatening thromboembolic events in carcinoma of the uterine cervix: the tip of the iceberg? A review of the literature

    International Nuclear Information System (INIS)

    Anders, Jon C; Grigsby, Perry W; Singh, Anurag K

    2006-01-01

    The risk of severe cardiovascular toxicity, specifically thromboembolic events (TE), in patients with cervical cancer receiving concurrent irradiation and cisplatin chemotherapy is reported to be less than 1% in several large prospective trials. However, the anecdotal risk appears to be far higher. A review of several prospective trials demonstrates no treatment related grade 4 cardiovascular toxicities and only two grade 5 toxicities in 1424 (0.1%) collective patients. A recent publication and our own unpublished experience finds 6 of 128 (4.7%) patients developed grade 4 to 5 cardiovascular (thrombosis/embolism) toxicity. The differenc in incidence of severe or life threatening cardiovascular toxicity of 0.1 versus 4.7% is highly statistically significant (p < 0.00001.) This dramatic difference in incidence of cardiovascular toxicity raises the possibility that cardiovascular toxicities were inadequately reported on the listed prospective trials. For those patients enrolled in prospective trials, we suggest that thromboses should be diligently documented and reported. Only after the true incidence of thromboses is established can we implement appropriate levels of early screening and intervention that may prevent life threatening complications

  17. Nutritional deficiency of selenium secondary to weight loss (bariatric) surgery associated with life-threatening cardiomyopathy.

    Science.gov (United States)

    Boldery, Rachel; Fielding, George; Rafter, Tony; Pascoe, Andrew L; Scalia, Gregory M

    2007-04-01

    Nutritional deficiencies of vitamins and minerals have been associated with reversible and irreversible cardiomyopathic processes. Selenium deficient dilated cardiomyopathy, first described in 1935 in the Keshan Province of China, was sometimes reversed with selenium supplementation. In the past three decades, selenium deficient cardiomyopathy has re-emerged in western medicine secondary to gastrointestinal disorders, long-term total parenteral nutrition (TPN) and gastrointestinal surgery. This report describes a case of selenium deficient cardiomyopathy secondary to the bariatric (weight loss) surgical operation bilio-pancreatic diversion (Scopinaro procedure). This patient presented with life-threatening heart failure nine months after this surgery, having lost 100 kg of body weight. Multiple nutritional deficiencies were detected and corrected including severely depleted selenium levels. Cardiac function and the clinical scenario improved dramatically over three weeks. Screening patients at risk of malnourishment for selenium deficiency as a potential cause of cardiomyopathy is indicated.

  18. Life-threatening intoxication with methylene bis(thiocyanate: clinical picture and pitfalls. A case report

    Directory of Open Access Journals (Sweden)

    Schnuelle Peter

    2006-04-01

    Full Text Available Abstract Background Methylene bis(thiocyanate (MBT is a microbiocidal agent mainly used in industrial water cooling systems and paper mills as an inhibitor of algae, fungi, and bacteria. Case presentation We describe the first case of severe intoxication following inhalation of powder in an industrial worker. Profound cyanosis and respiratory failure caused by severe methemoglobinemia developed within several minutes. Despite immediate admission to the intensive care unit, where mechanical ventilation and hemodialysis for toxin elimination were initiated, multi-organ failure involving liver, kidneys, and lungs developed. While liver failure was leading, the patient was successfully treated with the MARS (molecular adsorbent recirculating system procedure. Conclusion Intoxication with MBT is a potentially life-threatening intoxication causing severe methemoglobinemia and multi-organ failure. Extracorporeal liver albumin dialysis (MARS appears to be an effective treatment to allow recovery of hepatic function.

  19. Headache associated with sexual activity: From the benign to the life threatening

    Directory of Open Access Journals (Sweden)

    Frank Aiwansoba Imarhiagbe

    2016-01-01

    Full Text Available Background: Neurologic syndromes like headache may on occasion complicate sexual activity. Though largely benign, the headache may seldom be a symptom of an underlying sinister and life threatening neurologic disorder such as aneurysmal subarachnoid heamorrhage. Method: Relevant published materials on the subject of headache associated with sexual intercourse and their cross references from Pubmed Medline, Cochrane Library, International Headache society, EMBASE and other relevant bibliographic repositories were ferreted since 1980 till date. Result: HAS is mainly a diagnosis of exclusion. The secondary or malignant form has a course that is dictated by its underlying cause. HAS in the primary or benign form is amenable to treatment with drugs including indomethacin, propranolol and calcium channel blockers (nimodipine, verapamil and diltiazem with excellent prognosis. Conclusion: Early evaluation for underlying cause of HAS and institution of appropriate treatment is recommended.

  20. Docetaxel induced Lyell′s syndrome: A rare life threatening cause of dermatitis medicamentosas

    Directory of Open Access Journals (Sweden)

    Faheem Arshad

    2014-01-01

    Full Text Available Lyell′s syndrome or toxic epidermal necrolysis (TEN is a life threatening complication mostly caused by medications, characterized by desquamative lesions of the skin and mucous membranes with 30 percent or more epidermal involvement along with mucus membrane. We report a rare case of toxic epidermal necrolysis following administration of docetaxel, a semi-synthetic taxane. A female diagnosed as having metastatic breast carcinoma received chemotherapy in form of docetaxel after being exposed to adjuvant chemotherapy, developed severe involvement of skin and mucus membrane. Diagnosis of TEN was made and she was managed with steroids, antibiotics, intravenous fluids and antiseptic dressings. Common toxicities reported with this drug include myelosuppression, alopecia, nail damage, erythema multiforme major and neuropathy. We believe this is the first case report of Lyell′s syndrome following docetaxel. Main aim of this case is to make physicians aware of the severe skin reactions with docetaxel, measures to avoid them, early recognition and prompt treatment.

  1. Premenstrual Exacerbation of Life-Threatening Asthma: Effect of Gonadotrophin Releasing Hormone Analogue Therapy

    Directory of Open Access Journals (Sweden)

    Alun L Edwards

    1996-01-01

    Full Text Available Variability in the severity of asthma during various phases of the menstrual cycle has been frequently suspected. However, the hormonal changes that might affect mediators of bronchospasm have yet to be elucidated. The case of a 41-year-old woman suffering from longstanding asthma with life-threatening exacerbations is reported. The patient was treated with buserelin, a gonadotropin releasing hormone (GnRH analogue, which created a temporary chemical menopause and thus permitted diagnosis of a premenstrual exacerbation of asthma and offered insight into potential therapy. GnRH analogues may therefore be of value in assessing women with severe asthma suspected to vary with the menstrual cycle. The addition of estrogens and progestins at the same time as treatment with GnRH analogue may be of value in determining the role of these hormones in the pathogenesis of menstrually related exacerbations of asthma.

  2. Life-Threatening Abnormal Behavior Incidence in 10-19 Year Old Patients Administered Neuraminidase Inhibitors.

    Directory of Open Access Journals (Sweden)

    Yuuki Nakamura

    Full Text Available Much discussion has surrounded the association between the administration of neuraminidase inhibitors (NI and severe abnormal behaviors, including sudden running away and jumping from a high place, which can be life-threatening if no one intervenes. Using data on the number of abnormal behaviors and patients who had been prescribed NI in Japan, we calculated the incidence rate of severe abnormal behaviors among influenza patients who had been prescribed NI. Then, we evaluated the relative risk between the four types of NI on severe abnormal behavior. We found no significant difference in the incidence rates of abnormal behavior by the type of NI. Results implicate that the current policy of package inserts, which warn physicians that patients who were administered ANY type of NI might exhibit abnormal behavior, seems to be appropriate.

  3. The dorsolateral periaqueductal gray and its role in mediating fear learning to life threatening events.

    Directory of Open Access Journals (Sweden)

    Grasielle C Kincheski

    Full Text Available The dorsolateral column of the periaqueductal gray (dlPAG integrates aversive emotional experiences and represents an important site responding to life threatening situations, such as hypoxia, cardiac pain and predator threats. Previous studies have shown that the dorsal PAG also supports fear learning; and we have currently explored how the dlPAG influences associative learning. We have first shown that N-methyl-D-aspartate (NMDA 100 pmol injection in the dlPAG works as a valuable unconditioned stimulus (US for the acquisition of olfactory fear conditioning (OFC using amyl acetate odor as conditioned stimulus (CS. Next, we revisited the ascending projections of the dlPAG to the thalamus and hypothalamus to reveal potential paths that could mediate associative learning during OFC. Accordingly, the most important ascending target of the dlPAG is the hypothalamic defensive circuit, and we were able to show that pharmacological inactivation using β-adrenoceptor blockade of the dorsal premammillary nucleus, the main exit way for the hypothalamic defensive circuit to thalamo-cortical circuits involved in fear learning, impaired the acquisition of the OFC promoted by NMDA stimulation of the dlPAG. Moreover, our tracing study revealed multiple parallel paths from the dlPAG to several thalamic targets linked to cortical-hippocampal-amygdalar circuits involved in fear learning. Overall, the results point to a major role of the dlPAG in the mediation of aversive associative learning via ascending projections to the medial hypothalamic defensive circuit, and perhaps, to other thalamic targets, as well. These results provide interesting perspectives to understand how life threatening events impact on fear learning, and should be useful to understand pathological fear memory encoding in anxiety disorders.

  4. Situational and Age-Dependent Decision Making during Life Threatening Distress in Myotis macrodactylus.

    Directory of Open Access Journals (Sweden)

    Xiaobin Huang

    Full Text Available Echolocation and audiovocal communication have been studied extensively in bats. The manner in which these abilities are incorporated within escape behaviors during life-threatening distress is largely unknown. Here we tested the hypothesis that behavioral response profiles expressed during distress are relatively stereotypic given their evolutionary adaptations to avoid predators. We subjected juvenile and adult big-footed myotis (Myotis macrodactylus to a sequence of three types of life threatening distress: 1 trapping them in a mist-net (environmental threat, 2 approaching them when trapped (predator threat, and 3 partially restraining their freedom to move (arrest, and recorded their escape behavior in each of the three conditions. Response profiles differed across individuals and with the context in which they were expressed. During environmental and predator threat, bats displayed significantly more biting and wing-flapping behaviors and emitted more echolocation pulses than during arrest. Response profiles also varied with age. During arrest, juveniles were more likely than adults to emit distress calls and vice-versa for biting and wing flapping during environmental and predator threat. Overall, individualized response profiles were classified into ten clusters that were aligned along two divergent response trajectories when viewed within two-dimensional, multifactorial decision space. Juvenile behaviors tended to follow a predominantly "social-dependence" trajectory, whereas adult behaviors were mostly aligned along a "self-reliance" trajectory. We conclude that bats modify their vocal behavior and make age-appropriate and contextually adaptive decisions when distressed. This decision-making ability is consistent with observations in other social species, including humans.

  5. Gastric bypass in patients with BMI 32 without life-threatening co-morbidities: preliminary report.

    Science.gov (United States)

    Fobi, Mal; Lee, Hoil; Igwe, Daniel; Felahy, Basil; James, Elaine; Stanczyk, Malgorzata; Fobi, Nicole

    2002-02-01

    Surgical intervention is currently indicated for patients with BMI > 40 or > 35 with life-threatening comorbidities. Patients with BMI 32-40 without these comorbidities not only have the increased propensity to develop them but also suffer from similar psychosocioeconomic consequences. These patients may not respond to non-surgical treatment of obesity any better than those with BMI > 40. The question has been raised whether to offer them surgical intervention. A study was carried out to determine outcome of surgery on patients with BMI > 32 but social impairments affecting their quality of life. The approval of our Hospital Internal Review Board was obtained. In addition to routine evaluation for surgical intervention, these patients were required to have the approval of their primary care physician, be seen pre-operatively by a psychiatrist, and have a member of the family or a very close friend present at the time of discussion of operative risks and follow-up requirements. Patients committed to at least a 5-year follow-up. They were to be self-paying patients. The transected silastic ring vertical gastric bypass with a temporary gastrostomy was used. 50 patients, 49 women and one man, were entered into the study between May 1, 1999 and April 30, 2000. 50% were self-pay, and the other 50% were able to obtain coverage through their insurance companies. There were few peri-operative complications and no deaths. The late complications include incisional hernias, dumping and transient alopecia. Hospital stay averaged 3.7 days. Follow-up has been 18-27 months. Weight loss has been excellent. Preliminary results of surgical intervention extended to patients with BMI 32-40 without life-threatening comorbidities but with psychosocioeconomic ramifications are very promising. Long term follow-up and comparison with other bariatric patients are planned.

  6. The Dorsolateral Periaqueductal Gray and Its Role in Mediating Fear Learning to Life Threatening Events

    Science.gov (United States)

    Kincheski, Grasielle C.; Mota-Ortiz, Sandra R.; Pavesi, Eloisa; Canteras, Newton S.; Carobrez, Antônio P.

    2012-01-01

    The dorsolateral column of the periaqueductal gray (dlPAG) integrates aversive emotional experiences and represents an important site responding to life threatening situations, such as hypoxia, cardiac pain and predator threats. Previous studies have shown that the dorsal PAG also supports fear learning; and we have currently explored how the dlPAG influences associative learning. We have first shown that N-methyl-D-aspartate (NMDA) 100 pmol injection in the dlPAG works as a valuable unconditioned stimulus (US) for the acquisition of olfactory fear conditioning (OFC) using amyl acetate odor as conditioned stimulus (CS). Next, we revisited the ascending projections of the dlPAG to the thalamus and hypothalamus to reveal potential paths that could mediate associative learning during OFC. Accordingly, the most important ascending target of the dlPAG is the hypothalamic defensive circuit, and we were able to show that pharmacological inactivation using β-adrenoceptor blockade of the dorsal premammillary nucleus, the main exit way for the hypothalamic defensive circuit to thalamo-cortical circuits involved in fear learning, impaired the acquisition of the OFC promoted by NMDA stimulation of the dlPAG. Moreover, our tracing study revealed multiple parallel paths from the dlPAG to several thalamic targets linked to cortical-hippocampal-amygdalar circuits involved in fear learning. Overall, the results point to a major role of the dlPAG in the mediation of aversive associative learning via ascending projections to the medial hypothalamic defensive circuit, and perhaps, to other thalamic targets, as well. These results provide interesting perspectives to understand how life threatening events impact on fear learning, and should be useful to understand pathological fear memory encoding in anxiety disorders. PMID:23209724

  7. A Potential Life-Threatening Reaction to Glatiramer Acetate in Rett Syndrome.

    Science.gov (United States)

    Nissenkorn, Andreea; Kidon, Mona; Ben-Zeev, Bruria

    2017-03-01

    Rett syndrome is an X-linked dominant neurodevelopmental disorder manifesting with severe intellectual disability in females caused by various mutations in the MECP2 gene. Brain-derived neurotrophic factor (BDNF) is one of the main proteins regulated by the MECP2 protein; its overexpression in the MeCP2 mouse model partially corrects the Rett phenotype. Pharmacologic manipulations that lead to increased BDNF in individuals with Rett syndrome are expected to have a positive effect on the disorder. Glatiramer acetate, a well-known and safe multiple sclerosis immune modulator, increases BDNF levels in multiple sclerosis animal models and patients responding to treatment, as well as in Rett mouse models. Fourteen patients with mutation-proven Rett syndrome were recruited for a clinical trial with glatiramer acetate. Baseline data and follow-up data were collected during the trial, which had to be stopped because of a severe adverse event. Our objective is to describe this unexpected potentially life-threatening event in response to glatiramer in patients with Rett syndrome. Four of 14 patients with Rett syndrome who were recruited and treated with daily injections of glatiramer acetate as part of an open-label clinical trial developed an exaggerated immediate postinjection response, which was experienced as life threatening in three of the patients, necessitating arrest of the trial. Despite the known safety profile of glatiramer acetate in adult and pediatric patients with multiple sclerosis, its use in Rett syndrome should be cautiously reconsidered. The described severe adverse event can be related to these patients' primary autonomic nervous system dysfunction. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Workplace strength training prevents deterioration of work ability among workers with chronic pain and work disability: a randomized controlled trial.

    Science.gov (United States)

    Sundstrup, Emil; Jakobsen, Markus D; Brandt, Mikkel; Jay, Kenneth; Persson, Roger; Aagaard, Per; Andersen, Lars L

    2014-05-01

    Imbalance between work demands and individual resources can lead to musculoskeletal disorders and reduced work ability. The aim of this study was to evaluate the effect of two contrasting interventions on work ability among slaughterhouse workers with chronic pain and work disability. Sixty-six slaughterhouse workers with upper-limb chronic pain and work disability were randomly allocated to 10 weeks of either strength training for the shoulder, arm, and hand muscles (3 times per week, 10 minutes per session) or ergonomic training (usual care control group) from September to December 2012. The outcome measure was the change from baseline to 10-week follow-up in the work ability index (WAI). A priori hypothesis testing showed a group×time interaction for WAI (Ptraining group, WAI increased 2.3 [95% confidence interval (95% CI) 0.9-3.7] in the strength training group corresponding to a moderate effect size (Cohen's d 0.52). Within-group changes indicated that between-group differences were mainly caused by a reduction in WAI in the ergonomic group. Of the 7 items of WAI, item 2 (work ability in relation to the demands of the job) and item 7 (mental resources) increased following strength training compared with ergonomic training (Ptraining at the workplace prevents deterioration of work ability among manual workers with chronic pain and disability exposed to forceful and repetitive job tasks. Thus, strength training performed at the workplace may in fact be regarded as a complex biopsychosocial intervention modality that reaches further than the specific physiological benefits of training per se.

  9. Exercise training prevents the deterioration in the arterial baroreflex control of sympathetic nerve activity in chronic heart failure patients.

    Science.gov (United States)

    Groehs, Raphaela V; Toschi-Dias, Edgar; Antunes-Correa, Ligia M; Trevizan, Patrícia F; Rondon, Maria Urbana P B; Oliveira, Patrícia; Alves, Maria J N N; Almeida, Dirceu R; Middlekauff, Holly R; Negrão, Carlos E

    2015-05-01

    Arterial baroreflex control of muscle sympathetic nerve activity (ABRMSNA) is impaired in chronic systolic heart failure (CHF). The purpose of the study was to test the hypothesis that exercise training would improve the gain and reduce the time delay of ABRMSNA in CHF patients. Twenty-six CHF patients, New York Heart Association Functional Class II-III, EF ≤ 40%, peak V̇o2 ≤ 20 ml·kg(-1)·min(-1) were divided into two groups: untrained (UT, n = 13, 57 ± 3 years) and exercise trained (ET, n = 13, 49 ± 3 years). Muscle sympathetic nerve activity (MSNA) was directly recorded by microneurography technique. Arterial pressure was measured on a beat-to-beat basis. Time series of MSNA and systolic arterial pressure were analyzed by autoregressive spectral analysis. The gain and time delay of ABRMSNA was obtained by bivariate autoregressive analysis. Exercise training was performed on a cycle ergometer at moderate intensity, three 60-min sessions per week for 16 wk. Baseline MSNA, gain and time delay of ABRMSNA, and low frequency of MSNA (LFMSNA) to high-frequency ratio (HFMSNA) (LFMSNA/HFMSNA) were similar between groups. ET significantly decreased MSNA. MSNA was unchanged in the UT patients. The gain and time delay of ABRMSNA were unchanged in the ET patients. In contrast, the gain of ABRMSNA was significantly reduced [3.5 ± 0.7 vs. 1.8 ± 0.2, arbitrary units (au)/mmHg, P = 0.04] and the time delay of ABRMSNA was significantly increased (4.6 ± 0.8 vs. 7.9 ± 1.0 s, P = 0.05) in the UT patients. LFMSNA-to-HFMSNA ratio tended to be lower in the ET patients (P training prevents the deterioration of ABRMSNA in CHF patients. Copyright © 2015 the American Physiological Society.

  10. Life-threatening unilateral hearing impairments. Review of the literature on the association between inner ear malformations and meningitis.

    Science.gov (United States)

    Muzzi, E; Battelino, S; Gregori, M; Pellegrin, A; Orzan, E

    2015-12-01

    Bacterial meningitis is a life threatening disease that can be triggered by a CSF leak through an inner ear malformation. Early identification of the specific type of cochleovestibular dysplasia and the associated risk of meningitis is of vital importance. The objective of this review is to collect and discuss available data on the association between inner ear malformations and meningitis in children. Electronic databases were crosschecked for obtaining relevant papers published in the last 20 years, and further cases were identified by hand searching through the references. Demographic data were extracted from full texts, together with information on the severity of hearing impairment, the type of inner ear anomaly, the site of cerebrospinal fluid leak, the number of recurrent meningitis episodes. Sixty-seven cases of meningitis related to inner ear malformation have been identified among 45 papers. Mean age at presentation is 3.60±3.00 (range 0.1-14) years. Average diagnostic delay from the first episode of meningitis is 3.44±3.41 (range 0.00-10.00) years. The number of meningitis episodes that occurred before the correct diagnosis and definitive surgical treatment is 3.27±1.81 (range 1.00-10.00). Unilateral hearing impairment affects 70% of patients. Six patients had normal hearing at presentation. Two children are dead from inner-ear-malformation-related meningitis among reviewed reports. A high number of paediatric patients carrying inner ear malformations, especially when associated with unilateral hearing impairment, could be at risk to develop recurrent bacterial meningitis. Universal newborn hearing screening programs should prompt a diagnostic work-up even in the case of unilateral hearing impairment, in order to prevent inner ear malformation-related meningitis. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  11. Neonatal severe hyperparathyroidism caused by homozygous mutation in CASR: A rare cause of life-threatening hypercalcemia.

    Science.gov (United States)

    Murphy, Heidi; Patrick, Jessica; Báez-Irizarry, Eileen; Lacassie, Yves; Gómez, Ricardo; Vargas, Alfonso; Barkemeyer, Brian; Kanotra, Sohit; Zambrano, Regina M

    2016-04-01

    Neonatal severe hyperparathyroidism (NSHPT) is a rare, life-threatening condition that presents with severe hypercalcemia, hyperparathyroidism, and osteopenia in the newborn period. Treatment of NSHPT traditionally includes hydration and bisphosphonates; however newer calcimimetic agents, such as cinacalcet, are now being utilized to prevent or delay parathyroidectomy which is technically difficult in the newborn. Medical treatment success is related to calcium sensing receptor (CaSR) genotype. We report a 4-day-old infant who presented with hyperbilirubinemia, poor feeding, weight loss, severe hypotonia and was ultimately diagnosed with NSHPT. The patient's total serum calcium level of 36.8 mg/dL (reference range: 8.5-10.4 mg/dL) is, to our knowledge, the highest ever documented in this setting. Exome data previously obtained on the infant's parents was re-analyzed demonstrating bi-parental heterozygosity for a mutation of the CASR gene: c.206G > A, and Sanger sequencing data confirmed the patient was a homozygote for the same mutation. Though a patient with the same CaSR gene mutation described here has responded to cinacalcet, our patient did not respond and required parathyroidectomy. Though this case has previously been published as a surgical case report, a full report of the medical management and underlying genetic etiology is warranted; this case underscores the importance of disclosing bi-parental heterozygosity for a gene causing severe neonatal disease particularly when treatment is available and illustrates the need for further in vitro studies of this CaSR mutation. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  12. Emergency obstetric hysterectomy for life-threatening postpartum hemorrhage: A 12-year review.

    Science.gov (United States)

    Zhang, Yulong; Yan, Jianying; Han, Qing; Yang, Tingting; Cai, Lihong; Fu, Yuelin; Cai, Xiaolu; Guo, Meimei

    2017-11-01

    The aim of the study was to review the operative experiences of emergency hysterectomy for life-threatening postpartum hemorrhage (PPH) performed over a 12-year period at Fujian Provincial Maternity and Children's Hospital; to examine the incidence and risk factors for emergency obstetric hysterectomy; and to evaluate the curative effectiveness and safety of subtotal hysterectomy for life-threatening PPH.The records of all cases of emergency obstetric hysterectomy performed at Fujian Maternity and Children Health Hospital between January 2004 and June 2016 were analyzed. The incidence, risk factors, and outcomes of hysterectomy, the peripartum complications, and the coagulation function indices were evaluated.A total of 152,023 of women were delivered. The incidence of emergency postpartum hysterectomy was 0.63 per 1000 deliveries: 96 patients underwent hysterectomy for uncontrolled PPH, 19 (0.207‰) underwent hysterectomy following vaginal delivery, and 77 (1.28‰) underwent the procedure following cesarean delivery (P  6 (32.3%). Forty-one patients underwent subtotal abdominal hysterectomy (STH) and 55 patients underwent total abdominal hysterectomy (TH). The mean operation time was significantly shorter for TH (193.59 ± 83.41 minutes) than for STH (142.86 ± 78.32 minutes; P = .002). The mean blood loss was significantly greater for TH (6832 ± 787 mL) than for STH (6329 ± 893 mL; P = .003). The mean number of red cell units transfusion was higher during TH (16.24 ± 9.48 units vs 12.43 ± 7.2, respectively; P = .047). Postoperative prothrombin activity was significantly higher than preoperative levels (56.84 ± 14.74 vs 44.39 ± 15.69, respectively; P STH (57.63 ± 15.68 vs 47.87 ± 12.86, respectively; P STH for PPH.Cesarean deliveries were associated with an increased risk of emergency hysterectomy, and postpartum prothrombin activity STH was the preferred procedure for emergency

  13. Trends in a Life Threatening Condition: Morbid Obesity in Dutch, Turkish and Moroccan Children in The Netherlands

    NARCIS (Netherlands)

    Dommelen, P. van; Schönbeck, Y.; Buuren, S. van; Hirasing, R.

    2014-01-01

    Background: Morbid obesity can be a life threatening condition. The aim of our study is to assess the trend in morbid obesity in The Netherlands among children of Dutch origin since 1980, and among children of Turkish and Moroccan origin since 1997. Methods and Findings: Cross-sectional height and

  14. Trends in a life threatening condition : Morbid obesity in Dutch, Turkish and Moroccan children in the Netherlands

    NARCIS (Netherlands)

    Van Dommelen, Paula; Schönbeck, Yvonne; Van Buuren, Stef; HiraSing, Remy A.

    2014-01-01

    Background: Morbid obesity can be a life threatening condition. The aim of our study is to assess the trend in morbid obesity in The Netherlands among children of Dutch origin since 1980, and among children of Turkish and Moroccan origin since 1997. Methods and Findings: Cross-sectional height and

  15. Effectiveness of storytelling interventions on psychosocial outcomes in adult patients with a life-threatening illness: a systematic review protocol.

    Science.gov (United States)

    Schoenau, Mai Nanna; Jackson, Inger Marie

    2016-06-01

    The objective of this review is to identify the effectiveness of storytelling interventions on psychosocial outcomes. In this review, storytelling is where adult patients with a life-threatening illness tell their illness story, facilitated by a healthcare professional.Specifically the review questions are.

  16. Delayed life-threatening subdural hematoma after minor head injury in a patient with severe coagulopathy: a case report

    NARCIS (Netherlands)

    Engelen, Marc; Nederkoorn, Paul J.; Smits, Marion; van de Beek, Diederik

    2009-01-01

    Minor head injury is a frequent cause for neurologic consultation and imaging. Most patients with minor head injury will make an uneventful recovery, but in a very small proportion of these patients life threatening intracranial complications occur. We describe a patient on oral anticoagulation

  17. Delayed life-threatening subdural hematoma after minor head injury in a patient with severe coagulopathy: A case report

    NARCIS (Netherlands)

    M. Engelen (Marc); P.J. Nederkoorn (Paul); M. Smits (Marion); D. van de Beek (Diederik)

    2009-01-01

    textabstractMinor head injury is a frequent cause for neurologic consultation and imaging. Most patients with minor head injury will make an uneventful recovery, but in a very small proportion of these patients life threatening intracranial complications occur. We describe a patient on oral

  18. Defining clinical deterioration.

    Science.gov (United States)

    Jones, Daryl; Mitchell, Imogen; Hillman, Ken; Story, David

    2013-08-01

    To review literature reporting adverse events and physiological instability in order to develop frameworks that describe and define clinical deterioration in hospitalised patients. Literature review of publications from 1960 to August 2012. Conception and refinement of models to describe clinical deterioration based on prevailing themes that developed chronologically in adverse event literature. We propose four frameworks or models that define clinical deterioration and discuss the utility of each. Early attempts used retrospective chart review and focussed on the end result of deterioration (adverse events) and iatrogenesis. Subsequent models were also retrospective, but used discrete complications (e.g. sepsis, cardiac arrest) to define deterioration, had a more clinical focus, and identified the concept of antecedent physiological instability. Current models for defining clinical deterioration are based on the presence of abnormalities in vital signs and other clinical observations and attempt to prospectively assist clinicians in predicting subsequent risk. However, use of deranged vital signs in isolation does not consider important patient-, disease-, or system-related factors that are known to adversely affect the outcome of hospitalised patients. These include pre-morbid function, frailty, extent and severity of co-morbidity, nature of presenting illness, delays in responding to deterioration and institution of treatment, and patient response to therapy. There is a need to develop multiple-variable models for deteriorating ward patients similar to those used in intensive care units. Such models may assist clinician education, prospective and real-time patient risk stratification, and guide quality improvement initiatives that prevent and improve response to clinical deterioration. Crown Copyright © 2013. Published by Elsevier Ireland Ltd. All rights reserved.

  19. Sleep cyclic alternating pattern analysis in infants with apparent life-threatening events: a daytime polysomnographic study.

    Science.gov (United States)

    Miano, Silvia; Castaldo, Rosa; Ferri, Raffaele; Peraita-Adrados, Rosa; Paolino, Maria Chiara; Montesano, Marilisa; Villa, Maria Pia

    2012-07-01

    Non-REM sleep is characterized by a physiologic oscillating pattern that exhibits different levels of arousal, coded as cyclic alternating pattern. The aim of this study was to analyze the development of cyclic alternating pattern parameters in a group of infants with apparent life-threatening events. A total of 26 infants with apparent life-threatening events (14 females, mean age 3.4 months, 2.37 S.D., age range 0.5-9 months) were studied while they slept in the morning between feedings, by means of a 3-h video-electroencephalographic-polygraphic recording. Sleep was visually scored using standard criteria. The control group was composed of 36 healthy infants (16 females, mean age 3.2 months, 2.17 S.D., age range 0.5-9 months). Children with apparent life-threatening events showed an increased frequency of periodic breathing, gastroesofageal reflux and of other risk conditions. They presented also an increased obstructive apnoea/hypopnea index. A full NREM sleep development was found in a significantly smaller percentage of patients, and they showed a significant reduction of the percentage of REM sleep, of cyclic alternating pattern A1 subtypes, an increased percentage of A2 and A3 subtypes and increased index of A2, A3 subtypes and arousal, compared to normal controls. Cyclic alternating pattern rate showed a significant positive correlation with age, only in controls. Our results show a higher level of arousal and an increased non-REM sleep discontinuity in babies with apparent life-threatening events, compared to controls. The enhanced mechanism of arousal might counteract life-threatening events and represent an important neurophysiologic distinction from future victims of sudden infant death syndrome who also experience similar events. Copyright © 2011 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  20. Parental explicit heuristics in decision-making for children with life-threatening illnesses.

    Science.gov (United States)

    Renjilian, Chris B; Womer, James W; Carroll, Karen W; Kang, Tammy I; Feudtner, Chris

    2013-02-01

    To identify and illustrate common explicit heuristics (decision-making aids or shortcuts expressed verbally as terse rules of thumb, aphorisms, maxims, or mantras and intended to convey a compelling truth or guiding principle) used by parents of children with life-threatening illnesses when confronting and making medical decisions. Prospective cross-sectional observational study of 69 parents of 46 children who participated in the Decision-making in Pediatric Palliative Care Study between 2006 and 2008 at the Children's Hospital of Philadelphia. Parents were guided individually through a semistructured in-depth interview about their experiences and thoughts regarding making medical decisions on behalf of their ill children, and the transcribed interviews were qualitatively analyzed. All parents in our study employed explicit heuristics in interviews about decision-making for their children, with the number of identified explicit heuristics used by an individual parent ranging from tens to hundreds. The heuristics served 5 general functions: (1) to depict or facilitate understanding of a complex situation; (2) to clarify, organize, and focus pertinent information and values; (3) to serve as a decision-making compass; (4) to communicate with others about a complex topic; and (5) to justify a choice. Explicit heuristics played an important role in decision-making and communication about decision-making in our population of parents. Recognizing explicit heuristics in parent interactions and understanding their content and functions can aid clinicians in their efforts to partner with parents in the decision-making process.

  1. [A Case of Life-Threatening Angioedema Occurred During Prolonged Angiotensin-Converting Enzyme Inhibitor Treatment].

    Science.gov (United States)

    Nakamura, Rintaro; Nihei, Shun-Ichi; Arai, Hideaki; Nagata, Keiji; Isa, Yasuki; Harayama, Nobuya; Aibara, Keiji; Kamochi, Msayuki

    2016-03-01

    Although angiotensin-converting enzyme (ACE) inhibitors are widely used as the first choice drug for treating hypertension, we have only a superficial understanding of their relationship to angioedema. We report a case of life-threatening angioedema. The case was a 60-year-old man who had been taking an ACE inhibitor for hypertension for 11 years. He visited his home doctor for dyspnea, and tongue and neck swelling. He was transported to our hospital because of the possibility of airway obstruction. On admission, his tongue and neck swelling became more severe. We performed an intubation using an endoscope and started airway management. We also stopped his ACE inhibitor. The severe tongue and neck swelling improved gradually and he was extubated on day 3. On the fifth day he was discharged. We diagnosed angioedema caused by an ACE inhibitor. Although the risk of airway obstruction with ACE inhibitors is acknowledged, we have only a superficial understanding of how prolonged ACE inhibitor treatment induces angioedema. So we should consider angioedema in cases of taking ACE inhibitors, especially in cases of prolonged treatment.

  2. Life-threatening eosinophilic pleuropericardial effusion related to vitamins B5 and H.

    Science.gov (United States)

    Debourdeau, P M; Djezzar, S; Estival, J L; Zammit, C M; Richard, R C; Castot, A C

    2001-04-01

    To report a case of eosinophilic pleuropericarditis resulting from concomitant use of vitamins B5 and H. A 76-year-old white woman was admitted to the hospital because of chest pain and dyspnea related to pleurisy and a pericardial tamponade. This patient had no history of allergy and had been taking vitamins B5 and H for two months. Blood tests performed showed an inflammatory syndrome and a high eosinophil concentration (1200-1500 cells/mm3). Pleurocentesis and pericardiotomy yielded a sterile exudative fluid with an eosinophilic infiltrate. There were no nuclear antibodies and no rheumatic factor; screenings for viruses, parasites, bacteria, and malignant tumor were negative. A myelogram, biopsy of the iliac crest bone, and concentration of immunoglobulin E were also normal. After withdrawal of the vitamins, the patient recovered and the eosinophilia disappeared. Prolonged hypereosinophilia has marked predilection to damage specific organs, including the heart, but pleuropericardial effusion is uncommon. Drug-related pleuropericarditis usually occurs without an increased eosinophil count. Other drugs responsible for eosinophilic pleuropericarditis are cephalosporins, dantrolene, propylthiouracil, and nitrofurantoin. To our knowledge, this is the first case report of pleuropericarditis related to vitamins B5 and H. This case suggests that vitamins B5 and H may cause symptomatic, life-threatening, eosinophilic pleuropericarditis. Physicians prescribing these commonly used vitamins should be aware of this potential adverse reaction.

  3. A rare life-threatening disease: unilateral kidney compressed by huge chronic spontaneous retroperitoneal hemorrhage

    Directory of Open Access Journals (Sweden)

    Lu HY

    2018-03-01

    Full Text Available Hao-Yuan Lu,1,* Wei Wei,2,* Qi-Wei Chen,1,* Qing-Gui Meng,1 Gao-Hua Hu,1 Xian-Lin Yi,1,3 Xian-Zhong Bai1 1Department of Urology, Tumor Hospital of Guangxi Medical University and Guangxi Cancer Research Institute, Nanning 530021, China; 2Department of Radiology, Tumor Hospital of Guangxi Medical University and Guangxi Cancer Research Institute, Nanning 530021,China; 3Hubei Engineering Laboratory for Synthetic Microbiology, Wuhan Institute of Biotechnology, Wuhan 430075, China *These authors contributed equally to this work Objectives: To study an uncommon life-threatening disease, spontaneous retroperitoneal and perirenal hemorrhage. Case descriptions: A 69-year-old male presented with pain in the left waist and back of 1 month duration. The renal abscess was suspected by magnetic resonance imaging before operation. The perirenal hematoma was cleaned by operation. In another case, the patient had a functional solitary left kidney compressed by a huge retroperitoneal mass and uropenia appeared. Results: The first patient died of adult respiratory distress syndrome after surgery. The second patient died of cardiac insufficiency and pulmonary embolism on the second day after evacuation of retroperitoneal hematoma. Conclusion: Conservative surgery, such as selective arterial embolization, is a reasonable approach in patients with chronic spontaneous retroperitoneal and perirenal space hemorrhage and with poor general condition. We strongly recommend drainage or interventional therapy, but not a major surgery, in patients with poor condition. Keywords: kidney, spontaneous, retroperitoneal, hemorrhage, surgery

  4. Life-threatening complications of impacted common bile duct lithiasis. A case report.

    Science.gov (United States)

    Ionescu, Lidia; Timofte, D; Savin, M; Fotea, V; Dănilă, R

    2015-01-01

    Impacted common bile duct (CBD) lithiasis poses therapeutical challenges and repeated attempts of removal may result in life-threatening complications. CASE REPORT. A 45 year-old female patient was admitted in emergency for right upper quadrant abdominal pain and jaundice. Clinical, lab data, abdominal ultrasound (US) and cholangio-MRI established the diagnosis of acute cholecystitis and obstructive jaundice due to distal CBD lithiasis. Endoscopic retrograde colangiopancreatography (ERCP) confirmed the presence of a distal CBD stone but extraction failed. The patient was operated on and surgical procedure consisted of cholecistectomy, intraoperative cholangiography and a side-to-side choledocho-duodenal anastomosis was performed because all attempts to extract the stone through choledocotomy or duodenotomy and enlargement of endoscopic shincterotomy failed. The postoperative course was endangered by a severe pancreatitis, a massive upper digestive bleeding and portal vein thrombosis that responded to conservative management in the intensive care unit. The patient was discharged after 34 days in good clinical condition and approximately 9 months later was readmitted electively for an incisional hernia. Apart from this, physical examination, lab tests and imagistic studies were normal; the patient was operated and rapidly discharged in good condition. In conclusion, the management of CBD lithiasis may be a serious challenge both for interventional endoscopists and surgeons and require a concerted team effort.

  5. Increased incidence of apparently life-threatening events due to supine position.

    Science.gov (United States)

    Maggio, Albane B R; Schäppi, Michela G; Benkebil, Faiza; Posfay-Barbe, Klara M; Belli, Dominique C

    2006-11-01

    Gastro-oesophageal reflux (GOR) has a high prevalence in infancy. The supine position is among numerous aggravating factors. The exact relationship between GOR and apparently life-threatening events (ALTE) is not clear, although it has been repeatedly investigated. In 1992 the worldwide Back to Sleep campaign was implemented, which had a dramatic effect on the incidence of sudden infant death syndrome (SIDS) with a drop of 50%. Although the vast majority of children now sleep on their back, the effect of this position on ALTE has not been studied. In this retrospective study, we aim to define the potential association between GOR and ALTE. We hypothesise that the incidence of ALTE has increased since the 1992 recommendation. No bias in the population's selection was introduced, as our centre is the only one for paediatric emergencies in the county. A total of 107 children presenting with ALTE were identified during the study period (1987-99). A pH study was performed in the 75 patients presenting with ALTE in the last 6 years of the study (1994-99). Neither morbidity nor mortality was noted in a long-term 4-year follow-up. Our present results show that the frequency of ALTE increased sevenfold (P masks the negative effect of an increase in ALTE.

  6. Carbamazepine-induced Life-threatening Stevens-Johnson Syndrome and Agranulocytosis: The Maiden Case.

    Science.gov (United States)

    Avinash, A; Amberkar, V Mohanbabu; Kunder, Sushil Kiran; Madhyastha, Sharath; Meenakumari, K

    2016-12-01

    Stevens-Johnson syndrome is one of the few dermatological emergencies in clinical practice. The syndrome is often secondary to the usage of drugs, of which allopurinol, penicillins, sulfa drugs, ibuprofen, sodium valproate, phenytoin, lamotrigine and carbamazepine are commonly implicated. Agranulocytosis is the existence of a clinically significant reduction in neutrophil count. This condition is a serious threat to the patient, as he/she is at a greater risk of contracting bacterial or fungal infections, which may prove to be fatal. The co-existence of Stevens-Johnson syndrome and agranulocytosis in the same patient further increases the risk of morbidity and mortality. To the best of our knowledge, there are no reports available in the existing literature, of cases that were reported with both these life-threatening conditions in a single patient, at the same point of time. This is a case narrative of a patient who presented with both Stevens-Johnson syndrome and agranulocytosis, following the administration of carbamazepine The patient's differential leucocyte count revealed a neutrophil proportion of 2.33%. A causality assessment done using Naranjo's algorithm showed that carbamazepine "definitely" caused Agranulocytosis and "probably" caused Stevens-Johnson syndrome.

  7. Life-threatening infectious diseases of childhood: single-gene inborn errors of immunity?

    Science.gov (United States)

    Alcaïs, Alexandre; Quintana-Murci, Lluis; Thaler, David S; Schurr, Erwin; Abel, Laurent; Casanova, Jean-Laurent

    2010-12-01

    The hypothesis that inborn errors of immunity underlie infectious diseases is gaining experimental support. However, the apparent modes of inheritance of predisposition or resistance differ considerably among diseases and among studies. A coherent genetic architecture of infectious diseases is lacking. We suggest here that life-threatening infectious diseases in childhood, occurring in the course of primary infection, result mostly from individually rare but collectively diverse single-gene variations of variable clinical penetrance, whereas the genetic component of predisposition to secondary or reactivation infections in adults is more complex. This model is consistent with (i) the high incidence of most infectious diseases in early childhood, followed by a steady decline; (ii) theoretical modeling of the impact of monogenic or polygenic predisposition on the incidence distribution of infectious diseases before reproductive age; (iii) available molecular evidence from both monogenic and complex genetics of infectious diseases in children and adults; (iv) current knowledge of immunity to primary and secondary or latent infections; (v) the state of the art in the clinical genetics of noninfectious pediatric and adult diseases; and (vi) evolutionary data for the genes underlying single-gene and complex disease risk. With the recent advent of new-generation deep resequencing, this model of single-gene variations underlying severe pediatric infectious diseases is experimentally testable. © 2010 New York Academy of Sciences.

  8. Life-Threatening Postpneumonectomy Syndrome Complicated with Right Aortic Arch after Left Pneumonectomy.

    Science.gov (United States)

    Karasaki, Takahiro; Tanaka, Makoto

    2015-01-01

    A 54-year-old man with right aortic arch underwent left lower lobectomy and lingular segmentectomy, followed by complete pneumonectomy, for refractory nontuberculous mycobacterial infection. Three months after the pneumonectomy, he developed acute respiratory distress. Computed tomography showed an excessive mediastinal shift with an extremely narrowed bronchus intermedius and right lower bronchus compressed between the right pulmonary artery and the right descending aorta. Soon after the nearly obstructed bronchus intermedius was observed by bronchoscopy, he began to exhibit frequent hypoxic attacks, perhaps due to mucosal edema. Emergent surgical repositioning of the mediastinum and decompression of the bronchus was indicated. After complete adhesiolysis of the left thoracic cavity was performed, to maintain the proper mediastinal position, considering the emergent setting, an open wound thoracostomy was created and piles of gauze were inserted, mildly compressing the heart and the mediastinum to the right side. Thoracoplasty was performed three months later, and he was eventually discharged without any dressings needed. Mediastinal repositioning under thoracostomy should be avoided in elective cases because of its extremely high invasiveness. However, in the case of life-threatening postpneumonectomy syndrome in an emergent setting, mediastinal repositioning under thoracostomy may be an option to save life, which every thoracic surgeon could attempt.

  9. Primary Small Bowel GIST Presenting as a Life-Threatening Emergency: A Report of Two Cases

    Directory of Open Access Journals (Sweden)

    Safi Khuri

    2017-01-01

    Full Text Available Gastrointestinal stromal tumor (GIST is a rare stromal neoplasm, which represents the most common mesenchymal tumor of the gastrointestinal tract. It is characterized by indolent clinical symptoms, although it can present as a life-threatening emergency. Herein, we present two cases of primary small bowel GIST treated at our department. A 68-year-old female patient presented to our emergency department with a diffuse abdominal pain of acute onset. Imaging studies revealed a mass at proximal jejunum, with a nearby free air and fluid. At surgery, a mass of 9 cm was found at proximal jejunum, 3 cm distal to the treitz ligament, with perforation on the lateral wall of the mass. En bloc resection was performed. Pathology report was positive for gastrointestinal stromal tumor. A 70-year-old male patient presented to our emergency department with 3 days of dark tarry stool and few hours of hematochezia. Computed tomography angiography revealed a mass at the pelvis, with calcifications, attached to the distal ileum, with intraluminal blush of intravenous iodine. At surgery, a mass of 8 cm at the distal ileum was found. Resection of the mass along with a 20 cm of ileum was completed. Histopathology report was positive for malignant gastrointestinal stromal tumor.

  10. Life-Threatening Retropharyngeal Hemorrhage Secondary to Rupture of the Inferior Thyroid Artery

    Directory of Open Access Journals (Sweden)

    Cristina G. Calogero

    2015-01-01

    Full Text Available Inferior thyroid artery (ITA rupture is rare and may progress to life-threatening conditions. We present a patient who visited the emergency department after an episode of syncope and dizziness in which he had a mechanical fall that resulted in abrasions and a hematoma to his left forehead. The patient presented with dysphagia and anterior neck swelling that progressed rapidly into airway compromise requiring endotracheal intubation. Emergent computed tomography revealed a large retropharyngeal hematoma, with active arterial extravasation that was thought to be arising from the thyrocervical trunk on the left. The hematoma measured approximately 6.7 cm transversely and 3.2 cm anteroposteriorly and extended from the level of the lower nasopharynx, down the neck into the retropharyngeal and danger space and into the mediastinum posterior to the esophagus, overall approximately 25 cm. The larynx was deviated anteriorly and there was esophageal compression. An emergent arteriogram and catheterization confirmed bleeding from branches of the ITA, and successful embolization was performed. It is important to recognize the ITA rupture as a potential etiology of an acute airway compromise. In emergent situations, while securing an airway is a priority, rapidly initiating diagnostic testing to confirm the diagnosis and arranging for arterial embolization can be life-saving.

  11. Citation classics in suicide and life threatening behavior: a research note.

    Science.gov (United States)

    Stack, Steven

    2012-12-01

    The number of citations a scholarly work receives is a common measure of its impact on the scientific literature; "citation classics" are the most highly cited works. The content of Suicide and Life-Threatening Behavior (SLTB) citation classics is described here. The impact of SLTB citation classics is compared to their counterparts in journals having published the most suicide papers. All data are from the ISI electronic venue on the Web of Science and refer to the number of citations the top 1% of works received in each of ten journals from 1975 through August 10, 2011. Among all ten journals, SLTB ranked first in the number of works on suicide. The principle theme of half of SLTB suicide classics was literature review. The median number of citations for SLTB citation classics (top 1%) was 121.5, with a range between 96 and 279 citations, but classics from generalized psychiatric journals received more citations as anticipated. Journal impact factors explained 73% of the variance in classic's citation counts across journals. On average, suicide classics received 30% more citations than all classics. Among a second group of five specialized suicide journals, however, SLTB ranked first in average 5-year impact. Although SLTB produced the highest number of suicide articles of any journal, SLTB's citation classics received fewer citations than suicide classics in high-impact/prestige, general journals. Future work is needed to assess what predicts which SLTB articles ultimately become citation classics. © 2012 The American Association of Suicidology.

  12. An extended family suddenly confronted with a life-threatening hereditary arrhythmia.

    Science.gov (United States)

    Hendriks, K S W H; van Langen, I M; van Tintelen, J P; Grosfeld, F J M; Wilde, A A M; Ten Kroode, H F J

    2005-09-01

    This exploratory study serves to illustrate the psychological impact on an extended family in the process of genetic counselling and testing for a potentially life-threatening arrhythmia, the long-QT syndrome (LQTS). All members of the third generation and their partners (n=11) were interviewed, the mutation carriers with partners twice. In addition they completed measures for anxiety and depression three times in 18 months. During the interviews these family members emphasised the damaged solidarity when the family is divided into carriers and noncarriers of a mutation in a LQTS predisposing gene. This demonstrates one way in which a family can react to the reality of being at risk of a potentially severe disease. Rewriting family history and mourning early death seem other ways to deal with this. The distress scores, especially of the women, were moderate to clinically high, not because of their own chance of having an arrhythmia but more due to their children's risk. Mothers need educational even more than emotional support, because the lifestyle of their carrier children is in need of radical change. The setting of a combined outpatient cardiogenetic clinic with a medical and psychosocial staff meets such needs efficiently.

  13. [Study of risk factors for recurrence in severe life-threatening conditions in infants].

    Science.gov (United States)

    Rimet, Y; Poujol, A; Cournelle, M A; Cornus, P; Courcier, D; Brusquet, Y

    1993-01-01

    In a prospective study, 180 infants, mean age 2-6 months, hospitalized for apparent life threatening events between October 1985 and September 1988 (for 7,261 infants admitted into the pediatric unit during the same period), were submitted to the following investigations: careful anamnesis, complete clinical examination, systematic paraclinical investigations (standard biological studies, infectious and metabolic tests, investigations for gastro esophageal reflux (GER) and vagal hyper-reflectivity (VHR), polysomnography) or adapted to the clinical situation (toxic tests, brain computed scan, laryngoscopy, etc). Pathologies were mainly functional with neuro-vegetative immaturity (67.5%): gastro esophageal reflux (49%), vagal hyper-reflectivity (8.5%) or both (10%). An incidental pathological factor (breath holding spell, convulsion, intoxication, infection) was found in 18.5% of the infants, and 14% had normal results. Diphemanil 10 mg/kg/24h corrected the VHR and Metoclopramide 1 mg/kg/24h controlled 52% of the GER. The recurrence rate of illness in the GER and VHR groups was statistically lower with efficient therapy (12% vs 48%); no recurrence occurred in other groups.

  14. Apparent Life-Threatening Events: Patients' Health Status at 5 Years of Age.

    Science.gov (United States)

    Steiman, Brian; Watemberg, Nathan

    2015-11-01

    The long-term significance of apparent life-threatening events (ALTE) has not been thoroughly studied. To evaluate, at age 5 years, the health status of consecutive children diagnosed with ALTE in infancy. Based on the diagnostic workup, patients were classified into two groups: a 'broad' evaluation group (at least one test/procedure related to each of the five main causes: infectious, metabolic, cardiopulmonary, gastroenterological, neurological), and a 'narrow' workup group whose evaluation did not cover all five domains. Health status around age 5 was obtained from hospital records, community clinics and parents/caregivers. We identified 132 children with ALTE. Choking (49.2%) was the most common description, followed by apnea (13.6%), suspected seizure (12.9%), cyanosis (12.1%), breath-holding spell (8.3%), and pallor (3.8%). A broad diagnostic workup was performed in 62.1% of the infants, and a narrow workup in 37.9%. At age 5 years, 56.8% of the children were healthy; 27.3% reported chronic conditions unrelated to ALTE. Twenty-one children (15.9%) had unrelated neurodevelopmental conditions, mostly attention deficit disorder. One of the 132 ALTE patients relapsed and was eventually diagnosed with epilepsy. A single episode of ALTE in infancy was neither predictive of nor associated with chronic systemic or neurological-disease at age 5 years.

  15. [Life-threatening sleepwalking (Elpenor's syndrome) in a 10-year-old child].

    Science.gov (United States)

    Madigand-Tordjman, M-A; Egler, P-J; Bertran, F; Jokic, M; Guénolé, F

    2017-06-01

    Though benign in the majority of cases, sleepwalking sometimes causes injuries due, among other causes, to falls. Such accidents can be life-threatening - a situation that has been termed Elpenor syndrome (in reference to an accident experienced by a character in Homer's epic The Odyssey) - in particular when entailing defenestration. This syndrome has been described in adults and adolescents; we report here a case in a child. This 10-year-old girl was admitted at night to our hospital after a 3-m fall at home. She was alert (Glasgow score, 15) at admission; a frontal wound and a deformation of the right wrist were noted. Brain CT scans showed a frontal skull fracture and frontal lobe contusion, wrist x-rays showed a displaced right fracture. The patient underwent urgent neurosurgery (wound excision and suture after reduction of skull fracture) and closed reduction and immobilization of the wrist fracture, both under general anesthesia. She underwent a psychiatric assessment in the intensive care unit 3 days after her fall. She was alert, well-oriented in time and space, and spoke fluently. She had no memory of her fall, only remembering going to bed in the evening before the accident and waking up in the ambulance on the way to the hospital. She displayed no sign of a concurrent mental illness and no suicidal ideas. Her parents reported that the evening of the accident she and her two brothers had all fallen asleep about 11:00 pm while watching TV, in the double bed of the guest room, placed just beside its window. At approximately 1:00 am, her father, who was going to bed and had just made noise in the hall, heard a cry from the guest room. He entered the room immediately and saw the opened window and his daughter lying on the outside ground; the brothers only awakened after the fall. The family had returned 2 days before from a 6-month stay in the United States, with jet-lag, sleep deprivation, and a disorganized sleep/wake rhythm in the patient. There was

  16. Outcome of children with life-threatening asthma necessitating pediatric intensive care

    Directory of Open Access Journals (Sweden)

    Cheung Kam-Lau

    2010-07-01

    Full Text Available Abstract Objective To report the outcome of children with life-threatening asthma (LTA admitted to a university Pediatric Intensive Care Unit (PICU. Methods Retrospective study between October 2002 and May 2010 was carried out. Every child with LTA and bronchospasm was included. Results 30 admissions of 28 patients (13 M, 17 F were identified which accounted for 3% of total PICU admissions (n = 1033 over the study period. The majority of patients were toddlers (median age 3.1 years. Few had past history of prematurity, lung diseases, or neuro-developmental conditions. Approximately half had previous admissions for asthma and one-forth with history of non-compliance to recommended treatment for asthma. One patient had parainfluenza virus and one had rhinovirus isolated. None of these factors were associated with need for mechanical ventilation (n = 6 admissions. Comparing with patients who did not receive mechanical ventilation, ventilated children had significantly higher PIM2 score (1.65 versus 0.4, p 2 levels (9.3 kPa versus 5.1 kPa, p = 0.01 and longer PICU stay (median 2.5 days versus 2 days, p = 0.03 The majority of patients received systemic corticosteroids, intravenous or inhaled bronchodilators. There was one pneumothorax but no death in this series. Conclusions LTA accounted for a small percentage of PICU admissions. Previous hospital admissions for asthma and history of non-compliance were common. Approximately one quarters required ventilatory supports. Regardless of the need for mechanical ventilation, all patients survived with prompt treatment.

  17. Health Values and Treatment Goals of Older, Multimorbid Adults Facing Life-Threatening Illness.

    Science.gov (United States)

    Naik, Aanand D; Martin, Lindsey A; Moye, Jennifer; Karel, Michele J

    2016-03-01

    To identify a taxonomy of health-related values that frame goals of care of older, multimorbid adults who recently faced cancer diagnosis and treatment. Qualitative analysis of data from a longitudinal cohort study of multimorbid cancer survivors. Cancer registries from regional Department of Veterans Affairs networks in New England and southeast Texas. Multimorbid adults who completed interviews 12 months after diagnosis of head and neck, colorectal, gastric, or esophageal cancer and after cancer treatment (N = 146). An interdisciplinary team conducted thematic analyses of participants' intuitive responses to two questions: Now that you have had cancer and may face ongoing decisions about medical care in the future, what would you want your family, friends, and doctors to know about you, in terms of what is most important to you in your life? If your cancer were to recur, is there anything you'd want to be sure your loved ones knew about you and your goals of care? Analysis revealed five distinct health-related values that guide how multimorbid cancer survivors conceptualize specific health care goals and medical decisions: self-sufficiency, life enjoyment, connectedness and legacy, balancing quality and length of life, and engagement in care. Participants typically endorsed more than one value as important. Older multimorbid adults who recently faced life-threatening cancer endorsed a multidimensional taxonomy of health-related values. These health-related values guide how they frame their goals for care and treatment preferences. Eliciting individuals' sense of their values during clinical encounters may improve their experiences with health care and more effectively align treatments with goals of care. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

  18. Life-threatening ventricular tachyarrhythmias in the cardiology department: Implications for appropriate prescription of telemetry monitoring.

    Science.gov (United States)

    Zorzi, Alessandro; Peruzza, Francesco; Stella, Federica; Del Monte, Alvise; Migliore, Federico; Gasparetto, Nicola; Badano, Luigi; Iliceto, Sabino; Corrado, Domenico

    2016-04-01

    in-hospital life-threatening ventricular arrhythmias (LT-VA) may complicate the course of cardiovascular patients. We aimed to assess the incidence, circumstances, determinants, and outcome of in-hospital LT-VA in order to help clinicians in prescribing appropriate levels of monitoring. the study population consisted of all 10,741 consecutive patients (65 ± 15 years, 67.7% males) admitted to a cardiology department in 2009-2014. Terminally ill patients and those with primary arrhythmia diagnosis were excluded. The composite end-point included sudden arrhythmic death, ventricular fibrillation, unstable ventricular tachycardia and appropriate ICD shock unrelated to invasive interventions. the incidence of LT-VA was 0.6%, with no differences regarding age, gender and primary diagnosis of coronary artery disease between patients with and without LT-VA. The incidence of LT-VA was significantly higher (1.2% versus 0.1%, p<0.001) among urgent compared with elective admissions and among patients with left ventricular ejection fraction (LV-EF) <45% (1.7% versus 0.2%, p<0.001). At multivariable analysis, urgent admission and LV-EF <45%, but not primary diagnosis of coronary artery disease, remained independent predictors of LT-VA. At the time of the event, 97.1% fulfilled either class I or class II indications for telemetry monitoring according to the American Heart Association guidelines. Survival to discharge with good neurological status was 70.6%. acutely ill patients with heart failure and LV systolic dysfunction showed the highest rate of LT-VAs, regardless of the underlying cardiac disease (ischemic or non-ischemic). Current guidelines demonstrated high sensitivity in identifying patients at risk. These findings may favor proper utilization of telemetry monitoring resources. Copyright © 2016. Published by Elsevier Ireland Ltd.

  19. Self-reported recognition of undiagnosed life threatening conditions in chiropractic practice: a random survey

    Directory of Open Access Journals (Sweden)

    Daniel Dwain M

    2012-07-01

    Full Text Available Abstract Background The purpose of this study was to identify the type and frequency of previously undiagnosed life threatening conditions (LTC, based on self-reports of chiropractic physicians, which were first recognized by the chiropractic physician. Additionally this information may have a preliminary role in determining whether chiropractic education provides the knowledge necessary to recognize these events. Methods The study design was a postal, cross-sectional, epidemiological self-administered survey. Two thousand Doctors of Chiropractic in the US were randomly selected from a list of 57878. The survey asked respondents to state the number of cases from the list where they were the first physician to recognize the condition over the course of their practice careers. Space was provided for unlisted conditions. Results The response rate was 29.9%. Respondents represented 11442 years in practice and included 3861 patients with a reported undiagnosed LTC. The most commonly presenting conditions were in rank order: carcinoma, abdominal aneurysm, deep vein thrombosis, stroke, myocardial infarction, subdural hematoma and a large group of other diagnoses. The occurrence of a previously undiagnosed LTC can be expected to present to the chiropractic physician every 2.5 years based on the responding doctors reports. Conclusion Based on this survey chiropractic physicians report encountering undiagnosed LTC’s in the normal course of practice. The findings of this study are of importance to the chiropractic profession and chiropractic education. Increased awareness and emphasis on recognition of LTC is a critical part of the education process and practice life.

  20. Spontaneous bacterial peritonitis: How to deal with this life-threatening cirrhosis complication?

    Directory of Open Access Journals (Sweden)

    Tarsila CR Ribeiro

    2008-07-01

    Full Text Available Tarsila CR Ribeiro1, Julio MF Chebli2, Mario Kondo1, Pedro Duarte Gaburri3, Liliana Andrade Chebli2, Ana Cristina Amaral Feldner11Division of Gastroenterology, Department of Medicine of University Federal de São Paulo, UNIFESP, EPM, São Paulo, São Paulo, Brazil; 2Division of Gastroenterology, Department of Medicine of University Federal de Juiz de Fora, UFJF, Juiz de Fora, Minas Gerais, Brazil; 3Liver Unit Coordinator of Santa Casa de Misericórdia de Juiz de Fora, Minas Gerais, BrazilAbstract: Spontaneous bacterial peritonitis (SBP is one of the most common and life-threatening complications of cirrhosis. It occurs in 10% to 30% of patients admitted to hospital and recent studies tend to demonstrate that SBP incidence seems to be decreasing in its frequency. A bacterial overgrowth with translocation through the increased permeable small intestinal wall and impaired defense mechanisms is considered to be the main mechanism associated with its occurrence. The Gram-negative aerobic bacteria are the major responsible for SBP episodes and Gram-positive bacteria, mainly Staphylococcus aureus, are being considered an emergent agent causing SBP. The prompt diagnosis of SBP is the key factor for reduction observed in mortality rates in recent years. The clinical diagnosis of SBP is neither sensitive nor specific and the search for new practical and available tools for a rapid diagnosis of SBP is an important endpoint of current studies. Reagent strips were considered a promising and faster way of SBP diagnosis. The prompt use of empirical antibiotics, mostly cefotaxime, improves significantly the short-term prognosis of cirrhotic patients with SBP. The recurrence rate of SBP is high and antibiotic prophylaxis has been recommended in high-risk settings. Unfortunately, the long-term prognosis remains poor.Keywords: cirrhosis, ascites, diagnosis, peritonitis, treatment

  1. Diagnosis of Life-Threatening Alpha-Gal Food Allergy Appears to Be Patient Driven.

    Science.gov (United States)

    Flaherty, Mary Grace; Kaplan, Samantha Jan; Jerath, Maya R

    2017-10-01

    Patients exhibiting life-threatening symptoms associated with the alpha-gal food allergy (delayed urticaria or anaphylaxis due to mammalian meat) are frequently undiagnosed, causing unnecessary emergency department (ED) and health care visits, and extensive pain and suffering. This study aimed to determine the path to diagnosis experienced by alpha-gal patients. Semistructured interviews were conducted from March to June 2016 with a chronological systematic sample of approximately 10% of patients diagnosed with alpha-gal and treated by the University of North Carolina Allergy and Immunology Clinic (n = 28). Main outcome measures included average length of time between first symptoms' appearance and diagnosis, number and type of health care encounters en route to diagnosis, and typical symptom severity. Six interviewees (21%) were diagnosed within a year of experiencing symptoms, of the remaining 22, mean time to diagnosis was 7.1 years. In over 100 medical encounters (including 28 ED visits and 2 urgent care) the correct diagnosis or effective diagnosing referral occurred less than 10% of the time. Seventy-one percent (20/28) described their first symptoms as severe. More patients found the allergist specializing in this condition on their own (n = 12; 43%) than those who were formally diagnosed or received referrals (n = 10; 36%) through the health care system. The medical community is challenged to stay abreast of emerging and newly uncovered illnesses through traditional medical literature communication channels. Presently, patients more often discover a diagnosis of alpha-gal allergy by using information resources on their own than by presenting to the ED with anaphylaxis.

  2. The relationship between religion, illness and death in life histories of family members of children with life-threatening diseases.

    Science.gov (United States)

    Bousso, Regina Szylit; Serafim, Taís de Souza; Misko, Maira Deguer

    2010-01-01

    This qualitative study aimed to get to know the relationship between the experiences of families of children with a life-threatening disease and their religion, illness and life histories. The methodological framework was based on Oral History. The data were collected through interviews and the participants were nine families from six different religions who had lived the experience of having a child with a life-threatening disease. The interviews, held with one or two family members, were transcribed, textualized and, through their analysis, the Vital Tone was elaborated, representing the moral synthesis of each narrative. Three dimensions of spirituality were related to illness and death in their life histories: a Higher Being with a healing power; Development and Maintenance of a Connection with God and Faith Encouraging Optimism. The narratives demonstrated the family's search to attribute meanings to their experiences, based on their religious beliefs.

  3. Worksite interventions for preventing physical deterioration among employees in job-groups with high physical work demands

    DEFF Research Database (Denmark)

    Holtermann, Andreas; Jørgensen, Marie B; Gram, Bibi

    2010-01-01

    aims at improving physical capacity and promoting musculoskeletal and cardiovascular health. At the industrial work-place characterized by repetitive work tasks, the intervention aims at reducing physical exertion and musculoskeletal disorders by combined physical exercise training, CBTr...... and participatory ergonomics. The overall aim of the FINALE programme is to improve the safety margin between individual resources (i.e. physical capacities, and cognitive and behavioral skills) and physical work demands, and thereby reduce the physical deterioration in a long term perspective by interventions...

  4. Challenges in the management of massive intraorbital and hemifacial arteriovenous malformation as causing life-threatening epistaxis

    OpenAIRE

    Anura Michelle Manuel; Santhi Kalimuthu; Sitra Siri Pathmanathan; Prepageran Narayanan; Zurina Zainal Abidin; Khairul Azmi; Alizan Khalil

    2017-01-01

    Arteriovenous malformations are congenital lesions that may evolve with time and manifest in a plethora of presentations. They can occur as torrential epistaxis when it extensively involves the facial region. Multi-imaging modalities are available to assist in characterizing the structure of the lesion as well as its location and extent. This complex disease requires a multidisciplinary team approach with preoperative embolization and surgery. We present a rare cause of life-threatening epist...

  5. Warfarin-induced sublingual hematoma mimicking Ludwig angina: Conservative management of a potentially life-threatening condition.

    LENUS (Irish Health Repository)

    Cashman, Emma

    2012-02-01

    Sublingual hematoma secondary to excessive anticoagulation is a rare, life-threatening condition. Reports in the literature have emphasized the importance of a prompt reversal of the causative coagulopathy by intravenous administration of vitamin K and fresh frozen plasma. In the event of an unstable airway, surgical intervention via tracheostomy or cricothyroidectomy is advocated. We report a case of sublingual hematoma that was treated conservatively, and we discuss the presentation and management of this entity.

  6. Warfarin-induced sublingual hematoma mimicking Ludwig angina: Conservative management of a potentially life-threatening condition.

    LENUS (Irish Health Repository)

    Cashman, Emma

    2011-02-01

    Sublingual hematoma secondary to excessive anticoagulation is a rare, life-threatening condition. Reports in the literature have emphasized the importance of a prompt reversal of the causative coagulopathy by intravenous administration of vitamin K and fresh frozen plasma. In the event of an unstable airway, surgical intervention via tracheostomy or cricothyroidectomy is advocated. We report a case of sublingual hematoma that was treated conservatively, and we discuss the presentation and management of this entity.

  7. Creating doorways: Finding existential meaning and growth through the creative arts in the face of life-threatening illness

    OpenAIRE

    Reilly, Rosemary C.; Lee, Virginia; Laux, Kate; Robitaille, Andréanne; Saavedra Macías, Francisco Javier (Coordinador); Español Nogueiro, Alicia (Coordinador); Arias Sánchez, Samuel (Coordinador); Calderón García, Marina (Coordinador)

    2017-01-01

    Life-threatening illness can be sufficiently traumatic to shatter one‘s beliefs about self, others, and the world. This disruption can trigger an instinctive search for meaning. Research highlights that how individuals respond post-adversity can make the difference between experiencing posttraumatic stress or posttraumatic growth (PTG) and existential growth (EG). This paper presents the findings of a pilot study situated in a tertiary care cancer centre and details the impact of creative art...

  8. Effectiveness of hemodialysis with high-flux polysulfone membrane in the treatment of life-threatening methanol intoxication.

    Science.gov (United States)

    Peces, Ramón; Alvarez, Rafael

    2002-02-01

    Methanol poisoning may result in metabolic acidosis, blindness and death. In this report, we describe a case of life-threatening methanol intoxication in a 44-year-old man who was treated successfully with supportive care, ethanol infusion, folic acid and early hemodialysis with a high-flux polysulfone dialyzer. We conclude that hemodialysis as implemented in this case is a safe and effective approach to the management of methanol poisoning. Copyright 2002 S. Karger AG, Basel

  9. [Effectiveness of pre-emptive hemodialysis with high-flux membranes for the treatment of life-threatening alcohol poisoning].

    Science.gov (United States)

    Peces, R; Fernández, R; Peces, C; González, E; Olivas, E; Renjel, F; Jiménez, M; Costero, O; Montero, A; Selgas, R

    2008-01-01

    Alcohol intoxication (methanol, ethanol and ethylene glycol) may result in metabolic acidosis with increased anion gap, increased serum osmolal gap, and neurologic abnormalities ranging from drunkenness to coma, and death. The mortality and morbidity rates remain very high despite intensive care therapy. The toxicity of methanol and ethylene glycol is clearly correlated to the degree of metabolic acidosis. The established treatment of severe methanol and ethylene glycol intoxication is ethanol administration and hemodialysis (HD). By inhibiting the main metabolic pathway of methanol and ethylene glycol (alcohol dehydrogenase), ethanol prevents the formation of major toxic metabolites (formic acid, glycolic acid and oxalic acid). Conventional HD can reduce serum methanol, ethanol and ethylene glycol and its metabolites rapidly, but high-flux membranes should be capable of removing more toxic per hour of HD. In this report, we describe 14 cases of life-threatening alcohol intoxication (11 methanol, 1 ethanol, and 2 ethylene glycol) who were treated successfully with supportive care, ethanol infusion (methanol and ethylene glycol), and early HD with a high-flux dialyser. The median pH was 7.04 +/- 0.06 (range 6.60-7.33), median bicarbonate 9.9 +/- 1.9 mmol/l (range 1.4-25), and median base deficit 18.4 +/- 2.6 mmol/l (range 2-33). The median anion gap was 29.1 +/- 2.3 mmol/l (range 16-45) and the median osmolal gap was 119 +/- 47 mOsm/l (range 16-402). On admission there was an excellent linear correlation between the serum toxic alcohol concentrations and the osmolal gaps (R2 = 0.98, p = 0.0006). In all cases early HD corrected metabolic acidosis and osmolal abnormalities. The mortality was 7 % (1 from 14). We conclude that pre-emptive HD should be performed in severe intoxications to remove both the parent compound and its metabolites. The HD prescription should include a large surface area dialyser with high-flux membrane, a blood flow rate in excess of 250 ml

  10. Prior radiation and chemotherapy increase the risk of life-threatening complications after insertion of metallic stents for esophagogastric malignancy.

    Science.gov (United States)

    Kinsman, K J; DeGregorio, B T; Katon, R M; Morrison, K; Saxon, R R; Keller, F S; Rosch, J

    1996-03-01

    Self-expanding metallic stents (SEMS) are effective in relieving the symptoms of obstructing esophagogastric malignancy. While complications with SEMS have been described, factors influencing such occurrence have not been defined. Self-expanding Gianturco-Rosch Z-stents were placed successfully in 59 patients with obstructing esophagogastric malignancies. Early procedure-related complications occurred in 6 patients (10%) and were usually minor. Twenty-three late complications occurred in 22 patients (37.5%). Life-threatening complications occurred in 9 patients (15%), including gastrointestinal bleeding (7), perforation (1), and tracheoesophageal fistula (1) and contributed to all five deaths. Eight of 22 patients with prior radiation and/or chemotherapy (36.4%) had life-threatening complications compared to 1 of 37 (2.5%) without prior therapy (p = 0.001). Stent-related mortality occurred in 5 of 22 (23%) patients with prior therapy compared to none of the 37 without prior therapy (p = 0.005). Multivariate analysis confirmed the association between prior radiation and/or chemotherapy and life-threatening complications (p = 0.012; odds ratio, 32.63) and also an association with female gender (p = 0.032; odds ratio, 13.9). There was no association with tumor location or length, histologic type, age, prestent dysphagia grade, or previous surgical resection. Patients with prior radiation and/or chemotherapy have an increased risk of severe complications following placement of SEMS.

  11. Hyperferritinemia as the Diagnostic Clue in Life-Threatening Hemophagocytic Lymphohistiocytosis

    NARCIS (Netherlands)

    Kerzel, S.; Zemlin, M.; Koemhoff, M.; Klaus, G.; Maier, R. F.

    2009-01-01

    We report on a seventeen year old girl with persistent fever of unknown origin. An initial episode of abdominal pain led to laparotomy and appendectomy, which did not reveal any pathological findings. In the course of the next 3 weeks, the girl's general condition progressively deteriorated. Despite

  12. Use of Gypsum as a Preventive Measure for Strength Deterioration during Curing in Class F Fly Ash Geopolymer System

    Science.gov (United States)

    Jun, Yubin; Oh, Jae Eun

    2015-01-01

    This study discusses strength deterioration during the curing process of fly ash geopolymer and the use of CaSO4·2H2O (gypsum) as a deterioration remedy when the ash was synthesized using a 10M NaOH and Na-silicate solution. The strength decline was mainly due to the widespread formation of nanometer-sized cracks that were related to excessive Na and Si concentrations at an early age. Use of 2 wt% CaSO4·2H2O resulted in the best measured strength by temporarily reducing Na and Si concentrations; Na was absorbed by SO42−, up to 11% in the matrix within one day, and formed Na2SO4 (thenardite), which gradually dissolved over time, slowly releasing Na ions. However, more than 4% gypsum suppressed overall strength development because too many Na ions were locked into Na2SO4 and could not participate in geopolymerization. The addition of gypsum impeded glass dissolution and even halted the process when more than 4% gypsum was used.

  13. Distribution of Report on Procedures to Estimate Nitrogen Oxides (NOx) Emission Increases from Mobile and Area Sources for Prevention of Significant Deterioration (PSD) Increment Analyses

    Science.gov (United States)

    This document may be of assistance in applying the New Source Review (NSR) air permitting regulations including the Prevention of Significant Deterioration (PSD) requirements. This document is part of the NSR Policy and Guidance Database. Some documents in the database are a scanned or retyped version of a paper photocopy of the original. Although we have taken considerable effort to quality assure the documents, some may contain typographical errors. Contact the office that issued the document if you need a copy of the original.

  14. Deficient supplies of drugs for life threatening diseases in an African community

    Directory of Open Access Journals (Sweden)

    Andrew Marit

    2007-06-01

    Full Text Available Abstract Background In Malawi essential drugs are provided free of charge to patients at all public health facilities in order to ensure equitable access to health care. The country thereby spends about 30% of the national health budget on drugs. In order to investigate the level of drug shortages and eventually find the reasons for the drugs shortages in Malawi, we studied the management of the drug supplies for common and life threatening diseases such as pneumonia and malaria in a random selection of health centres. Methods In July and August 2005 we visited eight out of a total of 37 health centres chosen at random in the Lilongwe District, Malawi. We recorded the logistics of eight essential and widely used drugs which according to the treatment guidelines should be available at all health centres. Five drugs are used regularly to treat pneumonia and three others to treat acute malaria. Out-of-stock situations in the course of one year were recorded retrospectively. We compared the quantity of each drug recorded on the Stock Cards with the actual stock of the drug on the shelves at the time of audit. We reviewed 8,968 Patient Records containing information on type and amount of drugs prescribed during one month. Results On average, drugs for treating pneumonia were out of stock for six months during one year of observation (median value 167 days; anti-malarial drugs were lacking for periods ranging from 42 to138 days. The cross-sectional audit was even more negative, but here too the situation was more positive for anti-malarial drugs. The main reason for the shortage of drugs was insufficient deliveries from the Regional Medical Store. Benzyl penicillin was in shortest supply (4% received. The median value for non-availability was 240 days in the course of a year. The supply was better for anti-malarial drugs, except for quinine injections (9 %. Only 66 % of Stock Card records of quantities received were reflected in Patient Records

  15. Randomized clinical trial of clinic-integrated, low-intensity treatment to prevent deterioration of disease care in adolescents with type 1 diabetes.

    Science.gov (United States)

    Holmes, Clarissa S; Chen, Rusan; Mackey, Eleanor; Grey, Margaret; Streisand, Randi

    2014-06-01

    To evaluate the efficacy of two office-based treatments designed to prevent deterioration in glycemic control in young adolescents with type 1 diabetes in a randomized clinical trial. An individualized, more intensive family teamwork Coping skills program was compared with a diabetes Education treatment. A baseline assessment was followed by four brief treatment sessions and immediate posttesting over the course of 1.5 years. Families of 226 early adolescents (ages 11-14) were randomized to receive either individualized coping skills education or diabetes education as adjunctive treatment to quarterly medical appointments. Continued follow-up occurred at 3.5-month intervals for a long-term follow-up of up to 3 years. A post hoc Usual Care group facilitated comparisons of glycemic control. Growth curve analysis showed that both treatment groups successfully prevented deterioration in adolescent disease care and simultaneously improved adolescent and parent quality of life that included indicators of more effective communication and reduced adherence barriers-without a concomitant increase in diabetes-related or general family conflict. However, contrary to expectation, the Education group was more efficacious than the Coping group in improvement of disease adherence and glycemic control over a 3-year follow-up. Low-intensity office-based quarterly treatment can maintain or improve disease care adherence in early adolescence when provided to adolescent/parent dyads. Better outcomes are achieved when treatment goals and techniques match the needs of the targeted population. © 2014 by the American Diabetes Association.

  16. Visualising Deteriorating Conditions

    Directory of Open Access Journals (Sweden)

    Tom Andrews, RN, B.Sc. (Hons, M.Sc., Ph.D.

    2005-03-01

    Full Text Available The research aims were to investigate the difficulties ward staff experienced in detecting deterioration and how these were resolved. The emphasis within the literature tends to be on identifying premonitory signs that may be useful in predicting deterioration. Changes in respiratory rate is the most consistent of these (Fieselmann et al. 1993; Sax and Charlson 1987; Schein et al. 1990; Smith and Wood 1998 but in common with other signs, it lacks sensitivity and specificity. The sample consisted of 44 nurses, doctors (Interns and health care support workers from a general medical and surgical ward. Data were collected by means of nonparticipant observations and interviews, using grounded theory as originated by (Glaser and Strauss 1967 and (Glaser 1978. As data were collected, the constant comparative method and theoretical sensitivity were used as outlined in grounded theory. A core category of “visualising deteriorating conditions” emerged, together with its sub-core categories of “intuitive knowing”, “baselining” and “grabbing attention”.The main concern in visualising deteriorating conditions is to ensure that patients suspected of deterioration are successfully referred to medical staff. The aim is to convince those who can treat or prevent further deterioration to intervene. Through intuitive knowing they pick up that patients have changed in a way that requires a medical assessment. To make the referral more credible, nurses attempt to contextualise any changes in patients by baselining (establishing baselines. Finally with the backup of colleagues, nurses refer patients by providing as much persuasive information as possible in a way that grabs attention. The whole process is facilitated by knowledge and experience, together with mutual trust and respect.

  17. Hope in action—facing cardiac death: A qualitative study of patients with life-threatening disease

    Science.gov (United States)

    Schaufel, Margrethe Aase; Nordrehaug, Jan Erik; Malterud, Kirsti

    2011-01-01

    Coping with existential challenges is important when struck by serious disease, but apart from cancer and palliative care little is known about how patients deal with such issues and maintain hope. To explore how patients with life-threatening heart disease experience hope when coping with mortality and other existential challenges, we conducted a qualitative study with semi-structured interviews. We made a purposive sample of 11 participants (26–88 years) who had experienced life-threatening disease: eight participants with serious heart disease, two with cancer, and one with severe chronic obstructive pulmonary disease. Analysis was by systematic text condensation. The findings showed that hope could enhance coping and diminish existential distress when patients were confronted with mortality and other existential challenges. Hope was observed as three types of dynamic work: to shift perception of mortality from overwhelming horror toward suppression or peaceful acceptance, to foster reconciliation instead of uncertainty when adapting to the new phase of life, and to establish go-ahead spirit instead of resignation as their identity. Meaning of life could, hence, be sustained in spite of serious threats to the persons' future, everyday life, and self-conception. The work of hoping could be supported or disturbed by relationships with family, friends, and health care professionals. Hope can be regarded as an active, dynamic state of existential coping among patients with life-threatening disease. Physicians may support this coping and thereby provide personal growth and alleviation of existential distress by skillfully identifying, acknowledging, and participating in the work of hoping performed by the patient. PMID:21423599

  18. Life-threatening rupture of a renal angiomyolipoma in a patient taking over-the-counter horse chestnut seed extract.

    LENUS (Irish Health Repository)

    Snow, Aisling

    2011-02-09

    BACKGROUND: Alternative medical therapies are increasingly being prescribed due to their good safety profile and perceived limited side effects. They are often unregulated and prescribed over the counter. One such medication is horse chestnut seed extract (HCSE), which is used for the treatment of chronic venous insufficiency and is known to affect blood coagulation. Angiomyolipoma (AML) is a benign fat-containing mesenchymal tumor of the kidney. It is often found incidentally and in most cases can be managed conservatively. Rupture of the kidney with hemorrhage is a well-known complication that may be serious and life-threatening. Known risk factors for hemorrhage include anticoagulation as well as pregnancy, increased size of the lesion, high lesion vascularity, and aneurysm formation within the tumor. OBJECTIVES: The aim is to raise awareness of potential HCSE-induced anticoagulation, including, as in the case presented, acute renal AML hemorrhage. CASE REPORT: The case of a patient taking HCSE for venous insufficiency is presented. The patient suffered a life-threatening rupture of the kidney in the presence of known renal AML. She underwent emergency embolization with a successful outcome. Because HCSE-containing products are thought to be generally safe in the treatment of chronic venous insufficiency, it is important to be mindful of their potential anticoagulant properties and, therefore, their relative contraindication both in patients taking other anticoagulants and those with known renal AML. CONCLUSION: We demonstrate a potentially life-threatening association between HSCE-containing products and renal AML, highlighting the risk associated with HSCE-induced anticoagulation.

  19. Challenges in the management of massive intraorbital and hemifacial arteriovenous malformation as causing life-threatening epistaxis

    Directory of Open Access Journals (Sweden)

    Anura Michelle Manuel

    2017-03-01

    Full Text Available Arteriovenous malformations are congenital lesions that may evolve with time and manifest in a plethora of presentations. They can occur as torrential epistaxis when it extensively involves the facial region. Multi-imaging modalities are available to assist in characterizing the structure of the lesion as well as its location and extent. This complex disease requires a multidisciplinary team approach with preoperative embolization and surgery. We present a rare cause of life-threatening epistaxis in a gentleman with a longstanding orbital and hemifacial arteriovenous malformation and discuss the complexities involved in its management.

  20. Trocar injury of the retroperitoneal vessels followed by life-threatening postischemic compartment syndrome of both lower extremities.

    Science.gov (United States)

    Hauser, Joerg; Lehnhardt, Marcus; Steinau, Hans-Ulrich; Homann, Heinz-Herbert

    2008-04-01

    Lesions of the intra-abdominal organs and vessels caused by trocars and Verres needles are rare but serious complications during laparoscopic surgery. We report an unusual case of left common iliac artery and inferior vena cava injury during laparoscopy. This lesion was followed by a bilateral postischemic compartment syndrome of the lower extremities. The patient sustained massive rhabdomyolysis, renal failure, peroneal nerve palsy, and functional loss of the lower extremities. Postischemic tissue swelling should be recognized as early as possible because it is a life-threatening condition that necessitates immediate treatment.

  1. Pain with Life-Threatening Illness: Its Perception and Control Are Inextricably Linked with Quality of Life

    Directory of Open Access Journals (Sweden)

    S Robin Cohen

    2000-01-01

    Full Text Available This article describes how the quality of life of people with a life-threatening illness is affected by pain, and how their pain is influenced by all aspects of their quality of life. These aspects include the physical, psychological, cognitive, social, and spiritual and existential domains. This concept of pain is placed in the context of Ron Melzack's work highlighting the essential role of cognitive and emotional aspects of pain perception, and their influence on pain control. These issues continue to be a guiding force in the authors' own work and that of many others working in the field.

  2. Life-Threatening Contraceptive-Related Pulmonary Embolism in a 14-Year-Old Girl with Hereditary Thrombophilia

    DEFF Research Database (Denmark)

    Hellfritzsch, Maja; Grove, Erik Lerkevang

    2015-01-01

    . Based on a case of life-threatening COC-associated pulmonary embolism in a girl heterozygous for the prothrombin G20210A mutation and with a family history of thrombotic disease, we discuss the importance of assessing not just the genotype but also the phenotype when considering initiation of COCs...... in patients with thrombophilia. CASE REPORT: A 14-year-old girl presented with acute onset of chest pain and dyspnea followed by syncope. She was hypoxic and hemodynamically compromised at admission. Computed tomography pulmonary angiography revealed a large central "saddle" pulmonary embolism causing nearly...

  3. Challenges in the management of massive intraorbital and hemifacial arteriovenous malformation as causing life-threatening epistaxis.

    Science.gov (United States)

    Manuel, Anura Michelle; Kalimuthu, Santhi; Pathmanathan, Sitra Siri; Narayanan, Prepageran; Zainal Abidin, Zurina; Azmi, Khairul; Khalil, Alizan

    2017-04-01

    Arteriovenous malformations are congenital lesions that may evolve with time and manifest in a plethora of presentations. They can occur as torrential epistaxis when it extensively involves the facial region. Multi-imaging modalities are available to assist in characterizing the structure of the lesion as well as its location and extent. This complex disease requires a multidisciplinary team approach with preoperative embolization and surgery. We present a rare cause of life-threatening epistaxis in a gentleman with a longstanding orbital and hemifacial arteriovenous malformation and discuss the complexities involved in its management. Copyright © 2017. Published by Elsevier Taiwan.

  4. Comparison of different degrees of variability in tidal volume to prevent deterioration of respiratory system elastance in experimental acute lung inflammation.

    Science.gov (United States)

    Kiss, T; Silva, P L; Huhle, R; Moraes, L; Santos, R S; Felix, N S; Santos, C L; Morales, M M; Capelozzi, V L; Kasper, M; Pelosi, P; Gama de Abreu, M; Rocco, P R M

    2016-05-01

    Variable ventilation improves respiratory function, but it is not known whether the amount of variability in tidal volume (VT) can be reduced in recruited lungs without a deterioration of respiratory system elastance. Acute lung inflammation was induced by intratracheal instillation of lipopolysaccharide in 35 Wistar rats. Twenty-eight animals were anaesthetized and ventilated in volume-controlled mode. Lungs were recruited by random variation of VT (mean 6 ml kg(-1), coefficient of variation 30%, normal distribution) for 30 min. Animals were randomly assigned to different amounts of VT variability (n=7 for 90 min per group): 30, 15, 7.5, or 0%. Lung function, diffuse alveolar damage, and gene expression of biological markers associated with cell mechanical stress, inflammation, and fibrogenesis were assessed. Seven animals were not ventilated and served as controls for post-mortem analyses. A VT variability of 30%, but not 15, 7.5, or 0%, prevented deterioration of respiratory system elastance [Mean (SD) -7.5 (8.7%), Prespiratory system elastance and was not associated with lung histological damage. © The Author 2016. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  5. Using the ABCDE approach to assess the deteriorating patient.

    Science.gov (United States)

    Smith, Duncan; Bowden, Tracey

    2017-11-29

    Patients who deteriorate without recognition or timely interventions are at risk of critical care admission and increased morbidity or mortality. This article outlines the systematic ABCDE (airway, breathing, circulation, disability, exposure) approach to patient assessment, which enables healthcare practitioners to identify and respond to life-threatening conditions in order of priority. The patient's vital signs should be measured as part of the ABCDE assessment and recorded using a track and trigger tool to enhance recognition of physiological abnormalities that signal deterioration. To optimise communication and escalation of deteriorating patients, healthcare practitioners should report ABCDE assessment findings using a structured communication tool. ©2017 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

  6. Worksite interventions for preventing physical deterioration among employees in job-groups with high physical work demands: Background, design and conceptual model of FINALE

    Directory of Open Access Journals (Sweden)

    Mortensen Ole S

    2010-03-01

    Full Text Available Abstract Background A mismatch between individual physical capacities and physical work demands enhance the risk for musculoskeletal disorders, poor work ability and sickness absence, termed physical deterioration. However, effective intervention strategies for preventing physical deterioration in job groups with high physical demands remains to be established. This paper describes the background, design and conceptual model of the FINALE programme, a framework for health promoting interventions at 4 Danish job groups (i.e. cleaners, health-care workers, construction workers and industrial workers characterized by high physical work demands, musculoskeletal disorders, poor work ability and sickness absence. Methods/Design A novel approach of the FINALE programme is that the interventions, i.e. 3 randomized controlled trials (RCT and 1 exploratory case-control study are tailored to the physical work demands, physical capacities and health profile of workers in each job-group. The RCT among cleaners, characterized by repetitive work tasks and musculoskeletal disorders, aims at making the cleaners less susceptible to musculoskeletal disorders by physical coordination training or cognitive behavioral theory based training (CBTr. Because health-care workers are reported to have high prevalence of overweight and heavy lifts, the aim of the RCT is long-term weight-loss by combined physical exercise training, CBTr and diet. Construction work, characterized by heavy lifting, pushing and pulling, the RCT aims at improving physical capacity and promoting musculoskeletal and cardiovascular health. At the industrial work-place characterized by repetitive work tasks, the intervention aims at reducing physical exertion and musculoskeletal disorders by combined physical exercise training, CBTr and participatory ergonomics. The overall aim of the FINALE programme is to improve the safety margin between individual resources (i.e. physical capacities, and

  7. Antioxidant strategies for preventing oxidative flavour deterioration of foods enriched with n-3 polyunsaturated lipids: a comparative evaluation

    DEFF Research Database (Denmark)

    Jacobsen, Charlotte; Let, M.B.; Nielsen, Nina Skall

    2008-01-01

    The aim of this review is to provide a better base for predicting the ability of antioxidants to prevent lipid oxidation in food emulsions in general and in functional food systems enriched with n-3 PUFA in particular. Therefore, the antioxidant efficacies of a range of commercially available...... antioxidants in a number of fish oil enriched real food emulsions (milk, milk drink, salad dressing, mayonnaise and selected model emulsions) are compared. This comparison clearly shows that the same antioxidant exerts different effects in different systems. EDTA is a very efficient antioxidant in salad...

  8. Thrombotic thrombocytopenic purpura and systemic lupus erythematosus: a rare and life-threatening association.

    Science.gov (United States)

    El Khayat, Selma Siham; Medkouri, Ghislaine; Etomba, Armel Mbourou; Zamd, Mohamed; Gharbi, Mohamed Benghanem; Ramadani, Benyounes

    2012-05-01

    The association between thrombotic thrombocytopenic purpura (TTP) and systemic lupus erythematosus (SLE) is uncommon. Diagnosis is often difficult because of their clinical and biological similarities. The presence of TTP in SLE worsens the prognosis and causes high mortality in the absence of early therapeutic interventions. We report the case of a 20 year-old man, admitted with nephrotic range proteinuria, hematuria and rapidly progressive renal failure. He also had anemia, thrombocytopenia and pericardial effusion. The diagnosis of SLE was made based on these clinical findings along with positive antinuclear and anti dsDNA antibodies. Renal biopsy revealed class IV/ V lupus nephritis (LN) with active lesions of thrombotic microangiopathy. The evolution of neurological deficit, persistent thrombocytopenia and active microangiopathic changes suggested the diagnosis of associated TTP. The patient was treated initially with corticosteroids and cyclophosphamide. Plasmapheresis could only be started 16 days later. Mycophenolate mofetil and rituximab were successively tried in the absence of improvement in renal function and persistent thrombocytopenia. The patient's neurological condition deteriorated necessitating transfer to the intensive care unit and mechanical ventilation. There he developed pneumonia and died of septic shock two months after presentation. The coexistence of TTP and SLE needs to be considered early in SLE patients with complicated course. It may not respond to the conventional immunosuppressive treatment of SLE.

  9. Early psychological reactions in parents of children with a life threatening illness within a pediatric hospital setting.

    Science.gov (United States)

    Muscara, F; McCarthy, M C; Woolf, C; Hearps, S J C; Burke, K; Anderson, V A

    2015-07-01

    Parents of children with life threatening illness or injuries are at elevated risk of distress reactions, involving symptoms of acute stress disorder, depression and anxiety. Currently, the impact of child illness factors is unclear, and to date research systematically examining the prevalence of these psychological reactions across different illness groups with an acute life threat is sparse. This is important to explore given that studies show that parent functioning impacts on the psychological adjustment and recovery of the ill child. WHAT DOES THIS STUDY ADD?: At four weeks following a child's diagnosis of a serious illness, 49-54% of parents met DSM-IV criteria for acute stress disorder, across a number of illness groups, whereas 15-27% of parents were in the moderate/severe range for depression and anxiety, and 25-31% for stress. Results from this study demonstrate that rates and severity of these psychological reactions in parents of seriously ill children do not vary according to illness type. A life threatening childhood illness/injury can lead to significant distress reactions in parents, with independent studies finding such reactions in several different illness groups. To date, there is limited research systematically comparing the prevalence of adverse parental psychological reactions across different childhood illness groups with an acute life threat. This study aimed to investigate the frequency and severity of symptoms of acute traumatic stress, depression, anxiety and general stress in parents, following admission of their child to hospital for a life threatening illness. The study also aimed to explore the relationship between these symptoms, and to determine whether they differ according to illness/injury. Cross-sectional data from a prospective, longitudinal study are reported. Participants were 194 parents of 145 children (49 couples), admitted to cardiology (n=53), oncology (n=40) and pediatric intensive care units (n=52), for serious

  10. Mesenteric vascular occlusion: Comparison of ancillary CT findings between arterial and venous occlusions and independent CT findings suggesting life-threatening events

    Energy Technology Data Exchange (ETDEWEB)

    Wong, Yon Cheong; Wu, Cheng Hsien; Wang, Li Jen; Chen, Huan Wu; Lin, Being Chuan; Huang, Chen Chih [Chang Gung Memorial Hospital, Chang Gung University, Taoyuan (China)

    2013-01-15

    To compare the ancillary CT findings between superior mesenteric artery thromboembolism (SMAT) and superior mesenteric vein thrombosis (SMVT), and to determine the independent CT findings of life-threatening mesenteric occlusion. Our study was approved by the institution review board. We included 43 patients (21 SMAT and 22 SMVT between 1999 and 2008) of their median age of 60.0 years, and retrospectively analyzed their CT scans. Medical records were reviewed for demographics, management, surgical pathology diagnosis, and outcome. We compared CT findings between SMAT and SMVT groups. Multivariate analysis was conducted to determine the independent CT findings of life-threatening mesenteric occlusion. Of 43 patients, 24 had life-threatening mesenteric occlusion. Death related to mesenteric occlusion was 32.6%. A thick bowel wall (p < 0.001), mesenteric edema (p < 0.001), and ascites (p = 0.009) were more frequently associated with SMVT, whereas diminished bowel enhancement (p = 0.003) and paralytic ileus (p = 0.039) were more frequent in SMAT. Diminished bowel enhancement (OR = 20; p = 0.007) and paralytic ileus (OR = 16; p = 0.033) were independent findings suggesting life-threatening mesenteric occlusion. The ancillary CT findings occur with different frequencies in SMAT and SMVT. However, the independent findings indicating life-threatening mesenteric occlusion are diminished bowel wall enhancement and paralytic ileus.

  11. Mesenteric vascular occlusion: Comparison of ancillary CT findings between arterial and venous occlusions and independent CT findings suggesting life-threatening events

    International Nuclear Information System (INIS)

    Wong, Yon Cheong; Wu, Cheng Hsien; Wang, Li Jen; Chen, Huan Wu; Lin, Being Chuan; Huang, Chen Chih

    2013-01-01

    To compare the ancillary CT findings between superior mesenteric artery thromboembolism (SMAT) and superior mesenteric vein thrombosis (SMVT), and to determine the independent CT findings of life-threatening mesenteric occlusion. Our study was approved by the institution review board. We included 43 patients (21 SMAT and 22 SMVT between 1999 and 2008) of their median age of 60.0 years, and retrospectively analyzed their CT scans. Medical records were reviewed for demographics, management, surgical pathology diagnosis, and outcome. We compared CT findings between SMAT and SMVT groups. Multivariate analysis was conducted to determine the independent CT findings of life-threatening mesenteric occlusion. Of 43 patients, 24 had life-threatening mesenteric occlusion. Death related to mesenteric occlusion was 32.6%. A thick bowel wall (p < 0.001), mesenteric edema (p < 0.001), and ascites (p = 0.009) were more frequently associated with SMVT, whereas diminished bowel enhancement (p = 0.003) and paralytic ileus (p = 0.039) were more frequent in SMAT. Diminished bowel enhancement (OR = 20; p = 0.007) and paralytic ileus (OR = 16; p = 0.033) were independent findings suggesting life-threatening mesenteric occlusion. The ancillary CT findings occur with different frequencies in SMAT and SMVT. However, the independent findings indicating life-threatening mesenteric occlusion are diminished bowel wall enhancement and paralytic ileus.

  12. Development of an Educational Packet for Persons with Life-Threatening Food Allergies

    Science.gov (United States)

    Olson, Bradley F.; Teuber, Suzanne; Bruhn, Christine M.

    2009-01-01

    Previous studies have shown that those with severe food allergies have significant gaps in knowledge about their disease and how to prevent recurrences. The purpose of this study was to address these deficiencies by creating and testing an educational packet, "Coping with Food Allergies." Participants included 46 of 58 adults with documented…

  13. Ceftriaxone-induced immune hemolytic anemia as a life-threatening complication of antibiotic treatment of 'chronic Lyme disease'.

    Science.gov (United States)

    De Wilde, Maarten; Speeckaert, Marijn; Callens, Rutger; Van Biesen, Wim

    2017-04-01

    'Chronic Lyme disease' is a controversial condition. As any hard evidence is lacking that unresolved systemic symptoms, following an appropriately diagnosed and treated Lyme disease, are related to a chronic infection with the tick-borne spirochaetes of the Borrelia genus, the term 'chronic Lyme disease' should be avoided and replaced by the term 'post-treatment Lyme disease syndrome.' The improper prescription of prolonged antibiotic treatments for these patients can have an impact on the community antimicrobial resistance and on the consumption of health care resources. Moreover, these treatments can be accompanied by severe complications. In this case report, we describe a life-threatening ceftriaxone-induced immune hemolytic anemia with an acute kidney injury (RIFLE-stadium F) due to a pigment-induced nephropathy in a 76-year-old woman, who was diagnosed with a so-called 'chronic Lyme disease.'

  14. Bacteremia and Peritonitis in a Patient With Cirrhosis: A Life-Threatening Case From a Prick of a Cactus

    Directory of Open Access Journals (Sweden)

    Jodi-Anne Wallace MD

    2017-08-01

    Full Text Available A 58-year-old male with nonalcoholic steatohepatitis cirrhosis presents with right lower extremity cellulitis, abdominal tenderness, and severe sepsis after sustaining puncture injury from a cactus on a property with feral cats. Blood cultures and diagnostic paracentesis were consistent with spontaneous bacterial peritonitis due to Pasteurella multocida , a gram-negative coccobacillus found in the respiratory tract of domestic animals. The patient received timely antibiotic coverage with resolution of spontaneous bacterial peritonitis and sepsis after 14-day treatment. This case emphasizes the life-threatening nature of systemic Pasteurella multocida infection as well as an indirect way of acquiring a zoonotic infection in a patient with end-stage liver disease.

  15. Mind's response to the body's betrayal: Gestalt/Existential therapy for clients with chronic or life-threatening illnesses.

    Science.gov (United States)

    Imes, Suzanne A; Clance, Pauline Rose; Gailis, Andra T; Atkeson, Ellen

    2002-11-01

    In the literature on chronic or life-threatening illness, there is an overriding emphasis on clients' psychological coping styles and how they relate to psychological functioning. By contrast, in our approach, we look at the subjective mind/body experiences that clients have of their illness and how their lives are impacted by their illness. As psychotherapists, we address their existential distress, pain, body experience, thoughts, and feelings, as well as their efforts to cope or find meaning in their illness. We summarize Gestalt/Existential therapy for chronic illness, illustrate the approach with three case-vignettes, and stress the importance of attending to each client's unique responses to illness. Copyright 2002 Wiley Periodicals, Inc.

  16. Crouzon’s Syndrome with Life-Threatening Ear Bleed: Ruptured Jugular Vein Diverticulum Treated by Endovascular Embolization

    Energy Technology Data Exchange (ETDEWEB)

    Mondel, Prabath Kumar, E-mail: prabathmondel@gmail.com; Anand, Sunanda, E-mail: sunandaanand@gmail.com; Limaye, Uday S., E-mail: uslkem@gmail.com [Lilavati Hospital and Research Centre, Department of Interventional Neuroradiology (India)

    2015-08-15

    Crouzon’s syndrome is the commonest variety of syndromic craniosynostosis. Life-threatening ear bleed due to ruptured jugular venous diverticulum in Crouzon’s syndrome has not been described previously. In patients with syndromic craniosynostosis, definitive repair of jugular diverticulum by open surgery is fraught with high risk of bleeding, poor functional outcomes, and even death. A 24-year-old woman with Crouzon’s syndrome presented with conductive hearing loss and recurrent episodes of torrential bleeding from her left ear. On computed tomography, a defect in the roof of jugular fossa containing jugular venous diverticulum immediately inferior to the bony external auditory canal was seen. The clinical presentation, imaging features, and endovascular management of Crouzon’s syndrome due to a ruptured jugular venous diverticulum is described.

  17. Crouzon’s Syndrome with Life-Threatening Ear Bleed: Ruptured Jugular Vein Diverticulum Treated by Endovascular Embolization

    International Nuclear Information System (INIS)

    Mondel, Prabath Kumar; Anand, Sunanda; Limaye, Uday S.

    2015-01-01

    Crouzon’s syndrome is the commonest variety of syndromic craniosynostosis. Life-threatening ear bleed due to ruptured jugular venous diverticulum in Crouzon’s syndrome has not been described previously. In patients with syndromic craniosynostosis, definitive repair of jugular diverticulum by open surgery is fraught with high risk of bleeding, poor functional outcomes, and even death. A 24-year-old woman with Crouzon’s syndrome presented with conductive hearing loss and recurrent episodes of torrential bleeding from her left ear. On computed tomography, a defect in the roof of jugular fossa containing jugular venous diverticulum immediately inferior to the bony external auditory canal was seen. The clinical presentation, imaging features, and endovascular management of Crouzon’s syndrome due to a ruptured jugular venous diverticulum is described

  18. [The stress of mortally dangerous conditions: the individual psychophysiological mechanisms of adaptation in life-threatening situations].

    Science.gov (United States)

    Ushakov, I B; Bubeev, Iu A; Kvasovets, S V; Ivanov, A V

    2012-01-01

    Investigation into the mechanisms of the individual psychophysiological adaptation to life-threatening situations was performed. The data analysis of evoked potentials induced with verbal stimuli in 30-50-msec exposures was executed. Cross-correlation and wavelet analysis, as well as neurone algorithms were used to define total brain response to each stimulus and its duration. Correlation of the estimated parameters with subconscious aspects of psychic activity is discussed. Results of the studies performed with this neurosemantie method in various groups of subjects perceiving threat to life in the course of their performance, are presented. Described changes in the subconscious response mechanisms can help to clarify the direction for creation of new approaches with psychological correction and support.

  19. Evaluation of stress response using psychological, biological, and electrophysiological markers during immersive simulation of life threatening events in multidisciplinary teams.

    Science.gov (United States)

    Ghazali, D A; Darmian-Rafei, I; Nadolny, J; Sosner, P; Ragot, S; Oriot, D

    2017-07-27

    Stress might impair clinical performance in real life and in simulation-based education (SBE). Subjective or objective measures can be used to assess stress during SBE. This monocentric study aimed to evaluate the effects of simulation of life-threatening events on measurements of various stress parameters (psychological, biological, and electrophysiological parameters) in multidisciplinary teams (MDTs) during SBE. The effect of gender and status of participants on stress response was also investigated. Twelve emergency MDTs of 4 individuals were recruited for an immersive simulation session. Stress was assessed by: (1) self-reported stress; (2) Holter analysis, including heart rate and heart rate variability in the temporal and spectral domain (autonomic nervous system); (3) salivary cortisol (hypothalamic pituitary adrenal axis). Forty-eight participants (54.2% men, psychological, biological and electrophysiological parameters. Copyright © 2017 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

  20. Sodium hypochlorite accident resulting in life-threatening airway obstruction during root canal treatment: a case report

    Directory of Open Access Journals (Sweden)

    Al-Sebaei MO

    2015-03-01

    Full Text Available Maisa O Al-Sebaei,1 Omar A Halabi,2 Ibrahim E El-Hakim3 1Department of Oral and Maxillofacial Surgery, King Abdulaziz University – Faculty of Dentistry, Jeddah, Kingdom of Saudi Arabia; 2Saudi Board of Oral and Maxillofacial Surgery, Al-Noor Specialist Hospital, Makkah, Kingdom of Saudi Arabia; 3Department of Oral and Maxillofacial Surgery, Riyadh Colleges of Dentistry and Pharmacy, Riyadh, Kingdom of Saudi Arabia Aim: This case report describes a serious and life-threatening complication of the use of sodium hypochlorite as an irrigation solution in root canal therapy. Summary: This case report describes a hypochlorite accident that occurred in a healthy 42-year-old female who was undergoing routine root canal therapy for the lower right central incisor (tooth #41. After approximately 1 hour of irrigation with 3% sodium hypochlorite (for a total of 12 cc, the patient complained of severe pain and burning in the lip. The swelling progressed over the next 8 hours to involve the sublingual and submental fascial spaces with elevation of the tongue and resultant upper airway obstruction. The patient was intubated and remained on mechanical ventilation for 3 days. She recovered without any skin necrosis or nerve deficits. Key learning points: This case report highlights the importance of carefully performing root canal irrigation with sodium hypochlorite to avoid complications. Careful injection without pressure, the use of proper rubber dam isolation, and the use of the endodontic needle are necessary to avoid this type of complication. Although it is a safe root canal irrigation solution, its use may lead to life-threatening complications. Early recognition and management of the untoward effects of sodium hypochlorite are vital for the patient's safety. Keywords: complications of root canal, facial edema, root canal irrigation, root canal therapy, sodium hypochlorite, upper airway obstruction

  1. Acquired hemophilia as the cause of life-threatening hemorrhage in a 94-year-old man: a case report

    Directory of Open Access Journals (Sweden)

    Blanchard Elizabeth

    2010-07-01

    Full Text Available Abstract Introduction Acquired factor VIII deficiency is a rare entity that can lead to severe and life-threatening bleeding. We describe a case of severe bleeding from the tongue secondary to acquired hemophilia and discuss treatment options, including aminocaproic acid and recombinant factor VIII, which have not been widely reported in the literature for the management of such patients. Case presentation A 94-year-old Caucasian man presented to our institution with diffuse bruising and extensive bleeding from the tongue secondary to mechanical trauma. He had no prior history of bleeding and his medical history was unremarkable except for dementia and hypertension. Coagulation studies revealed a prolonged activated partial thromboplastin time and a mixing study was consistent with the presence of an inhibitor. Quantitative assays revealed a reduced level of factor VIII activity (1% and the presence of a factor VIII inhibitor, measured at seven Bethesda units, in the serum. Oral prednisone therapy (60mg/day was given. He also received intravenous aminocaproic acid and human concentrate of factor VIII (Humate-P and topical anti-thrombolytic agents (100 units of topical thrombin cream. His hospital course was prolonged because of persistent bleeding and the development of profuse melena. He required eight units of packed red blood cells for transfusion. Hospitalization was also complicated by bradycardia of unclear etiology, which started after infusion of aminocaproic acid. His activated partial thromboplastin time gradually normalized. He was discharged to a rehabilitation facility three weeks later with improving symptoms, stable hematocrit and resolving bruises. Conclusions Clinicians should suspect a diagnosis of acquired hemophilia in older patients with unexplained persistent and profound bleeding from uncommon soft tissues, including the tongue. Use of factor VIII (Humate-P and aminocaproic acid can be useful in this coagulopathy but

  2. Life-threatening complication of percutaneous transthoracic fine-needle aspiration biopsy: systemic arterial air embolism.

    Science.gov (United States)

    Olgun, Deniz Cebi; Samanci, Cesur; Ergin, Ayse Seda; Akman, Canan

    2015-02-01

    Computed tomography-guided percutaneous transthoracic fine-needle aspiration biopsy of lung lesions is a well known diagnostic technique. Nevertheless, it has some complications; such as pneumothorax, intraparenchymal hemorrhage and hemoptysis, which are not rare. Air embolism is one of the rare but potentially fetal complications of this procedure. Herein, we report the case of a 69-year-old male, in which case of systemic air embolism developed after the performance of lung biopsy. Early diagnosis and prompt oxygen therapy is crucial for patient's survival so careful reviewing of the obtained computed tomography images during the biopsy may prevent a missing systemic air embolism and provide an adequate therapy.

  3. Juzentaihoto Failed to Augment Antigen-Specific Immunity but Prevented Deterioration of Patients’ Conditions in Advanced Pancreatic Cancer under Personalized Peptide Vaccine

    Directory of Open Access Journals (Sweden)

    Shigeru Yutani

    2013-01-01

    Full Text Available Juzentaihoto (JTT is a well-known Japanese herbal medicine, which has been reported to modulate immune responses and enhance antitumor immunity in animal models. However, it is not clear whether JTT has similar effects on humans. In particular, there is little information on the effects of JTT in antigen-specific immunity in cancer patients. Here we conducted a randomized clinical study to investigate whether combined usage of JTT could affect antigen-specific immunity and clinical findings in advanced pancreatic cancer patients undergoing personalized peptide vaccination (PPV, in which HLA-matched vaccine antigens were selected based on the preexisting host immunity. Fifty-seven patients were randomly assigned to receive PPV with (n=28 or without (n=29 JTT. Unexpectedly, JTT did not significantly affect cellular or humoral immune responses specific to the vaccine antigens, which were determined by antigen-specific interferon-γ secretion in T cells and antigen-specific IgG titers in plasma, respectively. Nevertheless, JTT prevented deterioration of patients’ conditions, such as anemia, lymphopenia, hypoalbuminemia, plasma IL-6 elevation, and reduction of performance status, which are frequently observed in advanced cancers. To our knowledge, this is the first clinical study that examined the immunological and clinical effects of JTT in cancer patients undergoing immunotherapy in humans.

  4. Prevention of significant deterioration permit application for the Fueled Clad Fabrication System, the Radioisotope Power Systems Facility, and the Fuel Assembly Area

    Energy Technology Data Exchange (ETDEWEB)

    1989-08-01

    This New Source Review'' has been submitted by the US Department of Energy-Richland Operations Office (PO Box 550, Richland, Washington 99352), pursuant to WAC 173-403-050 and in compliance with the Department of Ecology Guide to Processing A Prevention Of Significant Deterioration (PSD) Permit'' for three new sources of radionuclide emissions at the Hanford Site in Washington State. The three new sources, the Fueled Clad Fabrication System (FCFS), the Radioisotope Power Systems Facility (RPSF), and the Fuel Assembly Area (FAA), will be located in one facility, the Fuels and Materials Examination Facility (FMEF) of the 400 Area. The FMEF was originally designed to provide for post-irradiation examination and fabrication of breeder reactor fuels. These FMEF missions were cancelled before the introduction of any fuel materials or any irradiated material. The current plans are to use the facility to fabricate power supplies for use in space applications and to produce Fast Flux Test Facility (FFTF) fuel and target assemblies. The FCFS and the RPSF will produce materials and assemblies for application in space. The FAA project will produce FFTF fuel and target assemblies. The FCFS and the RPSF will share the same building, stack, and, in certain cases, the same floor space. Given this relationship, these systems will be dealt with separately to the extent possible. The FAA is a comparatively independent operation though it will share the FMEF complex.

  5. Understanding, Predicting, and Preventing Life Changing and Life Threatening Health Changes among Aging Veterans and Civilians with Spinal Cord Injury

    Science.gov (United States)

    2017-10-01

    References 5 11. Appendices: Quad Chart 6 1 1. INTRODUCTION: Maintaining health is very difficult for both military veterans and civilians in the...health decline related to SHCs. We will conduct interviews with each of the 60 SCI participants and 30 family members to identify the pattern of SHCs...in a rich discussion of SHCs and negative health spirals. This will allow us to draw out common themes and patterns . We will learn from what has and

  6. Life-threatening neonatal epidural hematoma caused by precipitous vaginal delivery.

    Science.gov (United States)

    Josephsen, Justin B; Kemp, Joanna; Elbabaa, Samer K; Al-Hosni, Mohamad

    2015-01-30

    Neonatal in-hospital falls occur relatively frequently, although they are likely underreported. Significant intracranial head trauma from a fall or birth injury is not common in the immediate newborn period. Furthermore, intracranial bleeding requiring surgical intervention is exceedingly rare. We present an unusual case of an in-hospital fall in the delivery room requiring neurosurgical intervention. A term infant, appropriate for gestational age, delivered precipitously from a maternal standing position. The vertex neonate struck the linoleum floor after an approximate 80-cm fall, landing headfirst. The physical and neurological exams were initially normal, and skull films did not demonstrate an obvious fracture. The baby was closely observed, undergoing continuous cardiorespiratory monitoring. After the patient had an episode of apnea, a scalp hematoma was noted. A computed tomography (CT) scan revealed a left parietal fracture with an acute epidural hematoma, which required emergent craniotomy. The infant had an unremarkable post-operative course and had a normal neurodevelopmental assessment at 15 months of age. Close, continuous observation is recommended for infants following an in-hospital fall or after significant birth trauma. A high degree of suspicion for intracranial hemorrhage must be maintained. Fall prevention strategies should focus on careful baby handling by the convalescing mother.

  7. Presentation of life-threatening invasive nontyphoidal Salmonella disease in Malawian children: A prospective observational study.

    Science.gov (United States)

    MacLennan, Calman A; Msefula, Chisomo L; Gondwe, Esther N; Gilchrist, James J; Pensulo, Paul; Mandala, Wilson L; Mwimaniwa, Grace; Banda, Meraby; Kenny, Julia; Wilson, Lorna K; Phiri, Amos; MacLennan, Jenny M; Molyneux, Elizabeth M; Molyneux, Malcolm E; Graham, Stephen M

    2017-12-01

    Nontyphoidal Salmonellae commonly cause invasive disease in African children that is often fatal. The clinical diagnosis of these infections is hampered by the absence of a clear clinical syndrome. Drug resistance means that empirical antibiotic therapy is often ineffective and currently no vaccine is available. The study objective was to identify risk factors for mortality among children presenting to hospital with invasive Salmonella disease in Africa. We conducted a prospective study enrolling consecutive children with microbiologically-confirmed invasive Salmonella disease admitted to Queen Elizabeth Central Hospital, Blantyre, in 2006. Data on clinical presentation, co-morbidities and outcome were used to identify children at risk of inpatient mortality through logistic-regression modeling. Over one calendar year, 263 consecutive children presented with invasive Salmonella disease. Median age was 16 months (range 0-15 years) and 52/256 children (20%; 95%CI 15-25%) died. Nontyphoidal serovars caused 248/263 (94%) of cases. 211/259 (81%) of isolates were multi-drug resistant. 251/263 children presented with bacteremia, 6 with meningitis and 6 with both. Respiratory symptoms were present in 184/240 (77%; 95%CI 71-82%), 123/240 (51%; 95%CI 45-58%) had gastrointestinal symptoms and 101/240 (42%; 95%CI 36-49%) had an overlapping clinical syndrome. Presentation at Salmonella disease in Malawi is characterized by high mortality and prevalence of multi-drug resistant isolates, along with non-specific presentation. Young infants, children with dyspnea and HIV-infected children bear a disproportionate burden of the Salmonella-associated mortality in Malawi. Strategies to improve prevention, diagnosis and management of invasive Salmonella disease should be targeted at these children.

  8. Presentation of life-threatening invasive nontyphoidal Salmonella disease in Malawian children: A prospective observational study

    Science.gov (United States)

    Msefula, Chisomo L.; Gondwe, Esther N.; Gilchrist, James J.; Pensulo, Paul; Mandala, Wilson L.; Mwimaniwa, Grace; Banda, Meraby; Kenny, Julia; Wilson, Lorna K.; Phiri, Amos; MacLennan, Jenny M.; Molyneux, Elizabeth M.; Molyneux, Malcolm E.; Graham, Stephen M.

    2017-01-01

    Nontyphoidal Salmonellae commonly cause invasive disease in African children that is often fatal. The clinical diagnosis of these infections is hampered by the absence of a clear clinical syndrome. Drug resistance means that empirical antibiotic therapy is often ineffective and currently no vaccine is available. The study objective was to identify risk factors for mortality among children presenting to hospital with invasive Salmonella disease in Africa. We conducted a prospective study enrolling consecutive children with microbiologically-confirmed invasive Salmonella disease admitted to Queen Elizabeth Central Hospital, Blantyre, in 2006. Data on clinical presentation, co-morbidities and outcome were used to identify children at risk of inpatient mortality through logistic-regression modeling. Over one calendar year, 263 consecutive children presented with invasive Salmonella disease. Median age was 16 months (range 0–15 years) and 52/256 children (20%; 95%CI 15–25%) died. Nontyphoidal serovars caused 248/263 (94%) of cases. 211/259 (81%) of isolates were multi-drug resistant. 251/263 children presented with bacteremia, 6 with meningitis and 6 with both. Respiratory symptoms were present in 184/240 (77%; 95%CI 71–82%), 123/240 (51%; 95%CI 45–58%) had gastrointestinal symptoms and 101/240 (42%; 95%CI 36–49%) had an overlapping clinical syndrome. Presentation at <7 months (OR 10.0; 95%CI 2.8–35.1), dyspnea (OR 4.2; 95%CI 1.5–12.0) and HIV infection (OR 3.3; 95%CI 1.1–10.2) were independent risk factors for inpatient mortality. Invasive Salmonella disease in Malawi is characterized by high mortality and prevalence of multi-drug resistant isolates, along with non-specific presentation. Young infants, children with dyspnea and HIV-infected children bear a disproportionate burden of the Salmonella-associated mortality in Malawi. Strategies to improve prevention, diagnosis and management of invasive Salmonella disease should be targeted at these children

  9. Presentation of life-threatening invasive nontyphoidal Salmonella disease in Malawian children: A prospective observational study.

    Directory of Open Access Journals (Sweden)

    Calman A MacLennan

    2017-12-01

    Full Text Available Nontyphoidal Salmonellae commonly cause invasive disease in African children that is often fatal. The clinical diagnosis of these infections is hampered by the absence of a clear clinical syndrome. Drug resistance means that empirical antibiotic therapy is often ineffective and currently no vaccine is available. The study objective was to identify risk factors for mortality among children presenting to hospital with invasive Salmonella disease in Africa. We conducted a prospective study enrolling consecutive children with microbiologically-confirmed invasive Salmonella disease admitted to Queen Elizabeth Central Hospital, Blantyre, in 2006. Data on clinical presentation, co-morbidities and outcome were used to identify children at risk of inpatient mortality through logistic-regression modeling. Over one calendar year, 263 consecutive children presented with invasive Salmonella disease. Median age was 16 months (range 0-15 years and 52/256 children (20%; 95%CI 15-25% died. Nontyphoidal serovars caused 248/263 (94% of cases. 211/259 (81% of isolates were multi-drug resistant. 251/263 children presented with bacteremia, 6 with meningitis and 6 with both. Respiratory symptoms were present in 184/240 (77%; 95%CI 71-82%, 123/240 (51%; 95%CI 45-58% had gastrointestinal symptoms and 101/240 (42%; 95%CI 36-49% had an overlapping clinical syndrome. Presentation at <7 months (OR 10.0; 95%CI 2.8-35.1, dyspnea (OR 4.2; 95%CI 1.5-12.0 and HIV infection (OR 3.3; 95%CI 1.1-10.2 were independent risk factors for inpatient mortality. Invasive Salmonella disease in Malawi is characterized by high mortality and prevalence of multi-drug resistant isolates, along with non-specific presentation. Young infants, children with dyspnea and HIV-infected children bear a disproportionate burden of the Salmonella-associated mortality in Malawi. Strategies to improve prevention, diagnosis and management of invasive Salmonella disease should be targeted at these children.

  10. Focused sonography of the heart, lungs, and deep veins identifies missed life-threatening conditions in admitted patients with acute respiratory symptoms

    DEFF Research Database (Denmark)

    Laursen, Christian B; Sloth, Erik; Lambrechtsen, Jess

    2014-01-01

    Patients with acute respiratory symptoms still remain a diagnostic challenge. The aim of the study was to evaluate whether focused sonography could potentially diagnose life-threatening conditions missed at the primary assessment in a patient population consisting of admitted patients with acute ...

  11. Radiological findings of uterine arteriovenous malformation: a case report of an unusual and life-threatening cause of abnormal vaginal bleeding

    Directory of Open Access Journals (Sweden)

    Marcela Sales Farias

    2014-04-01

    Full Text Available Uterine arteriovenous malformations may cause life-threatening abnormal genital bleeding in women at childbearing age. Transvaginal Doppler ultrasonography is a widely available, noninvasive and excellent diagnostic method. The authors report the case of a patient with history of gestational trophoblastic disease and multiple curettage procedures who developed uterine arteriovenous malformations, with remission of the lesions after treatment with methotrexate.

  12. Acute and potentially life-threatening tropical diseases in western travelers--a GeoSentinel multicenter study, 1996-2011

    NARCIS (Netherlands)

    Jensenius, Mogens; Han, Pauline V.; Schlagenhauf, Patricia; Schwartz, Eli; Parola, Philippe; Castelli, Francesco; von Sonnenburg, Frank; Loutan, Louis; Leder, Karin; Freedman, David O.; Simon, Fabrice; Delmont, Jean; Carosi, Giampiero; Chappuis, François; Caumes, Eric; Pérignon, Alice; Burchard, Gerd-Dieter; Torresi, Joseph; Brown, Graham; Kain, Kevin; Boggild, Andrea; Keystone, Jay S.; Pandey, Prativa; Pradhan, Rashila; Murphy, Holly; Coyle, Christina M.; Wittner, Murray; de Vries, Peter; Grobusch, Martin C.; Gadroen, Kartini; Rapp, Christophe; Aoun, Olivier; Kanagawa, Shuzo; Kato, Yasuyuki; Mizunno, Yasutaka; Gkrania-Klotsas, Effrossyni; McCarthy, Anne; Weber, Rainer; Steffen, Robert; Hagmann, Stefan; Henry, Michael; Miller, Andy O.; Hale, Devon C.; Anand, Rahul; Gelman, Stephanie S.; Kozarsky, Phyllis E.; Fairley, Jessica; Franco-Paredes, Carlos; Barnett, Elizabeth D.; Libman, Michael D.; Ward, Brian; Maclean, J. Dick; Tachikawa, Natsuo; Kurai, Hanako; Sagara, Hiroko; López-Vélez, Rogelio; Pérez-Molina, Jose A.; Chen, Lin H.; Wilson, Mary E.; Cahill, John D.; McKinley, George; Licitra, Carmelo; Crespo, Antonio; Doyle, Patrick; Ghesquiere, Wayne; Stauffer, William M.; Walker, Patricia F.; Gurtman, Alejandra; Basto, Filipe; Abreu, Candida; Hynes, Noreen; Sack, R. Bradley; McKenzie, Robin; Askling, Helena Hervius; Bronner, Ulf; Lalloo, David G.; Beeching, Nicholas J.; Connor, Bradley A.; Shaw, Marc; Hern, Annemarie; Haulman, N. Jean; Roesel, David; Jong, Elaine C.; Field, Vanessa; Lim, Poh Lian; Wilder-Smith, Annelies; Piyaphanee, Watcharapong; Silachamroon, Udomsak; Lynch, Michael W.; Tenenboim, Shiri; McLellan, Susan; Mendelson, Marc; Vincent, Peter; Vincelette, Jean; Holtom, Paul; Goad, Jeff; Anglim, Anne; Wang, Andy; Eason, Jane; MacDonald, Susan; Nutman, Thomas B.; Klion, Amy D.; Phu, Phi Truong Hoang; Anderson, Nicole; Batchelor, Trish; Meisch, Dominique; Muller, Robert; Valdez, Luis M.; Siu, Hugo; Kass, Robert; Perret, Cecilia; Valdivieso, Francisca; Yates, Johnnie; Ansdell, Vernon; Anderson, Susan

    2013-01-01

    We performed a descriptive analysis of acute and potentially life-threatening tropical diseases among 82,825 ill western travelers reported to GeoSentinel from June of 1996 to August of 2011. We identified 3,655 patients (4.4%) with a total of 3,666 diagnoses representing 13 diseases, including

  13. [Apparent life-threatening event in infants: think about star anise intoxication!].

    Science.gov (United States)

    Perret, C; Tabin, R; Marcoz, J-P; Llor, J; Cheseaux, J-J

    2011-07-01

    last ingestion. We could prove the ingestion of anisatin, the toxic substance found in Japanese star anise, and the contamination of Chinese star anise by the Japanese species. Indeed, the anisatin analysis by liquid chromatography and mass spectroscopy (LC-MS) in a urine sample taken 22 h after the last infusion ingestion showed trace amounts of the substance. In another urine sample taken 33 h after ingestion, no anisatin could be detected. Furthermore, the analysis of the fruit sample gave an anisatin concentration of 7800 μg/kg while the maximum tolerance value in Switzerland is 1000 μg/kg. The evaluation of ALTE in infants should always include the possibility of intoxication. Star anise is generally considered a harmless medicine. Nevertheless, it can sometimes cause a severe intoxication resulting in various neurological and gastrointestinal symptoms. To prevent such events, not only the parents, but also the care personnel and pharmacists must be informed about the possible adverse effects caused either by the overdose of Chinese star anise or by the eventual contamination of herbal teas with Japanese star anise. A better control of the substances by the health authorities is also necessary. Copyright © 2011. Published by Elsevier SAS.

  14. Rituximab administration within 6 months of T cell-depleted allogeneic SCT is associated with prolonged life-threatening cytopenias.

    Science.gov (United States)

    McIver, Zachariah; Stephens, Nicole; Grim, Andrew; Barrett, A John

    2010-11-01

    The monoclonal anti-CD20 antibody Rituximab (RTX) is increasingly used in allogeneic stem cell transplantation (SCT) to treat lymphoproliferative disorders and chronic graft-versus-host disease (GVHD). RTX administration can be complicated by delayed and prolonged neutropenia, but the mechanism is unclear. We report the occurrence of profound cytopenias following RTX given in the conditioning regimen or early after T cell-deplete SCT to treat B cell lymphoproliferative disorders or chronic GVHD (cGVHD). Between 2006 and 2009, 102 patients (median age: 43 years, range: 13-68 years), received a myeloablative matched-sibling T cell-deplete SCT for lymphoid or myeloid hematologic disorders. Neutropenia occurring within 4 weeks of treatment developed in 16 of 17 patients given RTX within the first 190 days after SCT. Fourteen patients developed severe neutropenia (count SCT compared to patients with cGVHD not treated with early RTX (P SCT experienced only moderate neutropenia 3 to 5 months after treatment lasting 10 to 20 days while maintaining absolute neutrophil count (ANC) >1.0 × 10⁹/L. Although RTX rapidly controlled cGVHD, we conclude that its administration early after T cell-deplete SCT is associated with prolonged profound and life-threatening cytopenias, and should be avoided. Published by Elsevier Inc.

  15. Magnetic Resonance Imaging as a Predictor of Survival Free of Life-Threatening Arrhythmias and Transplantation in Cardiac Sarcoidosis.

    Science.gov (United States)

    Ekström, Kaj; Lehtonen, Jukka; Hänninen, Helena; Kandolin, Riina; Kivistö, Sari; Kupari, Markku

    2016-05-02

    Cardiac magnetic resonance imaging has a key role in today's diagnosis of cardiac sarcoidosis. We set out to investigate whether cardiac magnetic resonance imaging also helps predict outcome in cardiac sarcoidosis. Our work involved 59 patients with cardiac sarcoidosis (38 female, mean age 46±10 years) seen at our hospital since February 2004 and followed up after contrast-enhanced cardiac magnetic resonance imaging. The extent of myocardial late gadolinium enhancement (measured as percentage of left ventricular mass), the volumes and ejection fractions of the left and right ventricles, and the thickness of the basal interventricular septum were determined and analyzed for prognostic significance. By April 2015, 23 patients had reached the study's end point, consisting of a composite of cardiac death (n=3), cardiac transplantation (n=1), and occurrence of life-threatening ventricular tachyarrhythmias (n=19; ventricular fibrillation in 5 and sustained ventricular tachycardia in 14 patients). In univariate analysis, myocardial extent of late gadolinium enhancement predicted event-free survival, as did scar-like thinning (magnetic resonance imaging, with a hazard ratio of 2.22 per tertile (95% CI 1.07-4.59). An extent of late gadolinium enhancement >22% (third tertile) had positive and negative predictive values for serious cardiac events of 75% and 76%, respectively. Findings on cardiac magnetic resonance imaging and the extent of myocardial late gadolinium enhancement in particular help predict serious cardiac events in cardiac sarcoidosis. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  16. Relationship between Respiratory Load Perception and Perception of Nonrespiratory Sensory Modalities in Subjects with Life-Threatening Asthma

    Directory of Open Access Journals (Sweden)

    Kathleen L. Davenport

    2012-01-01

    Full Text Available Subjects with life-threatening asthma (LTA have reported decreased sensitivity to inspiratory resistive (R loads. It is unknown if decreased sensitivity is specific for inspiratory R loads, other types of respiratory loads, or a general deficit affecting sensory modalities. This study hypothesized that impairment is specific to respiratory stimuli. This study tested perceptual sensitivity of LTA, asthmatic (A, and nonasthmatic (NA subjects to 4 sensory modalities: respiratory, somatosensory, auditory, visual. Perceptual sensitivity was measured with magnitude estimation (ME: respiratory loads ME, determined using inspiratory R and pressure threshold (PT loads; somatosensory ME, determined using weight ranges of 2–20 kg; auditory ME, determined using graded magnitudes of 1 kHz tones delivered for 3 seconds bilaterally; visual ME, determined using gray-to-white disk intensity gradations on black background. ME for inspiratory R loads lessened for LTA over A and NA subjects. There was no significant difference between the 3 groups in ME for PT inspiratory loads, weight, sound, and visual trials. These results demonstrate that LTA subjects are poor perceivers of inspiratory R loads. This deficit in respiratory perception is specific to inspiratory R loads and is not due to perceptual deficits in other types of inspiratory loads, somatosensory, auditory, or visual sensory modalities.

  17. Barriers to emergency obstetric care services: accounts of survivors of life threatening obstetric complications in Malindi District, Kenya.

    Science.gov (United States)

    Echoka, Elizabeth; Makokha, Anselimo; Dubourg, Dominique; Kombe, Yeri; Nyandieka, Lillian; Byskov, Jens

    2014-01-01

    Pregnancy-related mortality and morbidity in most low and middle income countries can be reduced through early recognition of complications, prompt access to care and appropriate medical interventions following obstetric emergencies. We used the three delays framework to explore barriers to emergency obstetric care (EmOC) services by women who experienced life threatening obstetric complications in Malindi District, Kenya. A facility-based qualitative study was conducted between November and December 2010. In-depth interviews were conducted with 30 women who experienced obstetric "near miss" at the only public hospital with capacity to provide comprehensive EmOC services in the district. Findings indicate that pregnant women experienced delays in making decision to seek care and in reaching an appropriate care facility. The "first" delay was due to lack of birth preparedness, including failure to identify a health facility for delivery services regardless of antenatal care and to seek care promptly despite recognition of danger signs. The "second" delay was influenced by long distance and inconvenient transport to hospital. These two delays resulted in some women arriving at the hospital too late to save the life of the unborn baby. Delays in making the decision to seek care when obstetric complications occur, combined with delays in reaching the hospital, contribute to ineffective treatment upon arrival at the hospital. Interventions to reduce maternal mortality and morbidity must adequately consider the pre-hospital challenges faced by pregnant women in order to influence decision making towards addressing the three delays.

  18. Supporting children when a parent has a life-threatening illness: the role of the community practitioner.

    Science.gov (United States)

    Fearnley, Rachel

    2012-12-01

    The last two decades have seen an academic and practice based shift in the acknowledgment that children require support following the death of a significant person. However, the needs of children who are living amidst parental life threatening illness are not, as yet, so clearly recognised or acknowledged. These children are often forgotten and their needs are frequently peripheral, if not absent, within the clinical setting. The current study adopted qualitative methodology to explore children's experiences when living with a parent who is dying. A total of 36 people were interviewed, including children, their parents and professionals. The findings highlighted the importance of age appropriate information sharing with the children and the significant role professionals have in facilitating conversations either directly or through supporting the parents to hold these 'difficult' discussions. This paper offers an overview of the vital role community practitioners have in supporting the children of patients. It argues that they often have a more in-depth knowledge of the family and its functioning and that consequently they can add a different dimension to the care provided.

  19. Right coronary artery perforation by an active-fixation atrial pacing lead resulting in life-threatening tamponade.

    Science.gov (United States)

    Nakagawa, Eiichiro; Abe, Yukio; Komatsu, Ryushi; Naruko, Takahiko; Itoh, Akira

    2015-10-01

    Cardiac tamponade resulting from perforation of a cardiac chamber is a relatively rare complication of pacemaker implantation. We report the first case of perforation of the right coronary artery related to the implantation of a screw-in atrial pacing lead, presenting as life-threatening cardiac tamponade. We report the case of a 72-year-old woman with complete atrioventricular block and dyspnea on exertion. A permanent pacemaker was implanted with bipolar Medtronic active-fixation leads positioned in the right atrial appendage and at the right ventricular basal septum without any difficulty. Approximately 3.5 h after the procedure, the patient complained of nausea, and the systolic blood pressure decreased to less than 60 mmHg. Echocardiography revealed a large pericardial effusion. Because the effects of pericardiocentesis lasted for less than an hour, the patient underwent a thoracotomy. After evacuation of a massive hemopericardium, bright red blood was seen gushing out from the right coronary artery, which was located on the opposite site of the right atrial appendage where a small portion of the screw tip was observed to be penetrating the atrial wall. The right coronary artery perforation was repaired using autologous pericardium-reinforced 7-0 prolene mattress sutures. Perforation of the right coronary artery is a potential complication and should be part of the differential diagnosis of cardiac tamponade after pacemaker implantation.

  20. Life-threatening subdural hematoma after aortic valve replacement in a patient with Heyde syndrome: a case report.

    Science.gov (United States)

    Uchida, Tetsuro; Hamasaki, Azumi; Ohba, Eiichi; Yamashita, Atsushi; Hayashi, Jun; Sadahiro, Mitsuaki

    2017-08-08

    Heyde syndrome is known as a triad of calcific aortic stenosis, anemia due to gastrointestinal bleeding from angiodysplasia, and acquired type 2A von Willebrand disease. This acquired hemorrhagic disorder is characterized by the loss of the large von Willebrand factor multimers due to the shear stress across the diseased aortic valve. The most frequently observed type of bleeding in these patients is mucosal or skin bleeding, such as epistaxis, followed by gastrointestinal bleeding. On the other hand, intracranial hemorrhage complicating Heyde syndrome is extremely rare. A 77-year-old woman presented to our hospital with severe aortic stenosis and severe anemia due to gastrointestinal bleeding and was diagnosed with Heyde syndrome. Although aortic valve replacement was performed without recurrent gastrointestinal bleeding, postoperative life-threatening acute subdural hematoma occurred with a marked midline shift. Despite prompt surgical evacuation of the hematoma, she did not recover consciousness and she died 1 month after the operation. Postoperative subdural hematoma is rare, but it should be kept in mind as a devastating hemorrhagic complication, especially in patients with Heyde syndrome.

  1. Blood oozing: A cause of life-threatening bleeding without overt source after transcatheter aortic valve replacement.

    Science.gov (United States)

    Tarantini, Giuseppe; Mojoli, Marco; Barioli, Alberto; Battistel, Michele; Généreux, Philippe

    2016-12-01

    Post-procedure non-access site-related bleedings have a significant impact on mortality in patients treated by transcatheter aortic valve replacement (TAVR). Notwithstanding, the source of these bleedings is frequently indeterminate, with potentially serious clinical implications related to lack of diagnosis and treatment. Out of 513 TAVR performed between June 2007 and January 2016 in the Interventional Cardiology Laboratory of the Department of Cardiac, Thoracic and Vascular Sciences, University Hospital of Padua, we identified few proven cases of concealed bleeding after TAVR due to blood oozing. We report three cases of angiographically confirmed post-TAVR non-access bleedings related to spontaneous blood oozing, a life-threatening condition consisting of diffuse capillary hemorrhage developing from vessels not directly involved by the procedure. We hypothesize that spontaneous post-procedural blood oozing may account for a substantial proportion of non-overt, non-access site-related bleeding after TAVR. The possibility of post-TAVR blood oozing is largely neglected in the literature, and comprehensive categorization of non-access site bleedings in current standardized endpoints of TAVR studies is missing. Early assessment with arterial and venous contrast phase angio-MDCT scans in case of post-TAVR unexplained and persistent anemia may allow diagnosis and treatment of this subtle condition. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  2. Conveying hope in consultations with patients with life-threatening diseases: the balance between supporting and challenging the patient.

    Science.gov (United States)

    Werner, Anne; Steihaug, Sissel

    2017-06-01

    There is limited knowledge about the communication of hope and denial in consultations with patients with life-threatening diseases on a practical level. In this study, we explored a real-life medical consultation between a doctor and a patient with incurable cancer, focusing on conveying hope. We found one consultation especially suited for illustrating how a physician can convey and reinforce hope without attaching it to curative treatment. The consultation was analysed using a method for discourse analysis, where we took as a point of departure that discourse means language in use. The doctor communicated in a recognising manner, expressing respect for the patient as a subject and an authority of his own experiences. The doctor and patient succeeded in creating a good working alliance characterised by warmth and trust. Within this context, there was room for the doctor to challenge the patient's views and communicate disagreement. The doctor succeeds in conveying and maintaining hope. Within a good working alliance with the patient the doctor can convey hope by balancing between supporting and challenging him. Exploring and grasping the patient's real concerns is essential for being able to relieve and comfort him and convey hope.

  3. 40 CFR 52.1929 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... quality. 52.1929 Section 52.1929 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Significant deterioration of air quality. (a) Regulation for preventing significant deterioration of air... preventing significant deterioration of air quality. [56 FR 5656, Feb. 12, 1991, as amended at 68 FR 11324...

  4. Life-threatening and disabling injuries in car-to-car side impacts--implications for development of protective systems.

    Science.gov (United States)

    Håland, Y; Lövsund, P; Nygren, A

    1993-04-01

    Improvements to the passive safety of cars in lateral collisions are of great importance. This study of injuries in car side collisions in Sweden by the use of two evaluation methods has been performed to establish the basis for future development of protective systems for this type of accident. The Folksam car accident data file has been used. Injuries were found to be twice as common for near-side than for far-side* occupants in car to car impacts. Serious to fatal (AIS 3-6) injuries to belted front seat occupants in near side impacts (10% of all injuries) were compared with the estimated number of injuries to different parts of the body with risk of serious consequences (RSC)--either deaths or permanent disabilities (4.5% of all injuries). The two injury evaluation methods resulted in different ranking orders. AIS 3-6 injuries were received by the chest (37%), abdomen/pelvis (25%), and the head (15%). The RSC method gave a ranking order of head (25%), neck (21%), leg (15%), chest (14%), and abdomen/pelvis (11%). The method of evaluating AIS 3-6 injuries emphasizes only the threat to life. The RSC method also takes into account the risk of disabilities. Injuries to the neck and the leg were found to be most disabling, whilst the injuries to the head, chest, and abdomen/pelvis were the most life threatening. The study also shows that elderly people receive significantly more chest injuries (relative to the number of head injuries), on average four times more than young people.(ABSTRACT TRUNCATED AT 250 WORDS)

  5. Nonischemic Left Ventricular Scar as a Substrate of Life-Threatening Ventricular Arrhythmias and Sudden Cardiac Death in Competitive Athletes.

    Science.gov (United States)

    Zorzi, Alessandro; Perazzolo Marra, Martina; Rigato, Ilaria; De Lazzari, Manuel; Susana, Angela; Niero, Alice; Pilichou, Kalliopi; Migliore, Federico; Rizzo, Stefania; Giorgi, Benedetta; De Conti, Giorgio; Sarto, Patrizio; Serratosa, Luis; Patrizi, Giampiero; De Maria, Elia; Pelliccia, Antonio; Basso, Cristina; Schiavon, Maurizio; Bauce, Barbara; Iliceto, Sabino; Thiene, Gaetano; Corrado, Domenico

    2016-07-01

    The clinical profile and arrhythmic outcome of competitive athletes with isolated nonischemic left ventricular (LV) scar as evidenced by contrast-enhanced cardiac magnetic resonance remain to be elucidated. We compared 35 athletes (80% men, age: 14-48 years) with ventricular arrhythmias and isolated LV subepicardial/midmyocardial late gadolinium enhancement (LGE) on contrast-enhanced cardiac magnetic resonance (group A) with 38 athletes with ventricular arrhythmias and no LGE (group B) and 40 healthy control athletes (group C). A stria LGE pattern with subepicardial/midmyocardial distribution, mostly involving the lateral LV wall, was found in 27 (77%) of group A versus 0 controls (group C; P<0.001), whereas a spotty pattern of LGE localized at the junction of the right ventricle to the septum was respectively observed in 11 (31%) versus 10 (25%; P=0.52). All athletes with stria pattern showed ventricular arrhythmias with a predominant right bundle branch block morphology, 13 of 27 (48%) showed ECG repolarization abnormalities, and 5 of 27 (19%) showed echocardiographic hypokinesis of the lateral LV wall. The majority of athletes with no or spotty LGE pattern had ventricular arrhythmias with a predominant left bundle branch block morphology and no ECG or echocardiographic abnormalities. During a follow-up of 38±25 months, 6 of 27 (22%) athletes with stria pattern experienced malignant arrhythmic events such as appropriate implantable cardiac defibrillator shock (n=4), sustained ventricular tachycardia (n=1), or sudden death (n=1), compared with none of athletes with no or LGE spotty pattern and controls. Isolated nonischemic LV LGE with a stria pattern may be associated with life-threatening arrhythmias and sudden death in the athlete. Because of its subepicardial/midmyocardial location, LV scar is often not detected by echocardiography. © 2016 The Authors.

  6. Life-threatening false alarm rejection in ICU: using the rule-based and multi-channel information fusion method.

    Science.gov (United States)

    Liu, Chengyu; Zhao, Lina; Tang, Hong; Li, Qiao; Wei, Shoushui; Li, Jianqing

    2016-08-01

    False alarm (FA) rates as high as 86% have been reported in intensive care unit monitors. High FA rates decrease quality of care by slowing staff response times while increasing patient burdens and stresses. In this study, we proposed a rule-based and multi-channel information fusion method for accurately classifying the true or false alarms for five life-threatening arrhythmias: asystole (ASY), extreme bradycardia (EBR), extreme tachycardia (ETC), ventricular tachycardia (VTA) and ventricular flutter/fibrillation (VFB). The proposed method consisted of five steps: (1) signal pre-processing, (2) feature detection and validation, (3) true/false alarm determination for each channel, (4) 'real-time' true/false alarm determination and (5) 'retrospective' true/false alarm determination (if needed). Up to four signal channels, that is, two electrocardiogram signals, one arterial blood pressure and/or one photoplethysmogram signal were included in the analysis. Two events were set for the method validation: event 1 for 'real-time' and event 2 for 'retrospective' alarm classification. The results showed that 100% true positive ratio (i.e. sensitivity) on the training set were obtained for ASY, EBR, ETC and VFB types, and 94% for VTA type, accompanied by the corresponding true negative ratio (i.e. specificity) results of 93%, 81%, 78%, 85% and 50% respectively, resulting in the score values of 96.50, 90.70, 88.89, 92.31 and 64.90, as well as with a final score of 80.57 for event 1 and 79.12 for event 2. For the test set, the proposed method obtained the score of 88.73 for ASY, 77.78 for EBR, 89.92 for ETC, 67.74 for VFB and 61.04 for VTA types, with the final score of 71.68 for event 1 and 75.91 for event 2.

  7. Association between premature ventricular complexes during exercise, long-term occurrence of life-threatening arrhythmia and mortality.

    Science.gov (United States)

    Aviles-Rosales, Jorge; Ilarraza-Lomeli, Hermes; Garcia-Saldivia, Marianna; Rojano-Castillo, Jessica; Rius-Suarez, Maria-Dolores; Nunez-Urquiza, Juan-Pablo; Iturralde, Pedro

    2017-08-14

    Exercise-induced premature ventricular complexes (EiPVCs) are often considered as benign arrhythmias, although they are associated with a high risk of all-cause death in the general healthy population. However, an intermediate pathophysiological process remains unclear, particularly in patients with known cardiovascular disease. The aim of this study was to find an association between EiPVCs, the occurrence of life-threatening ventricular arrhythmias (LACO), and all-cause mortality in patients with cardiovascular disease. This was an observational study of a cohort of patients with coronary artery disease (CAD) or idiopathic cardiomyopathy (ICM). Stress testing was performed as a part of the routine cardiovascular evaluation. The occurrence of EiPVCs was evaluated during exercise testing (ET). At follow-up, long-term occurrence of LACO was evaluated. A bivariate and multivariate analysis was performed. Out of the total of 1442 patients analysed, 700 (49%) had EiPVCs. During 14 years of following-up after ET, 106 LACO outcomes were observed. Long-term all-cause mortality was 4% (n=61). A bivariate analysis showed that patients with EiPVCs had an increased risk for LACO (RR=2.81, 95% CI; 1.9-4.3, P<.001), and for mortality (RR=2.1, CI 95% 1.2-3.4, P<.01). Occurrence of LACO was also associated with a higher mortality risk (RR=5.7, 95% CI; 3.4-9.4, P<.001). After a post hoc analysis, LACO remained as a highly predictive variable for mortality. Patients with EiPVCs have a high risk of LACO and all-cause mortality. The presence of LACO could be an intermediate stage between EiPVCs and mortality in subjects with cardiovascular disease. Copyright © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.

  8. How should we manage a patient with invasive mucoromycosis who develops life-threatening reaction to amphotericin B? Report of two cases and literature review

    Directory of Open Access Journals (Sweden)

    Fereshte Sheybani

    2015-06-01

    Full Text Available This report presents two cases of invasive rhino-orbital mucormycosis who had life-threatening reactions to amphotericin B. Both cases were treated with a combination of posaconazole–caspofungin favorably with no evidence of recurrence upon long-term follow-up. To our knowledge, this is the first report of successful treatment of invasive mucormycosis with azole–echinocandin combination. It may suggest that caspofungin exerts additional or even synergistic antimucoral effects to posaconazole.

  9. High Signal Intensity on T2-Weighted Cardiovascular Magnetic Resonance Imaging Predicts Life-Threatening Arrhythmic Events in Hypertrophic Cardiomyopathy Patients.

    Science.gov (United States)

    Hen, Yasuki; Takara, Ayako; Iguchi, Nobuo; Utanohara, Yuko; Teraoka, Kunihiko; Takada, Kaori; Machida, Haruhiko; Takamisawa, Itaru; Takayama, Morimasa; Yoshikawa, Tsutomu

    2018-02-21

    The prognostic value of high signal intensity on T2-weighted cardiovascular magnetic resonance imaging (T2 high signal) in hypertrophic cardiomyopathy (HCM) patients in a single-center cohort was investigated.Methods and Results:A total of 237 HCM patients (median age, 62 years; 143 male) underwent T2-weighted, cine and late gadolinium enhancement (LGE) imaging, and were followed (median duration, 3.4 years) for life-threatening arrhythmic events. The clinical and magnetic resonance imaging characteristics were extracted, and predictors of life-threatening arrhythmic events were assessed on multivariate analysis. LGE was present in 180 patients (75.9%). Median LGE score was 3 in a left ventricle 17-segment model. T2 high signal was present in 49 patients (20.7%). The annual events rate was significantly higher in patients with extensive LGE (score ≥4) than in those without (3.0%/year vs. 0.5%/year, P=0.011). On multivariate analysis, extensive LGE (hazard ratio, 5.650; 95% CI: 1.263-25.000, P=0.024) as an independent predictor for life-threatening arrhythmic events. In patients with extensive LGE, the annual events rate was significantly higher in patients with T2 high signal than in those without (5.8%/year vs. 0.9%/year, P=0.008). Extensive LGE was an independent predictor of life-threatening arrhythmic events in HCM patients. Furthermore, T2 high signal is useful for the risk stratification of serious arrhythmic events in patients with extensive LGE.

  10. Life-threatening bleeding from a vertebral artery pseudoaneurysm after anterior cervical spine approach: endovascular repair by a triple stent-in-stent method. Case report

    Energy Technology Data Exchange (ETDEWEB)

    Alzamora, M.G.; Klisch, J. [Section of Neuroradiology, Neurocenter, University of Freiburg (Germany); Rosahl, S.K.; Lehmberg, J. [Department of Neurosurgery, Neurocenter, University of Freiburg (Germany)

    2005-04-01

    The incidence of injury to the cervical vertebral artery during surgery for stenosis of the cervical neuroforamina is very low. We present a case in which bleeding during microforaminotomy at the level C6/7 occurred. The bleeding could be controlled intraoperatively. Two days later, a life-threatening cervical hematoma required urgent bedside evacuation. A false aneurysm of the left cervical vertebral artery was successfully occluded by a modified triple stent-in-stent technique, maintaining the flow in the vessel.

  11. Life-threatening bleeding from a vertebral artery pseudoaneurysm after anterior cervical spine approach: endovascular repair by a triple stent-in-stent method. Case report

    International Nuclear Information System (INIS)

    Alzamora, M.G.; Klisch, J.; Rosahl, S.K.; Lehmberg, J.

    2005-01-01

    The incidence of injury to the cervical vertebral artery during surgery for stenosis of the cervical neuroforamina is very low. We present a case in which bleeding during microforaminotomy at the level C6/7 occurred. The bleeding could be controlled intraoperatively. Two days later, a life-threatening cervical hematoma required urgent bedside evacuation. A false aneurysm of the left cervical vertebral artery was successfully occluded by a modified triple stent-in-stent technique, maintaining the flow in the vessel

  12. Does Decisional Conflict Differ Across Race and Ethnicity Groups? A Study of Parents Whose Children Have a Life-Threatening Illness

    Science.gov (United States)

    Sberna-Hinojosa, Melanie; Baron-Lee, Jacqueline; Curtis, Charlotte; Huang, I-Chan

    2014-01-01

    Abstract Objective: Children with life-threatening illnesses and their families may face a myriad of medical decisions in their lifetimes. Oftentimes these complicated medical decisions cause disagreements among patients, families, and providers about what is the best course of action. Although no evidence exists, it is possible that conflict may affect subgroups of the population differently. This study aims to investigate how decisional conflict varies among racial and ethnic subgroups. Sample: Two hundred sixty-six surveys were completed with parents whose children have a life-threatening illness. All children lived in Florida and were enrolled in the Medicaid program. The Decisional Conflict Scale, overall and broken down into its five distinct subscales, was used to assess parental decision-making. Descriptive, bivariate, and multivariate analyses were conducted. Subgroup analyses were conducted on Latino respondents. Results: Our bivariate results suggest that minority parents report less Effective Decision Making (pethnic differences in decisional conflict of parents of children with life-threatening illnesses. Significant differences exist by race, ethnicity, language spoken, and diagnosis time across several subdomains of decisional conflict. These differences are important to address when creating clinical care plans, engaging in shared decision-making, and creating interventions to alleviate decisional conflict. PMID:24720434

  13. Does decisional conflict differ across race and ethnicity groups? A study of parents whose children have a life-threatening illness.

    Science.gov (United States)

    Knapp, Caprice; Sberna-Hinojosa, Melanie; Baron-Lee, Jacqueline; Curtis, Charlotte; Huang, I-Chan

    2014-05-01

    Children with life-threatening illnesses and their families may face a myriad of medical decisions in their lifetimes. Oftentimes these complicated medical decisions cause disagreements among patients, families, and providers about what is the best course of action. Although no evidence exists, it is possible that conflict may affect subgroups of the population differently. This study aims to investigate how decisional conflict varies among racial and ethnic subgroups. Two hundred sixty-six surveys were completed with parents whose children have a life-threatening illness. All children lived in Florida and were enrolled in the Medicaid program. The Decisional Conflict Scale, overall and broken down into its five distinct subscales, was used to assess parental decision-making. Descriptive, bivariate, and multivariate analyses were conducted. Subgroup analyses were conducted on Latino respondents. Our bivariate results suggest that minority parents report less Effective Decision Making (pethnic differences in decisional conflict of parents of children with life-threatening illnesses. Significant differences exist by race, ethnicity, language spoken, and diagnosis time across several subdomains of decisional conflict. These differences are important to address when creating clinical care plans, engaging in shared decision-making, and creating interventions to alleviate decisional conflict.

  14. Treatment of severe life threatening hypocalcemia with recombinant human teriparatide in patients with postoperative hypoparathyroidism - a case series.

    Science.gov (United States)

    Andrysiak-Mamos, Elżbieta; Żochowska, Ewa; Kaźmierczyk-Puchalska, Agnieszka; Popow, Michał; Kaczmarska-Turek, Dorota; Pachucki, Janusz; Bednarczuk, Tomasz; Syrenicz, Anhelli

    2016-01-01

    Hypocalcaemia is a common postoperative complication, both after the resection of parathyroid adenoma associated with primary hyperparathyroidism and after total thyroidectomy due to thyroid cancer or nodular goitre. For a few years, in patients with postoperative hypoparathyroidism and severe hypocalcaemia, who cannot discontinue intravenous calcium preparations even with the use of high vitamin D doses, attempts have been made to add recombinant human parathormone (rhPTH) to the treatment schedule. In this work, for the first time in Poland, we demonstrate the potential use of teriparatide for the treatment of severe hypocalcaemia based on three different cases of postoperative hypoparathyroidism. Case 1. Female (52) with postoperative hypoparathyroidism, after total thyroidectomy and the removal of lower left parathyroid gland due to hyperparathyroidism, several weeks after the surgery still required intravenous calcium infusions because of tetany symptoms. Just one month of teriparatide treatment at 20 μg/0.08 mL given in daily subcutaneous injections proved sufficient to control calcium levels with oral calcium and vitamin D preparations during the next few days until total resolution of hypocalcaemia symptoms and the achievement and maintenance of laboratory normocalcaemia in the following weeks. Female (33) with hypoparathyroidism following total thyroidectomy in 1996 because of papillary thyroid cancer, with congenital tubulopathy associated with renal loss of calcium and magnesium, and the symptoms of tetany recurring since the day of surgery, requiring intravenous calcium administration every 2-3 days. Currently, the patient has been hospitalised because of venous port infection, the only venous access, which made intravenous therapy impossible. Because of the life-threatening condition of the patient, bridging teriparatide treatment was prepared (20 μg/0.08 mL). Complete resolution of clinical symptoms of hypocalcaemia was obtained with teriparatide

  15. Maternal near miss and predictive ability of potentially life-threatening conditions at selected maternity hospitals in Latin America.

    Science.gov (United States)

    De Mucio, Bremen; Abalos, Edgardo; Cuesta, Cristina; Carroli, Guillermo; Serruya, Suzanne; Giordano, Daniel; Martinez, Gerardo; Sosa, Claudio G; Souza, João Paulo

    2016-11-04

    Every year millions of women around the world suffer from pregnancy, childbirth and postpartum complications. Women who survive the most serious clinical conditions are regarded as to have experienced a severe acute maternal complication called maternal near miss (MNM). Information about MNM cases may complement the data collected through the analysis of maternal death, and was proposed as a helpful tool to identify strengths and weaknesses of health systems in relation to maternal health care. The purpose of this study is to evaluate the performance of a systematized form to detect severe maternal outcomes (SMO) in 20 selected maternity hospitals from Latin America (LAC). Cross-sectional study. Data were obtained from analysis of hospital records for all women giving birth and all women who had a SMO in the selected hospitals. Univariate and multivariate adjusted logistic regression models were used to assess the predictive ability of different conditions to identify SMO cases. In parallel, external auditors were hired for reviewing and reporting the total number of discharges during the study period, in order to verify whether health professionals at health facilities identified all MNM and Potentially life-threatening condition (PLTC) cases. Twenty hospitals from twelve LAC were initially included in the study and based on the level of coverage, 11 hospitals with a total of 3,196records were included for the final analysis. The incidence of SMO and MNM outcomes was 12.9 and 12.3 per 1,000 live births, respectively. The ratio of MNM to maternal death was 19 to 1, with a mortality index of 5.1 %. Both univariate and multivariate analysis showed a good performance for a number of clinical and laboratory conditions to predict a severe maternal outcome, however, their clinical relevance remains to be confirmed. Coherence between health professionals and external auditors to identify SMO was high (around 100 %). The form tested, was well accepted by health

  16. An assessment of meaning in life-threatening illness: development of the Healing Experience in All Life Stressors (HEALS

    Directory of Open Access Journals (Sweden)

    Sloan DH

    2017-02-01

    Full Text Available Danetta Hendricks Sloan,1 Karlynn BrintzenhofeSzoc,2 Tiffany Kichline,1 Karen Baker,1 Jean-Paul Pinzon,1 Christina Tafe,1 Lingsheng Li,1 M Jennifer Cheng,1 Ann Berger1 1Pain and Palliative Care, National Institutes of Health, Clinical Center, Bethesda, MD, 2School of Social Work, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, USA Context: Patients with life-threatening or chronic illness report an experience of increased positive psychological, social, and/or spiritual change during diagnosis and/or treatment of their illness, even in the face of unfavorable prognosis. This transformation begins through the ability to make their life meaningful by forming meaningful connections that emerge through self-introspection and relationships with a divine entity, nature, and other people. The Healing Experience in All Life Stressors (HEALS assessment provides a way to identify distress-causing changes that may interfere with the development of meaning and psycho–social–spiritual homeostasis.Objective: Preliminary examination of responses to items on the HEALS and examination of the factor structure.Method: The 48-item HEALS questionnaire was developed using a multistep process: literature review for concept development, item generation from qualitative data, and face and content validity by expert panel. In the current study, HEALS was completed by 100 patients diagnosed with life-limiting disease and seen by the palliative care team at a large research institution in the US. Exploratory factor analysis techniques were used to determine scale structure of the instrument.Results: Outcome testing of sample adequacy using Kaiser–Meyer–Olkin statistic was 0.75, which exceeds the recommended value of 0.60. The HEALS show very good internal consistency with a Cronbach’s a of 0.94. Overall results of the exploratory factor analysis established a four-factor questionnaire: 1 religion; 2 spirituality, demonstrated by a

  17. 40 CFR 52.2497 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... quality. 52.2497 Section 52.2497 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Significant deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air... deterioration of air quality. (b) Regulations for preventing significant deterioration of air quality. The...

  18. 40 CFR 52.499 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... quality. 52.499 Section 52.499 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Significant deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air... deterioration of air quality. (b) Regulations for preventing significant deterioration of air quality. The...

  19. 40 CFR 52.2676 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... quality. 52.2676 Section 52.2676 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Significant deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air... deterioration of air quality. (b) Regulations for preventing significant deterioration of air quality. The...

  20. 40 CFR 52.2779 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... quality. 52.2779 Section 52.2779 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Significant deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air... deterioration of air quality. (b) Regulations for preventing significant deterioration of air quality. The...

  1. 40 CFR 52.1689 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... quality. 52.1689 Section 52.1689 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Significant deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air... deterioration of air quality. (b) Regulations for preventing significant deterioration of air quality. The...

  2. 40 CFR 52.1165 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... quality. 52.1165 Section 52.1165 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Significant deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air... deterioration of air quality. (b) Regulation for preventing significant deterioration of air quality. The...

  3. 40 CFR 52.1603 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... quality. 52.1603 Section 52.1603 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Significant deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air... deterioration of air quality. (b) Regulations for preventing significant deterioration of air quality. The...

  4. 40 CFR 52.2528 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... quality. 52.2528 Section 52.2528 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Significant deterioration of air quality. (a) The requirements of Sections 160 through 165 of the Clean Air... Quality Deterioration. (b) Regulations for Preventing Significant Deterioration of Air Quality, the...

  5. 40 CFR 52.2451 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... quality. 52.2451 Section 52.2451 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Significant deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air... Quality Deterioration. (b) Regulations for preventing significant deterioration of air quality. The...

  6. 40 CFR 52.2827 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... quality. 52.2827 Section 52.2827 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Significant deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air... deterioration of air quality. (b) Regulations for preventing significant deterioration of air quality. The...

  7. 40 CFR 52.1180 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... quality. 52.1180 Section 52.1180 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Significant deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air... deterioration of air quality. (b) Regulations for preventing significant deterioration of air quality. The...

  8. 40 CFR 52.530 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 3 2010-07-01 2010-07-01 false Significant deterioration of air quality. 52.530 Section 52.530 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... deterioration of air quality. (a) EPA approves the Florida Prevention of Significant Deterioration program, as...

  9. 40 CFR 52.1234 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... quality. 52.1234 Section 52.1234 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Significant deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air... deterioration of air quality. (b) Regulations for preventing significant deterioration of air quality. The...

  10. 40 CFR 52.2729 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... quality. 52.2729 Section 52.2729 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Significant deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air... deterioration of air quality. (b) Regulations for preventing significant deterioration of air quality. The...

  11. 40 CFR 52.1884 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... quality. 52.1884 Section 52.1884 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Significant deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air... deterioration of air quality. (b) Regulations for preventing significant deterioration of air quality. The...

  12. Bridge element deterioration rates.

    Science.gov (United States)

    2008-10-01

    This report describes the development of bridge element deterioration rates using the NYSDOT : bridge inspection database using Markov chains and Weibull-based approaches. It is observed : that Weibull-based approach is more reliable for developing b...

  13. Concrete pavement joint deterioration.

    Science.gov (United States)

    2015-12-01

    Concrete pavements are an important part of our national infrastructure. In recent years the relatively small number of reported joints deteriorating prematurely in concrete pavements around Indiana has increased. Changes over the past 45 years in IN...

  14. Intractable intraoperative brain herniation secondary to tension pneumocephalus: a rare life-threatening complication during drainage of subdural empyema

    Directory of Open Access Journals (Sweden)

    Li Lian Foo

    Full Text Available Abstract Tension pneumocephalus is rare but has been well documented following trauma and neurosurgical procedures. It is a surgical emergency as it can lead to neurological deterioration, brainstem herniation and death. Unlike previous cases where tension pneumocephalus developed postoperatively, we describe a case of intraoperative tension pneumocephalus leading to sudden, massive open brain herniation out of the craniotomy site. The possible causative factors are outlined. It is imperative to rapidly identify possible causes of acute intraoperative brain herniation, including tension pneumocephalus, and institute appropriate measures to minimize neurological damage.

  15. The effects of life review on psycho-spiritual well-being among patients with life-threatening illness: a systematic review and meta-analysis.

    Science.gov (United States)

    Chen, Ying; Xiao, Huimin; Yang, Yanqing; Lan, Xiuyan

    2017-07-01

    The aim of this study was to examine the strength of evidence regarding the effects of life review on psycho-spiritual well-being among patients with life-threatening illness. Life-threatening illness not only causes physical symptoms but also psycho-spiritual burdens. Life review has been widely implemented to assist people coping with these burdens. However, the effectiveness of life review is not clear. To date, no systematic review or meta-analysis has been published on this topic. A systematic review with meta- analysis consistent with the recommendations of the Cochrane Collaboration was conducted. Database searches included MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, PsycINFO, CNKI and VIP et al. up to April 2015. We also searched the grey literature, reviewed reference lists from relevant articles and book chapters and contacted experts. Nine randomized controlled trials (RCTs) and two controlled clinical trials (CCTs) were eligible for this systematic review and meta-analysis. The risk of bias for those studies were rated as moderate (n = 11). The meta-analyses demonstrated significant standardized mean differences or mean differences in favour of life review compared with the control for depression, quality of life and self-esteem. The findings indicate that life review can decrease depressive symptoms, improve quality of life and enhance self-esteem among patients with life-threatening illnesses. Multi-centre studies with adequate sample size and rigorous designs are needed in future research. © 2016 John Wiley & Sons Ltd.

  16. In-hospital organization of primary care of patients presenting a life-threatening emergency: A French national survey in 32 university hospitals.

    Science.gov (United States)

    Quintard, Hervé; Severac, Mathilde; Martin, Claude; Ichai, Carole

    2015-08-01

    The development of specialized units dedicated to life-threatening management has demonstrated to improve the prognosis of patients requiring such treatments. However, apart those focused on trauma and stroke, networks are still lacking in France. Despite, the implementation of standardisation of practices and guidelines, particularly in prehospital care, in-hospital clinical practices at admission remain heterogenous. This survey aimed to assess the structural and human organization of teaching hospitals in France concerning the primary in-hospital care for critically ill patients. A questionnaire of 45 items was sent by e-mail to 32 teaching hospitals between January and March 2013. It included information related to the description of the emergency department, of ICUs, and both structural and human organizations for primary in-hospital care of life-threatening patients. Seventy-five percent of teaching hospitals answered to the survey. Seven hundred to 1400 patients were admitted to emergency units per week and among them 10 to 20 were admitted for critically ill conditions. These latter were addressed in a specialized room of the emergency unit (Service d'admission des urgences vitales [SAUV]) in 40% of hospitals and in specialized room in ICU in 18% of cases. Intensivists were involved in 50% of hospitals, emergency physicians in 26% and it was mixed in 24% of hospitals. This survey is the first to assess the in-hospital organization of primary care for instable and life-threatening patients in France. Our results confirmed the extreme heterogeneity of structural and human organizations for primary in-hospital care of patients presenting at least one organ failure. Thus, a consensus is probably needed to homogenize and improve our practices. Copyright © 2015 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

  17. Safe and Effective Use of Chronic Transdermal Estradiol for Life-Threatening Uremic Bleeding in a Patient with Coronary Artery Disease

    Directory of Open Access Journals (Sweden)

    Atul Bali

    2014-08-01

    Full Text Available Uremic platelet dysfunction rarely causes significant bleeding in adequately dialyzed patients. When encountered, the management is complicated by a lack of well-supported treatment modalities. Estrogen use in uremic platelet dysfunction has been described, but enthusiasm for the treatment has been dampened by the risk of thrombotic events in vasculopathic dialysis patients. We present a patient on long-term peritoneal dialysis with coronary disease who developed recurrent life-threatening bleeding episodes secondary to uremia, where treatment with transdermal estrogen was used safely and effectively for a 24-month period.

  18. A rare case of acute pancreatitis and life-threatening hemolytic anemia associated with Epstein-Barr virus infection in a young healthy adult.

    Science.gov (United States)

    Singh, Sukhchain; Khosla, Pam

    2016-01-01

    Epstein-Barr virus (EBV) is a common infection that affects 95% of adults worldwide at some point during life. It is usually asymptomatic or causes a self-limiting clinical syndrome known as infectious mononucleosis. It rarely causes complications. Here, we present a case of a healthy 21-year-old female college student who suffered from severe pancreatitis and life-threatening autoimmune hemolytic anemia in association with EBV infection, and we also discuss the common presentation of EBV infection and the diagnosis and treatment of simple and complicated EBV infection. Copyright © 2015 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

  19. Individualized dosimetry-based activity reduction of {sup 90}Y-DOTATOC prevents severe and rapid kidney function deterioration from peptide receptor radionuclide therapy

    Energy Technology Data Exchange (ETDEWEB)

    Binnebeek, Sofie van; Baete, Kristof; Vanbilloen, Bert; Terwinghe, Christelle; Mortelmans, Luc [University Hospitals Leuven, Nuclear Medicine, Leuven (Belgium); KU Leuven, Department of Imaging and Pathology, Leuven (Belgium); Koole, Michel [University Medical Centre Groningen, Department of Nuclear Medicine, Groningen (Netherlands); Mottaghy, Felix M. [University Hospital Aachen, Department of Nuclear Medicine, Aachen (Germany); Maastricht University Medical Center, Department of Nuclear Medicine, Maastricht (Netherlands); Clement, Paul M. [University Hospitals Leuven, Medical Oncology, Leuven (Belgium); KU Leuven, Laboratory of Experimental Oncology, Leuven (Belgium); Haustermans, Karin [University Hospitals Leuven, Radiation Oncology, Leuven (Belgium); KU Leuven, Department of Oncology, Leuven (Belgium); Cutsem, Eric van; Verslype, Chris [KU Leuven, Department of Oncology, Leuven (Belgium); University Hospitals Leuven, Division of Digestive Oncology, Leuven (Belgium); Verbruggen, Alfons [KU Leuven, Laboratory for Radiopharmacy, Leuven (Belgium); Bogaerts, Kris [KU Leuven, Division of Public Health and Primary Care (I-Biostat), Leuven (Belgium); Deroose, Christophe M. [University Hospitals Leuven, Nuclear Medicine, Leuven (Belgium); KU Leuven, Department of Imaging and Pathology, Leuven (Belgium); UZ Leuven, Nuclear Medicine, Leuven (Belgium)

    2014-06-15

    Assessment of kidney function evolution after {sup 90}Y-DOTATOC peptide receptor radionuclide therapy (PRRT) with capped activity administration based on a 37-Gy threshold of biological effective dose (BED) to the kidney. In a prospective phase II study, patients with metastasized neuroendocrine tumours were evaluated for therapy using 185 MBq {sup 111}In-pentetreotide with amino acid coinfusion. Planar whole-body images were acquired at four time-points after injection and kidney volumes were measured using CT/MRI. BED to the kidneys was estimated using an extended BED formula and biexponential renal clearance. Based on published BED dose-toxicity relationships, we allowed a maximal kidney BED of 37 Gy; if the calculated BED exceeded 37 Gy, treatment activity was reduced accordingly. Kidney function was assessed at baseline and at 18 months, predominantly using {sup 51}Cr-EDTA. The rate of renal function decline was expressed as annual glomerular filtration rate loss (aGFRL). Only 22 of 50 patients reached the 18-months time-point, with most missing patients having died due to disease progression. In the 22 patients who reached 18 months, no rapid kidney function deterioration was observed over the 18 months, aGFRL >33 % was not seen, and only three patients showed an increase of one toxicity grade and one patient an increase of two grades. No significant correlations between kidney volume (p = 0.35), baseline GFR (p = 0.18), risk factors for renal function loss (p = 0.74) and aGFRL were observed. Among the 28 patients who did not reach 18 months, one developed grade 4 kidney toxicity at 15 months after PRRT. Prospective dosimetry using a 37 Gy BED as the threshold for kidney toxicity is a good guide for {sup 90}Y-DOTATOC PRRT and is associated with a low risk of rapid renal function deterioration and evolution to severe nephrotoxicity. (orig.)

  20. Cable deterioration analysis method

    International Nuclear Information System (INIS)

    Sugiyama, Masahiko; Nitta, Makoto.

    1997-01-01

    At first, a hardness of a minute region and an elongation at break are measured relative to a plurality of reference samples having deterioration which is different stepwise, to obtain a relation between the hardness of the minute region and the elongation at break. They are obtained as information of correlation showing the degree of deterioration of cables. Then, samples are collected. The samples are collected from a PVC sheath. In this case, the samples to be used for the measurement are extremely small piece having the size of one side of about several hundred μm. Then, the hardness of the minute region of the samples is measured. The measured hardness of the minute region is corresponded to the previously obtained information of the correlation for deteriorations to judge the state of deterioration for the collected samples. With such procedures, the state of deterioration for electric wires and cables to be used in nuclear facilities such as power plants can easily be diagnosed substantially non destructively. (I.N.)

  1. Antibiotics or probiotics as preventive measures against ventilator-associated pneumonia: a literature review

    NARCIS (Netherlands)

    Schultz, M.J.; Haas, L.E.

    2011-01-01

    Mechanically ventilated critically ill patients frequently develop ventilator-associated pneumonia (VAP), a life-threatening complication. Proposed preventive measures against VAP include, but are not restricted to, selective decontamination of the digestive tract (SDD), selective oropharyngeal

  2. LSD-assisted psychotherapy for anxiety associated with a life-threatening disease: a qualitative study of acute and sustained subjective effects.

    Science.gov (United States)

    Gasser, Peter; Kirchner, Katharina; Passie, Torsten

    2015-01-01

    A recently published study showed the safety and efficacy of LSD-assisted psychotherapy in patients with anxiety associated with life-threatening diseases. Participants of this study were included in a prospective follow-up. 12 months after finishing LSD psychotherapy, 10 participants were tested for anxiety (STAI) and participated in a semi-structured interview. A Qualitative Content Analysis (QCA) was carried out on the interviews to elaborate about LSD effects and lasting psychological changes. None of the participants reported lasting adverse reactions. The significant benefits as measured with the STAI were sustained over a 12-month period. In the QCA participants consistently reported insightful, cathartic and interpersonal experiences, accompanied by a reduction in anxiety (77.8%) and a rise in quality of life (66.7%). Evaluations of subjective experiences suggest facilitated access to emotions, confrontation of previously unknown anxieties, worries, resources and intense emotional peak experiences à la Maslow as major psychological working mechanisms. The experiences created led to a restructuring of the person's emotional trust, situational understanding, habits and world view. LSD administered in a medically supervised psychotherapeutic setting can be safe and generate lasting benefits in patients with a life-threatening disease. Explanatory models for the therapeutic effects of LSD warrant further study. © The Author(s) 2014.

  3. Off-Label Use of Agents for Management of Serious or Life-threatening Angiotensin Converting Enzyme Inhibitor-Induced Angioedema.

    Science.gov (United States)

    Culley, Colleen M; DiBridge, Julie N; Wilson, Gregory L

    2016-01-01

    To evaluate the place in therapy of fresh frozen plasma (FFP), C1 esterase concentrate (C1-INH), ecallantide, and icatibant in the management of angiotensin-converting enzyme inhibitor-induced angioedema (ACEI-IA). A literature search was performed using PubMed (1946 through August 2015) and Embase (angioedema, another bradykinin-mediated event, may be effective for use in ACEI-IA. Positive efficacy results were reported with FFP and C1-INH while mixed results have been seen with ecallantide. Off-label icatibant has the most evidence supporting its use in ACEI-IA with rapid symptom resolution (10 minutes to 6 hours) and avoidance of intubation and tracheotomy in several cases. These agents were well-tolerated in ACEI-IA. ACEI-IA is typically a self-limiting event. First-line therapies include ACEI discontinuation, observation, and supportive medications (eg, corticosteroids, antihistamines, and epinephrine). Symptom progression can be life-threatening and may require interventions such as tracheotomy and intubation. Off-label use of FFP and medications approved for hereditary angioedema have resulted in rapid resolution of symptoms and avoidance of intubation. Among these agents, icatibant has the most supporting evidence and has been incorporated into practice guidelines and algorithms as a second-line agent for serious life-threatening ACE-IA. © The Author(s) 2015.

  4. The role of icatibant-the B2 bradykinin receptor antagonist-in life-threatening laryngeal angioedema in the ED.

    Science.gov (United States)

    Bartal, Carmi; Zeldetz, Vladimir; Stavi, Vered; Barski, Leonid

    2015-03-01

    Angioedema is a localized, sudden, transient, and often recurrent swelling of the deeper layers of the skin or mucosa with no epidermal component. It is caused by vasoactive substances that produce a transient increase in endothelial permeability. Angioedema involving the laryngeal components is a life-threatening situation for the patient,and it is a challenge for the emergency medicine physician to rapidly achieve a safety airway. Most cases of laryngeal angioedema are induced by histamine release; but 10% are bradykinin induced, which does not respond to the conventional algorithm of treating allergic induced angioedema. We present a case report of an angiotensin converting enzyme (ACE) inhibitor–induced laryngeal angioedema alleviated only after treatment with the new bradykinin receptor inhibitor medication icatibant which was licensed only for use in hereditary angioedema. We reviewed the literature for the use of icatibant in acquired drug-induced angioedema; and because of the similar pathogenesis between the hereditary angioedema and the ACE inhibitor–induced angioedema,we propose an algorithm for careful use of icatibantin life-threatening angioedema in the emergency department.

  5. Neonatal near miss and mortality: factors associated with life-threatening conditions in newborns at six public maternity hospitals in Southeast Brazil

    Directory of Open Access Journals (Sweden)

    Pauline Lorena Kale

    Full Text Available Abstract: We aimed to evaluate factors associated with cases of neonatal near miss and neonatal deaths at six public maternity hospitals in São Paulo and Rio de Janeiro States, Brazil, in 2011. A prospective hospital-based birth cohort investigated these outcomes among live births with life-threatening conditions. Associations were tested using multinomial logistic regression models with hierarchical levels. High rates of near miss were observed for maternal syphilis (52.2‰ live births and lack of prenatal care (80.8‰ live births. Maternal black skin color (OR = 1.9; 95%CI: 1.2-3.2, hemorrhage (OR = 2.2; 95%CI: 1.3-3.9, hypertension (OR = 3.0; 95%CI: 2.0-4.4, syphilis (OR = 3.3; 95%CI: 1.5-7.2, lack of prenatal care (OR = 5.6; 95%CI: 2.6-11.7, cesarean section and hospital, were associated with near miss; while hemorrhage (OR = 4.6; 95%CI: 1,8-11.3, lack of prenatal care (OR = 17.4; 95%CI: 6.5-46.8 and hospital, with death. Improvements in access to qualified care for pregnant women and newborns are necessary to reduce neonatal life-threatening conditions.

  6. Deterioration of Concrete Structures

    DEFF Research Database (Denmark)

    Thoft-Christensen, Palle

    Chloride ingress is a common cause of deterioration of reinforced concrete bridges. Concrete may be exposed to chloride by seawater or de-icing salts. The chloride initiates corrosion of the reinforcement, which through expansion disrupts the concrete. In addition, the corrosion reduces the cross...

  7. Cyanotic breath-holding spell: a life-threatening complication after radical resection of a cervicomedullary ganglioglioma.

    Science.gov (United States)

    Fujisawa, Hironori; Yoshida, Yuya; Niida, Yo; Hasegawa, Mitsuhiro; Yamashita, Junkoh

    2005-01-01

    Cyanotic breath-holding spell is a benign and self-limiting disease of young children but occasionally associated with sudden, unexpected death. The authors report a rare case in a 2-year-old girl with a severe form that started after radical resection of a cervicomedullary ganglioglioma. She was admitted to our hospital because of delayed and unstable gait. Since magnetic resonance imaging showed a cervicomedullary tumor, she underwent a radical resection and histology showed the tumor to be a ganglioglioma. Postoperatively, the function of the lower cranial nerves and cerebellum deteriorated and hemiparesis on the left became apparent, but she returned to the preoperative state in a few months. In addition, mild sleep apnea (Ondine curse) and severe cyanotic breath-holding spells occurred. The former responded to medication but the latter failed and continued several times per day with a rapid onset and progression of hypoxemia, loss of consciousness, sweating and opisthotonos. Five months after the operation, the patient returned home with a portable oxygen saturation monitor equipped with an alarm. This case indicates that cyanotic breath-holding spell, as well as sleep apnea, is critical during the early postoperative period. This is the first report observing that such spells may occur as a complication of radical resection of a cervicomedullary tumor. Copyright (c) 2005 S. Karger AG, Basel.

  8. Management of potentially life-threatening emergencies at 74 primary level hospitals in Mongolia: results of a prospective, observational multicenter study.

    Science.gov (United States)

    Mendsaikhan, Naranpurev; Gombo, Davaa; Lundeg, Ganbold; Schmittinger, Christian; Dünser, Martin W

    2017-05-08

    While the capacities to care for and epidemiology of emergency and critically ill patients have been reported for secondary and tertiary level hospitals in Mongolia, no data exist for Mongolian primary level hospitals. In this prospective, observational multicenter study, 74 primary level hospitals of Mongolia were included. We determined the capacities of these hospitals to manage medical emergencies. Furthermore, characteristics of patients presenting with potentially life-threatening emergencies to these hospitals were evaluated during a 6 month period. An emergency/resuscitation room was available in 62.2% of hospitals. One third of the study hospitals had an operation theatre (32.4%). No hospital ran an intensive care unit or had trained emergency/critical care physicians or nurses available. Diagnostic resources were inconsistently available (sonography, 59.5%; echocardiography, 0%). Basic emergency procedures (wound care, 97.3%; foreign body removal, 86.5%; oxygen application, 85.2%) were commonly but advanced procedures (advanced cardiac life support, 10.8%; airway management, 13.5%; mechanical ventilation, 0%; renal replacement therapy, 0%) rarely available. During 6 months, 14,545 patients were hospitalized in the 74 study hospitals, of which 8.7% [n = 1267; median age, 34 (IQR 18-53) years; male gender, 54.4%] were included in the study. Trauma (excl. brain trauma) (20.4%), acute abdomen (16.9%) and heart failure (9.6%) were the most common conditions. Five-hundred-thirty patients (41.8%) were transferred to a secondary level hospital. The hospital mortality of patients not transferred was 3.2%. Capacities of Mongolian primary level hospitals to manage life-threatening emergencies are highly limited. Trauma, surgical and medical conditions make up the most common emergencies. In view of the fact that almost half of the patients with a potentially life-threatening emergency were transferred to secondary level hospitals and the mortality of those

  9. The potential of a heavy particle radiotherapy as the definitive noninvasive treatment for the life threatening ventricular tachy-arrhythmias

    International Nuclear Information System (INIS)

    Amino, Mari; Yoshioka, Kouichiro; Tanabe, Teruhisa

    2006-01-01

    Ionizing radiation has been shown to increase intercellular communication in skin and lungs through an increase of expression of connexin43 (Cx43). If analogous upregulation of Cx43 is induced in the heart, it would provide a new perspective for radiation therapy of arrhythmias. Non-transmural MI was created by microsphere injection into coronary arteries. Targeted heavy ion radiation (THIR, 15 Gy) was carried out 2w after MI by using an accelerator (HIMAC, Chiba, Japan). The hearts excised 2w later were employed for immunohistochemistry and high-resolution optical mapping. In MI hearts, a reduction of immunoreactive Cx43 and its displacement from the intercalated disc (ID) region were recognized in the peri-infarct zone. Application of THIR to MI resulted in a significant increase of Cx43 expression (by 61±25%). Optical signals in LV free wall of MI (n=6) were characterized by a marked increase of APD dispersion (APDD: 23±9.1 ms in MI vs. 13±3.8 ms in Control, p<0.05). In MI+THIR (n=4), APDD was reduced to 15±5.0 ms (p<0.05 vs. MI). VTs ere induced by premature stimuli in 5/6 MI, whereas 2/4 MI+THIR. VTs in MI showed disorganized rotors which were easily deteriorated in VF. VTs in MI+THIR showed more organized excitation and did not transformed into VF. THIR increases Cx43 expression, and improves the electrical stability of rabbit ventricles after MI. (author)

  10. Effectiveness of omalizumab in a patient with a life-threatening episode of bronchospasm and larynx angioedema after exposure to house dust.

    Science.gov (United States)

    Kupryś-Lipińska, Izabela; Korczyńska, Paulina; Tworek, Damian; Kuna, Piotr

    2014-02-01

    Omalizumab is a monoclonal antibody against IgE, nowadays approved for the treatment of persistent severe (EU) or moderate-to severe (USA) IgE-mediated asthma but there is also some evidence (case reports and four published clinical trials) on the effectiveness of this medication in urticaria and angioedema. The case of a 42-year-old woman suffering from severe allergic asthma and severe chronic urticaria with concomitant angioedema is presented in the article. She had a life-threatening episode of bronchospasm and larynx edema after exposure to house dust recorded in her medical history. The patient did not respond to standard therapy. The improvement in asthma control and remission of chronic urticaria and angioedema was achieved after introducing the therapy with omalizumab.

  11. Emergency medical dispatch priority in chest pain patients due to life threatening conditions: A cohort study examining circadian variations and impact of the education.

    Science.gov (United States)

    Rawshani, Araz; Rawshani, Nina; Gelang, Carita; Andersson, Jan-Otto; Larsson, Anna; Bång, Angela; Herlitz, Johan; Gellerstedt, Martin

    2017-06-01

    We examined the accuracy in assessments of emergency dispatchers according to their education and time of the day. We examined this in chest pain patients who were diagnosed with a potentially life-threatening condition (LTC) or died within 30days. Among 2205 persons, 482 died, 1631 experienced an acute coronary syndrome (ACS), 1914 had a LTC. Multivariable logistic regression was used to study how time of the call and the dispatcher's education were associated with the risk of missing to give priority 1 (the highest). Among patients who died, a 7-fold increase in odds of missing to give priority 1 was noted at 1.00pm, as compared with midnight. Compared with assistant nurses, odds ratio for dispatchers with no (medical) training was 0.34 (95% CI 0.14 to 0.77). Among patients with an ACS, odds ratio for calls arriving before lunch was 2.02 (95% CI 1.22 to 3.43), compared with midnight. Compared with assistant nurses, odds ratio for operators with no training was 0.23 (95% CI 0.13 to 0.40). Similar associations were noted for those with any LTC. Dispatcher's education was not associated with the patient's survival. In this group of patients, which experience substantial mortality and morbidity, the risk of not obtaining highest dispatch priority was increased up to 7-fold during lunchtime. Dispatch operators without medical education had the lowest risk, compared with nurses and assistant nurses, of missing to give priority 1, at the expense of lower positive predictive value. What is already known about this subject? Use of the emergency medical service (EMS) increases survival among patients with acute coronary syndromes. It is unknown whether the efficiency - as judged by the ability to identify life-threatening cases among patients with chest pain - varies according to the dispatcher's educational level and the time of day. What does this study add? We provide evidence that the dispatcher's education does not influence survival among patients calling the EMS due

  12. Exercise-Induced Anaphylaxis: A Case Report and Review of the Diagnosis and Treatment of a Rare but Potentially Life-Threatening Syndrome

    Directory of Open Access Journals (Sweden)

    Nathan T. Jaqua

    2013-01-01

    Full Text Available A 24-year-old male Marine with an uncomplicated medical history and a long history of strenuous, daily exercise presented to the emergency department after experiencing anaphylactic shock while running. Symptoms resolved following administration of intramuscular diphenhydramine, ranitidine, intravenous methylprednisolone, and intravenous fluids. On followup in the allergy clinic, a meticulous clinical history was obtained which elucidated a picture consistent with exercise-induced anaphylaxis. He had experienced diffuse pruritus and urticaria while exercising on multiple occasions over the last three years. His symptoms would usually increase as exercise continued. Prior to the first episode, he regularly exercised without symptoms. Exercise-induced anaphylaxis is a rare but potentially life-threatening syndrome that requires a careful clinical history and is a diagnosis of exclusion. Treatment is primarily exercise avoidance. Prophylactic mediations are inconsistently effective but are empirically used. Successful treatment with omalizumab was recently reported in a case of refractory exercise-induced anaphylaxis.

  13. Life After the Event: A Review of Basic Life Support Training for Parents Following Apparent Life-Threatening Events and Their Experience and Practices Following Discharge

    LENUS (Irish Health Repository)

    2017-05-01

    Apparent Life-Threatening Events (ALTEs) are a common presentation to paediatric hospitals and represent a significant cause of parental anxiety. Basic Life Support (BLS) training is recommended for all caregivers following ALTEs. This study aimed to assess the rate of caregiver BLS training and reviewed parents experience following discharge. Parents were interviewed by phone following discharge. Over the study period 25 children attended the Emergency Department with ALTE, 17\\/25 (68%) were trained and 13\\/17 (76%) were contactable for interview. All parents found training decreased their anxiety level and were interested in attending for re-training. BLS resuscitation was subsequently required by 2\\/13 (15%) of children. Non-medical grade monitors were in use by 10\\/13 (77%) of caregivers following discharge. Caregivers are eager to engage in BLS training and it effectively reduces their caregiver anxiety. We recommend an increase in instructor staff and use of group re-training post discharge

  14. Life After the Event: A Review of Basic Life Support Training for Parents Following Apparent Life-Threatening Events and Their Experience and Practices Following Discharge.

    Science.gov (United States)

    Macken, W L; Clarke, N; Nadeem, M; Coghlan, D

    2017-05-10

    Apparent Life-Threatening Events (ALTEs) are a common presentation to paediatric hospitals and represent a significant cause of parental anxiety. Basic Life Support (BLS) training is recommended for all caregivers following ALTEs. This study aimed to assess the rate of caregiver BLS training and reviewed parents experience following discharge. Parents were interviewed by phone following discharge. Over the study period 25 children attended the Emergency Department with ALTE, 17/25 (68%) were trained and 13/17 (76%) were contactable for interview. All parents found training decreased their anxiety level and were interested in attending for re-training. BLS resuscitation was subsequently required by 2/13 (15%) of children. Non-medical grade monitors were in use by 10/13 (77%) of caregivers following discharge. Caregivers are eager to engage in BLS training and it effectively reduces their caregiver anxiety. We recommend an increase in instructor staff and use of group re-training post discharge.

  15. PO02 - Clinical profile of children admitted to a paediatric intensive care unit due to acute clinical deterioration

    DEFF Research Database (Denmark)

    Jensen, Claus Sixtus; Aagaard, Hanne; Olesen, Hanne Vebert

    2016-01-01

    , an understanding of the nature of illness is important to patient safety. PURPOSE: This study described the frequency, clinical characteristics and outcomes of children who experience unplanned admission to a PICU due to clinical deterioration. METHODS: A registry retrospective descriptive study describing...... and exploring life-threatening situations leading to unexpected transfers to PICU in hospitalised children. The study includes all paediatric departments in the Central Denmark Region. PERSPECTIVE: This study will provide knowledge to assist the research efforts to identify and improve the management...

  16. Turmeric (Curcuma longa L.) extract may prevent the deterioration of spatial memory and the deficit of estimated total number of hippocampal pyramidal cells of trimethyltin-exposed rats.

    Science.gov (United States)

    Yuliani, Sapto; Mustofa; Partadiredja, Ginus

    2018-01-01

    Protection of neurons from degeneration is an important preventive strategy for dementia. Much of the dementia pathology implicates oxidative stress pathways. Turmeric (Curcuma longa L.) contains curcuminoids which has anti-oxidative and neuro-protective effects. These effects are considered to be similar to those of citicoline which has been regularly used as one of standard medications for dementia. This study aimed at investigating the effects of turmeric rhizome extract on the hippocampus of trimethyltin (TMT)-treated Sprague-Dawley rats. The rats were divided randomly into six groups, i.e., a normal control group (N); Sn group, which was given TMT chloride; Sn-Cit group, which was treated with citicoline and TMT chloride; and three Sn-TE groups, which were treated with three different dosages of turmeric rhizome extract and TMT chloride. Morris water maze test was carried out to examine the spatial memory. The estimated total number of CA1 and CA2-CA3 pyramidal cells was calculated using a stereological method. The administration of turmeric extract at a dose of 200 mg/kg bw has been shown to prevent the deficits in the spatial memory performance and partially inhibit the reduction of the number of CA2-CA3 regions pyramidal neurons. TMT-induced neurotoxic damage seemed to be mediated by the generation of reactive oxygen species and reactive nitrogen species. Turmeric extract might act as anti inflammatory as well as anti-oxidant agent. The effects of turmeric extract at a dose of 200 mg/kg bw seem to be comparable to those of citicoline.

  17. Cimicifuga racemosa and its triterpene-saponins prevent the Metabolic Syndrome and deterioration of cartilage in the knee joint of ovariectomized rats by similar mechanisms.

    Science.gov (United States)

    Seidlova-Wuttke, Dana; Eder, Nicole; Stahnke, Vera; Kammann, Markus; Stecher, Günter; Haunschild, Jutta; Wessels, Johannes T; Wuttke, Wolfgang

    2012-06-15

    this has adverse effects on knee cartilage tissue. Therefore, increased fat tissue in joints appears to belong to the Metabolic Syndrome. This effect can be largely prevented by CR BNO 1005 and its S- but not by its R-fraction. Hence, the saponins in CR BNO 1055 may be useful in preventing the Metabolic Syndrome and osteoarthritis. Copyright © 2012 Elsevier GmbH. All rights reserved.

  18. Vitamin K deficiency bleeding presenting as nodular purpura in infancy: A rare and life-threatening entity

    Directory of Open Access Journals (Sweden)

    Pratik Gahalaut

    2013-01-01

    Full Text Available Vitamin K deficiency bleeding (VKDB disorder is an uncommon entity, which occurs due to inadequate activity of vitamin K-dependant coagulation factors. An 8-months-old exclusively breast-fed male infant presented with multiple, purpuric and nodular non-collapsible swellings on trunk of 4 days duration. Investigations revealed raised activated partial thromboplastin time and prothrombintime. Fibrinogen level and platelet counts were normal. Late VKDB usually presents as intra-cranial or mucosal hemorrhages. [1] Though skin and mucosal bleeding may occur in 1/3 rd of infants with VKDB, ′nodular purpura′ is not the common presenting feature. Earlier recognition of VKDB and immediate investigation/treatment helps prevent the potentially fatal outcome of the disease. Very little is mentioned about this entity in dermatology literature.

  19. The horror of unsafe abortion: case report of a life threatening complication in a 29-year old woman.

    Science.gov (United States)

    Naqvi, Kaniz Zehra; Edhi, Muhammad Muzzammil

    2013-10-16

    Every year 42 million women with unintended pregnancies choose abortion, and fifty percent of these procedures, 20 million are unsafe. An unsafe abortion is defined as a procedure for terminating an unintended pregnancy carried out either by person lacking the necessary skills or in an environment that does not conform to minimal medical standards or both.Pakistan is the one of the six countries where more than 50% of the world's all maternal deaths occur. It is estimated that 890,000 induced abortions are performed annually in Pakistan, and estimate an annual abortion rate of 29 per 1000 women aged 15-49. Here we present a case report of a 29-year old woman who underwent an unsafe abortion for unintended pregnancy resulting in uterine perforation. The unskilled provider pulled out her bowel through vagina after perforating the uterus, as a result she lost major portion of her small intestine resulting in short bowel syndrome. The law of Pakistan only allows abortion during early stages of pregnancy for purpose of saving the life of a mother but does not cater for cases of rape, incest and fetal abnormalities or social reasons.Only legalization of abortion is not sufficient, preventing unintended pregnancy should be the priority of all the nations and for this reason contraception should be widely accessible.Practitioners need to become better trained in safer abortion methods and be to able transfer the patient to health facility when complications occur.

  20. Small nodular melanoma: the beginning of a life-threatening lesion. A clinical study on 11 cases.

    Science.gov (United States)

    Bono, Aldo; Tolomio, Elena; Carbone, Antonino; Moglia, Daniele; Crippa, Federica; Tomatis, Stefano; Santinami, Mario

    2011-01-01

    Because of its high thickness, nodular melanoma often bears a poor prognosis. Thus, an earlier diagnosis of this type of lesion while it is still thin would be an important step in secondary prevention. The principal aim of the present study was to better define the initial clinical features of nodular melanoma to allow an early diagnosis. A secondary aim was to establish the prognosis of this type of lesion. We retrospectively studied and illustrated the clinical features of 11 small (nodular melanomas seen and treated during a 10-year period. Prognostic characteristics of the various lesions were also described. The results of the study help to describe a small nodular melanoma as a dark and/or pink/red raised lesion, which may be evenly or unevenly colored, with well-defined borders, that often appears de novo. A correct clinical diagnosis was made in 7 of the cases. During a median follow-up of 6 years, none of the patients had local or distant relapses. Detection of small nodular melanoma is feasible by accurate visual inspection, provided that physicians are aware of this type of lesion and maintain the index of suspicion at a high level to bring about curative surgery.

  1. 40 CFR 52.432 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... quality. 52.432 Section 52.432 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air Act are not met... air quality. (b) Regulation for preventing significant deterioration of air quality. The provisions of...

  2. 40 CFR 52.270 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... quality. 52.270 Section 52.270 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... deterioration of air quality. (a) With the exception of the areas listed in paragraph (b) of this section: (1... plan does not include approvable procedures for preventing the significant deterioration of air quality...

  3. 40 CFR 52.683 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... quality. 52.683 Section 52.683 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... deterioration of air quality. (a) The State of Idaho Rules for Control of Air Pollution in Idaho, specifically... the Clean Air Act for preventing significant deterioration of air quality. (b) The requirements of...

  4. 40 CFR 52.1485 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... quality. 52.1485 Section 52.1485 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Significant deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air... include approvable procedures for preventing the significant deterioration of air quality. (b) Regulation...

  5. 40 CFR 52.632 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... quality. 52.632 Section 52.632 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air Act are not met... air quality. (b) Regulations for preventing significant deterioration of air quality. The provisions...

  6. 40 CFR 52.2581 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... quality. 52.2581 Section 52.2581 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Significant deterioration of air quality. (a)-(c) [Reserved] (d) The requirements of sections 160 through 165... provisions for prevention of significant deterioration of air quality at 40 CFR 52.21 are applicable to the...

  7. 40 CFR 52.793 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... quality. 52.793 Section 52.793 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air Act are not met... air quality. (b) Regulations for preventing significant deterioration of air quality. The provisions...

  8. 40 CFR 52.2346 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... quality. 52.2346 Section 52.2346 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Significant deterioration of air quality. (a) The Utah plan, as submitted, is approved as meeting the... construct on Indian Reservations. (b) Regulation for prevention of significant deterioration of air quality...

  9. 40 CFR 52.833 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... quality. 52.833 Section 52.833 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air Act are met... for preventing significant deterioration of air quality. The provisions of § 52.21 except paragraph (a...

  10. 40 CFR 52.1529 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 4 2010-07-01 2010-07-01 false Significant deterioration of air quality. 52.1529 Section 52.1529 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Significant deterioration of air quality. New Hampshire's Part Env-A 623, “Requirements for Prevention of...

  11. 40 CFR 52.738 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... quality. 52.738 Section 52.738 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air Act are not met... air quality. (b) Regulations for preventing significant deterioration of air quality. The provisions...

  12. 40 CFR 52.2178 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... quality. 52.2178 Section 52.2178 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Significant deterioration of air quality. (a) The South Dakota plan, as submitted, is approved as meeting the... on Indian reservations; (b) Regulations for preventing significant deterioration of air quality. The...

  13. 40 CFR 52.1987 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... quality. 52.1987 Section 52.1987 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Significant deterioration of air quality. (a) The Oregon Department of Environmental Quality rules for the prevention of significant deterioration of air quality (provisions of OAR chapter 340, Divisions 200, 202...

  14. 40 CFR 52.931 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... quality. 52.931 Section 52.931 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... deterioration of air quality. (a) Regulations for preventing significant deterioration of air quality. The..., the Kentucky Division for Air Quality has determined that the application complies with the applicable...

  15. 40 CFR 52.343 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... quality. 52.343 Section 52.343 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air Act are not met for the following categories of sources for preventing the significant deterioration of air quality...

  16. 40 CFR 52.2303 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... quality. 52.2303 Section 52.2303 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Significant deterioration of air quality. (a) The plan submitted by Texas is approved as meeting the requirements of part C, Clean Air Act for preventing significant deterioration of air quality. The plan...

  17. 40 CFR 52.986 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... quality. 52.986 Section 52.986 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... deterioration of air quality. (a) The plan submitted by the Governor of Louisiana on August 14, 1984 (as adopted... preventing significant deterioration of air quality. (b) The requirements of sections 160 through 165 of the...

  18. 40 CFR 52.144 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... quality. 52.144 Section 52.144 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Act are not met... lands does not include approvable procedures for preventing the significant deterioration of air quality...

  19. Efectividad de las intervenciones cognitivas en la prevención del deterioro de la memoria en las personas mayores sanas Review of the effectiveness of cognitive interventions in preventing cognitive deterioration in healthy elderly individuals

    Directory of Open Access Journals (Sweden)

    Ana M. Novoa

    2008-10-01

    Full Text Available Antecedentes: En los últimos años han aparecido diversas intervenciones no farmacológicas destinadas a prevenir el deterioro cognitivo asociado a la edad, concretamente los problemas de memoria, cuya efectividad no ha sido suficientemente evaluada. Objetivo: Establecer la efectividad de las intervenciones cognitivas en la prevención del deterioro de la memoria asociado a la edad mediante una revisión de la literatura científica. Métodos: Se realizó una búsqueda exhaustiva en PubMed. Se incluyeron los estudios publicados desde 1990 que evaluaran la efectividad de una intervención cognitiva sobre la memoria en personas mayores sin deterioro cognitivo leve ni demencia, y se clasificaron según su calidad. Se evaluaron los efectos, a corto y a largo plazo, sobre el rendimiento en tareas de memoria objetiva y subjetiva y la transferencia a otros dominios cognitivos. Resultados: Veinticinco estudios cumplieron los criterios de inclusión. Once (44% fueron considerados de elevada calidad, de los cuales todos excepto uno mejoraron algún indicador de memoria. El tipo de memoria más evaluada fue la memoria objetiva reciente verbal, que mejoró en 8 de 9 de los estudios de elevada calidad. La memoria objetiva reciente no verbal y de asociación, evaluadas principalmente por los estudios de calidad media, mejoraron en 4 de 7, y en 10 de 11 estudios, respectivamente. Los resultados referentes a memoria subjetiva fueron muy heterogéneos. La transferencia únicamente se observó en uno de 7 estudios de elevada calidad. Conclusiones: Los resultados sugieren que determinadas intervenciones cognitivas desarrolladas en personas mayores sanas son efectivas en la prevención del deterioro de la memoria, especialmente sobre la memoria reciente verbal.Background: In the last few years, several non-pharmacological interventions have been developed to prevent age-associated cognitive deterioration, specifically memory deterioration. The effectiveness of

  20. Product Assurance. Materiel Deterioration Prevention and Control.

    Science.gov (United States)

    1979-10-16

    sealants (either curi ,7 or noncurinI- types), and paint to provide sealed joints for spaces for compcncnts. An effective joint seal would consist of a flat...s size of 6’ .. i. ont --ray dictate. l. 1. ’. iren -ent,-:l c nditions will include humidity, temperature, salt at’ ,r-,e, rain, iun- i attj-ck

  1. Neonatal screening for life-threatening conditions persistent – pulmonary hypertension in newborns and critical congenital heart disease – by the method of pulse oximetry

    Directory of Open Access Journals (Sweden)

    D. I. Sadykova

    2017-01-01

    Full Text Available Research objective: to assess the diagnostic significance of the pulse oximetry performed by the newborn for the 3rd hour of life to identify critical conditions and to justify the expediency of further introduction of this technology in the work of obstetric institutions.Results. In 5 maternity hospitals of the Republic of Tatarstan, from April 2016 to February 2017, 8358 88.4% of newborns were pulsometrically screened. Positive results were obtained in 95 (1.14% patients. Because of screening, 13 newborns were diagnosed with congenital heart defects, not diagnosed in utero, in the first hours of life, five of them were critical. All newborns with critical congenital heart defects were successfully operated. Besides, 20 patients had persistent pulmonary hypertension, 30 had intrauterine pneumonia.Conclusions. The measurement of saturation at the 3rd hour of life of a newborn allows avoiding life-threatening complications in children with critical congenital heart defects and persistent pulmonary hypertension and in a stable state to transfer them to a further treatment stage.

  2. Life-Threatening Irinotecan-Induced Toxicity in an Adult Patient with Alveolar Rhabdomyosarcoma: The Role of a UGT1A1 Polymorphism

    Directory of Open Access Journals (Sweden)

    Arnaud Jannin

    2017-01-01

    Full Text Available Alveolar rhabdomyosarcoma (AR in adult patients is an exceptional malignancy. Management of AR is based on (neoadjuvant chemotherapy combining ifosfamide, vincristine, and actinomycin D and local curative-intent surgery/radiotherapy. In cases of relapsing AR, the combination of temozolomide/irinotecan is regarded as a possible option. Here we describe life-threatening long-lasting toxicity related to the 1st cycle of irinotecan-based chemotherapy in a 56-year-old woman suffering from locally advanced and metastatic head and neck AR. The patient experienced grade 4 vomiting and diarrheas resulting in acute functional renal failure, associated with grade 4 neutropenia complicated by severe septic shock. The hospital stay duration was 40 days. The analysis of the uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1 gene revealed homozygous UGT1A1 ⁎28 polymorphism with an associated homozygous mutation c.-3275T>G; the latter is associated with a decrease of about 80% of UGT1A1 transcription explaining this irinotecan induced toxicity. Physician must be aware of the potential hematological (mainly neutropenia and infectious disease and digestive (mainly diarrhea toxicities caused by irinotecan and especially when the patient presents a UGT1A1 ⁎28 homozygous allele. UGT1A genotyping performed before initiating treatment is useful to anticipate severe toxic reaction to irinotecan and improve the benefit/risk ratio of its use.

  3. Impact of sympathetic innervation on recurrent life-threatening arrhythmias in the follow-up of patients with idiopathic ventricular fibrillation

    Energy Technology Data Exchange (ETDEWEB)

    Paul, Matthias; Acil, Tayfun; Breithardt, Guenter; Wichter, Thomas [Hospital of the University of Muenster, Department of Cardiology and Angiology, Muenster (Germany); Schaefers, Michael; Kies, Peter; Schaefers, Klaus; Schober, Otmar [Hospital of the University of Muenster, Department of Nuclear Medicine, Muenster (Germany)

    2006-08-15

    Idiopathic ventricular fibrillation (IVF) is defined as VF in the absence of any identifiable structural or functional cardiac disease. The underlying pathophysiological mechanisms are unknown. This study was performed to investigate the potential impact of sympathetic dysfunction, assessed by {sup 123}I-meta-iodo-benzylguanidine scintigraphy ({sup 123}I-MIBG SPECT), on the long-term prognosis of patients with IVF. {sup 123}I-MIBG SPECT was performed in 20 patients (mean age 37{+-}13 years) with IVF. Mean follow-up of patients after study entry was 7.2{+-}1.5 years (range 4.9-10.5 years). Ten patients (five men, five women; mean age 43{+-}12 years; p=NS versus study group) with medullary carcinoma of the thyroid gland served as an age-matched control group. Abnormal {sup 123}I-MIBG uptake was observed in 13 patients (65%). During follow-up, 18 episodes of VF/fast polymorphic ventricular tachycardias occurred in four IVF patients with abnormal {sup 123}I-MIBG uptake whereas only two episodes of monomorphic ventricular tachycardia (and no VF) occurred in a single IVF patient with normal {sup 123}I-MIBG uptake. Impairment of sympathetic innervation may indicate a higher risk of future recurrent episodes of life-threatening ventricular tachyarrhythmias in patients with IVF. Studies in larger cohorts are required to validate the significance of {sup 123}I-MIBG SPECT during the long-term follow-up of these patients. (orig.)

  4. [Life Threatening Complications in Patients With ST-Elevation Acute Coronary Syndrome-Dependence on Reperfusion Interventions (Data of Federal Register of Patients With Acute Coronary Syndrome)].

    Science.gov (United States)

    Oshchepkova, E V; Dmitriev, V V

    2016-04-01

    to study rate and type of life-threatening complications (LC) in patients with ST-Elevation (STE) Acute Coronary Syndrome (ACS) and their relation to implementation of reperfusion measures. Database of the Federal Register of patients with ACS (FRACS) which functioned from 01/01/2009 to 01/01/2014 contains information on 212304 patients with verified diagnosis of ACS. From this pool using random number generator we selected a cohort comprising 10348 patients with STEACS (60% men, mean age 63.5+/-0.1 clinical systolic and diastolic arterial pressure [AP] 135.2+/-0.3 and 81.9+/-0.2 mm Hg, respectively). Killip class was used for determination of degree of acute heart failure. Most frequent forms of LC were heart rhythm disturbances (6.2%) and cardiogenic shock (5.4%). Patients subjected to percutaneous coronary intervention (PCI) including those in whom pharmacoinvasive approach was used had less LC and lower hospital mortality than patients who received only thrombolytic therapy (TLT). Reperfusion measures were administered mostly to patients with class I-II acute heart failure. Hospital mortality was highest (9.47%) among patients not subjected to reperfusion measures and lowest (1.09%) among patients treated with PCI+TLT. FRACS assesses LC in patients with STEACS in the context of implemented reperfusion measures. Data of FRACS can be used by the health service authorities for improvement of medical aid to patients with STEACS.

  5. Potentially life-threatening coagulopathy associated with simultaneous reduction in coagulation and fibrinolytic function in pediatric acute leukemia after hematopoietic stem-cell transplantation.

    Science.gov (United States)

    Ishihara, Takashi; Nogami, Keiji; Matsumoto, Tomoko; Nomura, Akitaka; Takeshita, Yasufumi; Ochi, Satoshi; Shima, Midori

    2017-07-01

    The pathogenesis of sinusoidal obstruction syndrome (SOS) and thrombotic microangiopathy (TMA) after hematopoietic stem cell transplantation (HSCT) is poorly understood, and limited information is available on global hemostatic function in HSCT. We assessed changes in coagulation and fibrinolysis using a simultaneous thrombin and plasmin generation assay (T/P-GA) during HSCT. Measurements of endogenous thrombin potential (T-EP) and plasmin peak height (P-Peak) using T/P-GA in six pediatric acute leukemia patients treated with HSCT were compared to normal plasma. In the SOS case, the ratios of T-EP and P-Peak to normal were simultaneously decreased at four weeks post-HSCT (Pre; ~1.1/1.1-1.4, Week+4; 0.14/0.0084, respectively). Similarly, in the TMA patient, both ratios were decreased at 3 weeks and recovered after 8 weeks (Pre; 1.2/~0.95, Week+3; 0.59/0.22, Week+8; 1.2/0.64-0.85). In the other patients, when SOS/TMA was not evident, the T/P-GA data remained within normal limits. These findings suggest that the simultaneous reduction of coagulation and fibrinolytic function in patients developing SOS/TMA can lead to a life-threatening coagulopathy. Further research is warranted to clarify global hemostatic function after HSCT to establish optimal supportive therapy for these critical clinical disorders of hemostasis.

  6. Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial.

    Science.gov (United States)

    Griffiths, Roland R; Johnson, Matthew W; Carducci, Michael A; Umbricht, Annie; Richards, William A; Richards, Brian D; Cosimano, Mary P; Klinedinst, Margaret A

    2016-12-01

    Cancer patients often develop chronic, clinically significant symptoms of depression and anxiety. Previous studies suggest that psilocybin may decrease depression and anxiety in cancer patients. The effects of psilocybin were studied in 51 cancer patients with life-threatening diagnoses and symptoms of depression and/or anxiety. This randomized, double-blind, cross-over trial investigated the effects of a very low (placebo-like) dose (1 or 3 mg/70 kg) vs. a high dose (22 or 30 mg/70 kg) of psilocybin administered in counterbalanced sequence with 5 weeks between sessions and a 6-month follow-up. Instructions to participants and staff minimized expectancy effects. Participants, staff, and community observers rated participant moods, attitudes, and behaviors throughout the study. High-dose psilocybin produced large decreases in clinician- and self-rated measures of depressed mood and anxiety, along with increases in quality of life, life meaning, and optimism, and decreases in death anxiety. At 6-month follow-up, these changes were sustained, with about 80% of participants continuing to show clinically significant decreases in depressed mood and anxiety. Participants attributed improvements in attitudes about life/self, mood, relationships, and spirituality to the high-dose experience, with >80% endorsing moderately or greater increased well-being/life satisfaction. Community observer ratings showed corresponding changes. Mystical-type psilocybin experience on session day mediated the effect of psilocybin dose on therapeutic outcomes. ClinicalTrials.gov identifier: NCT00465595. © The Author(s) 2016.

  7. Infliximab associated with life-threatening lung infection in a patient with Behcet disease with intestinal and hematopoietic system involvement: A case report.

    Science.gov (United States)

    Chen, Yong; Shen, Yan; Ma, Hai-Fen; Cai, Jian-Fei; Hua, Yan-Qin; Zou, Jun; Guan, Jian-Long

    2017-12-01

    Tumor necrosis factor (TNF-α) participates in the pathophysiology of Behcet's disease (BD) and myelodysplastic syndrome (MDS). Infliximab is recommaned for the most severe type of BD, however, there is little evidence for its effectiveness in BD associated MDS. A 46-year-old female, initially diagnosed with intestinal BD and leukopenia was later diagnosed as MDS. Treatement with infliximab and other immunoregulators lead to life-threatening pneumonia. Intestinal BD associated with MDS involving trisomy 8. The patient initially treated with methylprednisolone, thalidomide, cyclosporine A, and infliximab, which lead to severe lung infection. Therefore, the patient was transferred to Intensive Care Unit for life supportive, anti-infection and immune improving therapy. The patient survived from the lung infection. With combination of methylprednisolone, thalidomide and cyclosporine A, the patient recovered from her intestinal ulceration and MDS manifestations. Infliximab treatment may not benefit a patient with BD associated with MDS but place the patient at risk of infection. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

  8. [Prevention and management of postresectional bronchopleural fistula].

    Science.gov (United States)

    Ishikawa, Shigemi

    2008-07-01

    Bronchopleural fistula (BPF) is still a life-threatening complication after pulmonary resection. Several factors were identified to contribute BPF. Meticulous surgical technique and the liberal use of prophylactic, pedicled flaps are important for prevention. Although these patients often present compromised and moribund, evaluation and management should proceed in a logical, stepwise fashion. In high-risk surgical patients, bronchoscopic procedures using different glues and sealants may serve as a temporary bridge until the patient's recovery or as a permanent resolution. However persistent conservative therapy may deteriorate patient's condition. Immediate creation of open window thoracotomy has been shown to be a significant predictor of wound closure afterwards. Pedicled muscle or omental flaps are useful to close bronchial stump and to fill the residual space in the thorax after pulmonary resection. Once fistula closed, the pleural space is filled with an antibiotic solution and then the open window thoracotomy closed in layers as Clagett procedure. The transternal transpericardial approach to recalcitrant postpneumonectomy BPF can be considered when patients have failed prior closure attempt. To conclude, survival and excellent result of BPF depends on early diagnosis, and aggressive surgical intervention.

  9. E. Coli: Preventing Outbreaks at Camp.

    Science.gov (United States)

    McKinney, Mary D.

    1996-01-01

    One strain of E. coli is not usually found in foods, but has been related to consumption of undercooked ground beef. Symptoms are stomach cramps and diarrhea, and 2-7% of infections lead to hemolytic uremic syndrome, which is life threatening. Camps can prevent outbreaks by avoiding uncooked meat on overnight campouts and requiring appropriate…

  10. Life-Threatening Opioid Toxicity

    Science.gov (United States)

    1987-01-01

    Ventilatory depression (coma, ventilatory failure) Cardiovascular system Increased venous capacitance (orthostatic hypotension) Gastrointestinal system Stomach...carbon central nervous system with minor effects on dioxide. 20 The carotid body is particularly the cardiovascular, gastrointestinal , and well endowed...drawal symptoms occur following this dose, antral tone and the reduction in intestinal the patient can be treated symptomatically peristalsis , gastric

  11. EAMJ Life Threatening 09.indd

    African Journals Online (AJOL)

    2009-12-12

    Dec 12, 2009 ... ventilation for 48 hours. Over this period her serum electrolytes returned to normal with continued 0.18% saline/5% dextrose solution resuscitation. After extubation she resumed oral intake and on direct questioning admitted to routinely drinking 2-3 litres of carbonated drinks each night to try and quench her.

  12. Life-threatening mycobacteria infection

    NARCIS (Netherlands)

    Faber, William R.

    2005-01-01

    Most mycobacteria cause localized and often harmless infections of the skin, Leprosy. which dates back to approximately 60 BC in India,(1) was supposed to be eliminated as a Public health problem by the year 2000.(2) With a new case detection rate between 600,000 and 700,000 yearly, however.(3)

  13. At-admission risk stratification for in-hospital life-threatening ventricular arrhythmias and death in non-ST elevation myocardial infarction patients.

    Science.gov (United States)

    Zorzi, Alessandro; Turri, Riccardo; Zilio, Filippo; Spadotto, Veronica; Baritussio, Anna; Peruzza, Francesco; Gasparetto, Nicola; Marra, Martina Perazzolo; Cacciavillani, Luisa; Marzari, Armando; Tarantini, Giuseppe; Iliceto, Sabino; Corrado, Domenico

    2014-12-01

    Identification of patients with non-ST elevation acute myocardial infarction (NSTEMI) at higher risk of in-hospital life-threatening ventricular arrhythmias (LT-VA) and death is crucial for determining appropriate levels of care/monitoring during hospitalisation. We assessed predictors of in-hospital LT-VA and all-cause mortality in a consecutive series of NSTEMI patients. We prospectively studied 1325 consecutive patients (69.7% males, median age 70 (61-79) years) presenting with NSTEMI and undergoing continuous electrocardiographic monitoring. The primary study end-point was the occurrence of spontaneous (unrelated to coronary interventions) in-hospital LT-VA, including sustained ventricular tachycardia and ventricular fibrillation; the secondary end-point was in-hospital mortality from all causes. Of 1325 patients, 21 (1.5%) experienced LT-VA and 62 (4.7%) died from either arrhythmias (n=1) or other causes (n=61). Seven of the 20 patients who survived LT-VA subsequently died of heart failure. Independent predictors of in-hospital LT-VA were the Global Registry of Acute Coronary Events (GRACE) score >140 (odds ratio (OR)=7.5; 95% confidence interval (CI) 1.7-33.3; p=0.008) and left ventricular ejection fraction (LV-EF)140 (OR=14.6; 95% CI 3.4-62) and LV-EF 140 and LV-EF<35%, while it was respectively 0.2% and 0% among the 627 (47.3%) with GRACE score ≤140 and LV-EF ≥35%. Simple risk stratification at admission based on GRACE score and echocardiographic LV-EF allows early identification of NSTEMI patients at higher risk of both in-hospital LT-VA and all-cause mortality. © The European Society of Cardiology 2014.

  14. Ethics at the end of life: who should make decisions about treatment limitation for young children with life-threatening or life-limiting conditions?

    Science.gov (United States)

    Gillam, Lynn; Sullivan, Jane

    2011-09-01

    It is now ethical orthodoxy that parents should be involved in the decision-making about their children's health care. This extends to decisions about whether to continue or to limit life-sustaining medical treatment for a child with a life-limiting or life-threatening condition. What remains contested and uncertain is the extent and nature of parental involvement, especially in this emotionally charged situation. In particular, should it be the parents, who are the ultimate decision-makers, taking final responsibility, should it be a shared decision, or should it be a medical decision that parents are simply asked to consent to? One approach to this issue is to consider the in-principle ethical arguments and weigh their merits. The two key principles here are parental rights and authority, and the best interests of child, and the contested issue is what to do if these appear to clash. Another approach is to consider the principles in the practical clinical context. What would be the implications and consequences of adopting the model of parents as final decision-makers? Are parents able to carry out this role, and do they really want it? What is the effect on parents of taking this role? Answers to these questions could modify the in-principle ethical position. In this paper, we review the empirical evidence currently available on these questions, in relation to parents of infants and young children. Overall, the literature suggests that parents do want to be involved and do not suffer adverse psychological consequences from their involvement. However, the crucial ethical implication of the evidence is that the level and nature of parental involvement in decision-making should be negotiated with the parents in each case, because parents have a range of different views about taking final responsibility for decisions. © 2011 The Authors. Journal of Paediatrics and Child Health © 2011 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  15. How parents and practitioners experience research without prior consent (deferred consent) for emergency research involving children with life threatening conditions: a mixed method study

    Science.gov (United States)

    Woolfall, Kerry; Frith, Lucy; Gamble, Carrol; Gilbert, Ruth; Mok, Quen; Young, Bridget

    2015-01-01

    Objective Alternatives to prospective informed consent to enable children with life-threatening conditions to be entered into trials of emergency treatments are needed. Across Europe, a process called deferred consent has been developed as an alternative. Little is known about the views and experiences of those with first-hand experience of this controversial consent process. To inform how consent is sought for future paediatric critical care trials, we explored the views and experiences of parents and practitioners involved in the CATheter infections in CHildren (CATCH) trial, which allowed for deferred consent in certain circumstances. Design Mixed method survey, interview and focus group study. Participants 275 parents completed a questionnaire; 20 families participated in an interview (18 mothers, 5 fathers). 17 CATCH practitioners participated in one of four focus groups (10 nurses, 3 doctors and 4 clinical trial unit staff). Setting 12 UK children's hospitals. Results Some parents were momentarily shocked or angered to discover that their child had or could have been entered into CATCH without their prior consent. Although these feelings resolved after the reasons why consent needed to be deferred were explained and that the CATCH interventions were already used in clinical care. Prior to seeking deferred consent for the first few times, CATCH practitioners were apprehensive, although their feelings abated with experience of talking to parents about CATCH. Parents reported that their decisions about their child's participation in the trial had been voluntary. However, mistiming the deferred consent discussion had caused distress for some. Practitioners and parents supported the use of deferred consent in CATCH and in future trials of interventions already used in clinical care. Conclusions Our study provides evidence to support the use of deferred consent in paediatric emergency medicine; it also indicates the crucial importance of practitioner communication

  16. Risk Factors Analysis and Death Prediction in Some Life-Threatening Ailments Using Chi-Square Case-Based Reasoning (χ2 CBR) Model.

    Science.gov (United States)

    Adeniyi, D A; Wei, Z; Yang, Y

    2018-01-30

    A wealth of data are available within the health care system, however, effective analysis tools for exploring the hidden patterns in these datasets are lacking. To alleviate this limitation, this paper proposes a simple but promising hybrid predictive model by suitably combining the Chi-square distance measurement with case-based reasoning technique. The study presents the realization of an automated risk calculator and death prediction in some life-threatening ailments using Chi-square case-based reasoning (χ 2 CBR) model. The proposed predictive engine is capable of reducing runtime and speeds up execution process through the use of critical χ 2 distribution value. This work also showcases the development of a novel feature selection method referred to as frequent item based rule (FIBR) method. This FIBR method is used for selecting the best feature for the proposed χ 2 CBR model at the preprocessing stage of the predictive procedures. The implementation of the proposed risk calculator is achieved through the use of an in-house developed PHP program experimented with XAMP/Apache HTTP server as hosting server. The process of data acquisition and case-based development is implemented using the MySQL application. Performance comparison between our system, the NBY, the ED-KNN, the ANN, the SVM, the Random Forest and the traditional CBR techniques shows that the quality of predictions produced by our system outperformed the baseline methods studied. The result of our experiment shows that the precision rate and predictive quality of our system in most cases are equal to or greater than 70%. Our result also shows that the proposed system executes faster than the baseline methods studied. Therefore, the proposed risk calculator is capable of providing useful, consistent, faster, accurate and efficient risk level prediction to both the patients and the physicians at any time, online and on a real-time basis.

  17. Impact of indoor air pollution from the use of solid fuels on the incidence of life threatening respiratory illnesses in children in India.

    Science.gov (United States)

    Upadhyay, Ashish Kumar; Singh, Abhishek; Kumar, Kaushalendra; Singh, Ashish

    2015-03-28

    India contributes 24% of the global annual child deaths due to acute respiratory infections (ARIs). According to WHO, nearly 50% of the deaths among children due to ARIs is because of indoor air pollution (IAP). There is insufficient evidence on the relationship between IAP from the use of solid fuels and incidence of life threatening respiratory illnesses (LTRI) in children in India. Panel data of children born during 2001-02, from the Young Lives Study (YLS) conducted in India during 2002 and 2006-07 was used to estimate the impact of household use of solid fuels for cooking on LTRI in children. Multivariable two-stage random effects logistic regression model was used to estimate the odds of suffering from LTRI among children from households using solid fuels relative to children from households using other fuels (Gas/Electricity/Kerosene). Bivariate results indicate that the probability of an episode of LTRI was considerably higher among children from households using solid fuels for cooking (18%) than among children from households using other fuels (10%). Moreover, children from households using solid fuels in both the rounds of YLS were more likely to suffer from one or more than one episode of LTRI compared to children from households using solid fuels in only one round. Two-stage random effects logistic regression result shows that children from households using solid fuels were 1.78 (95% CI: 1.05-2.99) times as likely to suffer from LTRI as those from households using other fuels. The findings of this paper provide conclusive evidence on the harmful effects of the use of solid fuels for cooking on LTRI in India. The Government of India must make people aware about the health risks associated with the use of solid fuels for cooking and strive to promote the use of cleaner fuels.

  18. Antipsychotics, glycemic disorders, and life-threatening diabetic events: a Bayesian data-mining analysis of the FDA adverse event reporting system (1968-2004).

    Science.gov (United States)

    DuMouchel, William; Fram, David; Yang, Xionghu; Mahmoud, Ramy A; Grogg, Amy L; Engelhart, Luella; Ramaswamy, Krishnan

    2008-01-01

    disproportionality reporting ratios relating to glycemic effects, especially life-threatening events, in the AERS database. The relative associational rankings of drugs are similar in reports from younger and older patients. These results agree with several other reports in the literature, do not support a "class effect" hypothesis, and provide a strong rationale for further studies to clarify the issue.

  19. A pre-test and post-test study of the physical and psychological effects of out-of-home respite care on caregivers of children with life-threatening conditions.

    Science.gov (United States)

    Remedios, Cheryl; Willenberg, Lisa; Zordan, Rachel; Murphy, Andrea; Hessel, Gail; Philip, Jennifer

    2015-03-01

    Respite services are recommended as an important support for caregivers of children with life-threatening conditions. However, the benefits of respite have not been convincingly demonstrated through quantitative research. To determine the impact of out-of home respite care on levels of fatigue, psychological adjustment, quality of life and relationship satisfaction among caregivers of children with life-threatening conditions. A mixed-methods, pre-test and post-test study A consecutive sample of 58 parental caregivers whose children were admitted to a children's hospice for out-of-home respite over an average of 4 days. Caregivers had below-standard levels of quality of life compared to normative populations. Paired t-tests demonstrated that caregivers' average psychological adjustment scores significantly improved from pre-respite (mean = 13.9, standard error = 0.71) to post-respite (mean = 10.7, standard error = 1); p psychological adjustment of caregivers of children with life-threatening conditions. Study outcomes inform service provision and future research efforts in paediatric palliative care. © The Author(s) 2015.

  20. "Card sorting": a tool for research in ethics on treatment decision-making at the end of life in Alzheimer patients with a life threatening complication

    Directory of Open Access Journals (Sweden)

    Cretin Elodie

    2011-03-01

    Full Text Available Abstract Background End stage dementia is a particularly difficult aspect of care for patients with Alzheimer's disease and related dementias. In care institutions, caregivers and family are concerned by treatment decision-making for an acute life threatening complication occurring in Alzheimer patients at the end of life. How should the best treatment pathway be decided: to treat or not to treat? Which arguments are used for decision-making? These are mainly ethical questions which are currently difficult to express and investigate. Methods/Design Cross sectional multicentre study of clinical cases involving 67 health centres (university hospitals, general hospitals, local hospitals and homes for the elderly in the east of France. The method was based on the "card sorting" technique, with a set of 36 cards, each labelled with a different item relating to arguments for treatment decision-making. For each clinical case, medical staff and carers expressed in a meeting the pieces of information which they believed had been taken into account in the decision. Each participant received a card game, selected fewer than ten and ranked them according to the importance they attached to each one. All selected cards were then put on the table anonymously for participants, respecting the order of importance of the cards in each pile. Lastly, all games were photographed together in order to analyse occurrence and order frequencies. The cards were then classified on the table by frequency to open the discussion. Discussion time, which was conducted by the head carer of the department, concerned the clinical situation of the patient based on the shared responses. Discussion During team meetings, the "card sorting" method was quickly adopted by professionals as a tool to assist with discussion beyond the context of the study. The participants were not compelled to mention their feelings in relation to a case, and it is significant that the anonymity which we

  1. 40 CFR 52.1634 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... quality. 52.1634 Section 52.1634 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Significant deterioration of air quality. (a) The plan submitted by the Governor of New Mexico on February 21... adopted by the NMEID on March 9, 1990), Air Quality Control Regulation 707—Permits, Prevention of...

  2. Maintenance planning for a deteriorating production process

    International Nuclear Information System (INIS)

    Ahmadi, Reza; Fouladirad, Mitra

    2017-01-01

    We consider a system subject to degradation, more precisely a production process with three quality states evolving according to a homogeneous Markov process. The degradation decreases the income generated by the system. To maintain revenue stream and prevent the loss of revenue, the system is inspected according to a Markov-modulated Poisson process. It is assumed that each inspection at time t incurs a time dependent cost. Each inspection improves the system health and therefore the degradation level jumps to a less deteriorated state. In absence of inspections, the system state is prone to shift to a more deteriorated state with a constant rate. The problem is to determine an optimal operating (stopping) time which truly balances some flow of income and increasing costs due to inspections, and so maximizes the expected gain of the proposed policy. To demonstrate the applicability of the explored approach and its effectiveness, some numerical results are provided. - Highlights: • An integrated model based on a quality state-dependent reward structure is explored. • The model allows the revenue stream responds to variation in the quality state. • The production process is inspected according to a Markovmodulated Poisson process. • Assuming a Markovian structure, we predict the quality state behavior. • We determine an optimal production run length based on a stopping decision rule.

  3. Evento com aparente risco de morte: uma revisão Evento con aparente riesgo de muerte (alte: una revisión Apparent life-threatening event: a review

    Directory of Open Access Journals (Sweden)

    Mariana Tresoldi das N. Romaneli

    2012-12-01

    Full Text Available OBJETIVO: Realizar uma revisão crítica reunindo informações disponíveis a respeito dos eventos com aparente risco de morte. FONTES DE DADOS: Revisão bibliográfica dos artigos (em português, inglês e espanhol obtidos dos bancos de dados eletrônicos Medline, Lilacs e SciELO, utilizando as palavras-chave: eventos com aparente risco de morte, evento com aparente risco de vida infantil, lactente, apneia, monitorização e cianose. SÍNTESE DOS DADOS: Os eventos com aparente risco de mortesão súbitos e caracterizados por uma combinação de apneia, alteração na coloração da pele e tônus muscular, com inúmeras causas subjacentes. Sua incidência verdadeira é desconhecida e a faixa etária mais acometida é de 11 a 12 semanas. Não há correlação entre o evento com aparente risco de morte e a síndrome da morte súbita do lactente, embora já tenham sido consideradas manifestações da mesma doença. Muitas vezes, o lactente tem aparência saudável ao ser avaliado pelo pediatra após apresentar eventos com aparente risco de morte, porém, isso não afasta a possibilidade de existir uma doença grave associada ao evento, que deve ser investigada e tratada. Quando não são encontradas as causas, o evento é idiopático, geralmente com boa evolução. CONCLUSÕES: É necessário investigar os lactentes levados ao pronto-socorro após apresentarem eventos com aparente risco de morte, devido ao risco de sequelas e mortalidade. Não há uma padronização das condutas a serem realizadas diante de um lactente com aparência saudável que tenha evento com aparente risco de morte, mas recomenda-se que o paciente seja internado e a causa do evento, investigada. A observação e o monitoramento em ambiente hospitalar devem ocorrer no mínimo 24 horas após o evento.OBJETIVO: Realizar una revisión crítica, reuniendo las informaciones disponibles respecto a los Eventos con Aparente Riesgo de Muerte (ALTE - Apparent life-threatening event

  4. 40 CFR 1033.245 - Deterioration factors.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 32 2010-07-01 2010-07-01 false Deterioration factors. 1033.245... CONTROLS CONTROL OF EMISSIONS FROM LOCOMOTIVES Certifying Engine Families § 1033.245 Deterioration factors. Establish deterioration factors for each pollutant to determine, as described in § 1033.240, whether your...

  5. 40 CFR 1042.245 - Deterioration factors.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 32 2010-07-01 2010-07-01 false Deterioration factors. 1042.245... Certifying Engine Families § 1042.245 Deterioration factors. This section describes how to determine deterioration factors for Category 1 and Category 2 engines, either with an engineering analysis, with pre...

  6. Cultural Attitudes and Body Dissatisfaction: Morgan State Researchers Find that Perceptions of Body Image among Young African Americans May Be Life Threatening

    Science.gov (United States)

    Hawkins, B. Denise

    2005-01-01

    Young African Americans don't appear to perceive obesity in the way the medical community does, putting them at greater risk for developing chronic diseases such as diabetes, hypertension and cancer, says a first-ever study led by researchers at the Morgan State University Prevention Sciences Research Center. The pilot study, which provides a rare…

  7. Do Work Characteristics Predict Health Deterioration Among Employees with Chronic Diseases?

    NARCIS (Netherlands)

    Wind, A. de; Boot, C.R.L.; Sewdas, R.; Scharn, M.; Heuvel, S.G. van den; Beek, A.J. van der

    2017-01-01

    Purpose In our ageing workforce, the increasing numbers of employees with chronic diseases are encouraged to prolong their working lives. It is important to prevent health deterioration in this vulnerable group. This study aims to investigate whether work characteristics predict health deterioration

  8. Strategies for Playground Injury Prevention: An Overview of a Playground Project

    Science.gov (United States)

    Olsen, Heather; Hudson, Susan D.; Thompson, Donna

    2010-01-01

    Preventing injuries to children, especially debilitating and life threatening, requires an awareness of where these types of injuries occur during the school days. This review examines falls from playground equipment, events that have been identified as the leading causes of nonfatal unintentional injuries for children. Thus, the issue of…

  9. Cardiac Tamponade as a Life-Threatening Complication of Laparoscopic Antireflux Surgery: The Real Incidence and 3D Anatomy of a Heart Injury by Helical Tacks.

    Science.gov (United States)

    Yerdel, Mehmet Ali; Şen, Ozan; Zor, Utku; Kara, Simay; Acunaş, Bülent

    2018-03-01

    Cardiac tamponade (CT) is a dreadful complication of laparoscopic antireflux surgery (LARS) with unknown incidence, and preventive measures are yet to be defined. Incidence during LARS with respect to usage/configuration of graft deployment is analyzed. Three-dimensional (3D) analysis of tack distribution provided anatomical insight to prevent cardiac injury. Data regarding the usage and configuration of graft deployment are retrieved from the prospective database. Grafting was "posterior" or "posterior + anterior." Incidence of CT in all hiatoplasties is calculated. Tomography is reconstructed in 3D, showing the spatial distribution of the tacks. Tacks are numbered in the surgical video. Corresponding numbering is applied to the tacks in any particular tomography slice, utilizing the 3D images as an interface. A numbering-blinded radiologist is asked to identify the offending and the nonoffending tacks as the cause of tamponade. Tack-to-pericardium distances are recorded. Tacks having no measurable distance from the pericardium are regarded as offensive. One CT occurred in 1302 consecutive LARS (0.076%). The incidence is 0% when "no" (379) or "posterior" (880) graft is used as opposed to 2.3% rate in "posterior + anterior" (43) grafting. The distribution of "offensive," "nonoffensive but nearest," and "safe" tacks followed a pattern. All offensive tacks belonged to the anterior graft fixation, which we referred as the critical zone. CT during LARS is rare, and associated with graft fixation anterior to the hiatal opening. Avoiding graft fixation to the critical zone may prevent cardiac injury.

  10. Development of Enhanced Pavement Deterioration Curves

    OpenAIRE

    Ercisli, Safak

    2015-01-01

    Modeling pavement deterioration and predicting the pavement performance is crucial for optimum pavement network management. Currently only a few models exist that incorporate the structural capacity of the pavements into deterioration modeling. This thesis develops pavement deterioration models that take into account, along with the age of the pavement, the pavement structural condition expressed in terms of the Modified Structural Index (MSI). The research found MSI to be a significant input...

  11. Prevention

    Science.gov (United States)

    ... Error processing SSI file About Heart Disease & Stroke Prevention Heart disease and stroke are an epidemic in ... secondhand smoke. Barriers to Effective Heart Disease & Stroke Prevention Many people with key risk factors for heart ...

  12. Perceptions of an implantable cardioverter-defibrillator: A qualitative study of families with a history of sudden life-threatening cardiac events and recommendations to improve care.

    Science.gov (United States)

    Linder, Jarrett; Hidayatallah, Nadia; Stolerman, Marina; McDonald, Thomas V; Marion, Robert; Walsh, Christine; Dolan, Siobhan

    2013-01-01

    To identify major concerns associated with implantable cardioverter-defibrillators (ICDs) and to provide recommendations to adult and pediatric physicians involved in the care of patients with ICDs. Cardiac ion channelopathies are a well-recognized cause of sudden cardiac death in infants, children, adolescents, and young adults. ICDs are effective in preventing sudden death from fatal arrhythmias in patients with known cardiac channelopathies. There is a paucity of research on the effect of ICDs on quality of life in patients with cardiac channelopathy diagnoses, especially young patients. A qualitative study interviewing patients and families affected by inherited arrhythmias was conducted. Fifty participants with personal or family histories of cardiac events or sudden death were interviewed individually or in focus groups by clinical psychologists. All interviews were transcribed verbatim and then analyzed and coded based on current qualitative research theory to identify themes related to the research question. Twenty-four participants discussed ICDs in their interviews. Participants reported concerns about ICDs, and these concerns were categorized into six themes: (1) comprehension and physician-patient communication; (2) anxiety; (3) restrictions and fallacies; (4) complications; (5) utility; and (6) alternative therapy. Participants noted communication breakdowns between providers and their colleagues, and between providers and their patients. Participants and their families experienced many different forms of anxiety, including worry about the aesthetics of the ICDs and fears of being shocked. Multiple restrictions, fallacies, and complications were also cited. Interview themes were used to formulate recommendations for counseling and educating patients with ICDs.

  13. European Association for Cardio-Thoracic Surgery expert consensus statement on the prevention and management of mediastinitis

    DEFF Research Database (Denmark)

    Abu-Omar, Yasir; Kocher, Gregor J; Bosco, Paolo

    2017-01-01

    Mediastinitis continues to be an important and life-threatening complication after median sternotomy despite advances in prevention and treatment strategies, with an incidence of 0.25-5%. It can also occur as extension of infection from adjacent structures such as the oesophagus, airways and lung...

  14. Schroth physiotherapeutic scoliosis-specific exercises for adolescent idiopathic scoliosis: how many patients require treatment to prevent one deterioration? – results from a randomized controlled trial - “SOSORT 2017 Award Winner”

    Directory of Open Access Journals (Sweden)

    Sanja Schreiber

    2017-11-01

    Full Text Available Abstract Background Recent randomized controlled trials (RCTs support using physiotherapeutic scoliosis-specific exercises (PSSE for adolescents with idiopathic scoliosis (AIS. All RCTs reported statistically significant results favouring PSSE but none reported on clinical significance. The number needed to treat (NNT helps determine if RCT results are clinically meaningful. The NNT is the number of patients that need to be treated to prevent one bad outcome in a given period. A low NNT suggests that a therapy has positive outcomes in most patients offered the therapy. The objective was to determine how many patients require Schroth PSSE added to standard care (observation or brace treatment to prevent one progression (NNT of the Largest Curve (LC or Sum of Curves (SOC beyond 5° and 10°, respectively over a 6-month interval. Methods This was a secondary analysis of a RCT. Fifty consecutive participants from a scoliosis clinic were randomized to the Schroth PSSE + standard of care group (n = 25 or the standard of care group (n = 25. We included males and females with AIS, age 10–18 years, all curve types, with curves 10°- 45°, with or without brace, and all maturity levels. We excluded patients awaiting surgery, having had surgery, having completed brace treatment and with other scoliosis diagnoses. The local ethics review board approved the study (Pro00011552. The Schroth intervention consisted of weekly 1-h supervised Schroth PSSE sessions and a daily home program delivered over six months in addition to the standard of care. A prescription algorithm was used to determine which exercises patients were to perform. Controls received only standard of care. Cobb angles were measured using a semi-automatic system from posterior-anterior standing radiographs at baseline and 6 months. We calculated absolute risk reduction (ARR and relative risk reduction (RRR. The NTT was calculated as: NNT = 1/ARR. Patients with missing values (PSSE

  15. Prevention

    Science.gov (United States)

    ... Contact Aging & Health A to Z Find a Geriatrics Healthcare Professional Medications & Older Adults Making Your Wishes ... Prevention Hearing Loss Heart Attack High Blood Pressure Nutrition Osteoporosis Shingles Skin Cancer Related News Quitting Smoking, ...

  16. Evaluating the combined efficacy of polymers with fungicides for protection of museum textiles against fungal deterioration in Egypt.

    Science.gov (United States)

    Abdel-Kareem, Omar

    2010-01-01

    Fungal deterioration is one of the highest risk factors for damage of historical textile objects in Egypt. This paper represents both a study case about the fungal microflora deteriorating historical textiles in the Egyptian Museum and the Coptic museum in Cairo, and evaluation of the efficacy of several combinations of polymers with fungicides for the reinforcement of textiles and their prevention against fungal deterioration. Both cotton swab technique and biodeteriorated textile part technique were used for isolation of fungi from historical textile objects. The plate method with the manual key was used for identification of fungi. The results show that the most dominant fungi isolated from the tested textile samples belong to Alternaria, Aspergillus, Chaetomium, Penicillium and Trichoderma species. Microbiological testing was used for evaluating the usefulness of the suggested conservation materials (polymers combined with fungicides) in prevention of the fungal deterioration of ancient Egyptian textiles. Textile samples were treated with 4 selected polymers combined with two selected fungicides. Untreated and treated textile samples were deteriorated by 3 selected active fungal strains isolated from ancient Egyptian textiles. This study reports that most of the tested polymers combined with the tested fungicides prevented the fungal deterioration of textiles. Treatment of ancient textiles by suggested polymers combined with the suggested fungicides not only reinforces these textiles, but also prevents fungal deterioration and increases the durability of these textiles. The tested polymers without fungicides reduce the fungal deterioration of textiles but do not prevent it completely.

  17. A Life Threatening Rash, an Unexpected Cause

    Directory of Open Access Journals (Sweden)

    Dhiraj Jain

    2014-01-01

    Full Text Available We describe a 74-year-old man with purpura fulminans and altered sensorium following an acute febrile illness. Intensive sepsis management was to no avail, until institution of doxycycline therapy following confirmation of scrub typhus. Empirical doxycycline needs to be considered in endemic areas for patients presenting with purpura fulminans.

  18. Life-Threatening Cardiac Manifestations of Pheochromocytoma

    Directory of Open Access Journals (Sweden)

    Luiz R. Leite

    2010-01-01

    Full Text Available Pheochromocytoma is a catecholamine-secreting tumor of the adrenal glands, usually with benign manifestations, whose typical clinical presentation includes the triad of headache, palpitations and diaphoresis. However, a wide range of signs and symptoms may be present. In the cardiovascular system, the most common signs are labile hypertension and sinus tachycardia. Systolic heart failure and ST-segment deviations mimicking myocardial infarction have also been reported, as well as QT interval prolongation and, rarely, ventricular tachycardia. We describe a challenging diagnosis of pheochromocytoma with many cardiovascular manifestations, which could have been missed due to the absence of typical symptoms.

  19. Loperamide Induced Life Threatening Ventricular Arrhythmia

    Directory of Open Access Journals (Sweden)

    Ankit Upadhyay

    2016-01-01

    Full Text Available Loperamide is over-the-counter antidiarrheal agent acting on peripherally located μ opioid receptors. It is gaining popularity among drug abusers as opioid substitute. We report a case of a 46-year-old male that was presented after cardiac arrest. After ruling out ischemia, cardiomyopathy, pulmonary embolism, central nervous system pathology, sepsis, and other drug toxicity, we found out that patient was using around 100 mg of Loperamide to control his chronic diarrhea presumably because of irritable bowel syndrome for last five years and consumed up to 200 mg of Loperamide daily for last two days before the cardiac arrest. We hypothesize that the patient’s QTc prolongation and subsequent cardiac arrest are due to Loperamide toxicity. Patient experienced gradual resolution of tachyarrhythmia and gradual decrease in QTc interval during hospitalization which supports the evidence of causal relationship between Loperamide overdose and potentially fatal arrhythmias. It also provided the clue that patient may have congenital long QT syndrome which was unmasked by Loperamide causing ventricular arrhythmias. This case adds one more pearl in the literature to support that Loperamide overdose related cardiac toxicity does exist and it raises concerns over Loperamide abuse in the community.

  20. Developing deterioration models for Nebraska bridges.

    Science.gov (United States)

    2011-07-01

    Nebraska Bridge Management System (NBMS) was developed in 1999 to assist in optimizing budget allocation for : the maintenance, rehabilitation and replacement needs of highway bridges. This requires the prediction of bridge : deterioration to calcula...

  1. The deterioration of intermediate moisture foods

    Science.gov (United States)

    Labruza, T. P.

    1971-01-01

    Deteriorative reactions are low and food quality high if intermediate moisture content of a food is held at a water activity of 0.6 to 0.75. Information is of interest to food processing and packaging industry.

  2. Multitasking Scheduling Problems with Deterioration Effect

    Directory of Open Access Journals (Sweden)

    Zhanguo Zhu

    2017-01-01

    Full Text Available Multitasking scheduling problems with a deterioration effect incurred by coexisting behavioral phenomena in human-related scheduling systems including deteriorating task processing times and deteriorating rate-modifying activity (DRMA of human operators are addressed. Under the assumption of this problem, the processing of a selected task suffers from the joint effect of available but unfinished waiting tasks, the position-dependent deterioration of task processing time, and the DRMA of human operators. Traditionally, these issues have been considered separately; herein, we address their integration. We propose optimal algorithms to solve the problems to minimize makespan and the total absolute differences in completion time, respectively. Based on the analysis, some special cases and extensions are also discussed.

  3. Deterioration and cost information for bridge management.

    Science.gov (United States)

    2012-05-01

    This study applies contract bid tabulations and elementlevel condition records to develop elementlevel actions, : costs for actions, transition probabilities for models of deterioration of bridge elements, and transition probabilities : for imp...

  4. Deteriorating Inventory Model for Chilled Food

    OpenAIRE

    Yang, Ming-Feng; Tseng, Wei-Chung

    2015-01-01

    With many aspects that affect inventory policy, product perishability is a critical aspect of inventory policy. Most goods will deteriorate during storage and their original value will decline or be lost. Therefore, deterioration should be taken into account in inventory practice. Chilled food products are very common consumer goods that are, in fact, perishable. If the chilled food quality declines over time customers are less likely to buy it. The value the chilled food retains is, however,...

  5. Early warnings of heart rate deterioration

    OpenAIRE

    Almeida, Vânia G.; Nabney, Ian T.

    2016-01-01

    Hospitals can experience difficulty in detecting and responding to early signs of patient deterioration leading to late intensive care referrals, excess mortality and morbidity, and increased hospital costs. Our study aims to explore potential indicators of physiological deterioration by the analysis of vital-signs. The dataset used comprises heart rate (HR) measurements from MIMIC II waveform database, taken from six patients admitted to the Intensive Care Unit (ICU) and diagnosed with sever...

  6. Rule based deterioration identification and management system

    International Nuclear Information System (INIS)

    Kataoka, S.; Pavinich, W.; Lapides, M.

    1993-01-01

    Under the sponsorship of IHI and EPRI, a rule-based screening system has been developed that can be used by utility engineers to determine which deterioration mechanisms are acting on specific LWR components, and to evaluate the efficacy of an age-related deterioration management program. The screening system was developed using the rule-based shell, NEXPERT, which provides traceability to the data sources used in the logic development. The system addresses all the deterioration mechanisms of specific metals encountered in either BWRs or PWRs. Deterioration mechanisms are listed with reasons why they may occur during the design life of LWRs, considering the plant environment, manufacturing process, service history, material chemical composition, etc. of components in a specific location of a LWR. To eliminate the evaluation of inactive deterioration quickly, a tier structure is applied to the rules. The reasons why deterioration will occur are extracted automatically by backward chaining. To reduce the amount of user input, plant environmental data are stored in files as default environmental data. (author)

  7. Prevention

    DEFF Research Database (Denmark)

    Halken, S; Høst, A

    2001-01-01

    , breastfeeding should be encouraged for 4-6 months. In high-risk infants a documented extensively hydrolysed formula is recommended if exclusive breastfeeding is not possible for the first 4 months of life. There is no evidence for preventive dietary intervention neither during pregnancy nor lactation...... populations. These theories remain to be documented in proper, controlled and prospective studies. Breastfeeding and the late introduction of solid foods (>4 months) is associated with a reduced risk of food allergy, atopic dermatitis, and recurrent wheezing and asthma in early childhood. In all infants....... Preventive dietary restrictions after the age of 4-6 months are not scientifically documented....

  8. Reliability analysis and updating of deteriorating systems with subset simulation

    DEFF Research Database (Denmark)

    Schneider, Ronald; Thöns, Sebastian; Straub, Daniel

    2017-01-01

    An efficient approach to reliability analysis of deteriorating structural systems is presented, which considers stochastic dependence among element deterioration. Information on a deteriorating structure obtained through inspection or monitoring is included in the reliability assessment through B...

  9. Eventos com aparente risco de vida: incidência, etiologia e investigação clínica = Apparent life-threatening events: incidence, etiology and investigation

    Directory of Open Access Journals (Sweden)

    Anjos, Alessandra Marques dos

    2005-01-01

    Full Text Available Objetivo: Avaliar a incidência, fatores etiológicos e investigação clínica de pacientes com Evento com Aparente Risco de vida (Apparent life-threatening event – ALTE. Métodos: Revisão da literatura através de pesquisa no banco de dados Medline e LILACS entre 1986- 2006 e publicações da Associação Latinoamericana de Pediatria, selecionados a partir de autores com experiência reconhecida em ALTE. Foram revisados 13 artigos de autores renomados além de 3 consensos: americano sobre apnéia infantil e monitorização domiciliar, consenso latinoamericano sobre ALTE e consenso da sociedade européia para estudo e preven- ção de morte infantil. Resultados: A incidência de ALTE descrita foi de 0,6 a 2,27% nos casos revisados. Quanto a etiologia aproximadamente 50% dos casos de ALTE são sintomáticos, sendo mais freqüente doenças do trato gastrointestinal e neurológicas. A investigação deve ser realizada seguindo protocolo padrão e estar direcionada para o diagnóstico da doença de base que definirá o prognóstico do ALTE. Casos recorrentes sem etiologia definida na investigação inicial necessitam de exames complementares, devendo ser considerado o abuso infantil e Munchausen por procura- ção como diagnóstico diferencial. Conclusão: Como o episódio de ALTE pode ser a manifestação inicial de entidades nosológicas diversas recomenda-se sempre sua investigação diagnóstica direcionada para doença de base

  10. Rock Pore Structure as Main Reason of Rock Deterioration

    Science.gov (United States)

    Ondrášik, Martin; Kopecký, Miloslav

    2014-03-01

    even when the temperature decreases to -20 ºC, and the second group F in which the pore water freezes. It has been found that the rocks from group N contain critical portion of adsorbed water in pores which prevents freezing of the pore water. The presence of adsorbed water enables thermodynamic processes related to osmosis which are dominantly responsible for deterioration of rocks from group N. A high correlation (R = 0.81) between content of adsorbed water and freeze-thaw loss was proved and can be used as durability estimator of rocks from group N. The rock deterioration of group F is caused not only by osmosis, but also by some other processes and influences, such as hydraulic pressure, permeability, grain size, rock and mineral tensile strength, degree of saturation, etc., and the deterioration cannot be predicted yet without the freeze-thaw test. Since the contents of absorbed water and ratio between adsorbed and bulk water (of which the absorbed water consists) is controlled by the porosity and pore structure, it can be concluded that the deterioration of some rocks is strongly related to rock pore structure.

  11. [On the causes of medical errors in life-threatening conditions--a medico-legal assessment based on the material of the chair and Department of Forensic Medicine, Medical University of Silesia, Katowice, collected between 2000 and the end of June, 2006].

    Science.gov (United States)

    Chowaniec, Czesław; Chowaniec, Małgorzata; Kobek, Mariusz; Nowak, Agnieszka

    2007-01-01

    The authors analyzed the medico-legal opinions on medical management issued by the Chair and Department of Forensic Medicine Katowice between 2000 and the end of June 2006. Among 101 cases, in which medical errors were recognized, in 82 instances inappropriate medical management was associated with direct life-threatening conditions, such as acute cardiac syndrome, cerebrocranial injuries, cerebral an aortic aneurysms, pulmonary embolisms, acute abdominal diseases, such as perforated gastric and duodenal ulcers, appendicitis, post-traumatic rupture of the spleen, and acute metabolic disorders. The majority of errors was diagnostic in character and involved the staff of emergency services, admission rooms and detoxification centers. The investigators also drew attention to factors affecting the degree of risk of medical error commission and the most common causes of inappropriate medical in life-threatening conditions.

  12. Bio-deterioration of breadfruit (Artocarpus Communis)

    African Journals Online (AJOL)

    Gaga E Tonukari

    deteriorating breadfruit in storage The freshly harvested breadfruit has 70.2% carbohydrate which reduced to 59.4% within 9 days of storage under room temperature. The amount of fat content, protein and the energy of the breadfruit also reduced in fruit samples stored for 9 days, while there was an increase in the moisture ...

  13. Modelling of Deterioration Effects on Concrete Structures

    Directory of Open Access Journals (Sweden)

    B. Teplý

    2002-01-01

    Full Text Available In order to predict the service life of concrete structures models for deterioration effects are needed. This paper has the form of a survey, listing and describing such analytical models, namely carbonation of concrete, ingress of chlorides, corrosion of reinforcing steel and prestressing tendons. The probabilistic approach is applied.

  14. Prediction of Deterioration of Concrete Bridges

    NARCIS (Netherlands)

    Gaal, G.C.M.

    2004-01-01

    In the early 20th century, the general idea was that concrete structures would never show deterioration. However, in the 1990s concrete structures showed an increase in number of cracks and area of spalling. Especially spalling of the concrete cover could create a harmful situation to the users.

  15. Deterioration of gait and balance over time

    DEFF Research Database (Denmark)

    Kreisel, Stefan H; Blahak, Christian; Bäzner, Hansjörg

    2013-01-01

    Cross-sectional studies have shown an association between the severity of age-related white matter change (ARWMC) and lower body motor function. However, the association between prevalent ARWMC and incident deterioration of balance and gait remains insufficiently investigated. This study investig......Cross-sectional studies have shown an association between the severity of age-related white matter change (ARWMC) and lower body motor function. However, the association between prevalent ARWMC and incident deterioration of balance and gait remains insufficiently investigated. This study...... relevance: given the increasing use of neuroimaging, incidental white matter pathology is common; being able to delineate natural trajectories of balance and gait function given ARWMC may improve patient advice and help optimize allocation of care....

  16. The connection of hydronephrosis and microcirculation deterioration

    Directory of Open Access Journals (Sweden)

    Vorobets Dmytro

    2016-09-01

    Full Text Available In this study, we have analyzed the influence of hydronephrosis upon the microcirculation system, in situations of pyeloureteral junction obstruction. Herein, bulbar conjunctiva has been chosen as the object of this biomicroscopic study because of its simplicity and the method availability in clinic practice. In fulfilling this work, we ascertained the connections between extravascular, intravascular, vascular and general conjunctival indices of the patients before radical and paliatic correction of the pyeloureteral junction obstruction (i.e. by open and laparoscopic pyeloplasty, endopyelotomy, laser resection and balloon dilatation. We concluded that, apart from the proved deterioration of kidney function, systemic deteriorations of microcirculation may be observed in situations of clinically marked hydronephrosis, according to the results of radioisotope renography and excretory urography.

  17. Tree mineral nutrition is deteriorating in Europe

    DEFF Research Database (Denmark)

    Jonard, Mathieu; Fürst, Alfred; Verstraeten, Arne

    2015-01-01

    The response of forest ecosystems to increased atmospheric CO2 is constrained by nutrient availability. It is thus crucial to account for nutrient limitation when studying the forest response to climate change. The objectives of this study were to describe the nutritional status of the main...... that were observed in foliar nutrient concentrations, 20 were decreasing and two were increasing. Some of these trends were alarming, among which the foliar P concentration in F. sylvatica, Q. Petraea and P. sylvestris that significantly deteriorated during 1992–2009. In Q. Petraea and P. sylvestris...... to higher nutrient demand by trees. As the soil nutrient supply was not always sufficient to meet the demands of faster growing trees, this could partly explain the deterioration of tree mineral nutrition. The results suggest that when evaluating forest carbon storage capacity and when planning to reduce CO...

  18. A new deteriorated energy-momentum tensor

    International Nuclear Information System (INIS)

    Duff, M.J.

    1982-01-01

    The stress-tensor of a scalar field theory is not unique because of the possibility of adding an 'improvement term'. In supersymmetric field theories the stress-tensor will appear in a super-current multiplet along with the sypersymmetry current. The general question of the supercurrent multiplet for arbitrary deteriorated stress tensors and their relationship to supercurrent multiplets for models with gauge antisymmetric tensors is answered for various models of N = 1, 2 and 4 supersymmetry. (U.K.)

  19. Deterioration Assessment of Bridge Rubber Bearings

    OpenAIRE

    Gu, Haosheng; 伊藤, 義人; Itoh, Yoshito

    2005-01-01

    Natural rubber (NR) with lead plugs and high damping rubber (HDR) are often used for base-isolated rubber bearings. However, it is usually known that ageing causes rubber performance to drop. This research is to study the deterioration characteristics of these two kinds of bridge rubber bearings through accelerated thermal oxidation tests. The property variations inside the aged rubber blocks are investigated. For natural rubber bearing, the mechanical properties on the surface change the mos...

  20. Deterioration and fermentability of energy cane juice

    Directory of Open Access Journals (Sweden)

    Sandra Regina Ceccato-Antonini

    Full Text Available ABSTRACT: The main interest in the energy cane is the bioenergy production from the bagasse. The juice obtained after the cane milling may constitute a feedstock for the first-generation ethanol units; however, little attention has been dedicated to this issue. In order to verify the feasibility of the energy cane juice as substrate for ethanol production, the objectives of this research were first to determine the microbiological characteristics and deterioration along the time of the juices from two clones of energy cane (Type I and second, their fermentability as feedstock for utilization in ethanol distilleries. There was a clear differentiation in the bacterial and yeast development of the sugarcane juices assayed, being much faster in the energy canes than in sugarcane. The storage of juice for 8 hours at 30oC did not cause impact in alcoholic fermentation for any sample analyzed, although a significant bacterial growth was detected in this period. A decrease of approximately seven percentage points in the fermentative efficiency was observed for energy cane juice in relation to sugarcane in a 24-hour fermentation cycle with the baking yeast. Despite the faster deterioration, the present research demonstrated that the energy cane juice has potential to be used as feedstock in ethanol-producing industries. As far as we know, it is the first research to deal with the characteristics of deterioration and fermentability of energy cane juices.

  1. Do Work Characteristics Predict Health Deterioration Among Employees with Chronic Diseases?

    Science.gov (United States)

    de Wind, Astrid; Boot, Cécile R L; Sewdas, Ranu; Scharn, Micky; van den Heuvel, Swenne G; van der Beek, Allard J

    2017-06-29

    Purpose In our ageing workforce, the increasing numbers of employees with chronic diseases are encouraged to prolong their working lives. It is important to prevent health deterioration in this vulnerable group. This study aims to investigate whether work characteristics predict health deterioration over a 3-year period among employees with (1) chronic diseases, and, more specifically, (2) musculoskeletal and psychological disorders. Methods The study population consisted of 5600 employees aged 45-64 years with a chronic disease, who participated in the Dutch Study on Transitions in Employment, Ability and Motivation (STREAM). Information on work characteristics was derived from the baseline questionnaire. Health deterioration was defined as a decrease in general health (SF-12) between baseline and follow-up (1-3 years). Crude and adjusted logistic regression analyses were performed to investigate prediction of health deterioration by work characteristics. Subgroup analyses were performed for employees with musculoskeletal and psychological disorders. Results At follow-up, 19.2% of the employees reported health deterioration (N = 1075). Higher social support of colleagues or supervisor predicted health deterioration in the crude analyses in the total group, and the groups with either musculoskeletal or psychological disorders (ORs 1.11-1.42). This effect was not found anymore in the adjusted analyses. The other work characteristics did not predict health deterioration in any group. Conclusions This study did not support our hypothesis that work characteristics predict health deterioration among employees with chronic diseases. As our study population succeeded continuing employment to 45 years and beyond, it was probably a relatively healthy selection of employees.

  2. A model for determining condition-based maintenance policies for deteriorating multi-component systems

    NARCIS (Netherlands)

    Hontelez, J.A.M.; Wijnmalen, D.J.D.

    1993-01-01

    We discuss a method to determine strategies for preventive maintenance of systems consisting of gradually deteriorating components. A model has been developed to compute not only the range of conditions inducing a repair action, but also inspection moments based on the last known condition value so

  3. The journey through care: study protocol for a longitudinal qualitative interview study to investigate the healthcare experiences and preferences of children and young people with life-limiting and life-threatening conditions and their families in the West Midlands, UK

    Science.gov (United States)

    Slowther, Anne-Marie; Coad, Jane

    2018-01-01

    Introduction The number of children and young people living with life-limiting and life-threatening conditions is rising. Providing high-quality, responsive healthcare for them and for their families presents a significant challenge. Their conditions are often complex and highly unpredictable. Palliative care is advocated for people with life-limiting and life-threatening conditions, but these services for children are highly variable in terms of availability and scope. Little is known about the lived experiences and preferences of children and their families in terms of the palliative care that they do, or do not, receive. This study aims to produce an in-depth insight into the experiences and preferences of such children and families in order to develop recommendations for the future provision of services. The study will be carried out in the West Midlands, UK. Methods and analysis A qualitative study comprising longitudinal interviews over a 12-month period with children (aged 5–18 years) living with life-limiting or life-threatening conditions and their family members. Data analysis will start with thematic analysis, followed by narrative and cross-case analysis to examine changing experiences and preferences over time, at the family level and within the wider healthcare system. Patient and public involvement (PPI) has informed the design and conduct of the study. Findings will be used to develop recommendations for an integrated model of palliative care for children in partnership with the patient and public involvement (PPI) group. Ethics and dissemination Ethical approval was granted in September 2016 by the National Health Service Health Research Authority (IRAS ID: 196816, REC reference: 16/WM/0272). Findings will be of immediate relevance to healthcare providers, policy-makers, commissioners and voluntary sector organisations in the UK and internationally. Reports will be prepared for these audiences, as well as for children and their families

  4. Deterioration of J-bar reinforcement in abutments and piers.

    Science.gov (United States)

    2011-12-31

    Deterioration and necking of J-bars has been reportedly observed at the interface of the footing and stem wall during the demolition : of older retaining walls and bridge abutments. Similar deterioration has been reportedly observed between the pier ...

  5. Investigation of mechanistic deterioration modeling for bridge design and management.

    Science.gov (United States)

    2017-04-01

    The ongoing deterioration of highway bridges in Colorado dictates that an effective method for allocating limited management resources be developed. In order to predict bridge deterioration in advance, mechanistic models that analyze the physical pro...

  6. Characterization and mediation of microbial deterioration of concrete bridge structures.

    Science.gov (United States)

    2013-04-01

    Samples obtained from deteriorated bridge structures in Texas were cultured in growth medium containing thiosulfate as an energy source and investigated for acid production, type of acid produced by microbes and the bio-deterioration of concrete cyli...

  7. Bridge deterioration models to support Indiana's bridge management system.

    Science.gov (United States)

    2016-02-01

    An effective bridge management system that is equipped with reliable deterioration models enables agency engineers to carry out : monitoring and long-term programming of bridge repair actions. At the project level, deterioration models help the agenc...

  8. Application of Chemical Kinetics to Deterioration of Foods.

    Science.gov (United States)

    Labuza, T. P.

    1984-01-01

    Possible modes of food deterioration (such as microbial decay, nonenzymatic browning, senescence, lipid oxidation) are reviewed. A basic mathematical approach to the kinetics of food deterioration, kinetic approach to accelerating shelf-life deterioration, and shelf-life predictions are discussed. (JN)

  9. Early warnings of heart rate deterioration.

    Science.gov (United States)

    Almeida, Vania G; Nabney, Ian T

    2016-08-01

    Hospitals can experience difficulty in detecting and responding to early signs of patient deterioration leading to late intensive care referrals, excess mortality and morbidity, and increased hospital costs. Our study aims to explore potential indicators of physiological deterioration by the analysis of vital-signs. The dataset used comprises heart rate (HR) measurements from MIMIC II waveform database, taken from six patients admitted to the Intensive Care Unit (ICU) and diagnosed with severe sepsis. Different indicators were considered: 1) generic early warning indicators used in ecosystems analysis (autocorrelation at-1-lag (ACF1), standard deviation (SD), skewness, kurtosis and heteroskedasticity) and 2) entropy analysis (kernel entropy and multi scale entropy). Our preliminary findings suggest that when a critical transition is approaching, the equilibrium state changes what is visible in the ACF1 and SD values, but also by the analysis of the entropy. Entropy allows to characterize the complexity of the time series during the hospital stay and can be used as an indicator of regime shifts in a patient's condition. One of the main problems is its dependency of the scale used. Our results demonstrate that different entropy scales should be used depending of the level of entropy verified.

  10. 77 FR 60907 - Approval and Promulgation of Implementation Plans; Vermont: Prevention of Significant...

    Science.gov (United States)

    2012-10-05

    ... Promulgation of Implementation Plans; Vermont: Prevention of Significant Deterioration; Greenhouse Gas... February 14, 2011. The SIP revision modifies Vermont's Prevention of Significant Deterioration (PSD... at the U.S. Environmental Protection Agency, EPA New England Regional Office, Office of Ecosystem...

  11. 77 FR 5700 - Approval and Promulgation of Implementation Plans; New Hampshire: Prevention of Significant...

    Science.gov (United States)

    2012-02-06

    ... Promulgation of Implementation Plans; New Hampshire: Prevention of Significant Deterioration; Greenhouse Gas... revision modifies New Hampshire's Prevention of Significant Deterioration (PSD) program to establish... of Ecosystem Protection, Air Permits, Toxics, and Indoor Programs Unit, 5 Post Office Square--Suite...

  12. The economy of preventive maintenance of concrete bridges : final report.

    Science.gov (United States)

    2016-03-01

    The most economical approach to maintain existing concrete bridges is by adopting an active preventive maintenance : approach. An in-depth investigation of the combined deterioration effects of various deterioration mechanisms is needed : to establis...

  13. Damage Detection and Deteriorating Structural Systems

    DEFF Research Database (Denmark)

    Long, Lijia; Thöns, Sebastian; Döhler, Michael

    2017-01-01

    This paper addresses the quantification of the value of damage detection system and algorithm information on the basis of Value of Information (VoI) analysis to enhance the benefit of damage detection information by providing the basis for its optimization before it is performed and implemented....... The approach of the quantification the value of damage detection information builds upon the Bayesian decision theory facilitating the utilization of damage detection performance models, which describe the information and its precision on structural system level, facilitating actions to ensure the structural...... integrity and facilitating to describe the structural system performance and its functionality throughout the service life. The structural system performance is described with its functionality, its deterioration and its behavior under extreme loading. The structural system reliability given the damage...

  14. Optimal Control Inventory Stochastic With Production Deteriorating

    Science.gov (United States)

    Affandi, Pardi

    2018-01-01

    In this paper, we are using optimal control approach to determine the optimal rate in production. Most of the inventory production models deal with a single item. First build the mathematical models inventory stochastic, in this model we also assume that the items are in the same store. The mathematical model of the problem inventory can be deterministic and stochastic models. In this research will be discussed how to model the stochastic as well as how to solve the inventory model using optimal control techniques. The main tool in the study problems for the necessary optimality conditions in the form of the Pontryagin maximum principle involves the Hamilton function. So we can have the optimal production rate in a production inventory system where items are subject deterioration.

  15. Capacitive sensor for engine oil deterioration measurement

    Science.gov (United States)

    Shinde, Harish; Bewoor, Anand

    2018-04-01

    A simple system or mechanism for engine Oil (lubricating oil) deterioration monitoring is a need. As engine oil is an important element in I C engines and it is exposed to various strains depending on the operating conditions. If it becomes contaminated with dirt and metal particles, it can become too thick or thin and loses its protective properties, leads to unwanted friction. In turn, to avoid an engine failure, the oil must be changed before it loses its protective properties, which may be harmful to engine which deteriorates vehicle performance. At the same time, changing the lubricant too early, cause inefficient use of already depleting resources, also unwanted impact on the environment and economic reasons. Hence, it will be always helpful to know the quality of the oil under use. With this objective, the research work had been undertaken to develop a simple capacitance sensor for quantification of the quality of oil under use. One of the investigated parameter to quantify oil degradation is Viscosity (as per standard testing procedure: DIN 51562-1). In this research work, an alternative method proposed which analyzing change in capacitance of oil, to quantify the quality of oil underuse and compared to a conventional standard method. The experimental results reported in this paper shows trend for the same. Engine oil of grade SAE 15W40 used for light-duty vehicle, vans and passenger cars is used for experimentation. Suggested method can form a base for further research to develop a cost-effective method for indicating the time to change in engine oil quality have been presented.

  16. Tree mineral nutrition is deteriorating in Europe.

    Science.gov (United States)

    Jonard, Mathieu; Fürst, Alfred; Verstraeten, Arne; Thimonier, Anne; Timmermann, Volkmar; Potočić, Nenad; Waldner, Peter; Benham, Sue; Hansen, Karin; Merilä, Päivi; Ponette, Quentin; de la Cruz, Ana C; Roskams, Peter; Nicolas, Manuel; Croisé, Luc; Ingerslev, Morten; Matteucci, Giorgio; Decinti, Bruno; Bascietto, Marco; Rautio, Pasi

    2015-01-01

    The response of forest ecosystems to increased atmospheric CO2 is constrained by nutrient availability. It is thus crucial to account for nutrient limitation when studying the forest response to climate change. The objectives of this study were to describe the nutritional status of the main European tree species, to identify growth-limiting nutrients and to assess changes in tree nutrition during the past two decades. We analysed the foliar nutrition data collected during 1992-2009 on the intensive forest monitoring plots of the ICP Forests programme. Of the 22 significant temporal trends that were observed in foliar nutrient concentrations, 20 were decreasing and two were increasing. Some of these trends were alarming, among which the foliar P concentration in F. sylvatica, Q. Petraea and P. sylvestris that significantly deteriorated during 1992-2009. In Q. Petraea and P. sylvestris, the decrease in foliar P concentration was more pronounced on plots with low foliar P status, meaning that trees with latent P deficiency could become deficient in the near future. Increased tree productivity, possibly resulting from high N deposition and from the global increase in atmospheric CO2, has led to higher nutrient demand by trees. As the soil nutrient supply was not always sufficient to meet the demands of faster growing trees, this could partly explain the deterioration of tree mineral nutrition. The results suggest that when evaluating forest carbon storage capacity and when planning to reduce CO2 emissions by increasing use of wood biomass for bioenergy, it is crucial that nutrient limitations for forest growth are considered. © 2014 John Wiley & Sons Ltd.

  17. An inventory model of instantaneous deteriorating items with controllable deterioration rate for time dependent demand and holding cost

    Directory of Open Access Journals (Sweden)

    Vinod Kumar Mishra

    2013-06-01

    Full Text Available Purpose: The purpose of this paper to develop an inventory model for instantaneous deteriorating items with the consideration of the facts that the deterioration rate can be controlled by using the preservation technology (PT and the holding cost & demand rate both are linear function of time which was treated as constant in most of the deteriorating inventory model. Design/methodology/approach: Developed the mathematical equation of deterministic deteriorating inventory model in which demand rate and holding cost both is linear function of time, deterioration rate is constant, backlogging rate is variable and depend on the length of the next replenishment, shortages are allowed and partially backlogged and obtain an analytical solution which optimizes the total cost of the proposed inventory model. Findings: The model can be applied for optimizing the total inventory cost of deteriorating items inventory for such business enterprises where they use the preservation technology to control the deterioration rate under other assumptions of the model. Originality/value: The inventory system for deteriorating items has been an object of study for a long time, but little is known about the effect of investing in reducing the rate of product deterioration and their significant impact in the business. The proposed model is effective as well as efficient for the business organization that uses the preservation technology to reduce the deterioration rate of the instantaneous deteriorating items of the inventory.

  18. Takotsubo Cardiomyopathy in Intensive Care Unit: Prevention, Diagnosis and Management

    Directory of Open Access Journals (Sweden)

    Hannah Masoud

    2016-01-01

    Full Text Available Accurate diagnosis of Takotsubo Cardiomyopathy has substantial prognostic implications in an intensive care unit, given its increased mortality risk and association with life-threatening complications. This report seeks to discuss diagnostic modalities that can be useful in accurately differentiating Takotsubo Cardiomyopathy from Acute Coronary Syndrome, and also briefly discuss prevention and management of this cardiomyopathy in an intensive care unit. For critically ill Takotsubo patients, intensive clinicians can consider establishment of diagnosis by specific electrocardiograph changes, distinctive marked release of cardiac enzymes, characteristic echocardiograph findings, as well as invasive coronary angiography or noninvasive cardiac magnetic imaging.

  19. Deterioration and conservation of plasticized poly (vinyl chloride) objects

    DEFF Research Database (Denmark)

    Shashoua, Yvonne

    2002-01-01

    Plasticized poly (vinyl chloride) (PVC) in museum collections deteriorates by migration, loss and chemical breakdown of the plasticizer, accompanied by dehydrochlorination of the polymer. The extent, rate and mechanisms of deterioration of new and deteriorated plasticized PVC were compared during...... of samples. Optical densitometry was used to quantify darkening of the PVC component of samples. Degradation of new and deteriorated PVC was inhibited by enclosing it in a non-adsorbent material, such as glass containing non-agitated air. Such storage inhibited migration and loss of DEHP....

  20. Early deterioration of coarse woody debris.

    Energy Technology Data Exchange (ETDEWEB)

    Tainter, Frank, H.; McMinn, James, W.

    1999-02-16

    Tainter, F.H., and J.W. McMinn. 1999. Early deterioration of coarse woody debris. In: Proc. Tenth Bien. South. Silv. Res. Conf. Shreveport, LA, February 16-18, 1999. Pp. 232-237 Abstract - Coarse woody debris (CWD) is an important structural component of southern forest ecosystems. CWD loading may be affected by different decomposition rates on sites of varying quality. Bolts of red oak and loblolly pine were placed on plots at each of three (hydric, mesic. and xerlc) sites at the Savannah River Site and sampled over a I6-week period. Major changes were in moisture content and nonstructural carbohydrate content (total carbohydrates, reducing sugars, and starch) of sapwood. Early changes in nonstructural carbohydrate levels following placement of the bolts were likely due to reallocation of these materials by sapwood parenchyma cells. These carbohydrates later formed pools increasingly metabolized by bacteria and invading fungi. Most prevalent fungi in sapwood were Ceratocysfis spp. in pine and Hypoxy/on spp. in oak. Although pine sapwood became blue stained and oak sapwood exhibited yellow soft decay with black zone lines, estimators of decay (specific gravity, sodium hydroxide solubility, and holocellulose content) were unchanged during the 16-week study period. A small effect of site was detected for starch content of sapwood of both species. Fungal biomass in sapwood of both species, as measured by ergosterol content, was detectable at week zero, increased somewhat by week three and increased significantly by week 16.

  1. Evento com aparente risco de morte recorrente como manifestação inicial de síndrome miastênica congênita Evento con aparente riesgo de muerte recurrente como manifestación inicial de síndrome miasténico congénito Recurrent apparent life-threatening event as the first manifestation of congenital myasthenia

    Directory of Open Access Journals (Sweden)

    Mariana Tresoldi das N. Romaneli

    2013-03-01

    miastenia congénita. Después de la confirmación del diagnóstico, se mantuvo el tratamiento ambulatorial con piridostigmina, con recuperación nutricional y neurológica, sin nuevos eventos con aparente riesgo de muerte en los tres años siguientes. COMENTARIOS: La investigación minuciosa de las causas de eventos con aparente riesgo de muerte puede llevar a diagnósticos menos frecuentes que exigen tratamiento específico, como la miastenia congénita.OBJECTIVE: To alert pediatricians about the importance of a careful investigation on recurrent apparent life-threatening events. Reports of the association of these events with congenital myasthenic syndromes were not found. CASE DESCRIPTION: A seven-month-old infant with recurrent apparent life-threatening events was admitted for investigation. During hospital stay, she presented cyanosis and respiratory failure, requiring mechanical ventilation for three days. After clinical improvement, hypotheses of gastroesophageal reflux and pulmonary aspiration were ruled out. The presence of eyelid ptosis, general hypotonia and weak crying led to the suspicion of congenital myasthenia, which was confirmed. Treatment with oral piridostigmine led to neurological and nutritional normalization, without any other apparent life-threatening event during the next three years. COMMENTS: The careful etiological investigation of apparent life-threatening events may lead to rare diagnosis that requires specific treatments, such as congenital myasthenia.

  2. 40 CFR 52.1436 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 4 2010-07-01 2010-07-01 false Significant deterioration of air quality. 52.1436 Section 52.1436 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Significant deterioration of air quality. The requirements of sections 160 through 165 of the Clean Air Act...

  3. 40 CFR 52.1029 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 4 2010-07-01 2010-07-01 false Significant deterioration of air quality. 52.1029 Section 52.1029 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Significant deterioration of air quality. The program to review operation and construction of new and modified...

  4. 40 CFR 52.1116 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... quality. 52.1116 Section 52.1116 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Significant deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air... deterioration of air quality. (b) The following provisions of 40 CFR 52.21 are hereby incorporated and made a...

  5. 40 CFR 52.581 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 3 2010-07-01 2010-07-01 false Significant deterioration of air quality. 52.581 Section 52.581 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... deterioration of air quality. (a) All applications and other information required pursuant to § 52.21 of this...

  6. 40 CFR 52.2131 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 4 2010-07-01 2010-07-01 false Significant deterioration of air quality. 52.2131 Section 52.2131 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Significant deterioration of air quality. (a)-(b) [Reserved] (c) All applications and other information...

  7. 40 CFR 52.181 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 3 2010-07-01 2010-07-01 false Significant deterioration of air quality. 52.181 Section 52.181 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... deterioration of air quality. (a) The plan submitted by the Governor of Arkansas as follows: (1) April 23, 1981...

  8. 40 CFR 52.1280 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 4 2010-07-01 2010-07-01 false Significant deterioration of air quality. 52.1280 Section 52.1280 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Significant deterioration of air quality. (a) All applications and other information required pursuant to § 52...

  9. 40 CFR 52.2380 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 4 2010-07-01 2010-07-01 false Significant deterioration of air quality. 52.2380 Section 52.2380 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Significant deterioration of air quality. The program to review the construction and operation of new and...

  10. 40 CFR 52.2083 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 4 2010-07-01 2010-07-01 false Significant deterioration of air quality. 52.2083 Section 52.2083 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Significant deterioration of air quality. (a) The Rhode Island plan, as submitted, is approved as meeting the...

  11. 40 CFR 52.96 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... quality. 52.96 Section 52.96 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... deterioration of air quality. (a) The State of Alaska Department of Environmental Conservation Air Quality... deterioration of air quality. (b) The requirements of sections 160 through 165 of the Clean Air Act are not met...

  12. 40 CFR 52.382 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 3 2010-07-01 2010-07-01 false Significant deterioration of air quality. 52.382 Section 52.382 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... deterioration of air quality. (a) The requirements of sections 160 through 165 of the Clean Air Act are not met...

  13. 40 CFR 52.884 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 3 2010-07-01 2010-07-01 false Significant deterioration of air quality. 52.884 Section 52.884 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... deterioration of air quality. (a) The requirements of section 160 through 165 of the Clean Air Act, as amended...

  14. Concern With Environmental Deterioration and Attitudes Toward Population Limitation

    Science.gov (United States)

    Barnett, Larry D.

    1970-01-01

    Analysis of Gallup Poll data of Junuary 1969 reveals weak association between concern about environmental deterioration and the recognition of need for eventual limitation of human population. Suggests that to increase favorable attitudes to population control, role of overpopulation in causing environmental deterioration needs to be presented to…

  15. microbial deterioration studies of military cotton and leather based ...

    African Journals Online (AJOL)

    BSN

    Microbial deterioration studies on selected cotton based uniforms were carried out using test-fungi earlier isolated from the uniforms stored in the Military Warehouses. These fungi includes, Aspergillus nigar, A. fumigatus, C. gwbosum, C. thermophile, Var. coprohile, B. stolonifer and S. pulveru/entum. The deteriorative ...

  16. Microbial deterioration studies of military cotton and leather based ...

    African Journals Online (AJOL)

    Microbial deterioration studies on selected cotton based uniforms were carried out using test-fungi earlier isolated from the uniforms stored in the Military Warehouses. These fungi includes, Aspergillus nigar, A. fumigatus, C. gwbosum, C. thermophile, Var.coprohile, B. stolonifer and S. pulverulentum. The deteriorative ...

  17. Acute functional deterioration in a child with cerebral palsy.

    LENUS (Irish Health Repository)

    Smyth, Elizabeth

    2012-01-01

    We describe a case of acute functional deterioration in a 13-year-old girl with severe spastic diplegia (GMFCS III) and a new diagnosis of diffuse intrinsic pontine glioma (DIPG). She presented with acute deterioration in mobility and motor function over 1 month, which was associated with dysarthria, dysphagia and behavioural change. Her mother had noticed subtle functional deterioration over the 2 months prior to this. Her physiotherapist who was concerned about her acute functional deterioration referred her for emergency review. Neurological imaging revealed a diffuse pontine lesion consistent with DIPG. She was subsequently referred to oncology. She deteriorated further, clinically, over the next few days and following discussion with the team; her family opted for palliative treatment, given the poor prognosis associated with DIPG.

  18. Nocturnal bladder emptying: a simple technique for reversing urinary tract deterioration in children with neurogenic bladder.

    Science.gov (United States)

    Koff, Stephen A; Gigax, Michael R; Jayanthi, Venkata R

    2005-10-01

    simply represent normal progression of NGB disease. These changes may be avoidable consequences of untreated SNOB. Early institution of NBE may prevent urinary tract deterioration from developing in this population.

  19. Analysis of Pitch Gear Deterioration using Indicators

    DEFF Research Database (Denmark)

    Nielsen, Jannie Jessen; Sørensen, John Dalsgaard

    2011-01-01

    of the damage, and can be used for Bayesian updating of a damage model used for risk-based decision making. For this decision problem, the risk of failure should be compared to the cost of preventive maintenance. The hypothesis that the maximum pitch motor torque is an indicator of the damage size is supported...... by results from a measurement campaign where measurements are available both before and after maintenance was performed. The loads dramatically decreased after the maintenance. However, after a few more months of measurements, and by including data from the SCADA system, it became obvious that seasonal...

  20. 76 FR 34630 - Approval and Promulgation of Implementation Plans; New Hampshire: Prevention of Significant...

    Science.gov (United States)

    2011-06-14

    ... Promulgation of Implementation Plans; New Hampshire: Prevention of Significant Deterioration; Greenhouse Gas... Deterioration (PSD) program to establish appropriate emission thresholds for determining which new stationary... Protection Agency, EPA New England Regional Office, Office of Ecosystem Protection, 5 Post Office Square...

  1. Performance assessment of deteriorated and retrofitted steel HP piles.

    Science.gov (United States)

    2016-06-01

    Steel piles are known to deteriorate at high rates in Nebraska, partially as a result of exposure to weathering, and partially due to corrosive soils. The Nebraska Department of Roads (NDOR) employs a reinforced concrete jacket to slow the progressio...

  2. Primary Prevention of Food Allergy.

    Science.gov (United States)

    Greenhawt, Matthew J; Fleischer, David M

    2017-04-01

    Food allergy is estimated to affect approximately 8% of children in the USA. This is a disease without any known treatment or cure and, for some, a disease that can be quite severe, even life-threatening. While recent advances in potential treatment have made remarkable strides, with two food-targeted immunotherapy products now in phase III trials, perhaps the biggest gains in the field have come in the advent of potential preventative strategies to avoid the development of food allergy in high-risk individuals. There have been multiple, randomized, controlled trials (RCTs) performed in the past 5 years that have demonstrated significant risk reduction from early allergen introduction. These include two trials for early peanut introduction and five trials for early egg introduction in the first year of life. The results indicate that primary prevention of food allergy through early allergen introduction may represent a strategy that could potentially avert tens of thousands of children from becoming food allergic. In support of the data for peanut, the National Institute of Allergy and Infectious Diseases recently sponsored an addendum to the 2010 food allergy guidelines, specifically recommending peanut be introduced in both high- and standard-risk infants to reduce the risk of developing peanut allergy. To date, no formal recommendations have been made for egg, however. This review will focus on the latest evidence supporting early introduction as a strategy to prevent food allergy, as well as on practical aspects for its successful implementation.

  3. A literature review of time-deterioration prediction techniques

    Science.gov (United States)

    Purvis, Ronald L.; Graber, Donald R.; Clear, Kenneth C.; Markow, Michael J.

    1992-07-01

    A literature review of existing deterioration models used to predict corrosion-related deterioration on reinforced concrete bridges is presented. Most models in this review are based on the performance of all bridges in a system. In addition, the model information was developed using condition ratings provided by technical-inspectors performing visual surveys in accordance with the National Bridge Inspection Standards (NBIS). Discussion of the models illuminates equation definitions, research parameters, and life-cycle cost analyses. An annotated bibliography is included.

  4. Measurement of Deterioration of Frying Oil Using Electrical Properties

    OpenAIRE

    羽倉, 義雄; 佐々木, 芳浩; 鈴木, 寛一

    2006-01-01

    In this study, the relationship between the electrical properties of frying oil (relative dielectric constant and conductance) and its deterioration indicators (acid value, amounts of polymerized triacylglycerols and chromaticity) were examined, focusing on the changes in electrical properties that accompany deterioration. The samples of frying oil used in this experiment were collected from fried food processing sites (school, hospital and factory feeding centers) and were collected at closi...

  5. Bundle Pricing Decisions for Fresh Products with Quality Deterioration

    OpenAIRE

    Fang, Yan; Jiang, Yiping; Han, Xingxing

    2018-01-01

    How to sell fresh products quickly to decrease the storage cost and to meet customer quality requirement is of vital importance in the food supply chain. Bundling fresh products is an efficient strategy to promote sales and reduce storage pressure of retailers. In this paper, we consider the bundle pricing decisions for homogeneous fresh products with quality deterioration. The value of fresh products with quality deterioration is approximated as an exponential function based on which custome...

  6. Modelling of the Deterioration of Reinforced Concrete Structures

    DEFF Research Database (Denmark)

    Thoft-Christensen, Palle

    Stochastic modelling of the deterioration of reinforced concrete structures is addressed in this paper on basis of a detailed modelling of corrosion initiation and corrosion cracking. It is proposed that modelling of the deterioration of concrete should be based on a sound understanding...... of the physical and chemical properties of the concrete. The relationship between rebar corrosion and crack width is investigated. A new service life definition based on evolution of the corrosion crack width is proposed....

  7. Preventing School Violence

    Science.gov (United States)

    Rulloda, Rudolfo Barcena

    2011-01-01

    School violence has mushroomed into a devastating epidemic and is deteriorating the basic foundation of education. In this article, the author will present several teaching strategies for preventing school violence from becoming an arduous enigma within the classroom and school environments, and focus on assessment and reflection in order to…

  8. Prevention of complications in glycogen storage disease type Ia with optimization of metabolic control.

    Science.gov (United States)

    Dambska, M; Labrador, E B; Kuo, C L; Weinstein, D A

    2017-08-01

    Prior to 1971, type Ia glycogen storage disease was marked by life-threatening hypoglycemia, lactic acidosis, severe failure to thrive, and developmental delay. With the introduction of continuous feeds in the 1970s and cornstarch in the 1980s, the prognosis improved, but complications almost universally developed. Changes in the management of type Ia glycogen storage disease have resulted in improved metabolic control, and this manuscript reviews the increasing evidence that complications can be delayed or prevented with optimal metabolic control as previously was seen in diabetes. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  9. Electrical failure during cardiopulmonary bypass: an evaluation of incidence, causes, management and guidelines for preventative measures.

    LENUS (Irish Health Repository)

    Hargrove, M

    2012-02-03

    The incidence of electrical failure during cardiopulmonary bypass (CPB) has been reported to occur in approximately 1 per 1000 cases. While the resultant morbidity and mortality is low, electrical failure is a life-threatening scenario. We report three major electrical failures during CPB in a patient population of 3500 over a 15-year period. These cases involved mains failure and generator shut down, mains failure and generator power surge, and failure of the uninterruptable power supply (UPS), which caused protected sockets to shut down. Protocols for preventative maintenance, necessary equipment, battery backup and guidelines for the successful management of such accidents during CPB are discussed.

  10. Knowledge of the Warning Signs of Foot Ulcer Deterioration Among Patients With Diabetes.

    Science.gov (United States)

    Chin, Yen-Fan; Yeh, Jiun-Ting; Yu, Hsing-Yi; Weng, Li-Chueh

    2017-12-07

    Seeking treatment in a timely manner may prevent lower limb amputation subsequent to diabetic foot ulcers. Knowledge regarding the warning signs is one important factor that is related to the timely treatment seeking of patients with diabetic foot ulcers. However, there is no previous research on which aspects of such knowledge that patients with diabetes are lacking. The aims of this study were to test the psychometric properties of a questionnaire that was designed to assess the knowledge of the warning signs of diabetic foot ulcer deterioration and to determine the knowledge of these warning signs among patients with a history of diabetic foot ulcers. A cross-sectional study design was used. Patients with a history of diabetic foot ulcers were recruited using convenience sampling (N = 385). Data were analyzed using Spearman's rank correlation and the Mann-Whitney U test. The questionnaire showed good known-group validity, satisfied internal consistency (Kuder-Richardson Formula 20 = .82), and exhibited acceptable 2-week test-retest reliability (Spearman's rho coefficient = .75). More than 30% of the participants were unaware of the warning signs of peripheral vascular insufficiency and severe infection. Of the participants, 75.8% felt that the time to seek medical treatment of diabetic foot ulcers was when they experienced wound deterioration. Those who held this opinion had significantly less knowledge regarding the warning signs of diabetic foot ulcer deterioration than did those who had not. Other factors that were significantly associated with less knowledge included being older, having less education, not having an existing foot ulcer, having no foot ulcer treatment history, and never having received education regarding foot ulcers. The questionnaire showed adequate validity and reliability and thus may be used by healthcare practitioners and researchers to assess the knowledge of at-risk patients regarding the warning signs of diabetic foot ulcer

  11. Optimal pricing and marketing planning for deteriorating items.

    Directory of Open Access Journals (Sweden)

    Seyed Reza Moosavi Tabatabaei

    Full Text Available Optimal pricing and marketing planning plays an essential role in production decisions on deteriorating items. This paper presents a mathematical model for a three-level supply chain, which includes one producer, one distributor and one retailer. The proposed study considers the production of a deteriorating item where demand is influenced by price, marketing expenditure, quality of product and after-sales service expenditures. The proposed model is formulated as a geometric programming with 5 degrees of difficulty and the problem is solved using the recent advances in optimization techniques. The study is supported by several numerical examples and sensitivity analysis is performed to analyze the effects of the changes in different parameters on the optimal solution. The preliminary results indicate that with the change in parameters influencing on demand, inventory holding, inventory deteriorating and set-up costs change and also significantly affect total revenue.

  12. Application of Artificial Intelligence for Bridge Deterioration Model

    Science.gov (United States)

    Chen, Zhang; Wu, Yangyang; Sun, Lijun

    2015-01-01

    The deterministic bridge deterioration model updating problem is well established in bridge management, while the traditional methods and approaches for this problem require manual intervention. An artificial-intelligence-based approach was presented to self-updated parameters of the bridge deterioration model in this paper. When new information and data are collected, a posterior distribution was constructed to describe the integrated result of historical information and the new gained information according to Bayesian theorem, which was used to update model parameters. This AI-based approach is applied to the case of updating parameters of bridge deterioration model, which is the data collected from bridges of 12 districts in Shanghai from 2004 to 2013, and the results showed that it is an accurate, effective, and satisfactory approach to deal with the problem of the parameter updating without manual intervention. PMID:26601121

  13. Optimal pricing and marketing planning for deteriorating items.

    Science.gov (United States)

    Moosavi Tabatabaei, Seyed Reza; Sadjadi, Seyed Jafar; Makui, Ahmad

    2017-01-01

    Optimal pricing and marketing planning plays an essential role in production decisions on deteriorating items. This paper presents a mathematical model for a three-level supply chain, which includes one producer, one distributor and one retailer. The proposed study considers the production of a deteriorating item where demand is influenced by price, marketing expenditure, quality of product and after-sales service expenditures. The proposed model is formulated as a geometric programming with 5 degrees of difficulty and the problem is solved using the recent advances in optimization techniques. The study is supported by several numerical examples and sensitivity analysis is performed to analyze the effects of the changes in different parameters on the optimal solution. The preliminary results indicate that with the change in parameters influencing on demand, inventory holding, inventory deteriorating and set-up costs change and also significantly affect total revenue.

  14. Optimal dynamic pricing and replenishment policies for deteriorating items

    Directory of Open Access Journals (Sweden)

    Masoud Rabbani

    2014-08-01

    Full Text Available Marketing strategies and proper inventory replenishment policies are often incorporated by enterprises to stimulate demand and maximize profit. The aim of this paper is to represent an integrated model for dynamic pricing and inventory control of deteriorating items. To reflect the dynamic characteristic of the problem, the selling price is defined as a time-dependent function of the initial selling price and the discount rate. In this regard, the price is exponentially discounted to compensate negative impact of the deterioration. The planning horizon is assumed to be infinite and the deterioration rate is time-dependent. In addition to price, the demand rate is dependent on advertisement as a powerful marketing tool. Several theoretical results and an iterative solution algorithm are developed to provide the optimal solution. Finally, to show validity of the model and illustrate the solution procedure, numerical results are presented.

  15. Application of Artificial Intelligence for Bridge Deterioration Model.

    Science.gov (United States)

    Chen, Zhang; Wu, Yangyang; Li, Li; Sun, Lijun

    2015-01-01

    The deterministic bridge deterioration model updating problem is well established in bridge management, while the traditional methods and approaches for this problem require manual intervention. An artificial-intelligence-based approach was presented to self-updated parameters of the bridge deterioration model in this paper. When new information and data are collected, a posterior distribution was constructed to describe the integrated result of historical information and the new gained information according to Bayesian theorem, which was used to update model parameters. This AI-based approach is applied to the case of updating parameters of bridge deterioration model, which is the data collected from bridges of 12 districts in Shanghai from 2004 to 2013, and the results showed that it is an accurate, effective, and satisfactory approach to deal with the problem of the parameter updating without manual intervention.

  16. Bundle Pricing Decisions for Fresh Products with Quality Deterioration

    Directory of Open Access Journals (Sweden)

    Yan Fang

    2018-01-01

    Full Text Available How to sell fresh products quickly to decrease the storage cost and to meet customer quality requirement is of vital importance in the food supply chain. Bundling fresh products is an efficient strategy to promote sales and reduce storage pressure of retailers. In this paper, we consider the bundle pricing decisions for homogeneous fresh products with quality deterioration. The value of fresh products with quality deterioration is approximated as an exponential function based on which customer’s reservation prices are calculated. A nonlinear mixed integer programming model is used to formulate the bundle pricing problem for fresh products. By adding auxiliary decision variables, this model is converted into a mixed integer linear program. Numerical experiments and sensitive analysis are conducted to provide managerial insights for bundling fresh products with quality deterioration.

  17. Optimal pricing and marketing planning for deteriorating items

    Science.gov (United States)

    Moosavi Tabatabaei, Seyed Reza; Sadjadi, Seyed Jafar; Makui, Ahmad

    2017-01-01

    Optimal pricing and marketing planning plays an essential role in production decisions on deteriorating items. This paper presents a mathematical model for a three-level supply chain, which includes one producer, one distributor and one retailer. The proposed study considers the production of a deteriorating item where demand is influenced by price, marketing expenditure, quality of product and after-sales service expenditures. The proposed model is formulated as a geometric programming with 5 degrees of difficulty and the problem is solved using the recent advances in optimization techniques. The study is supported by several numerical examples and sensitivity analysis is performed to analyze the effects of the changes in different parameters on the optimal solution. The preliminary results indicate that with the change in parameters influencing on demand, inventory holding, inventory deteriorating and set-up costs change and also significantly affect total revenue. PMID:28306750

  18. Application of Artificial Intelligence for Bridge Deterioration Model

    Directory of Open Access Journals (Sweden)

    Zhang Chen

    2015-01-01

    Full Text Available The deterministic bridge deterioration model updating problem is well established in bridge management, while the traditional methods and approaches for this problem require manual intervention. An artificial-intelligence-based approach was presented to self-updated parameters of the bridge deterioration model in this paper. When new information and data are collected, a posterior distribution was constructed to describe the integrated result of historical information and the new gained information according to Bayesian theorem, which was used to update model parameters. This AI-based approach is applied to the case of updating parameters of bridge deterioration model, which is the data collected from bridges of 12 districts in Shanghai from 2004 to 2013, and the results showed that it is an accurate, effective, and satisfactory approach to deal with the problem of the parameter updating without manual intervention.

  19. The enhancement of the deteriorated South African bond options market

    Directory of Open Access Journals (Sweden)

    Coert Frederik Erasmus

    2015-06-01

    Full Text Available nvestments, especially those in the bond market, carry a level of risk. Risks in the bond market can be mitigated by transacting in option contracts. In the developing South African economy, trading activity of over-the-counter (OTC bond options decreased significantly. Possible deteriorating factors and interventions to enhance OTC bond options were investigated in this research. Experts in the OTC bond option market were surveyed and the quantitative data collected was analysed with descriptive statistical methods. Results indicated that three factors were positively identified as deteriorating factors in the OTC bond option market and that five different interventions were possible to possible enhance this market.

  20. A production inventory model with deteriorating items and shortages

    Directory of Open Access Journals (Sweden)

    Samanta G.P.

    2004-01-01

    Full Text Available A continuous production control inventory model for deteriorating items with shortages is developed. A number of structural properties of the inventory system are studied analytically. The formulae for the optimal average system cost, stock level, backlog level and production cycle time are derived when the deterioration rate is very small. Numerical examples are taken to illustrate the procedure of finding the optimal total inventory cost, stock level, backlog level and production cycle time. Sensitivity analysis is carried out to demonstrate the effects of changing parameter values on the optimal solution of the system.

  1. [Neonatal subgaleal haemorrhage; a potential life-threatening extracranial haemorrhage

    NARCIS (Netherlands)

    Fuijkschot, J.; Antonius, T.A.J.; Meijers, P.W.; Vrancken, S.L.A.G.

    2008-01-01

    A female neonate delivered at term developed hypovolemic shock due to a subgaleal haemorrhage, i.e. extracranial bleeding between the galea aponeurotica and the cranial periosteum. The subgaleal haemorrhage was most likely the result of a traumatic vacuum extraction. The patient was treated with

  2. Life threatening causes of syncope: channelopathies and cardiomyopathies.

    Science.gov (United States)

    Herman, Adam; Bennett, Matthew T; Chakrabarti, Santabhanu; Chakrabarti, Santabahnu; Krahn, Andrew D

    2014-09-01

    Syncope is common, has a high recurrence rate and carries a risk of morbidity and, dependent on the cause, mortality. Although the majority of patients with syncope have a benign prognosis, syncope as a result of cardiomyopathy or channelopathy carries a poor prognosis. In addition, the identification of these disorders allows for the institution of treatments, which are effective at reducing the risk of both syncope and mortality. It is for these reasons that the identification of a cardiomyopathy or channelopathy in patients with syncope is crucial. This review article will describe the characteristics of common cardiomyopathies and channelopathies and their investigation. Copyright © 2014 Elsevier B.V. All rights reserved.

  3. Serious life threatening upper airway obstruction in congenital ...

    African Journals Online (AJOL)

    Reda A. Abolila

    2012-07-15

    Jul 15, 2012 ... some cases including: del (6)(q12q15); monosomy 9 q; trisomy. 16 q [6,7]. For the surviving babies spontaneous regression is usual (within one to two years) ... of Turner syndrome and showed regression of the lesions [13]. 2. Case presentation. Our patient was a girl the product of full term (38 weeks ges-.

  4. Acute pancreatitis associated with hypertriglyceridemia: a life-threatening complication.

    Science.gov (United States)

    Kayataş, Semra Eser; Eser, Mehmet; Cam, Cetin; Cogendez, Ebru; Guzin, Kadir

    2010-03-01

    Acute pancreatitis is rare cause in pregnancy and gallstones are clearly the most common cause of pancreatitis during pregnancy. Only a small percentage of women with acute pancreatitis are associated with hypertriglyceridemia and it is most often noted during the last two trimesters of pregnancy. Hypertriglyceridemia is a rare cause of pancreatitis in pregnant women and complication such as pancreatitis carries a higher risk of mortality for both the mother and the fetus. Our purpose was to report our experience with acute pancreatitis as a lethal complication of hypertriglyceridemia during the third trimester of pregnancy.

  5. Life threatening spinal shock and complete neurological recovery ...

    African Journals Online (AJOL)

    It is against this background that we present a 41 year old male with cervical spinal stenosis who developed marked quadriparesis and respiratory embarrassment following collision with a colleague. He was admitted to the intensive care unit, electively sedated, paralysed and ventilated for a period of 48 hours. During the ...

  6. Life threatening arrhythmias: Knowledge and skills among nurses ...

    African Journals Online (AJOL)

    User

    It is important that hospital administration take into consideration the identified areas of deficiency and work to improve the skills among nurses and enhance optimal care of patients. Keywords: arrhythmias, knowledge, skills, nurses, critical care settings, Tanzania. Introduction. Arrhythmias are abnormal heart rhythms due to ...

  7. Large aneurysm in renal angiomyolipoma causing life-threatening ...

    African Journals Online (AJOL)

    P.C. Magabe

    A 22-year-old female presented with sudden onset of acute right abdominal pain, hematuria and fainting. At evaluation in the ... Contrast enhanced CT scan of the abdomen showed a large fatty mass of the right kidney with a surrounding .... the aneurysm. Management of renal AML is aimed at minimizing risks of hem-.

  8. spontaneous life-threatening urinary bladder hemorrhage in ...

    African Journals Online (AJOL)

    abc

    ents which worsen during pregnancy. Respiratory function is adversely affected with advancing gesta- tion due to lack of available space in abdomen for uterine enlargement as well as diminished pulmo- nary reserve. Respiratory function may be affected to such an extent that baby may have to be deli- vered preterm, as ...

  9. Life-threatening complications of ibogaine: three case reports.

    Science.gov (United States)

    Paling, F P; Andrews, L M; Valk, G D; Blom, H J

    2012-11-01

    Ibogaine is a naturally occurring psychoactive alkaloid extracted from the roots of the Tabernanthe iboga plant, which in alternative medicine is used to treat drug dependency. However, this upcoming, online advocated therapy can be dangerous due to its potentially lethal adverse effects. We present three cases in which toxic side effects were noted. We used the Naranjo scale to estimate the probability of a causal relationship between these effects and ibogaine. Findings in these three cases are suggestive of a causal relationship between the use of ibogaine and serious respiratory and cardiac problems (including lengthening of the QT interval). In our opinion it is of great importance that clinicians are aware of these potentially serious side effects and realise that widespread online marketing practices will give many more people access to ibogaine.

  10. Life-threatening lithium-induced diabetes insipidus after colonic ...

    African Journals Online (AJOL)

    ... concentration of 185mmol/l and required ventilation after a respiratory arrest. We suggest any surgical patient who describes a history of bipolar disorder or lithium therapy should be questioned directly to ascertain confirmatory features of LINDI, and have post-operative polyuria treated with aggressive fluid replacement.

  11. Case Report: Life-threatening angiomyxoma of the larynx | Yaman ...

    African Journals Online (AJOL)

    Also, he had suffered from dysphagia, dysphonia, cough, and obstructive sleep apnea in the supine position for 6 months. He was operated on via transoral approach under general anesthesia with orotracheal intubation. The mass was encapsulated and completely removed. The histopathologic diagnosis was reported as ...

  12. Sevoflurane therapy for life-threatening asthma in children.

    NARCIS (Netherlands)

    Schutte, D.; Zwitserloot, A.M.; Houmes, R.; Hoog, M. de; Draaisma, J.M.T.; Lemson, J.

    2013-01-01

    BACKGROUND: /st> Asthma is a common disease in children and often develops early in life. This multicentre retrospective case series describe the use and effectiveness of sevoflurane inhalation therapy in a series of children with severe asthma in the paediatric intensive care unit (PICU). METHODS:

  13. Case Report - Serious life threatening upper airway obstruction in ...

    African Journals Online (AJOL)

    We are reporting this patient who was presented with severe upper air way obstruction soon after delivery. She was a girl born with multiple firm nodules, variable in size, widespread all over the body with affection of the oropharynx, long bones, ribs, muscles, subcutaneous tissues, also lungs and intestine. Infantile ...

  14. Sociodemographic characteristics and handling of life-threatening ...

    African Journals Online (AJOL)

    not enough to cater for the needs of women mostly in the remote areas of the state. The women are therefore left in the hands of unskilled TBAs who are untrained on general safety precaution and lack the knowledge in identifying danger signs in pregnancy, labor, or in the puerperium for prompt referral and interventions.

  15. Life threatening vaginal haemorrhage from coital laceration in a post ...

    African Journals Online (AJOL)

    Case report: A 55-year-old woman who presented as an emergency with haemorrhagic shock following vaginal bleeding from consensual coitus is presented. She was resuscitated with intravenous fluids and blood transfusions. The vaginal laceration of about 5 cm on the right side of the posterior fornix was sutured ...

  16. Determined to Learn: Accessing Education despite Life-Threatening Disasters

    Science.gov (United States)

    SchWeber, Claudine

    2008-01-01

    The "right to education" proclaimed by the 1948 Universal Declaration of Human Rights requires access to learning as well as the support systems. Since access can be interrupted by various circumstances, the possibility of providing continuity despite external dangers by using online distance education, offers an intriguing and valuable…

  17. A life-threatening ectopic pregnancy with etonogestrel implant.

    Science.gov (United States)

    Bouquier, Julie; Fulda, Virginie; Bats, Anne-Sophie; Lécuru, Fabrice; Huchon, Cyrille

    2012-02-01

    Etonogestrel contraceptive implant is a highly effective subdermal method of long-acting hormonal contraception for women. We describe a case of ruptured ectopic pregnancy occurring in a patient with an etonogestrel contraceptive implant (Implanon®). The only factor predisposing to a failure in this case is a moderately elevated body mass index of 29. However, the implant was in place for less than 2 years, and the plasma levels of etonogestrel were within the expected range. This case report emphasizes the fact that ectopic pregnancy should not be formally ruled out in women using this contraceptive, and it highlights the need for further study of the effect of body weight on this contraceptive method. Copyright © 2012 Elsevier Inc. All rights reserved.

  18. Surviving life-threatening illness: keys to optimal nursing care.

    Science.gov (United States)

    Moorman, Sandra

    2010-01-01

    Necrotizing fasciitis (NF) is a rare yet life-altering infection. Disfigurement and death ensue without accurate diagnosis and treatment. Educational awareness can assist nurses to advocate for differential diagnosis, immediate treatment, and plan of care. This article examines the experience of a mother with NF, application of Neuman's Systems Model (NSM) to address her healing needs, and nursing practice guided by one's personal worldview. NSM was chosen because it is holistic and concise and can be utilized from a Christian perspective.

  19. Pre-eclampsia: a Life-threatening Pregnancy Syndrom

    Czech Academy of Sciences Publication Activity Database

    Brázdová, A.; Keprová, Alena; Zídková, J.; Madar, J.

    2014-01-01

    Roč. 57, č. 5 (2014), s. 701-705 ISSN 1516-8913 Grant - others:GA AV ČR(CZ) IAA600110902 Program:IA Institutional support: RVO:61388963 Keywords : placenta * pre-eclampsia * pregnancy * oxidative stress Subject RIV: CE - Biochemistry Impact factor: 0.546, year: 2014

  20. EAMJ Life Threatening Nov 09 copy.indd

    African Journals Online (AJOL)

    2009-11-11

    Nov 11, 2009 ... per the National Acute Spinal Cord Injury Studies (NASCIS) protocol. Forty five hours later he had regained full neurological and respiratory function, allowing extubation and subsequent discharge from the intensive care unit. While patients with cervical spinal cord trauma in a setting of cervical canal ...

  1. Risk of life-threatening arrhythmias in smoking patients

    Directory of Open Access Journals (Sweden)

    A. I. Vytryhovskiy

    2017-06-01

    Full Text Available Despite the prophylactic medicine achievements through the past decade, tobacco smoking remains one of the main risk factors of appearance and progression of diseases, which are accompanied by the high population mortality. Aim: development of the new approaches of complications prediction, prophylaxis and treatment in patients with high and very high total cardiovascular risk, which are based on the heart rhythm turbulence evaluation. Materials and Methods: 603 patients were chosen for the research. All patients were divided into tree groups. The first – patients with IHD without concomitant risk factors, such as smoking, obesity, metabolic syndrome. The second – patients, who smoke for more than 2 years (people with very high cardiovascular risk by SCORE scale. The third group – patients with metabolic syndrome without IHD or hypertension (patients with high cardiovascular risk. Control group included 149 patients. Holter monitoring of the heart rhythm was performed in patients with high and very high cardiovascular risk by the SCORE scale with myocardial infarction to study the specifications of the heart rhythm turbulence. Plasma calcium and magnesium levels were measured to establish the correlation between appearance and progression of ventricular arrhythmia and increase of the heart rhythm turbulence phenomenon. Results. The prevalence of ventricular and supraventricular arrhythmia is reliably higher among the smokers than among healthy persons. The highest percentage of the ventricular extrasystoles both the early appearing extrasystoles and the group extrasystoles is observed among smokers. Among healthy people every fourth person has deviations in heart rhythm turbulence indices, and every seventeenth has significant deviations and high risk of cardiac sudden death. Smokers have reliable decrease of calcium and increase of magnesium plasma levels. People with heart rhythm turbulence, metabolic syndrome and hypertension have reliable increased in calcium plasma concentration compared with people with metabolic syndrome but without hypertension. Conclusions. 1 Smoking contributes to increase the polytopic extrasystoles prevalence. 2 Smokers have higher acceleration and deceleration levels of the heart rhythm turbulence. 3 Changes of calcium and magnesium plasma levels in smokers do not cause the ventricular extrasystole. 4 Studying of the heart rhythm turbulence is available marker of fatal arrhythmias occurrence predicting.

  2. Life-threatening acute lung injury after gamma butyrolactone ingestion

    NARCIS (Netherlands)

    van Gerwen, M.; Scheper, H.; Touw, D. J.; van Nieuwkoop, C.

    We describe a case of a 44-year-old woman with a borderline personality disorder and chronic gamma-butyrolactone (GBL) use who presented with progressive dyspnoea and an altered mental status. A high anion gap metabolic acidosis and acute lung injury was diagnosed. We hypothesise this was caused by

  3. Life Threatening Idiopathic Recurrent Angioedema Responding to Cannabis

    Directory of Open Access Journals (Sweden)

    Amit Frenkel

    2015-01-01

    Full Text Available We present a case of a 27-year-old man with recurrent episodes of angioedema since he was 19, who responded well to treatment with medical grade cannabis. Initially, he responded to steroids and antihistamines, but several attempts to withdraw treatment resulted in recurrence. In the last few months before prescribing cannabis, the frequency and severity of the attacks worsened and included several presyncope events, associated with scrotal and neck swelling. No predisposing factors were identified, and extensive workup was negative. The patient reported that he was periodically using cannabis socially and that during these periods he was free of attacks. Recent data suggest that cannabis derivatives are involved in the control of mast cell activation. Consequently, we decided to try a course of inhaled cannabis as modulators of immune cell functions. The use of inhaled cannabis resulted in a complete response, and he has been free of symptoms for 2 years. An attempt to withhold the inhaled cannabis led to a recurrent attack within a week, and resuming cannabis maintained the remission, suggesting a cause and effect relationship.

  4. Prevention of OHSS: Current strategies and new insights

    Directory of Open Access Journals (Sweden)

    Cristiano E. Busso

    2010-10-01

    Full Text Available Ovarian hyperstimulation syndrome (OHSS is an iatrogenic and potentially life threatening condition that affects young healthy patients. Many strategies have been proposed to prevent this syndrome. However, to avoid OHSS without compromising on IVF outcome is still a challenge. The most important action is to identify patients at risk even before ovarian stimulation is initiated and to give them special attention. Coasting is the most popular method to avoid/minimize OHSS. Cycle cancellation, cryopreservation, GnRH antagonists, GnRH agonists, i.v. albumin are other strategies that can provide some kind of benefit but do not completely avoid both early and late forms of OHSS and/or cannot be applied to every patient. Recent studies demonstrate that dopamine agonists can prevent or minimize OHSS without affecting IVF outcome but clinical protocols are not well established yet.

  5. Preemptive antiviral therapy with entecavir can reduce acute deterioration of hepatic function following transarterial chemoembolization.

    Science.gov (United States)

    Yoo, Sun Hong; Jang, Jeong Won; Kwon, Jung Hyun; Jung, Seung Min; Jang, Bohyun; Choi, Jong Young

    2016-12-01

    Hepatic damage during transarterial chemoembolization (TACE) is a critical complication in patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). Apart from its role in preventing HBV reactivation, there is some evidence for the benefits of preemptive antiviral therapy in TACE. This study evaluated the effect of preemptive antiviral therapy on acute hepatic deterioration following TACE. This retrospective observational study included a prospectively collected cohort of 108 patients with HBV-related HCC who underwent TACE between January 2007 and January 2013. Acute hepatic deterioration following TACE was evaluated. Treatment-related hepatic decompensation was defined as newly developed encephalopathy, ascites, variceal bleeding, elevation of the bilirubin level, prolongation of prothrombin time, or elevation of the Child-Pugh score by ≥2 within 2 weeks following TACE. Univariate and multivariate analyses were conducted to identify factors influencing treatment-related decompensation. Preemptive antiviral therapy involves directing prophylaxis only toward high-risk chronic hepatitis B patients in an attempt to prevent the progression of liver disease. We regarded at least 6 months as a significant duration of preemptive antiviral treatment before diagnosis of HCC. Of the 108 patients, 30 (27.8%) patients received preemptive antiviral therapy. Treatment-related decompensation was observed in 25 (23.1%) patients during the follow-up period. Treatment-related decompensation following TACE was observed more frequently in the nonpreemptive group than in the preemptive group (29.5% vs. 6.7%, P =0.008). In the multivariate analysis, higher serum total bilirubin (Hazard ratio [HR] =3.425, P =0.013), hypoalbuminemia (HR=3.990, P =0.015), and absence of antiviral therapy (HR=7.597, P =0.006) were significantly associated with treatment-related hepatic decompensation. Our findings suggest that preemptive antiviral therapy significantly reduces the

  6. Application of particle swarm optimisation for solving deteriorating inventory model with fluctuating demand and controllable deterioration rate

    Science.gov (United States)

    Chen, Yu-Ren; Dye, Chung-Yuan

    2013-06-01

    In most of the inventory models in the literature, the deterioration rate of goods is viewed as an exogenous variable, which is not subject to control. In the real market, the retailer can reduce the deterioration rate of product by making effective capital investment in storehouse equipments. In this study, we formulate a deteriorating inventory model with time-varying demand by allowing preservation technology cost as a decision variable in conjunction with replacement policy. The objective is to find the optimal replenishment and preservation technology investment strategies while minimising the total cost over the planning horizon. For any given feasible replenishment scheme, we first prove that the optimal preservation technology investment strategy not only exists but is also unique. Then, a particle swarm optimisation is coded and used to solve the nonlinear programming problem by employing the properties derived from this article. Some numerical examples are used to illustrate the features of the proposed model.

  7. Resistance of biofilm-covered mortars to microbiologically influenced deterioration simulated by sulfuric acid exposure

    Energy Technology Data Exchange (ETDEWEB)

    Soleimani, Sahar, E-mail: ssoleima@connect.carleton.ca; Isgor, O. Burkan, E-mail: burkan_isgor@carleton.ca; Ormeci, Banu, E-mail: banu_ormeci@carleton.ca

    2013-11-15

    Following the reported success of biofilm applications on metal surfaces to inhibit microbiologically influenced corrosion, effectiveness and sustainability of E. coli DH5α biofilm on mortar surface to prevent microbiologically influenced concrete deterioration (MICD) are investigated. Experiments simulating microbial attack were carried out by exposing incrementally biofilm-covered mortar specimens to sulfuric acid solutions with pH ranging from 3 to 6. Results showed that calcium concentration in control reactors without biofilm was 23–47% higher than the reactors with biofilm-covered mortar. Formation of amorphous silica gel as an indication of early stages of acid attack was observed only on the control mortar specimens without biofilm. During acidification, the biofilm continued to grow and its thickness almost doubled from ∼ 30 μm before acidification to ∼ 60 μm after acidification. These results demonstrated that E. coli DH5α biofilm was able to provide a protective and sustainable barrier on mortar surfaces against medium to strong sulfuric acid attack. -- Highlights: •Effectiveness of E.coli DH5α biofilm to prevent MICD was studied. •Conditions that lead to MICD were simulated by chemical acidification. •Biofilm-covered mortar specimens were exposed to sulfuric acid solutions. •The presence of biofilm helped reduce the chemically-induced mortar deterioration. •Biofilm remained alive and continued to grow during the acidification process.

  8. Microbial deterioration of surface paint coatings. | Ogbulie | Global ...

    African Journals Online (AJOL)

    Bacterial and fungal species associated with the normal and deteriorated painted surface in Owerri, Imo State were isolated and identified. The bacteria genera isolated were Pseudomonas, Bacillus, Micrococcus, Staphylococcus, Enterobacter and Streptomces, whereas the fungal genera isolated were Rhizopus, ...

  9. Inhibition of Growth of Fungi Isolated From Deteriorating Melon ...

    African Journals Online (AJOL)

    A study was conducted to investigate the effect of extracts of Punica granatum and Cymbopogon citratus on Aspergillus nivale, Rhizopus stolonifer , Mucor mucido and Aspergillus fumigatus isolated from deteriorating melon seed using radial growth technique. Phytochemical screening revealed that extracts the plants ...

  10. 40 CFR 52.1778 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... quality. 52.1778 Section 52.1778 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Significant deterioration of air quality. (a)-(b) [Reserved] (c) All applications and other information... Resources, Division of Air Quality, 1641 Mail Service Center, Raleigh, North Carolina 27699-1641 or local...

  11. 40 CFR 52.60 - Significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... quality. 52.60 Section 52.60 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... deterioration of air quality. (a) All applications and other information required pursuant to § 52.21 from... “Guideline on Air Quality Models (Revised)” or other models approved by EPA. [42 FR 22869, May 5, 1977, as...

  12. Maintenance Models for Systems subject to Measurable Deterioration

    NARCIS (Netherlands)

    R.P. Nicolai (Robin)

    2008-01-01

    textabstractComplex engineering systems such as bridges, roads, flood defence structures, and power pylons play an important role in our society. Unfortunately such systems are subject to deterioration, meaning that in course of time their condition falls from higher to lower, and possibly even to

  13. Inhibition of Growth of Fungi Isolated From Deteriorating Melon ...

    African Journals Online (AJOL)

    BSN

    Abstract. A study was conducted to investigate the effect of extracts of Punica granatum and. Cymbopogon citratus on Aspergillus nivale, Rhizopus stolonifer , Mucor mucido and. Aspergillus fumigatus isolated from deteriorating melon seed using radial growth technique. Phytochemical screening revealed that extracts the ...

  14. Bio-deterioration of breadfruit (Artocarpus Communis) in storage ...

    African Journals Online (AJOL)

    The bio-deterioration of breadfruit in storage and its effects on the nutrient composition of the fruit was investigated at Ibadan, Southwestern Nigeria. Freshly dropped fruits were stored under laboratory conditions for a period of 9 days. Aspergillus niger, Rhizopus stolonifer, Botryodiplodia theobromae, Mycovellosiella fulva, ...

  15. Catalyst deterioration over the lifetime of small utility engines.

    Science.gov (United States)

    Doll, Nicholas J; Reisel, John R

    2007-10-01

    In this paper, the deterioration of catalysts in small, four-stroke, spark-ignition engines is described. The laboratory testing performed followed a proven test method that mimics the lifetime of a small air-cooled utility engine operating under normal field conditions. The engines used were single-cylinder, 6.5-hp, side-valve engines. These engines have a nominal 125-hr lifetime. The effectiveness of the catalysts was determined by testing exhaust emissions before and after the catalyst to determine the catalyst's efficiency. This was done several times during the lifetime of the engines to determine the deterioration in the performance of the catalysts at lowering pollutant emissions. Additional testing was performed on the catalysts to determine wear patterns, contamination, and recoverable activity. The results indicate that considerable catalyst deterioration is occurring over the lifetime of the engine. The results reveal that soot buildup, poisons, and active surface loss appear to be the contributing factors to the deterioration. These results were determined after analyzing the exhaust emissions data, scanning electron microscope results analysis, and the impact of regeneration attempts. An ANOVA statistical analysis was performed, and it was determined that the emissions are also impacted, to some degree, by time and the engine itself.

  16. Optimal time policy for deteriorating items of two-warehouse ...

    Indian Academy of Sciences (India)

    We consider the problem of a two-warehouse inventory system under the effect of stock dependent demand. There are two warehouses to store the goods in which the first is rented warehouse and the second is own warehouse that deteriorates with two different rates. The aim of this study is to determine the optimal order ...

  17. Perceived Visual Deterioration among a Selected Group of Dental ...

    African Journals Online (AJOL)

    To assess the perceived visual deterioration and the determinants among selected dental surgeons in Nigeria. A cross-sectional survey of Resident doctors attending the Revision course of Faculty of Dental Surgery of the National Postgraduate Medical College of Nigeria in Lagos University Teaching Hospital, Lagos, ...

  18. Optimal time policy for deteriorating items of two-warehouse

    Indian Academy of Sciences (India)

    ... goods in which the first is rented warehouse and the second is own warehouse that deteriorates with two different rates. The aim of this study is to determine the optimal order quantity to maximize the profit of the projected model. Finally, some numerical examples and sensitivity analysis of parameters are made to validate ...

  19. Effectiveness of respiratory rates in determining clinical deterioration

    DEFF Research Database (Denmark)

    Mølgaard, Rikke Rishøj; Larsen, Palle; Håkonsen, Sasa Jul

    2016-01-01

    Review question/objective: The objective of this systematic review is to identify, appraise and synthesize the best available evidence on the effectiveness of manually measuring respiratory rates for 60 s or less in detecting clinical deterioration of inpatients. More specifically, the review...

  20. Clinical challenge: Deteriorating liver function in TB and HIV co ...

    African Journals Online (AJOL)

    ... and ask them to describe the approach that they would take if they saw the case in their local hospital setting. In our first edition, a patient with deteriorating liver function is presented by Prof. Francois Venter and Dr Ntsakisi Masingi, and then discussed by Dr Sarah Stacey in Johannesburg and Dr Sarah Fidler in London.

  1. Microbial deterioration of stored water for users supplied by stand ...

    African Journals Online (AJOL)

    Two forms of water service delivery in peri-urban settlements in the eThekwini municipal region are communal stand-pipes and household ground-tanks. Water from these sources requires storage prior to use. Previous studies have shown that water quality tends to deteriorate during storage. This study was conducted ...

  2. A fast ethanol assay to detect seed deterioration

    NARCIS (Netherlands)

    Kodde, J.; Buckley, W.T.; Groot, de C.C.; Retiere, M.; Víquez Zamora, A.M.; Groot, S.P.C.

    2012-01-01

    The most common way to test seed quality is to use a simple and reliable but time- and space-consuming germination test. In this paper we present a fast and simple method to analyse cabbage seed deterioration by measuring ethanol production from partially imbibed seeds. The method uses a modified

  3. An EOQ Model for Delayed Deteriorating Items with Linear Time ...

    African Journals Online (AJOL)

    An EOQ model for delayed deteriorating items with linear time dependent holding cost is considered in this paper. This is a little deviation from most inventory models that consider the holding cost to be constant. In this paper, permissible delay in payment is not considered rather the payment is made immediately the ...

  4. Optimization of Weibull deteriorating items inventory model under ...

    Indian Academy of Sciences (India)

    In this study, we have discussed the development of an inventory model when the deterioration rate of the item follows Weibull two parameter distributions under the effect of selling price and time dependent demand, since, not only the selling price, but also the time is a crucial factor to enhance the demand in the market as ...

  5. The impact of water quality deterioration on macroinvertebrate ...

    African Journals Online (AJOL)

    A multimetric approach, using 21 metrics representing five categories — abundance, composition, richness, diversity and biotic indices — was applied to investigate the impacts of water quality deterioration on macro - invertebrate communities in the Swartkops River. Macroinvertebrates were sampled seasonally between ...

  6. Reducing post-harvest physiological deterioration in cassava ...

    African Journals Online (AJOL)

    Cassava roots are notable for their short shelf-life due to post-harvest physiological deterioration (PPD). PPD is initiated by mechanical damage, which typically occurs during harvesting and progresses from the proximal site of damage to the distal end, making the roots unpalatable within 72h. The short shelf-life severely ...

  7. Best practices and performance assessment for preventive maintenance treatments for Virginia pavements.

    Science.gov (United States)

    2015-08-01

    Preventive maintenance has the potential to improve network condition by retarding future pavement deterioration. This : report outlines guidelines for implementing a preventive maintenance policy for bituminous pavements. : Preventive maintenance tr...

  8. Deterioration of noise-induced hearing loss among bottling factory workers.

    Science.gov (United States)

    Ologe, F E; Olajide, T G; Nwawolo, C C; Oyejola, B A

    2008-08-01

    monitoring hearing deterioration. It is necessary to enforce existing occupational health laws in our industries in order to prevent noise-induced hearing loss, since it is eminently preventable.

  9. Korsakoff's syndrome is preventable

    NARCIS (Netherlands)

    Oudman, Erik; Wijnia, Jan W.

    2014-01-01

    Wernicke-Korsakoff syndrome (WKS) is a life-threatening neuropsychiatric disorder caused by thiamine (vitamin B1) deficiency. Wernicke-Korsakoff syndrome is associated with mammillary body edema and small vessel ischemia. Many patients who develop WKS have a history of serious alcoholism and

  10. Protective effects of ethanol extracts of Artemisia asiatica Nakai ex Pamp. on ageing-induced deterioration in mouse oocyte quality.

    Science.gov (United States)

    Jeon, Hyuk-Joon; You, Seung Yeop; Kim, Dong Hyun; Jeon, Hong Bae; Oh, Jeong Su

    2017-08-01

    Following ovulation, oocytes undergo a time-dependent deterioration in quality referred to as post-ovulatory ageing. Although various factors influence the post-ovulatory ageing of oocytes, oxidative stress is a key factor involved in deterioration of oocyte quality. Artemisia asiatica Nakai ex Pamp. has been widely used in East Asia as a food ingredient and traditional medicine for the treatment of inflammation, cancer, and microbial infections. Recent studies have shown that A. asiatica exhibits antioxidative effects. In this study, we investigated whether A. asiatica has the potential to attenuate deterioration in oocyte quality during post-ovulatory ageing. Freshly ovulated mouse oocytes were cultured with 0, 50, 100 or 200 μg/ml ethanol extracts of A. asiatica Nakai ex Pamp. After culture for up to 24 h, various ageing-induced oocyte abnormalities, including morphological changes, reactive oxygen species (ROS) accumulation, apoptosis, chromosome and spindle defects, and mitochondrial aggregation were determined. Treatment of oocytes with A. asiatica extracts reduced ageing-induced morphological changes. Moreover, A. asiatica extracts decreased ROS generation and the onset of apoptosis by preventing elevation of the Bax/Bcl-2 expression ratio during post-ovulatory ageing. Furthermore, A. asiatica extracts attenuated the ageing-induced abnormalities including spindle defects, chromosome misalignment and mitochondrial aggregation. Our results demonstrate that A. asiatica can relieve deterioration in oocyte quality and delay the onset of apoptosis during post-ovulatory ageing.

  11. Seed deterioration in flooded agricultural fields during winter

    Science.gov (United States)

    Nelms, C.O.; Twedt, D.J.

    1996-01-01

    We determined rate of seed deterioration for 3 crops (corn, rice, and soybean) and 8 weeds commonly found in agricultural fields and moist-soil management units in the Mississippi Alluvial Valley (MAV). The weeds were broadleaf signalgrass (Brachiaria platyphylla), junglerice barnyardgrass (Echinochloa colonum), morningglory (Ipomoea sp.), panic grass (Panicum sp.), bull paspalum (Paspalum boscianum), red rice (Oryza sativa), hemp sesbania (Sesbania exaltata), and bristlegrass (Setaria sp.). Weed seeds, except morningglory, deteriorated slower than corn and soybean, whereas rice decomposed slower than all weed seeds except red rice and bull paspalum. For land managers desiring to provide plant food for wintering waterfowl, rice is clearly the most persistent small grain crop in the MAV. Persistence of weed seeds under flooded conditions throughout winter makes them a cost-effective alternative to traditional crops on land managed for waterfowl.

  12. Optimal control of decoupling point with deteriorating items

    Directory of Open Access Journals (Sweden)

    Kuan Yang

    2014-10-01

    Full Text Available Purpose: The aim of this paper is to develop a dynamic model to simultaneously determine the optimal position of the decoupling point and the optimal path of the production rate as well as the inventory level in a supply chain. With the objective to minimize the total cost of the deviation from the target setting, the closed forms of the optimal solution are derived over a finite planning horizon with deterioration rate under time-varying demand rate.Design/methodology/approach: The Pontryagin's Maximum Principle is employed to explore the optimal position of decoupling point and the optimal production and inventory rate for the proposed dynamic models. The performances of parameters are illustrated through analytical and numerical approaches.Findings: The results denote that the optimal production rate and inventory level are closely related to the target setting which are highly dependent on production policy; meanwhile the optimal decoupling point is exist and unique with the fluctuating of deteriorating rate and product life cycle. The further analyses through both mathematic and numerical approaches indicate that the shorten of product life cycle shifts the optimal decoupling point forward to the end customer meanwhile a backward shifting appears when the deterioration rate increase.Research limitations/implications: There is no shortage allowed and the replacement policy is not taken into account.Practical implications: Solutions derived from this study of the optimal production-inventory plan and decoupling point are instructive for operation decision making. The obtained knowledge about the performance of different parameters is critical to deteriorating supply chains management.Originality/value: Many previous models of the production-inventory problem are only focused on the cost. The paper introduces the decoupling point control into the production and inventory problem such that a critical element-customer demand, can be taken into

  13. Risk-Based Decision Making for Deterioration Processes Using POMDP

    DEFF Research Database (Denmark)

    Nielsen, Jannie Sønderkær; Sørensen, John Dalsgaard

    2015-01-01

    This paper proposes a method for risk-based decision making for maintenance of deteriorating components, based on the partially observable Markov decision process (POMDP). Unlike most methods, the decision polices do not need to be stationary and can vary according to seasons and near the end...... of the lifetime. The approach is demonstrated through two examples, and the total expected costs are similar to those of another efficient method....

  14. Seed wintering and deterioration characteristics between weedy and cultivated rice

    OpenAIRE

    Baek, Jung-Sun; Chung, Nam-Jin

    2012-01-01

    Background Incidences of weedy rice continuously occurred in paddy fields because its shattering seeds were able to over-winter. In this research, the seed deterioration of weedy rice was investigated compared with cultivated rice, and the wintering characteristics of these two types of rice were investigated with the field wintering test, freezing resistance test, and accelerated aging test. Results For the wintering test, the seeds of weedy rice were placed on the soil surface of a paddy wi...

  15. Quantifying reinforced concrete bridge deck deterioration using ground penetrating radar

    Science.gov (United States)

    Martino, Nicole Marie

    Bridge decks are deteriorating at an alarming rate due to corrosion of the reinforcing steel, requiring billions of dollars to repair and replace them. Furthermore, the techniques used to assess the decks don't provide enough quantitative information. In recent years, ground penetrating radar (GPR) has been used to quantify deterioration by comparing the rebar reflection amplitudes to technologies serving as ground truth, because there is not an available amplitude threshold to distinguish healthy from corroded areas using only GPR. The goal of this research is to understand the relationship between GPR and deck deterioration, and develop a model to determine deterioration quantities with GPR alone. The beginning of this research determines that not only is the relationship between GPR and rebar corrosion stronger than the relationship between GPR and delaminations, but that the two are exceptionally correlated (90.2% and 86.6%). Next, multiple bridge decks were assessed with GPR and half-cell potential (HCP). Statistical parameters like the mean and skewness were computed for the GPR amplitudes of each deck, and coupled with actual corrosion quantities based on the HCP measurements to form a future bridge deck model that can be used to assess any deck with GPR alone. Finally, in order to understand exactly which component of rebar corrosion (rust, cracking or chloride) attenuates the GPR data, computational modeling was carried out to isolate each variable. The results indicate that chloride is the major contributor to the rebar reflection attenuation, and that computational modeling can be used to accurately simulate GPR attenuation due to chloride.

  16. Can Sensors Solve the Deterioration Problems of Public Infrastructure?

    Science.gov (United States)

    Miki, Chitoshi

    2014-11-01

    Various deteriorations are detected in public infrastructures, such as bridges, viaducts, piers and tunnels and caused fatal accidents in some cases. The possibility of the applications of health monitoring by using sensors is the issues of this lecture. The inspection and diagnosis are essential in the maintenance works which include appropriate rehabilitations and replacements. The introduction of monitoring system may improve accuracy and efficiency of inspection and diagnosis. This seems to be innovation of maintenance, old structures may change smart structures by the installation of nerve network and brain, specifically. Cost- benefit viewpoint is also important point, because of public infrastructures. The modes of deterioration are fatigue, corrosion, and delayed fracture in steel, and carbonization and alkali aggregate reaction in concrete. These are like adult disease in human bodies. The developments of Infrastructures in Japan were concentrated in the 1960th and 1970th. These ages are approaching 50 and deterioration due to aging has been progress gradually. The attacks of earthquakes are also a major issue. Actually, these infrastructures have been supporting economic and social activities in Japan and the deterioration of public infrastructure has become social problems. How to secure the same level of safety and security for all public infrastructures is the challenge we face now. The targets of monitoring are external disturbances such as traffic loads, earthquakes, winds, temperature, responses against external disturbances, and the changes of performances. In the monitoring of infrastructures, 3W1H(WHAT, WHERE, WHEN and HOW) are essential, that is what kind of data are necessary, where sensors place, when data are collected, and how to collect and process data. The required performances of sensors are accuracy, stability for long time. In the case of long term monitoring, the durability of systems needs more than five years, because the interval

  17. Film with anthocyanins as an indicator of chilled pork deterioration

    Directory of Open Access Journals (Sweden)

    Luana Baptista Golasz

    2013-02-01

    Full Text Available An indicator can be defined as a substance which indicates the presence or absence of another substance or the degree of a certain reaction through characteristic changes, especially color. Therefore, the aim of this work is to evaluate the performance of a bio-based film with anthocyanin as an indicator of chilled pork deterioration. A film made of cassava starch, glycerol, and grape anthocyanins was prepared using the casting technique. Pork loin samples were put in Petri dishes containing an anthocyanin film on the bottom and stored at 4 ºC. Psychrotrophic microorganism count and the pH of the pork loin samples were analyzed for a 14 day- period. At the same time, the films were subjected to colorimetric analysis using D65 illuminant and the CIELAB system. Chroma and hue angle data for these films were evaluated by Anova and Dunnett's test. An increase in the microbial population and in the pH was observed over the storage period as result of pork deterioration. Color changes were also identified in the film. However, only at the beginning of the storage period was it possible to establish a correlation between film color and pork deterioration. The shelf life end-point could not be clearly detected by the film.

  18. Radiation deterioration of several aromatic polymers under oxidative conditions

    International Nuclear Information System (INIS)

    Sasuga, Tsuneo; Hagiwara, Miyuki

    1987-01-01

    Radiation-induced oxidative irradiation effects (with γ-rays under oxygen pressure) or poly(aryl sulphones) (U-PS and PES), poly(aryl ester) (U-Polymer), poly(aryl amide) (A-Film) and poly(aryl ether ether ketone) (PEEK) have been studied based on changes in tensile properties. The deterioration dose estimated from the decrease in the elongation at break was as low as one-fifth to one-tenth of that in high-dose-rate electron-beam irradiation, but the order of radiation resistance of the polymers did not differ from that in electron-beam irradiation, i.e. PEEK > A-Film > U-Polymer > U-PS > PES. The radiation stability of aromatic units under oxidative conditions was estimated from a comparison of the radiation resistance of the polymers themselves and their chemical structures. The following order was obtained: diphenyl ether, diphenyl ketone > aromatic amide>> bisphenol A > diphenyl sulphone. The deterioration mechanism of PEEK under oxidative irradiation was studied by measuring dynamic viscoelastic properties. It was concluded that deterioration in mechanical properties under oxidative irradiation was brought about by chain scission only. (author)

  19. Heterogeneity in Red Wine Polyphenolic Contents Differentially Influences Alzheimer's Disease-type Neuropathology and Cognitive Deterioration

    Science.gov (United States)

    Ho, Lap; Chen, Ling Hong; Wang, Jun; Zhao, Wei; Talcott, Stephen T.; Ono, Kenjiro; Teplow, David; Humala, Nelson; Cheng, Alice; Percival, Susan S.; Ferruzzi, Mario; Janle, Elsa; Dickstein, Dara L.; Pasinetti, Giulio Maria

    2009-01-01

    We recently found that moderate consumption of two unrelated red wines generate from different grape species, a Cabernet Sauvignon and a muscadine wine that are characterized by distinct component composition of polyphenolic compounds, significantly attenuated the development of Alzheimer's disease (AD)-type brain pathology and memory deterioration in a transgenic AD mouse model. Interestingly, our evidence suggests that the two red wines attenuated AD phenotypes through independent mechanisms. In particular, we previously found that treatment with Cabernet Sauvignon reduced the generation of AD-type amyloid-β (Aβ) peptides. In contrast, evidence from our present study suggests that muscadine treatment attenuates Aβ neuropathology and Aβ-related cognitive deterioration in Tg2576 mice by interfering with the oligomerization of Aβ molecules to soluble high-molecular-weight Aβ oligomer species that are responsible for initiating a cascade of cellular events resulting in cognitive decline. Collectively, our observations suggest that distinct polyphenolic compounds from red wines may be bioavailable at the organism level and beneficially modulate AD phenotypes through multiple Aβ-related mechanisms. Results from these studies suggest the possibility of developing a “combination” of dietary polyphenolic compounds for AD prevention and/or therapy by modulating multiple Aβ-related mechanisms. PMID:19158422

  20. Seniors' self-preservation by maintaining established self and defying deterioration - A grounded theory.

    Science.gov (United States)

    Eriksson, Jeanette Källstrand; Hildingh, Cathrine; Buer, Nina; Thulesius, Hans

    2016-01-01

    The purpose of this classic grounded theory study was to understand how seniors who are living independently resolve issues influenced by visual impairment and high fall risk. We interviewed and observed 13 seniors with visual impairment in their homes. We also interviewed six visual instructors with experience from many hundreds of relevant incidents from the same group of seniors. We found that the seniors are resolving their main concern of "remaining themselves as who they used to be" by self-preservation. Within this category, the strategies maintaining the established self and defying deterioration emerged as the most prominent in our data. The theme maintaining the established self is mostly guided by change inertia and includes living the past (retaining past activities, reminiscing, and keeping the home intact) and facading (hiding impairment, leading to avoidance of becoming a burden and to risk juggling). Defying deterioration is a proactive scheme and involves moving (by exercising, adapting activities, using walking aids, driving), adapting (by finding new ways), and networking by sustaining old support networks or finding new networks. Self-preservation is generic human behavior and modifying this theory to other fields may therefore be worthwhile. In addition, health care providers may have use for the theory in fall preventive planning.

  1. [Refeeding syndrome : Pathophysiology, risk factors, prevention, and treatment].

    Science.gov (United States)

    Wirth, R; Diekmann, R; Janssen, G; Fleiter, O; Fricke, L; Kreilkamp, A; Modreker, M K; Marburger, C; Nels, S; Pourhassan, M; Schaefer, R; Willschrei, H-P; Volkert, D

    2018-04-01

    Refeeding syndrome is a life-threatening complication that may occur after initiation of nutritional therapy in malnourished patients, as well as after periods of fasting and hunger. Refeeding syndrome can be effectively prevented and treated if its risk factors and pathophysiology are known. The initial measurement of thiamine level and serum electrolytes, including phosphate and magnesium, their supplementation if necessary, and a slow increase in nutritional intake along with close monitoring of serum electrolytes play an important role. Since refeeding syndrome is not well known and the symptoms can be extremely heterogeneous, this complication is poorly recognized, especially against the background of severe disease and multimorbidity. This overview aims to summarize the current knowledge and increase awareness about refeeding syndrome.

  2. Evaluation of the olivocochlear efferent reflex strength in the susceptibility to temporary hearing deterioration after music exposure in young adults

    Directory of Open Access Journals (Sweden)

    Keppler Hannah

    2014-01-01

    Full Text Available The objective of the current study was to evaluate the predictive role of the olivocochlear efferent reflex strength in temporary hearing deterioration in young adults exposed to music. This was based on the fact that a noise-protective role of the medial olivocochlear (MOC system was observed in animals and that efferent suppression (ES measured using contralateral acoustic stimulation (CAS of otoacoustic emissions (OAEs is capable of exploring the MOC system. Knowing an individual′s susceptibility to cochlear damage after noise exposure would enhance preventive strategies for noise-induced hearing loss. The hearing status of 28 young adults was evaluated using pure-tone audiometry, transient evoked OAEs (TEOAEs and distortion product OAEs (DPOAEs before and after listening to music using an MP3 player during 1 h at an individually determined loud listening level. CAS of TEOAEs was measured before music exposure to determine the amount of ES. Regression analysis showed a distinctive positive correlation between temporary hearing deterioration and the preferred gain setting of the MP3 player. However, no clear relationship between temporary hearing deterioration and the amount of ES was found. In conclusion, clinical measurement of ES, using CAS of TEOAEs, is not correlated with the amount of temporary hearing deterioration after 1 h music exposure in young adults. However, it is possible that the temporary hearing deterioration in the current study was insufficient to activate the MOC system. More research regarding ES might provide more insight in the olivocochlear efferent pathways and their role in auditory functioning.

  3. Prevention of allergic reactions in anesthetized patients.

    Science.gov (United States)

    Caffarelli, C; Stringari, G; Miraglia Del Giudice, M; Crisafulli, G; Cardinale, F; Peroni, D G; Bernardini, R

    2011-01-01

    Hypersensitivity reactions during perioperative period are increasing and may be potentially life-threatening. Therefore, major emphasis is given to prevention. We perform a review to examine which measures should be taken to prevent reactions to products used in elective and emergency surgery. Any patient with a history of previous anaphylaxis or severe reaction during anaesthesia should be referred to allergist for detection of the offending compound. However, the identification of the triggering agent is not always feasible because of the low accuracy of diagnostic tests. In these cases and when emergency surgery is required, it should be considered to replace all drugs administered before the onset of the reaction with alternatives. Furthermore, any cross-reacting agent and latex, especially in patients belonging to populations at-risk for latex allergy should be avoided. In susceptible patients, premedication with antihistamines and corticosteroids might reduce the severity of reaction to drugs or contrast material while it is unclear whether pre-treatment decreases incidence of anaphylactic reactions. There is no evidence that premedication prevents allergic reactions to latex. Overall, physicians should not rely on the efficacy of premedication.

  4. Design Of A Laboratory Set-up For Evaluating Structural Strength Of Deteriorated Concrete Sewer Pipes

    NARCIS (Netherlands)

    Stanic, N.; Salet, T.; Langeveld, J.G.; Clemens, F.H.L.R.

    2014-01-01

    The principle of structural behaviour of buried concrete pipes is fairly understood, except for how material deterioration affects structural behaviour and performance. Consequently, information on the structural behaviour of deteriorated sewer pipes will contribute to better understanding of the

  5. Breaking object correspondence across saccadic eye movements deteriorates object recognition

    Directory of Open Access Journals (Sweden)

    Christian H. Poth

    2015-12-01

    Full Text Available Visual perception is based on information processing during periods of eye fixations that are interrupted by fast saccadic eye movements. The ability to sample and relate information on task-relevant objects across fixations implies that correspondence between presaccadic and postsaccadic objects is established. Postsaccadic object information usually updates and overwrites information on the corresponding presaccadic object. The presaccadic object representation is then lost. In contrast, the presaccadic object is conserved when object correspondence is broken. This helps transsaccadic memory but it may impose attentional costs on object recognition. Therefore, we investigated how breaking object correspondence across the saccade affects postsaccadic object recognition. In Experiment 1, object correspondence was broken by a brief postsaccadic blank screen. Observers made a saccade to a peripheral object which was displaced during the saccade. This object reappeared either immediately after the saccade or after the blank screen. Within the postsaccadic object, a letter was briefly presented (terminated by a mask. Observers reported displacement direction and letter identity in different blocks. Breaking object correspondence by blanking improved displacement identification but deteriorated postsaccadic letter recognition. In Experiment 2, object correspondence was broken by changing the object’s contrast-polarity. There were no object displacements and observers only reported letter identity. Again, breaking object correspondence deteriorated postsaccadic letter recognition. These findings identify transsaccadic object correspondence as a key determinant of object recognition across the saccade. This is in line with the recent hypothesis that breaking object correspondence results in separate representations of presaccadic and postsaccadic objects which then compete for limited attentional processing resources (Schneider, 2013. Postsaccadic

  6. Influence of nuclear glasses composition on their liability to deterioration

    International Nuclear Information System (INIS)

    Tovena, I.

    1995-01-01

    The aim of this thesis is to contribute to the study of the nuclear glasses composition influence on their liability to deterioration. The methodology of the experimental research used has lead to define between the thirty oxides which form the reference glass light water, six oxides of interest. For each of these oxides, a composition variation area has been defined. A matrix of twenty glass compositions has then been defined. The preparation of materials of these compositions has sometimes lead to materials weakly heterogeneous which have been characterized before deterioration. This study has been completed by those of three glasses in a composition variation area narrower of the light water nuclear glass : the R7T7 and two glasses at limits having respectively an initial dissolution velocity at 100 degrees Celsius theoretically maximum and minimum. Some deterioration parameters in pure water have been experimentally measured on the twenty three glasses : 1) an initial dissolution velocity at 100 degrees (Vo 1 00) Celsius and another one at 90 degrees Celsius (Vo 9 0) 2) a dissolution velocity in conditions near the saturation at 90 degrees Celsius 3) an apparent solubility of glass based on the ortho silicic acid activity 4) the evolution of the dissolution kinetics at 90 degrees Celsius in sub-saturated medium towards saturated medium 5) the alteration films nature developed at the glasses surface during these last alteration tests. Some thermodynamic and structural models have been studied in order to predict Vo 9 0 and Vo 1 00. The dissolution kinetic law developed from reference glass dissolution results has been studied with the calculation code LIXIVER. It has not been able to be used for most of the glasses compositions studied. As a consequence, the glasses dissolution control by a surface reaction which are itself controlled by the only dissolved silica is an hypothesis which is not verified for the greater part of the glasses. (O.L.). refs., figs

  7. Entrepreneurial Behaviour in Periods of Deterioration of Small Firms' Condition

    Directory of Open Access Journals (Sweden)

    Jarosław Ropęga

    2016-06-01

    Full Text Available Objective: The aim of the paper is to indicate types of entrepreneurial behaviour which should be triggered during periods of deterioration of small firms' condition. Research Design & Methods: The study concerned the causes and symptoms of economic failure identified along the trajectories of this phenomenon. The paper uses selected parts of the study related to the non-occurrence of entrepreneurial behaviour or errors in this behaviour identified in the surveyedfirms. The entire study was conducted based on the analysis of 32 case studies carried out among the former entrepreneurs  of  micro  and  small  firms  liquidated  in  the  period  from  01.01.2006  to 31.12.2011. Findings: The  study  helped  to  identify  shortcomings  in  the  entrepreneurial  process along individual trajectories of economic failure of the surveyed companies. Implications & Recommendations: As  a  result  of  the  conscious  entrepreneurial  process, small firms have the opportunity to leave the trajectory of economic failure, indicated by the deteriorating condition of the company.  It is therefore necessary to develop knowledge concerning the entrepreneurial processand entrepreneurship among managers of small firms. Contribution & Value Added: According to the author, one of the key factors affecting the survival of small businesses in the period of deterioration of their condition is the initiation of the entrepreneurial process and/or its deliberate continuation. It seems quite natural to base components of this process on the existing support tools for entrepreneurs that are at risk of economic failure.

  8. Exercise training prior to myocardial infarction attenuates cardiac deterioration and cardiomyocyte dysfunction in rats

    Directory of Open Access Journals (Sweden)

    Luiz Henrique Marchesi Bozi

    2013-04-01

    Full Text Available OBJECTIVES: The present study was performed to investigate 1 whether aerobic exercise training prior to myocardial infarction would prevent cardiac dysfunction and structural deterioration and 2 whether the potential cardiac benefits of aerobic exercise training would be associated with preserved morphological and contractile properties of cardiomyocytes in post-infarct remodeled myocardium. METHODS: Male Wistar rats underwent an aerobic exercise training protocol for eight weeks. The rats were then assigned to sham surgery (SHAM, sedentary lifestyle and myocardial infarction or exercise training and myocardial infarction groups and were evaluated 15 days after the surgery. Left ventricular tissue was analyzed histologically, and the contractile function of isolated myocytes was measured. Student's t-test was used to analyze infarct size and ventricular wall thickness, and the other parameters were analyzed by the Kruskal-Wallis test followed by Dunn's test or a one-way analysis of variance followed by Tukey's test (p<0.05. RESULTS: Myocardial infarctions in exercise-trained animals resulted in a smaller myocardial infarction extension, a thicker infarcted wall and less collagen accumulation as compared to myocardial infarctions in sedentary animals. Myocardial infarction-induced left ventricular dilation and cardiac dysfunction, as evaluated by +dP/dt and -dP/dt, were both prevented by previous aerobic exercise training. Moreover, aerobic exercise training preserved cardiac myocyte shortening, improved the maximum shortening and relengthening velocities in infarcted hearts and enhanced responsiveness to calcium. CONCLUSION: Previous aerobic exercise training attenuated the cardiac dysfunction and structural deterioration promoted by myocardial infarction, and such benefits were associated with preserved cardiomyocyte morphological and contractile properties.

  9. Predicting Future Deterioration of Hydraulic Steel Structures with Markov Chain and Multivariate Samples of Statistical Distributions

    Directory of Open Access Journals (Sweden)

    Guillermo A. Riveros

    2014-01-01

    Full Text Available Combined effects of several complex phenomena cause the deterioration of elements of steel hydraulic structures on the nation’s lock systems: loss of protective systems, corrosion, cracking and fatigue, impacts, and overloads. This paper presents examples of deterioration of steel hydraulic structures. A method for predicting future deterioration based on current conditions is also presented. This paper also includes a procedure for developing deterioration curves when condition state data is available.

  10. Development of Improved Mechanistic Deterioration Models for Flexible Pavements

    DEFF Research Database (Denmark)

    Ullidtz, Per; Ertman, Hans Larsen

    1998-01-01

    The paper describes a pilot study in Denmark with the main objective of developing improved mechanistic deterioration models for flexible pavements based on an accelerated full scale test on an instrumented pavement in the Danish Road Tessting Machine. The study was the first in "International...... Pavement Subgrade Performance Study" sponsored by the Federal Highway Administration (FHWA), USA. The paper describes in detail the data analysis and the resulting models for rutting, roughness, and a model for the plastic strain in the subgrade.The reader will get an understanding of the work needed...

  11. Mine water quality deterioration due to acid mine drainage

    Science.gov (United States)

    Singh, Gurdeep

    1987-03-01

    Water quality deterioration due to acid mine drainage is of concern in the northeastern coalfield of India as the water in this area is severely polluted. The mine drainage water emanating from various collieries are highly acidic in character and contain high hardness, sulphate, total dissolved solids and iron coupled with low pH values—which further results in contamination of trace (heavy) metals at significant levels. Trace metals are highly toxic and undesirable and are injurious to human health. These acidic waters are also typically hard in character because of iron sulphate content rather than common Ca-Mg bicarbonate type hardness.

  12. Deterioration of plasticized PVC components in Apollo spacesuits

    DEFF Research Database (Denmark)

    Shashoua, Yvonne; Schnell, Ulrich; Young, Lisa

    2002-01-01

    in the Life Support System, used to transport air and water to the astronaut, and in the Liquid Cooling Garment, used to cool the wearer of the spacesuit, exhibited high levels of deterioration. Tubing was unacceptably discoloured, tacky to the touch and surfaces were obscured by crystals. Visual examination......, Fourier Transform infrared spectroscopy and Low-Vacuum scanning electron microscopy suggested that discolouration was a result of dehydrochlorination of the PVC polymer, tackiness was caused by migration of di (2-ethylhexyl) phthalate (DEHP) plasticizer to surfaces, and phthalic acid crystals formed...

  13. Deterioration of hearing in a cochlear implantee with relapsing polychondritis.

    Science.gov (United States)

    Patrizia, Mancini; Giuseppe, Attanasio; Marika, Viccaro; Roberto, Filipo

    2011-06-01

    We report on a rare case of cochlear implantation in a patient affected by relapsing polychondritis (RP), which over time induced cochlear fibrosis/ossification and deterioration of previously excellent hearing performance. The clinical course was determined by CT scan, electrophysiology, and speech perception data. We conclude that RP is a severe autoimmune connective disorder that can cause profound sensorineural hearing loss. Cochlear implantation in these patients can provide excellent performance. Continuation of therapy may improve prognosis, but relapses involving inner ear structures can determine fibrosis/ossification of the modiolus and interfere with cochlear implant use.

  14. Cognitive Deterioration in Adults with Down Syndrome: Effects on the Individual, Caregivers, and Service Use.

    Science.gov (United States)

    Oliver, Chris; Crayton, Lissa; Holland, Anthony; Hall, Scott

    2000-01-01

    Individuals with Down syndrome (n=49) were assigned to three groups: those showing cognitive deterioration, those comparable in age, and those not showing cognitive deterioration but younger. Those experiencing cognitive deterioration were less likely to receive day services, had more impoverished life experiences, and required more support.…

  15. Tardily accelerated neurologic deterioration in two-step thallium intoxication.

    Science.gov (United States)

    Kuroda, Hiroshi; Mukai, Yoshiyuki; Nishiyama, Shuhei; Takeshita, Takayuki; Tateyama, Maki; Takeda, Atsushi; Aoki, Masashi

    2016-12-01

    Thallium intoxication was reported in cases with accidental ingestion, suicide attempt, and criminal adulteration. Reported cases were mostly one-time ingestion, therefore, the clinical course of divisional ingestion has not been fully known. Here, we report a case with two-step thallium intoxication manifesting as tardily accelerated neurologic deterioration. A 16-year-old adolescent was cryptically poisoned with thallium sulfate twice at an interval of 52days. After the first ingestion, neurologic symptoms including visual loss, myalgia, and weakness in legs developed about 40days after the development of acute gastrointestinal symptoms and alopecia. After the second ingestion, neurologic symptoms deteriorated rapidly and severely without gastrointestinal or cutaneous symptoms. Brain magnetic resonance imaging exhibited bilateral optic nerve atrophy. Nerve conduction studies revealed severe peripheral neuropathies in legs. Thallium intoxication was confirmed by an increase in urine thallium egestion. Most of the neurologic manifestations ameliorated in two years, but the visual loss persisted. The source of thallium ingestion was unraveled afterward because a murder suspect in another homicidal assault confessed the forepast adulteration. This discriminating clinical course may be attributable to the cumulative neurotoxicity due to the longer washout-time of thallium in the nervous system than other organs. It is noteworthy that the divisional thallium intoxication may manifest as progressive optic and peripheral neuropathy without gastrointestinal or cutaneous symptoms. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. Microbial deterioration of Mayan stone buildings at Uxmal, Yucatan, Mexico

    International Nuclear Information System (INIS)

    Ortega-Morales, O.; Guezennec, J.; Hernandez D, G.; Jozsa, P.; Sand, W.; Crassous, P.

    1998-01-01

    The microbial communities associated to Uxmal Mayan monuments (Yucatan, Mexico) and their role in stone deterioration were preliminary characterized by chemical, biochemical, microbiological, microscopical and surface analysis methods under two climatic seasons (1997). The organic matter and organic carbon and nitrogen were in the range of those reported for other stone buildings, indicating that oligo trophic conditions prevail at Uxmal. Quantitative differences in microbial biomass was higher at indoor section were the organic matter content was the highest and micro-environmental conditions (availability of water and protection to direct sunlight) are more suitable for microbial growth. The microbiological analysis underestimated the microbial biomass, as revealed by biochemical approaches. Nitrate and nitrite-oxidizing, metilotrophic and heterotrophic bacteria and fungi were detected in most surfaces. The heterotrophic bacteria were the most abundant microbial group (microbiological data). However, the chlorophyll profiles and Scanning Electron Microscopy showed that the microalgae are the most abundant colonizers in Uxmal stone buildings. EDAX analysis showed that the most surfaces were covered by an organic layer (cells and exo polymers). Gypsum was found in few samples. The large photo trophic biomass seems to play a role in stone bio deterioration by supporting growth of heterotrophic microorganisms (bacteria and fungi) which are known to produce organic acids leading to calcite dissolution and cations chelation. Further studies are being carried out in order to determine the role of exo polysaccharides which are thought to play a role in chemical degradation of limestone substrates in Uxmal. (Author)

  17. Credit financing for deteriorating imperfect quality items with allowable shortages

    Directory of Open Access Journals (Sweden)

    Aditi Khanna

    2016-01-01

    Full Text Available The outset of new technologies, systems and applications in manufacturing sector has no doubt lighten up our workload, yet the chance causes of variation in production system cannot be eliminated completely. Every produced/ordered lot may have some fraction of defectives which may vary from process to process. In addition the situation is more susceptible when the items are deteriorating in nature. However, the defective items can be secluded from the good quality lot through a careful inspection process. Thus, a screening process is obligatory in today’s technology driven industry which has the customer satisfaction as its only motto. Moreover, in order to survive in the current global markets, credit financing has been proven a very influential promotional tool to attract new customers and a good inducement policy for the retailers. Keeping this scenario in mind, the present paper investigates an inventory model for a retailer dealing with imperfect quality deteriorating items under permissible delay in payments. Shortages are allowed and fully backlogged. This model jointly optimizes the order quantity and shortages by maximizing the expected total profit. A mathematical model is developed to depict this scenario. Results have been validated with the help of numerical example. Comprehensive sensitivity analysis has also been presented.

  18. 76 FR 752 - Approval and Promulgation of Implementation Plans; Connecticut: Prevention of Significant...

    Science.gov (United States)

    2011-01-06

    ... Promulgation of Implementation Plans; Connecticut: Prevention of Significant Deterioration; Greenhouse Gas... changes impacting Connecticut's New Source Review (NSR) Prevention of Significant Deterioration (PSD... Regional Office, Office of Ecosystem Protection, 5 Post Office Square-- Suite 100 (Mail code OEP05-2...

  19. Deteriorating ischaemic stroke. cytokines, soluble cytokine receptors, ferritin, systemic blood pressure, body temperature, blood glucose, diabetes, stroke severity, and CT infarction-volume as predictors of deteriorating ischaemic stroke

    DEFF Research Database (Denmark)

    Christensen, Hanne; Boysen, Gudrun; Johannesen, Helle Hjorth

    2002-01-01

    Although the causes of neurological deterioration in acute cerebral infarction have not yet been identified, many variables have been associated with deterioration. The aim of this study was to investigate deteriorating ischaemic stroke....

  20. Physical exercise at the workplace prevents deterioration of work ability among healthcare workers

    DEFF Research Database (Denmark)

    Jakobsen, Markus D.; Sundstrup, Emil; Brandt, Mikkel

    2015-01-01

    BACKGROUND: Imbalance between individual resources and work demands can lead to musculoskeletal disorders and reduced work ability. The purpose of this study was to investigate the effect of workplace- versus home-based physical exercise on work ability among healthcare workers. METHODS: Two...... hundred female healthcare workers (Age: 42.0, BMI: 24.1, work ability index [WAI]: 43.1) from 18 departments at three Danish hospitals participated (Copenhagen, Denmark, Aug 2013-Jan 2014). Participants were randomly allocated at the cluster level to 10 weeks of: 1) workplace physical exercise (WORK......) performed during working hours for 5x10 min per week and up to 5 group-based coaching sessions on motivation for regular physical exercise, or 2) home-based physical exercise (HOME) performed during leisure time for 5x10 min per week. Both groups received ergonomic counseling on patient handling and use...

  1. 40 CFR 52.21 - Prevention of significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... fuel is generated from municipal solid waste; (e) Use of an alternative fuel or raw material by a..., taking into account energy, environmental, and economic impacts and other costs, determines is achievable... nonair quality environmental impacts. (20) Fugitive emissions means those emissions which could not...

  2. 40 CFR 51.166 - Prevention of significant deterioration of air quality.

    Science.gov (United States)

    2010-07-01

    ... a steam generating unit to the extent that the fuel is generated from municipal solid waste; (e) Use... account energy, environmental, and economic impacts and other costs, determines is achievable for such... environmental impacts. (20) Fugitive emissions means those emissions which could not reasonably pass through a...

  3. 75 FR 70916 - Notice of Prevention of Significant Deterioration Applicability Determination for the Carlsbad...

    Science.gov (United States)

    2010-11-19

    ... currently has a total of five natural gas-fired boilers, which are allowed to use No. 6 fuel oil during curtailments, and three fuel oil storage tanks. The Encina Power Station is an existing major source, and the... Carlsbad Energy Center Project, a proposed natural gas-fired power plant, at the existing Encina Power...

  4. 76 FR 4347 - Notice of Re-Issuance of the Prevention of Significant Deterioration Applicability Determination...

    Science.gov (United States)

    2011-01-25

    ... boilers, which are allowed to use No. 6 fuel oil during curtailments, and three fuel oil storage tanks... Energy Center Project is a proposed 540 MW net (558 MW gross) combined cycle natural gas-fired power... County, California. The Carlsbad Energy Center Project will replace three of five existing natural gas...

  5. 78 FR 6818 - Notice of Issuance of Prevention of Significant Deterioration Modification and Part 71 Operating...

    Science.gov (United States)

    2013-01-31

    ... Treasure Island Resort and Casino on land held in trust for the Prairie Island Indian Community in Red Wing... diesel-fired generators for peak load management and backup power at the casino. DATES: During the public... Treasure Island Resort and Casino in Red Wing, Minnesota. All four generators are located on land held in...

  6. 78 FR 73698 - Prevention of Significant Deterioration for Particulate Matter Less Than 2.5 Micrometers...

    Science.gov (United States)

    2013-12-09

    ... things, compliance with emission limitations achievable through installation of best achievable control... confusion on the part of the regulated industry and state, local and tribal air agencies about how the Court... U.S.C. 7401-7671q. 0 2. Section 51.166 is amended as follows: 0 a. By removing the words ``4 g/m\\3...

  7. 75 FR 77697 - Action To Ensure Authority To Issue Permits Under the Prevention of Significant Deterioration...

    Science.gov (United States)

    2010-12-13

    ...). Industry group NAICS \\a\\ Utilities (electric, natural 2211, 2212, 2213 gas, other systems). Manufacturing... certain types of biomass and other biogenic sources (e.g., biogas from landfills) for energy generation... assessing them.] These comments, among other things, suggest that certain biomass feedstocks (e.g., biogas...

  8. Physical exercise at the workplace prevents deterioration of work ability among healthcare workers

    DEFF Research Database (Denmark)

    Jakobsen, Markus D; Sundstrup, Emil; Brandt, Mikkel

    2015-01-01

    ) performed during working hours for 5x10 min per week and up to 5 group-based coaching sessions on motivation for regular physical exercise, or 2) home-based physical exercise (HOME) performed during leisure time for 5x10 min per week. Both groups received ergonomic counseling on patient handling and use......BACKGROUND: Imbalance between individual resources and work demands can lead to musculoskeletal disorders and reduced work ability. The purpose of this study was to investigate the effect of workplace- versus home-based physical exercise on work ability among healthcare workers. METHODS: Two...... hundred female healthcare workers (Age: 42.0, BMI: 24.1, work ability index [WAI]: 43.1) from 18 departments at three Danish hospitals participated (Copenhagen, Denmark, Aug 2013-Jan 2014). Participants were randomly allocated at the cluster level to 10 weeks of: 1) workplace physical exercise (WORK...

  9. 76 FR 17548 - Prevention of Significant Deterioration (PSD) and Nonattainment New Source Review (NSR...

    Science.gov (United States)

    2011-03-30

    ...) Kraft pulp mills; (iii) Portland cement plants; (iv) Primary zinc smelters; (v) Iron and steel mills... acid plants; (x) Petroleum refineries; (xi) Lime plants; (xii) Phosphate rock processing plants; (xiii...) Kraft pulp mills; (c) Portland cement plants; (d) Primary zinc smelters; (e) Iron and steel mills; (f...

  10. 75 FR 16012 - Prevention of Significant Deterioration (PSD) and Nonattainment New Source Review (NSR...

    Science.gov (United States)

    2010-03-31

    ... cement plants; ] (iv) Primary zinc smelters; (v) Iron and steel mills; (vi) Primary aluminum ore... refineries; (xi) Lime plants; (xii) Phosphate rock processing plants; (xiii) Coke oven batteries; (xiv...); (b) Kraft pulp mills; (c) Portland cement plants; (d) Primary zinc smelters; (e) Iron and steel mills...

  11. 75 FR 19567 - Prevention of Significant Deterioration (PSD) and Nonattainment New Source Review (NSR...

    Science.gov (United States)

    2010-04-15

    ... included as part of the comment that is placed in the public docket and made available on the Internet. If... as copyrighted material, is not placed on the Internet and will be publicly available only in hard... dependence. In NRDC's view, because the statute covers ``any physical change,'' and the NSR Aggregation...

  12. 75 FR 53892 - Action To Ensure Authority To Issue Permits Under the Prevention of Significant Deterioration...

    Science.gov (United States)

    2010-09-02

    ... GHGs; however, these states have other constitutional, State law, or SIP provisions that may limit... State authority. These constitutional or statutory provisions may limit the scope of the State PSD... received information about other provisions in the State constitutional or other State or SIP law that...

  13. 76 FR 5272 - Removal of Limitation of Approval of Prevention of Significant Deterioration Provisions...

    Science.gov (United States)

    2011-01-31

    ... Regulatory Development Section, Air Planning Branch, Air, Pesticides and Toxics Management Division, U.S..., Regulatory Development Section, Air Planning Branch, Air, Pesticides and Toxics Management Division, Region 4... Gas Emitting-Sources in State Implementation Plans; Alabama AGENCY: Environmental Protection Agency...

  14. 75 FR 82535 - Limitation of Approval of Prevention of Significant Deterioration Provisions Concerning...

    Science.gov (United States)

    2010-12-30

    ..., Kentucky, Development Section, Mississippi, North Air, Pesticides and Carolina, South Toxics Management... greenhouse gases under the Clean Air Act. These actions include, as they are commonly called, the... engines contribute to the greenhouse gas air pollution that endangers public health and welfare under CAA...

  15. 75 FR 82246 - Action To Ensure Authority To Issue Permits Under the Prevention of Significant Deterioration...

    Science.gov (United States)

    2010-12-30

    ... care 6221, 6231, 6232, 6233, 6239. facilities. Personal and laundry services 8122, 8123. Residential... small entities, small entity is defined as: (1) A small business that is a small industrial entity as...

  16. 75 FR 31513 - Prevention of Significant Deterioration and Title V Greenhouse Gas Tailoring Rule

    Science.gov (United States)

    2010-06-03

    ... and residential care 6221, 6231, 6232, 6233, 6239. facilities. Personal and laundry services 8122... 2 O, and HFCs) are emitted by motor vehicles. In the United States industrial processes (such as the...

  17. 75 FR 53883 - Action To Ensure Authority To Issue Permits Under the Prevention of Significant Deterioration...

    Science.gov (United States)

    2010-09-02

    .... Personal and laundry services 8122, 8123. Residential/private households......... 8141. Non-residential... notice on small entities, small entity is defined as: (1) A small business that is a small industrial...

  18. 76 FR 2581 - Action To Ensure Authority To Issue Permits Under the Prevention of Significant Deterioration...

    Science.gov (United States)

    2011-01-14

    .... Personal and laundry services 8122, 8123 Residential/private households 8141 Non-residential (commercial... as: (1) A small business that is a small industrial entity as defined in the U.S. Small Business...

  19. Diagnosis of Cryptococcosis and Prevention of Cryptococcal Meningitis Using a Novel Point-of-Care Lateral Flow Assay

    Directory of Open Access Journals (Sweden)

    Ashar Dhana

    2013-01-01

    Full Text Available Despite access to antiretroviral therapy, mortality from cryptococcal meningitis (CM is high among persons with advanced HIV infection in sub-Saharan Africa. Cryptococcal antigen (CrAg is present several weeks to months before the onset of symptoms of meningitis and can be screened to prevent life threatening meningitis. Recently, the World Health Organisation recommended that a new rapid CrAg lateral flow ‘‘dipstick’’ assay (LFA is to be used to screen HIV-infected persons with CD4 counts of less than 100 cells/µL. In this paper, we describe two cases of cryptococcosis with differing outcomes. In the first case, the new CrAg LFA was used as part of a screen and preemptive treatment strategy to prevent CM. In the second case, our patient had no access to the CrAg LFA and subsequently developed life threatening meningitis. To the best of our knowledge, this is the first case report of cryptococcosis diagnosed using this novel assay.

  20. close: Closure of patent foramen ovale, oral anticoagulants or antiplatelet therapy to prevent stroke recurrence: Study design.

    Science.gov (United States)

    Mas, Jean-Louis; Derumeaux, Geneviève; Amarenco, Pierre; Arquizan, Caroline; Aubry, Pierre; Barthelet, Martine; Bertrand, Bernard; Brochet, Eric; Cabanes, Laure; Donal, Erwan; Dubois-Randé, Jean-Luc; Durand-Zaleski, Isabelle; Ernande, Laura; Finet, Gérard; Fraisse, Alain; Giroud, Maurice; Guérin, Patrice; Habib, Gilbert; Juliard, Jean-Michel; Leys, Didier; Lièvre, Michel; Lusson, Jean-René; Marcon, François; Michel, Patrick; Moulin, Thierry; Mounier-Vehier, François; Pierard, Luc; Piot, Christophe; Rey, Christian; Rodier, Gilles; Roudaut, Raymond; Schleich, Jean-Marc; Teiger, Emmanuel; Turc, Guillaume; Vuillier, Fabrice; Weimar, Christian; Woimant, France; Chatellier, Gilles

    2016-08-01

    Currently available data do not provide definitive evidence on the comparative benefits of closure of patent foramen ovale, oral anticoagulants and antiplatelet therapy in patients with patent foramen ovale-associated cryptogenic stroke To assess whether transcatheter patent foramen ovale closure plus antiplatelet therapy is superior to antiplatelet therapy alone and whether oral anticoagulant therapy is superior to antiplatelet therapy, for secondary stroke prevention in patients aged 16 to 60 years with a large patent foramen ovale or a patent foramen ovale associated with an atrial septal aneurysm, and an otherwise unexplained ischaemic stroke or retinal ischaemia. Six hundred and sixty-four patients were included in the study. CLOSE is an academic-driven, multicentre, randomized, open-label, three-group, superiority trial with blinded adjudication of outcome events. The trial has been registered with Clinical Trials Register (Clinicaltrials.gov, NCT00562289). Patient recruitment started in December 2007. Patient follow-up will continue until December 2016. Expected mean follow-up = 5.6 years. The primary efficacy outcome is the occurrence of fatal or nonfatal stroke. Safety outcomes include fatal, life-threatening or major procedure- or device-related complications and fatal, life-threatening or major haemorrhagic complications. CLOSE is the first specifically designed trial to assess the superiority of patent foramen ovale closure over antiplatelet therapy alone and the superiority of oral anticoagulants over antiplatelet therapy to prevent stroke recurrence in patients with patent foramen ovale-associated cryptogenic stroke. © 2016 World Stroke Organization.