Replantation in scapulothoracic avulsion amputation of the right upper limb in a 3-year-old child- A preliminary report

Replantations for major amputations of upper extremity have been widely performed. We report a unique case of successful replantation of scapulothoracic avulsion amputation in a child. In this manuscript, we discuss the various challenges faced during the procedure and chances of neural recovery.

Bronchodilators, Antibiotics, and Oral Corticosteroids Use in Primary Care for Children With Cough

Real-world management decisions for acute cough in children in primary care practice are not well understood. This study is an analysis of 560 encounters for children with cough, 19 days to 18 years of age, seen in a predominantly suburban academic pediatric practice, over 1 year. Past history, cough duration, and cough characteristics significantly affected treatment decisions. Children with cough frequently had a history of preterm birth, allergies, asthma, and neurological conditions. Most common therapies were bronchodilators, antibiotics, and oral corticosteroids. Children prescribed antibiotics were older, more likely to have a wet or productive cough, history of sinusitis, pneumonia or dysphagia, and longer cough duration. Children prescribed oral corticosteroids were younger, less likely to be wet or productive and more likely to have history of asthma or dysphagia. Children prescribed bronchodilators were more likely to have fever, nasal congestion, and wheezing and history of previous asthma, pneumonia, or dysphagia.

Calciphylaxis in a renal transplant recipient with normal graft function: A case report and review of literature

Calciphylaxis, also known as calcific uremic arteriolopathy, is a rare, life-threatening complication of end-stage renal disease. However, it may also occur in patients without renal failure, the nonuremic calciphylaxis. Most patients present with painful skin ulcers. Delayed diagnosis can lead to sepsis-related morbidity and mortality. Aberrations in calcium, phosphate, and parathyroid hormone physiology are common and biopsy is diagnostic. Early diagnosis and correction of vascular and metabolic aberrations may assist in healing as may the use of sodium thiosulfate and hyperbaric oxygen therapy. We report on successful treatment of a case of calciphylaxis in a renal transplant recipient with normal allograft function.

The optimization of home oxygen weaning in premature infants trial: Design, rationale, methods, and lessons learned

Improved survival among preterm infants has led to an increase in diagnosis of chronic lung disease and infants discharged home from the NICU on supplemental oxygen. Despite this increased prevalence, no clearly defined guidelines for the management of home oxygen therapy (HOT) exist. This lack of consensus leads to significant variability in the duration of home oxygen therapy and a general paucity of evidence-based practice. Our team has identified recorded home oxygen therapy (RHO) as a potential new resource to guide clinical decision making in the outpatient pulmonology clinic. By recording extended O2 saturation data during the weaning process, RHO has the potential to save cost and improve the processes of HOT management. Our team is currently supporting a prospective, multi-center, randomized, controlled trial of RHO guided HOT weaning with the aims of determining effect upon duration of HOT, perceived parent quality of life and effect upon growth and respiratory outcomes. We plan to randomize 196 infants into one of two study arms evaluating standard HOT management versus RHO guided oxygen weaning. Our primary outcomes are total HOT duration and parental quality of life. This trial represents an unprecedented opportunity to test a novel home monitoring intervention for weaning within a vulnerable yet quickly growing population. If effective, the use of RHO may provide clinicians a tool for safe weaning.

Contribution of Calcium and Other Dietary Components to Global Variations in Bone Mineral Density in Young Adults

A research project on comparative international studies of osteoporosis using isotope techniques was organized by the International Atomic Energy Agency (IAEA) with the participation of 12 countries (Brazil, Canada, Chile, China, Croatia, Hungary, Philippines, Russia, Singapore, South Africa, Turkey, and the United Kingdom). Participating centers in 11 countries (all but the UK) made measurements and collected data on men and women aged 15 to 49 years. In addition to studies of bone mineral density (BMD) at the femoral neck and lumbar spine using DEXA, anthropometric, lifestyle, and nutritional data were also collected. The results of the nutritional studies are reviewed in this paper. Overall, about 8% of the observed variability in spine BMD could be attributed to nutritional factors in men and women; in men, no such relationship could be determined. No single nutritional component (not even calcium) stood out as being of particular importance across all participating centers.

Effect of Lanthanum Substitution on Magnetic and Structural Properties of Nickel Ferrite

Inverse spinel ferrites have demanded substantial attention in the recent past owing to their diverse technological deeds by conquering admirably with its surface, finite size effects and optical properties which has its proficient applications in photocatalytic degradation, magnetic resonance imaging and sensors etc. The substituted La3+ ions delay the development of grain growth of the materials in a meticulous manner compared with that of the pure Ni ferrites. We tale development of magnetic features in La3+ substituted Ni nano-ferrites synthesized by co-precipitation technique and then analyzed from the structural and magnetic perspectives. A credible and thriftily doable co-precipitation method has been the spotlight of forethought in recent decades to synthesize these ferrite nanoparticles. Enviable inverse spinel phase has been observed, as it is essential to modify and optimise its micro structural and magnetic features. The phase formation and significant properties of Ni1-xLaxFe2O4 ferrites were investigated using XRD, FTIR, TEM, UV-visible, VSM and FT-Raman techniques. The crystallite size of the as-synthesized nanoparticles were observed after the substitution of La3+ content in the range of 8 to 15 nm. As the dopant concentration increases the crytallite size increases and other changes in crystallographic parameters, as well as the cation distribution also observed. The TEM micrograph clearly reveals the cubic and the notable polycrystalline nature. The FTIR measurements carried out in the range of 400-4000 cm-1 elucidates the occurrence of functional groups. The UV-visible spectrum analysis reveals the optical property of as-synthesized nanoparticle and hence their band gap was found using Kubelka-Munk plot. The magnetic parameters were studied by vibrating sample magnetometer and the saturation magnetization of the ferrites at the room temperature decreases with the reduction in size.

Asthma, Environment and Pollution: Where the Rubber Hits the Road

The detrimental effects of environmental pollution on one's health are undeniable and have been demonstrated time and time again. Breathing in pollutants in ambient air often has consequences throughout the body, including cardiovascular disease, effects on the reproductive system, and oncologic implications. In the respiratory system, chronic exposure yields a number of outcomes, including chronic obstructive pulmonary disease (COPD) and asthma exacerbations, increased rates of hospitalizations, and increased severity of acute illnesses. On a macro-level, this morbidity and mortality then leads to vast and far-reaching public health consequences the world over, including the loss of billions of dollars' worth of labor. This is especially applicable in developing countries, which often undergo rapid growth, industrialization and urbanization with a resultant increase in vehicular traffic, coal combustion, and fuel emissions as a whole. For this reason, environmental pollutants have been studied extensively, and countries around the globe have established laws that regulate ambient air levels of so-called criteria pollutants. This article will explore several of these criteria pollutants, including particulate matter, nitrogen dioxide, sulfur dioxide, and ozone, and their individual relationships to asthma pathophysiology. However, it is also emphasized that though each one of these toxins yields its own effects, the group of them often works together to have cumulative consequences. For these reasons and many more, it is important to remain aware and educated about these omnipresent environmental pollutants.

An Ecosystem for Comprehensive Cervical Cancer Prevention in India: Formative Study in India

Background: Despite being preventable, cervical cancer is the third most common cancer in India, accounting for the highest number of cancer deaths. India has made limited progress toward introducing the safe and effective vaccine to prevent human papilloma virus (HPV) infections, which has been available for a decade. Aim: Using qualitative research, we examined opportunities for comprehensive cervical cancer prevention, including HPV vaccination in two Indian states - Tamil Nadu (TN) and Karnataka (KA). Methods: We used a socio-ecological framework to identify and map key stakeholders and structures that create the ecosystem for comprehensive cervical cancer prevention. Data were collected through semistructured in-depth interviews and focus group discussions. Key stakeholders included women and men (30-45 years) residing in selected slums/villages, community influencers (village government, self-help group members), district and state-level government health and education officials, specialist doctors, frontline health workers, staff of cancer-related nongovernmental organizations, and journalists. Results: As neither state had initiated public provision of the HPV vaccine, discussions focused on stakeholders' knowledge about the vaccine and factors that could inform a policy decision and facilitate or pose barriers to roll-out. Government officials and specialists in both states were aware of HPV vaccination for primary prevention of cervical cancer. Officials in KA noted concerns about the vaccine's safety and efficacy more emphatically than officials in TN. Specialists, particularly those in leadership positions in the Federation of Obstetrics and Gynecology Societies of India and the Indian Academy of Pediatrics were strong advocates of vaccination. Several specialists contrasted the numerous implementation challenges of cervical cancer screening with India's successes in routine immunization. However, a few specialists also expressed concerns regarding safety of the HPV vaccine. Community members lacked awareness about the vaccine and raised concerns on its safety, side effects and benefits as they would have for any new vaccine. All stakeholders highlighted cost as a major barrier to public provision of the vaccine. Government officials were concerned about how a vaccine program could be financed and sustained. The consensus, particularly in TN, was that the HPV vaccine would need to be introduced through the Universal Immunization Program as a partnership between the health and education departments to ensure widespread access. Conclusion: State-level implementation of comprehensive cervical cancer prevention hinges on the inclusion of HPV vaccination in the national immunization program. Cultivating vaccine champions and identifying appropriate financing mechanisms to implement and sustain comprehensive cervical cancer prevention along with careful planning and implementation has the potential to save the lives of many women.

The World Could End Cervical Cancer if It Tried: Embracing the Power of Youth

Background and context: The human papillomavirus (HPV) is a ubiquitous virus that causes many cancers: cervical, oropharyngeal, anal, penile, vaginal and vulvar cancers, the most serious consequence being cervical cancer that takes the life of a woman between the ages of 35-60 every two minutes in this world. There are existing tools to prevent this cancer today: at the primary prevention level, the HPV vaccines that are up to 90%-97% preventive; at the secondary level, simple screening tests including Pap test, HPV DNA testing, and VIA; and at tertiary level, effective early treatment of precancerous conditions. Yet, cervical cancer is the second most common cancer among women in the developing world. One of the main reasons for this gap is the lack of awareness that cervical cancer is a preventable public health problem. Hence, education and innovative models are necessary for successful control of this disease. The HPV vaccines are recommended between 9-26 years in males and females. Hence, our organization, The Global Initiative Against HPV and Cervical Cancer (GIAHC), decided to empower the next generation to join the fight against HPV and cervical cancer. Aim: To empower the younger generation to play a proactive role to raise awareness and increase the uptake of HPV vaccination and cervical cancer screening through the use of arts in medicine and social media. Strategy/Tactics: An educational PowerPoint presentation was developed by medical and nursing students to present to middle and high school students and in other community settings. Program/Policy process: A 30-minute-long presentation was developed so that it could fit into a classroom period. A script for the presenter, a reference sheet, slides to highlight how HPV can affect both sexes, risk factors and effective ways to prevent it were developed. Emphasis was placed on the HPV vaccine for boys and girls. This was followed by a game, and a short inspirational and aspirational film and a few words to empower them. Outcomes: The program has met with good success: The presentation has been shown by our students in several states in the US and in other countries. Our student group has grown from 2 to 60 in one year. Middle and high school students also want to get involved to spread the message. Students are continually coming up with other creative ways through, dance, painting, poetry video clips and using social media to spread the message. Students of the American Medical Women's Association (AMWA) and Medical Women's International Association (MWIA) have now partnered with us. The Department of Education has expressed an interest to collaborate with us. What was learned: Empowering the younger generation and providing them with the tools to play a pro active role to interweave science with various creative art forms can have far-reaching and greater impact on communities and societies to raise awareness about HPV.

A High Sensitivity Isopropanol Vapor Sensor Based on Cr₂O₃-SnO₂ Heterojunction Nanocomposites via Chemical Precipitation Route

Cr2O3-SnO2 heterojunction nanocomposites were prepared via chemical precipitation method. The prepared samples were characterized by X-ray diffraction (XRD), Transmission electron microscopy (TEM), UV-Vis diffuse reflectance spectra and Field Emission Electron Microscopy (FESEM). The XRD spectrum confirms the presence of both tetragonal rutile SnO2 and rhombohedral corundum Cr2O3 structure. Further investigation into the gas sensing performances of the prepared Cr2O3-SnO2 nanocomposites exhibited an enhanced sensitivity towards VOPs such as isopropanol, acetone, ethanol and formaldehyde. Especially, isopropanol vapor sensor shows excellent sensitivity at an operating temperature of 100 °C. The highest sensitivity for Cr2O3-SnO2 heterojunction nanocomposites indicate that these materials can be a good candidate for the production of high-performance isopropanol sensors.

Investigation on the Magnetically Separable Zn Substituted CoFe₂O₄ Nanoparticles with Enhanced Photo-Fenton Degradation

We report the influence of Co1-xZnxFe2O4 nanoferrites for the photodegradation of organic pollutant present in the aqueous solution. A series of Co1-xZnxFe2O4 (x = 0.01, 0.03, 0.05 and 0.10) nanoferrites have been synthesized via a facile and economically viable coprecipitation technique and investigated the effect of zinc dopant in their structural, optical, electrical and magnetic properties. X-ray diffraction and Fourier Transform Infrared spectral studies reveal the spinel phase formation of the as-synthesized nanoferrites. Photoluminescence and UV-visible spectral studies show the bandgap of nanoferrites increase from 2.47-2.67 eV and exhibited a blue shift in the band edge emission with respect to increase in Zn content. Phase transition of the samples from weak ferromagnetic to superparamagnetic nature has been observed by Vibrating Sample Magnetometer at room temperature. Furthermore, the Co1-xZnxFe2O4 was assessed for the degradation of Methylene Blue (MB) dye and the sample with Co1-0.10Zn0.10Fe2O4 showed better photocatalytic degradability of organic MB due to its enhanced adsorption in the visible region and the existence of lower concentration charge-carriers.