Differing radiation exposure in scrub technicians and rotating staff in cardiac catheterization laboratory: occupation matters

Funding Acknowledgements

Type of funding sources: None.

Background

Radiation exposure of cardiac catheterization lab personnel is an evolving area of concern, due to long term, repetitive exposure causing deterministic and stochastic effects(1,2). Current radiation protection measures are based on increasing distance, shielding from fluoroscopy source and depend on primary operator behavior(3)

Effective dose(ED) in micro Sieverts( μSv) as a measure of individual absorbed radiation dose provides feedback as to occupational exposure and risks. Dosimeter badges worn over equipment measure ED correlating with radiation exposure of areas unprotected by standard lead apron such as head, neck, lens and upper limbs. (4)

Most studies focus on primary operator exposure (5,6,7), overlooking non physician staff comprising scrub technicians working as assistants to primary operator physicians, and rotating staff involved in peri-procedural care of patients.

Purpose

This study aimed to find out ED acquired by scrub technicians(ED.S) and rotating staff(ED.R) in interventional cardiology and invasive electrophysiology procedures, utilizing external dosimeters worn over lead aprons.

Methods

We prospectively collected radiation data over forty six invasive Cardiology procedures from 15th March 2021 to 1st June 2021 comprising fourteen diagnostic coronary and graft angiograms, seventeen combined diagnostic and interventional cardiology procedures, nine sole percutaneous coronary interventions and six electrophysiology procedures. Nine staff members: two female and seven male members participated as scrub technicians and rotating staff, provided with external dosimeter badges. ED was obtained by logging in dosimeter badges into pre calibrated monitors.

Results

Significantly high mean ED was acquired by rotating staff as compared to scrub technicians, mean ED.R:21.04 μSv( SD: +/-39.64) and mean ED.S: 7.54 μSv( SD:+/- 17.23), this three fold difference in radiation exposure was statistically significant with a p-value of 0.03.

This was consistent across procedure groups, with rotating staff acquiring higher ED compared to their scrub technician colleagues in diagnostic, interventional and electrophysiology cases. Statistically significant differences in radiation exposure of both staff groups were demonstrated in diagnostic and interventional cardiology procedures, with p-values of 0.04 and 0.01 respectively.(See Table)

Conclusion

This small, single center study highlights occupational role as a significant factor in varying radiation exposure amongst non-physician staff . Higher ED was attributed to rotating staff duties involving proximity and mobility around fluoroscopy source and patient, devoid of protective lead shields.

Based on these findings, avoiding fluoroscopy use while staff performs duties involving proximity to patient such is mandatory. Other essential measures should include accessory left sided leads shields, mandatory protective lens and head shields for rotating staff. Abstract Table

Photosynthetic acclamatory response of Panicum antidotale Retz. populations to root zone desiccation stress

Growth of plants is severely reduced due to water stress by affecting photosynthesis including photosystem II (PSII) activity and electron transport. This study emphasised on comparative and priority targeted changes in PSII activity due to progressive drought in seven populations of Panicum antidotale (P. antidotale) collected from Cholistan Desert and non-Cholistan regions. Tillers of equal growth of seven populations of P. antidotale grown in plastic pots filled with soil were subjected progressive drought by withholding water irrigation for three weeks. Progressive drought reduced the soil moisture content, leaf relative water content, photosynthetic pigments and fresh and dry biomass of shoots in all seven populations. Populations from Dingarh Fort, Dingarh Grassland and Haiderwali had higher growth than those of other populations. Cholistani populations especially in Dingarh Grassland and Haiderwali had greater ability of osmotic adjustment as reflected by osmotic potential and greater accumulation of total soluble proteins. Maximum H2O2 under water stress was observed in populations from Muzaffargarh and Khanewal but these were intermediate in MDA content. Under water stress, populations from Muzaffargarh and Dingarh Fort had greater K+ accumulation in their leaves. During progressive drought, non-Cholistani populations showed complete leaf rolling after 23 days of drought, and these populations could not withstand with more water stress condition while Cholistani populations tolerated more water stress condition for 31 days. Moreover, progressive drought caused PSII damages after 19 days and it became severe after 23 days in non-Cholistani populations of P. antidotale than in Cholistani populations.

Metric mechanics with nontrivial topology: Actuating irises, cylinders, and evertors

Liquid crystal elastomers contract along their director on heating and recover on cooling, offering great potential as actuators and artificial muscles. If a flat sheet is programed with a spatially varying director pattern, then it will actuate into a curved surface, allowing the material to act as a strong machine such as a grabber or lifter. Here we study the actuation of programed annular sheets which, owing to their central hole, can sidestep constraints on area and orientation. We systematically catalog the set of developable surfaces encodable via axisymmetric director patterns and uncover several qualitatively new modes of actuation, including cylinders, irises, and everted surfaces in which the inner boundary becomes the outer boundary after actuation. We confirm our designs with a combination of experiments and numerics. Many of our actuators can reattain their initial inner or outer radius upon completing actuation, making them particularly promising, as they can avoid potentially problematic stresses in their activated state even when fixed onto a frame or pipe.

Radiological-pathological correlation of negative CT biopsy results enables high negative predictive value for thoracic malignancy

AIM

To evaluate multidisciplinary team (MDT) practice of radiological-pathological correlation of non-malignant biopsy results to examine the additive effect on the predictive values of computed tomography (CT) biopsy for malignancy and their subsequent management and outcomes.

MATERIALS AND METHODS

A service evaluation of the MDT management of non-malignant lung biopsy results (May 2014- May 2017) was undertaken.

RESULTS

Sixty patients had a non-malignant diagnosis on initial CT biopsy. Five patients were lost to follow-up leaving 55 in the final cohort. Forty-eight of the 55 patients had biopsy results classified as potentially non-specific, of which 26 were classified as concordant with radiology (e.g., organising pneumonia with compatible CT features), and 22 were classified as discordant (e.g., non-specific inflammation and yet sufficiently suspicious CT features). Patients with concordant negative pathology showed resolution (n=19) or stability (n=6) on imaging follow-up. One lesion demonstrated growth and was proven malignant on surgical resection. Discordant lesions were managed with repeat biopsy (n=8) or surgical resection (n=13), with 12 final benign diagnoses and nine malignancies. The negative predictive value of CT biopsy alone was 44/55 (80%), following repeat biopsy was 44/50 (88%), and following radiological-pathological assessment was 32/33 (97%). No patients underwent a shift in stage from time of biopsy to resection.

CONCLUSION

Combining radiological-pathological interpretation of negative biopsy results offers superior negative predictive value for lung malignancy without delayed diagnosis of lung cancer.

Installing oncofertility programs for common cancers in limited resource settings (Repro-Can-OPEN Study): An extrapolation during the global crisis of Coronavirus (COVID-19) pandemic

PURPOSE

The state of limited resource settings that Coronavirus (COVID-19) pandemic has created globally should be taken seriously into account especially in healthcare sector. In oncofertility, patients should receive their fertility preservation treatments urgently even in limited resource settings before initiation of anticancer therapy. Therefore, it is very crucial to learn more about oncofertility practice in limited resource settings such as in developing countries that suffer often from shortage of healthcare services provided to young patients with cancer.

METHODS

As an extrapolation during the global crisis of COVID-19 pandemic, we surveyed oncofertility centers from 14 developing countries (Egypt, Tunisia, Brazil, Peru, Panama, Mexico, Colombia, Guatemala, Argentina, Chile, Nigeria, South Africa, Saudi Arabia, and India). Survey questionnaire included questions on the availability and degree of utilization of fertility preservation options in case of childhood cancer, breast cancer, and blood cancer.

RESULTS

All surveyed centers responded to all questions. Responses and their calculated oncofertility scores showed different domestic standards for oncofertility practice in case of childhood cancer, breast cancer, and blood cancer in the developing countries under limited resource settings.

CONCLUSIONS

Medical practice in limited resource settings has become a critical topic especially after the global crisis of COVID-19 pandemic. Understanding the resources necessary to provide oncofertility treatments is important until the current COVID-19 pandemic resolves. Lessons learned will be valuable to future potential worldwide disruptions due to infectious diseases or other global crises.

Optimization of protein in supplementary feeds for pond raised cyprinids

Labeo rohita, Gibelion catla, Cirrhinus mrigala, Ctenopharyngodon idella and Hypophthalmichthys molitrix were grown together for 365 days in triplicate ponds. Six iso-caloric feeds having varying protein levels i.e. 22, 24, 26, 28, 30 and 32% were prepared and supplemented to fish at 2% fish weight daily. Significantly, higher final average weight (793 ± 197 g) and total length gain (398 ± 40 mm) was recorded for Ctenopharyndodon idella. Net fish yield enhanced as the level of digestible protein (DP) in the supplementary diets increased and plateaued at 28% DP level, thereafter significant reduction (P<0.05) in fish weight increments was experienced at any surplus protein level. Among the supplementary feeds, 28% DP level resulted in maximum net fish yield (4304 ± 33 kg ha^-1 year^-1) and a significantly higher overall nitrogen conversion ratio (NCR) of 1:5.2 ± 0.14. Higher level of DP in supplementary feeds resulted in reduced fish growth.

Molecular diversity of Pakistani mango (Mangifera indica L.) varieties based on microsatellite markers

Understanding the genetic diversity of different Pakistani mango varieties is important for germplasm management and varietal characterization. Microsatellites are efficient and highly polymorphic markers for comparative genome mapping, and were used in the present study to determine the genetic relatedness and variability among 15 indigenous mango cultivars (Mangifera indica L.). Overall, 181 bands were produced using 12 simple sequence repeat (SSR) primers. Out of the 12 primers used, 10 were polymorphic and two were monomorphic. Genetic relatedness among cultivars was assessed by constructing a dendrogram using the unweighted pair group method of arithmetic means. The accessions exhibited coefficients of similarity ranging from 75 to 100%, indicating the frequent use of only a few parent cultivars and the presence of inbreeding. The primers used in the present study were found to be valuable for identifying genetic relationships among mango cultivars.

Assessment of genetic diversity of cotton genotypes for various economic traits against cotton leaf curl disease (CLCuD)

In Pakistan, cotton crop has been under enormous threat of cotton leaf curl disease (CLCuD) over the last four decades. In order to estimate genetic diversity in cotton germplasm CLCuD resistance, we assessed 100 cotton genotypes for their CLCuD resistance/tolerance and other related agronomical traits. Various statistical analytical tools, including correlation analysis, cluster analysis, and principal component analysis (PCA), were used to select the best genotypes. These genotypes can be used in future breeding programs to generate CLCuD resistant varieties. The same set of procedures could be utilized for other diseases in other crops. CLCuD incidence showed a significant negative genotypic correlation with yield-contributing traits followed by a significant negative association for phenotypic correlation. The seed cotton yield showed significant positive genotypic and phenotypic correlations with plant height, number of bolls per plant, and boll weight. From the PCA we identified five principal components (PCs) that explained a significant amount of the variance among the variables, which may be used for selection of cotton genotypes with CLCuD resistance. Of the five PCs, the first four contributed more towards the total variability and had eigenvalues greater than one. The cluster analysis showed that the genotypes in one of the clusters performed particularly well with respect to CLCuD tolerance. These genotypes can be utilized for development of varieties with increased CLCuD tolerance.

An improved agar medium for growth of Geobacillus thermoglucosidarius strains

Geobacillus species have potential applications in many biotechnological processes. They are fastidious in their vitamin and amino acid requirements. A new semi-defined agar medium (SDM) was developed which gave consistently high viable cell counts of various G. thermoglucosidasius strains (5×10⁸-6×10⁸cfu/ml) under aerobic conditions at 70°C.

Scaling of heat transfer and temperature distribution in granular flows in rotating drums

Accurate prediction of the time required to heat up granular materials to a target temperature is crucial for several processes. However, we do not have quantitative models to predict the average temperature or the temperature distribution of the particles. Here, we computationally investigate the scaling of heat transfer in granular flows in rotating drums. Based on our simulations, which include a wide range of system and material properties, we identify the appropriate characteristic time that is used to derive equations that predict the particles' average temperature and the particles' temperature distribution.

Estimation of genetic variability among peanut genotypes for resistance to leaf spot disease

This study aimed to identify high-yielding peanut genotypes with resistance to leaf spot disease. The experiments included material from fourteen local and four exotic peanut genotypes that showed highly significant differences among morphological and disease severity parameters in all the genotypes which, in turn, suggested diversity genotypes. Disease severity analysis showed that the highest disease score and damaged leaf area were observed in the genotype Kelincer and the lowest scores and leaf damaged areas were observed in Majalaya super and BARI-2000, respectively. Based on these results, the genotypes BARI-2011, Chakori, Golden, BARI-89, Majalaya Super, BARD-699, BARI-2000, SP-1, and No. 334 can be used by breeders in peanut improvement programs for the development of new cultivars with higher disease resistance and increased yield.

Epidemiology and financial implications of self-inflicted burns

INTRODUCTION

The cost of the treatment of burns is high especially in self-inflicted burns with prolonged treatment. We performed a retrospective review of the self-inflicted burns at our regional burns centre to determine the costs incurred in their management and to identify factors which could reduce the financial burden in the future.

METHODS

The data was collected retrospectively of all the inpatient and outpatient self-inflicted burns presenting to our regional burns centre in the year 2011.

RESULTS

Twenty one patients (out of a total of 870 patients) presented with self-inflicted burns to our centre in 2011. Five (23.8%) were major burns with an average of 53.2% Total Body Surface Area (TBSA) and 16 (76.2%) were minor burns with an average of 0.5% TBSA. 11 (52.4%) patients had flame burns including 4 self-immolation burns. The mortality rate was 4.8% (n=1). Five (23.8%) patients underwent surgical treatment. Seven (33.3%) patients were treated in intensive care and with average stay of 46.85 days. Critical care and theatre attendances made up most of the costs with average ICU stay per patient calculated at £313,131/day. The total cost of all 21 patients was £1,581,856.

CONCLUSION

Burns are preventable injuries, early detection and intervention in patients with propensity to self-inflict burns can possibly reduce the costs of treatment in the future.

Diallel cross analysis of plesiomorphic traits in Triticum aestivum L. genotypes

We conducted a 5 x 5 complete diallel cross experiment in bread wheat (Triticum aestivum) with the genotypes 6309, Chkwal-50, Dhrabi, Bhkhar-02, and FS-08. Our objective was to evaluate the type of gene action and the general and specific combining abilities required for various morphological traits in wheat. The results of analysis of variance revealed highly significant differences among genotypes for all the investigated traits. The results of joint regression analysis showed that the data for all the investigated traits fitted a simple additive dominance model. Graphical representation of variance and covariance suggested that most of the investigated traits were controlled by overdominance gene action. However, the peduncle length and plant height were controlled by additive gene action. Variety 6309 carried the highest number of dominant genes for the number of spikelets per spike, number of tillers per plant, plant height, number of fertile tillers per plant, and grain yield per plant. Chakwal-50 carried the highest number of recessive genes for grain yield per plant, number of tillers per plant, number of grains per spike, number of fertile tillers per plant, and plant height. Chakwal-50 and 6309 were the best general combiners for number of spikelets per spike, number of grains per spike, grain yield per plant, 1000-grain weight, number of fertile tillers per plant, and number of tillers per plant. On other hand, 6309 performed well in specific crosses with Chakwal-50, FS-08, and Bhakhar-02 for spike length and number of tillers per plant.

Safe corridors for K-wiring in phalangeal fractures

BACKGROUND

Unstable phalangeal fractures are commonly treated with K-wire fixation. Operative fixation must be used judiciously and with the expectation that the ultimate outcome should be better than the outcome after nonoperative management. It is necessary to achieve a stable fracture fixation and early mobilization. In order to achieve this goal, one should closely understand the safe portals/corridors in hand for K-wire entry for fractures of the phalanges. Safe corridors were defined and tested using a pilot cadaveric and a clinical case study by assessing the outcome.

MATERIALS AND METHODS

In our prospective case series, 50 patients with 64 phalangeal fractures were treated with closed reduction and K-wires were inserted through safe portals identified by a pilot cadaveric study. On table active finger movement test was done and the results were analyed using radiology, disabilities of the arm, shoulder, and hand (DASH) score and total active motion (TAM). In our study, little finger (n = 28) was the most commonly involved digit. In fracture pattern, transverse (n = 20) and spiral (n = 20) types were common. Proximal phalanx (n = 38) was commonly involved and the common site being the base of the phalanx (n = 28).

RESULTS

47 (95%) patients had excellent TAM and the mean postoperative DASH score was 58.05. All patients achieved excellent and good scores proving the importance of the safe corridor concept.

CONCLUSION

K-wiring through the safe corridor has proved to yield the best clinical results because of least tethering of soft tissues as evidenced by performing "on-table active finger movement test" at the time of surgery. We strongly recommend K-wiring through safe portals in all phalangeal fractures.

Use of a mobile device app: a potential new tool for poster presentations and surgical education

INTRODUCTION

Poster presentations are an important part of presenting scientific techniques and represent an integral part of conferences and meetings. Traditionally, paper format is used; however, in recent years electronic posters and other methods, such as incorporating a DVD player as part of a poster, have been successfully used. We describe and demonstrate the use of an augmented reality application for smartphones and tablets as a potential future addition to the presentation of scientific work and surgical techniques in poster format. This method allows the audience to view surgical techniques and research as 3D animation or video by using a trigger image in a poster/journal/text book via their smart device.

METHOD

The author used the free Aurasma© application available on both iOS and Android 2.2 and higher platforms from iTunes App Store and Google Play. Once installed, any user with a 3G or WiFi connection via a smart phone or tablet can subscribe to the Medical Illustration channel for free. The user can then scan the trigger image placed on a poster with a mobile device to view videos, animations or 3D data. Further interaction can direct the user to a website for more content.

RESULT

The author has trialled this method at a regional burns and plastic surgery centre and found it to be highly effective.

CONCLUSION

The use of this novel method adds a new dimension to the presentation of scientific work at surgical and medical conferences and as part of journals and textbooks by permitting users to view scientific data and techniques on mobile devices as videos or as three dimensional environments at their own leisure.

A new recreational mechanism for the boxer's knuckle: cause for concern?

Traumatic injuries of the metacarpophalangeal joints are a common occurrence in professional and recreational sports such as boxing and martial arts, especially the fourth and fifth metacarpals. Injury usually results from a forceful impact with a clenched fist. The spectrum of injuries varies from simple skin laceration to extensor mechanism disruption, dorsal capsule rupture, metacarpal fractures and carpometacarpal joint injuries. These injuries are well documented in boxers as well as in patients who had been involved in fights and assaults. We report on two patients sustaining similar injuries to the dorsum of the hand but following punching of a recreational 'punching machine'. We describe the patterns of injury encountered and summarise the treatment. For clinical and safety reasons as well as the potential medicolegal implications, we believe it is important to highlight this mechanism of injury.

Cardiac ischaemia and rhythm disturbances during elective colonoscopy

BACKGROUND

The number of colonoscopic procedures continues to rise rapidly. With widespread adoption of colonoscopy based bowel screening programmes, this rising trend is set to continue.

AIMS

This study aimed to identify whether elective colonoscopy could provoke cardiac rhythm disturbances and/or myocardial ischaemia, as evidenced by 12 lead Holter ECG recordings and troponin I (cTnI) changes.

MATERIALS AND METHODS

Patients were stratified into three groups based on the presence of cardiac disease or cardiovascular risk factors. They underwent real time 12 lead Holter monitoring before, during and after colonoscopy. Bloods were taken for pre- and post-procedure cTnI estimation.

RESULTS

Holter ECG recordings of the three groups showed a high incidence of new but silent ischaemic and arrhythmic ECG changes during the colonoscopy in patients with documented but stable heart disease and to a lesser extent in those patients with one or more risk factors for heart disease. Three patients had high cTnI concentrations both before and after colonoscopy. Two patients with known heart disease died within 30 days of colonoscopy.

CONCLUSIONS

This study demonstrates for the first time the occurrence of potentially clinically significant ST-T wave changes and rhythm disturbances during elective colonoscopy in patients with known heart disease and to a lesser extent in those patients with a known cardiovascular risk profile.

Oral dantrolene and severe respiratory failure in a patient with chronic spinal cord injury

Oral dantrolene is used widely for the treatment of spasticity in patients with spinal cord injury. A 60-year-old patient in the rehabilitation phase following cervical spine injury presented with generalised weakness and deteriorating respiratory function, requiring intensive care admission, tracheal intubation and ventilation. He had bilateral basal lung collapse and a raised diaphragm and was on high-dose oral dantrolene. The cessation of dantrolene resulted in a dramatic recovery of respiratory function within two days. High-dose oral dantrolene can cause severe respiratory insufficiency and may present difficulties in the differential diagnosis of respiratory failure in patients with high cervical spinal cord injuries.

The incidence of non ulcer dyspepsia and its response to treatment

BACKGROUND

This study was undertaken to identify Non Ulcer Dyspepsia (NUD) in young patients presenting with peptic ulcer like symptoms. Their response to treatment was also determined.

METHODS

100 patients between the ages of 20-40 of both sexes were included in the study. Investigations done were Chest X-ray Plain Abdominal X-ray, ECG, ESR, LFTs Amylase Abdominal Ultrasound and upper GI endoscopy. All patients then received 6-week therapy with Omeprazole and Helicobacter Pylori eradication with Clarithromycin and Tinidazole.

RESULTS

NUD was by far the most common cause (59%) in both the sexes. Response to therapy was unsatisfactory.

CONCLUSIONS

This relatively newly discovered clinical entity should be kept in mind while dealing with patients presenting with refractory dyspeptic symptoms.

Superficial siderosis of the central nervous system

Two patients with superficial siderosis of the central nervous system are reported. Both developed progressive deafness over many years; one with associated anosmia and partial seizures; the other with progressive ataxia and diplopia. The cerebrospinal fluid was xanthochromic in one and the protein was raised in both. Magnetic resonance imaging revealed a hypodense rim around the eighth cranial nerve, cerebellum, brain stem and spinal cord. Despite extensive investigations the cause of the superficial siderosis in both patients remains undetermined.

Familial hemiplegic migraine and autosomal dominant arteriopathy with leukoencephalopathy (CADASIL)

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a recently described familial cerebrovascular disorder shown to map to chromosome 19q12. Familial hemiplegic migraine has also been shown in some families to map close to the CADASIL locus. The fully developed CADASIL phenotype consists of recurrent strokes developing in the fourth decade, progressing to a pseudobulbar palsy, spastic quadriparesis, and subcortical dementia. In an Irish family 15 members were fully investigated by magnetic resonance scanning; 10 had typical magnetic resonance features of CADASIL. Five members of this family had familial hemiplegic migraine and 4 of these had magnetic resonance evidence of CADASIL. Two other members had migraine with and without aura as a presenting clinical symptom of CADASIL. This disorder has been shown by linkage analysis to map to the CADASIL locus at chromosome 19. The phenotype at presentation of CADASIL in this family was variable and age related and included familial hemiplegic migraine, migraine with and without aura, transient ischemic attacks, strokes, and spinal cord infarction. This family study increases our understanding of the spectrum of clinical manifestations of this underrecognized familial cerebrovascular disorder.

Do alpha-blockers have a role in lower urinary tract dysfunction in multiple sclerosis?

Lower urinary tract dysfunction is a major cause of morbidity in patients with multiple sclerosis. alpha 1-Adrenergic receptors are present at the bladder neck, where increased tone may be responsible for urinary retention and diminished flow rates. A randomized placebo controlled study was designed to test the hypothesis that blockade of these receptors using the selective alpha 1-adrenergic receptor antagonist indoramin would improve bladder emptying in patients with multiple sclerosis. Peak and mean urinary flow rates, residual volume and symptom score were evaluated at trial entry and again after 4 weeks in 18 men with multiple sclerosis. There was a mean 41% improvement in peak flow rate in the actively treated group compared with a 7.4% deterioration in the placebo group (p < 0.05). Residual volume improved in both groups. Patients taking indoramin reported a greater improvement in urinary symptoms. Modulation of the alpha 1-receptor may have a role in the management of lower urinary tract dysfunction in multiple sclerosis.

Sneddon's syndrome--clinical course and out-come

Five patients presented with Sneddon's syndrome characterised by cerebral infarction, livedo reticularis, hypertension, epilepsy and a progressive dementia. Two patients had raised anticardiolipin antibody titres. The clinical symptoms and immunological disturbance in Sneddon's syndrome and the antiphospholipid syndrome are similar, and may indicate the importance of immune mediated thrombosis in Sneddon's syndrome.