Tuesday, 7 August 2018

Use of Laser in the Treatment of Urethral Hemangioma


The urethral localization of anhemangiomas is very rare. Responsible for urethrorrhagia and/or hemospermia, the diagnosis is easily made by endoscopy. On the other hand, the treatment remains difficult because of the localization urethral. Nous report the case of a man of 28 years treated with Laser Nd YAG.A man of 28, with no particular history, had urethrorrhages associated with initial hematuria since the age of 20 years. A first endoscopic assessment, found a single hemangiomatous lesion located in the navicular fossa that was treated by electrocoagulation. Six months later, with a greater bleeding recurrence, a new urethrocystoscopy showed the appearance of a new hemangiomatous localization extended to the ventral side of the maxillary anterior urethra in the bulbar urethra and extending to on the meatus.

Arteriography was performed in search of a lesion that could be treated by embolization. This one did not find an arterial anomaly, but only a vascular puddle corresponding to the urethra at the venous time. Two years after, a new abundant urethrorrhagia, motivated an attempt of endoscopic treatment by electrocoagulation at the level of the most voluminous lesion located just under the striated sphincter. Due to the risk of secondary stenosis, coagulation was deliberately incomplete and bleeding recurrences were early.

The patient then presented daily urethrorrhages of low abundance without any repercussion or hemodynamic, nor anemia, but with a psychological and professional repercussion 3 months later, Laser Nd YAG coagulation was performed. The procedure was performed under general anesthesia, using an SLT Side Firing fiber equipped with the 40-watt lateral firing tip, positioned next to a cystoscope (Storz).

Monday, 6 August 2018

Management of Dengue Fever with Severe Thrombocytopenia in a Patient While on Warfarin: A Case Report


Dengue fever is a potentially lethal illness that is universally prevalent in the tropics. Dengue hemorrhagic fever is characterized by a ‘leakage phase’ (or critical phase) usually lasting 48 hours following an initial febrile phase. During the leakage phase, an increase in capillary permeability leads to extravasation of fluid and haemoconcentration. During the latter part of febrile phase and early leakage phase (or even later), there is a steady drop in platelet count. Some patients with dengue fever will develop severe thrombocytopenia during the course of the illness even without going into a critical phase and the platelet count does not necessarily indicate the severity of infection. At occasions, it can drop as low as 500/μl in previously healthy individuals (normal platelet count in a healthy adult: 150,000-400,000/μl). The exact mechanism of this drop is unclear but presumed to be immunological. The low platelet count leaves the patient at a significant risk of spontaneous bleeding. The management is further complicated by pre-existing co-morbidities that interfere with the usual therapeutic guidelines. Use of oral anticoagulants is one such situation where management of dengue fever could be challenging. We report a patient with severe dengue infection with very low platelet counts without bleeding manifestations who was on anticoagulation with warfarin for atrial fibrillation with severe mitral regurgitation awaiting prosthetic mitral valve replacement.

A fifty one year old Sri Lankan male, presented with fever for three days and arthralgia, myalgia and retro orbital headache. There were no other systemic symptoms to suggest any focus of infection. He had mitral regurgitation following papillary muscle rupture due to a myocardial infarction one year ago complicated with atrial fibrillation for which he was on anticoagulant therapy with warfarin. His target PT INR (Prothrombin Time International Normalized Ratio) of 2-3, maintained with 7mg of warfarin per day. His other medications included; digoxin, and a combination of hydrochlorothiazide and furosemide. His 2D echocardiography done on August-2016 revealed grade 1V mitral regurgitation with left ventricular ejection fraction of 60%. On admission, he was hemodynamically stable with an irregularly irregular pulse at a rate of 76 beats per minute and a blood pressure of 110/60mmHg. All the peripheral pulses were felt and capillary refilling time was <2 seconds. On auscultation, there was a pan-systolic murmur at cardiac apex with radiation to axilla.

Friday, 3 August 2018

Fifty (50) Year Experience at the NBRL, Boston, Massachusetts to Study the Survival and Function of Fresh, Liquid, and Freeze Preserved Human and Baboon Red Blood Cells, Platelets, and Plasma Clotting Proteins


Between 1965 and 1974, the NBRL was located at the Chelsea Naval Hospital which was renamed the Boston Naval Hospital. Two books were written to report the studies performed and the data reported during this period: Blood Banking and the Use of Frozen Blood Products and Hypovolemic Anemia of Trauma: The Missing Blood Syndrome. In addition a monograph published in 2006 reported the 30-year experience at the NBRL to study the survival and function of fresh, liquid preserved, and frozen baboon RBC, platelets, and plasma clotting proteins: The survival and function of baboon red blood cells, platelets and plasma proteins: a review of the experience from 1972 to 2002 at the Naval Blood Research Laboratory, Boston, Massachusetts. In the 65 peer-reviewed NBRL publications reported in the monograph, the bleeding time measurement was shown to be an accurate method to assess the hemostatic function of fresh, liquid preserved and cryopreserved baboon red blood cells, platelets, and plasma clotting proteins.

In 2007, the monograph: Non-surgical bleeding diathesis in anemic thrombocytopenic patients: Role of temperature, RBC, platelets, and plasma clotting proteins was published. This monograph reports that nonsurgical blood loss correlated to the bleeding time in normal volunteers and in patients. The bleeding time measurement was affected by the temperature and the function of the RBC, platelets, and plasma clotting proteins. The monograph summarized 45 peer-reviewed NBRL publications which measured the bleeding time in normal volunteers and patients to assess the hemostatic effect of the red blood cells, platelets, and plasma proteins to reduce the bleeding time and reduce the nonsurgical blood loss. The monograph identified that the temperature had a significant effect on the bleeding time. Hypothermia produced a significant increase in the bleeding time and increase in nonsurgical blood loss and increase in temperature reduced the bleeding time and reduced the nonsurgical blood loss.

Sustainable Approach to Modify the CPD Process for Knit Garments and Analysis the Effect of Curing Treatment on CPD


The purpose of thestudy is to minimize the energy load of Cold pigment dyeing (CPD) process by minimizing the process steps. As a representative effort in this direction, the current paper describes the effect of curing treatment on Cold pigment dyed garments considering different properties .Samples pretreatment were done in the same bath and same method followed for both samples. In case of dyeing, two different methods i.e. existing (Pad-dry-cure) and experimental (pad-dry) were used to develop the samples. Prepared samples were evaluated in terms of CMCΔE value, color fastness properties, drape co-efficient, GSM, fabric strength and surface morphology respectively. Results of the study evinced that experimental process is better than existing process by considering process time and energy savings. Color fastness value of the experimental sample offer comparatively better values than the existing process while other results are within range. Experimental process can reduced up to 6% processing time along with 2.35 Kw power savings for each batch. The experimental (pad-dry) process of CPD will provide a strong economical benchmark for the garments dyeing industry to adopt this sustainable process.

In the fast fashion world when time to market is paramount, the concept of garment dyeing post make up is increasingly adopted by manufacturers. Garment dyeing can be defined as the “application of color to fully fashioned apparel articles, may be in the form of garments cut and sewn either prepared or unprepared knitted fabrics and then dyed, garments and / or components knitted from either prepared or unprepared yarn and then dyed, The benefits of processing good through garment dyeing procedure revolve around quick response with minimize lead time and improved inventory control.

It is also increased the challenges of achieving the unique ,fashionable & value added products, while remaining comparative in price similar to reduction in operating margins, the dyeing process should be more economical while producing high value product. Pigments are kinds of insoluble colorants used for fibers, yarns and garments very commonly, which can retain stable chemical structure throughout the coloration process in its dispersed solution. Water-based pigment systems, are eco-friendly pathways. Pigments are dispersed into water with the assist of auxiliaries, such as dispersants, emulsifiers, anti-setting agents, etc. Water-based pigment has been widely applied in coloration for textiles, paints, architecture, and wood and so on. The Cold pigment dyeing is one kind of garments dyeing process which give an uneven look at low temperature. This process is also referred to as wave dyeing, top dyeing, oil wash and random dyeing. It is a simple and eco-friendly pigment dyeing process obtained by the usage of a binder, fixer along with pigments (any color).

Thursday, 2 August 2018

HLA Incompatible Successful Renal Transplantation Across Bw4/Bw6 Alleles in Two Patients


AMR: Antibody Mediated Rejection; BSHI: British Society for Histocompatibility and Immunogenetics; CDCXM: CDC Cross-Match; CREG: Cross Reactive Group; DSA: Donor Specific Antibody; FCXM: Flowcytometry Cross-Match; HLA: Human Leukocyte antigen; HLAi: HLA incompatible; IVIg: Intra Venous Immuno globulin; KSS: UK Living Donor Kidney Sharing Scheme; MFI: Mean Fluorescence Intensity; MMF: Mycophenolate Mofetil μ mol/L: Micromoles/litre; PRA: Panel Reactive Antibody; POD: Post Operative Day; SAB: Single Antigen Bead.

HLA Incompatible (HLAI) renal transplantation with desensitization is being increasingly performed in Northern Ireland because it results in better quality of life and improved survival compared to long term maintenance dialysis. Risk stratification for potential recipients in the United Kingdom is performed according to British Society of Histocompatibility and Immunogenetics (BSHI) / British Transplant Society (BTS) guidelines, which involves comprehensive evaluation by a combination of Complement Dependent Cytotoxicity Cross-Match (CDCXM), Flowcytometry Cross-Match (FCXM) and Luminex Single Antigen Bead (SAB) assay, and correlation with sensitization history. Transplanting successfully across a broad specificity such as HLA- Bw4 or Bw6 may prove more difficult, because non–DSA reacting with Bw4 or Bw6 epitopes could have an additive effect and hence greater overall reactivity even if reactivity against the donor mismatched allele is low. In this paper the workup leading to successful outcome of two HLAI transplants performed in Belfast City Hospital is presented. Maintenance immunosuppression was with the triple drug regimen of Prednisolone, Mycophenolate Mofetil (MMF) and Tacrolimus.

Wednesday, 1 August 2018

Skin-On-Chips for Drug Discovery of Chronic Wounds


Diabetic foot ulcers, venous leg ulcers, and pressure ulcers contribute to majority of chronic wounds. The importance of improved wound healing measure is especially well demonstrated by the healing problems in diabetes. It is estimated that about 30% of all the costs for diabetes relates to wound care in USA. In addition, 2.4-4.5 million people have been reported to have chronic lower extremity ulcers in USA only. Pressure ulcers and leg ulcers, including venous ulcers, cost as high as $8 billion annually in USA, and are a significant cause of morbidity in aged population. Although a slow wound repair is a self-limiting process and not a pathogenesis in itself, severe chronic wounds can also lead to chronic inflammatory diseases, fibrosis, and cancer, comprising stifling economic health care burdens.

Wound healing in clinical settings relies primarily on enabling the natural course of epidermal tissue regeneration. In many cases, the involved processes and the progress of regeneration may be insufficient to save severely injured patients. Especially difficult are various types of chronic wounds, with diabetic wounds being the most severe type. Current conventional treatment of chronic wound comprises mainly approaches with various types of dressings, bandages, and antibiotics. Several skin substitutes have reached the market place for second-line therapy of chronic ulcers, but they have not had the impact that was predicted. In severe cases where the wounds do not heal, amputation is the only treatment option that is available. Therefore, there is a great need for better wound healing treatments, in particular to cure diabetic and other chronic wounds. Another challenge in clinics is the lack of available evidence demonstrating efficacy for the advanced wound care products. Personalized medicine based on a systematic evaluation of patients and their wound conditions comprise an attractive approach to accelerate and strengthen wound healing processes in the future.

Monday, 30 July 2018

Nontuberculous Mycobacteria in Critical Care


Recentstudies inpatients, who are hospitalized in Intensive Care Unit (ICU), show that 51% of them have infections, and 71% are given treatment. Bacterial and some fungal infections, as opportunistic microorganism are the primary concern. Hospitalizing in ICU is associated with increasing in mortality rate and excess expenses. Pharmacokinetics, absorption, distribution, metabolism, and excretion of drugs experience many changes in critical illness.

NTM, are a group of mycobacteria which is not a causative organism of tuberculosis or leprosy, so they called as Mycobacteria Other Than Tuberculosis (MOTT). NTM bacteria are a family of small, rod-shaped bacilli which have more than 150 species. Atypical mycobacteria have different favor in choosing their environment and are identified as environmental mycobacteria. NTM are the causative organisms in pulmonary diseases like tuberculosis, lymphadenitis, skin disease, or disseminated disease. Major clinical manifestations of NTM Infections are presented in Table 1. In 1950s, they were accepted as human pathogens. Unlike tuberculosis and leprosy, spreading NTM infections from one person to another person is rare. Environmental exposure is the major way of contagion. The risk of getting infected by a particular species of NTM is dependent on pathogenicity of microorganism, the method of exposure and frequency of exposure. In the last decade, (NTM) infections have worldwide increasing in incidence and mortality. The reasons for this increase are not obvious. But increasing incidence of acquired immune compromised syndrome, cancer, diabetes mellitus, chronic lung injuries, and continues supportive ventilation could be causative.

A retrospective study in medical center of Taiwan from January 1999 to June 2007 was planned to evaluate medical ICU patients whose respiratory specimens were positive for NTM. They defined tree group of patients, one group with NTM pulmonary infection, the other with NTM colonization and a control group who have culture negative samples for mycobacteria. Clinical sign, symptoms and outcomes were compared. Their finally result was that, increment in mortality rate in patients who have NTM pulmonary. Suitable treatment against NTM would followed by better result.

Use of Laser in the Treatment of Urethral Hemangioma

                                                      http://austinpublishinggroup.com/urology/ The urethral localization  of anheman...