Gd2O3-modulated borate glass for the enhancement of near-infrared emission via energy transfer from Gd3+ to Nd3.

(Li2O)0.20(SrO)0.30(Nd2O3)0.01(B2O3)0.49-x(Gd2O3)x, where x = 0, 3, 5, 7, and 10 mol%, glass was melt-quenched to test it as a laser source in the near-infrared (NIR) region. The structural modification, absorption spectra, Judd-Ofelt (J-O) parameters, luminescence spectra, radiative laser parameters, lifetimes, XRD, and FTIR spectra were studied. Luminescence spectra excited at λexc = 584 nm revealed the highest intensity peak at 1073 nm due to the transition of 4F3/2 → 4I11/2. An important phenomenon of concentration quenching was observed and optimized luminescence was achieved with the sample having the concentration x = 07 mol%. The lifetimes of the donor and acceptor and energy transfer from gadolinium to neodymium were obtained from the luminescence decay kinetics. The findings show that Nd-doped Gd2O3-modified glass materials have potential as NIR laser sources.

Functional Outcome of Arthroscopic Anterior Cruciate Ligament Reconstruction Using Hamstring Autograft with Fixation Using Endobutton at Femoral End and Bioabsorbable Screw at Tibial End.

Anterior cruciate ligament (ACL) is the most frequently injured ligament of the knee. It can be repaired and reconstructed by open and endoscopic method, the gold standard is, however, endoscopic reconstruction. It is usually reconstructed using bone patellar tendon bone (BPTB) or Hamstring autograft. The graft is supported using endobutton at the femoral end while bioabsorbable interference screw at the tibial end. This study aimed to determine how a certain fixation procedure for quadrupled hamstring autografts worked out. This prospective observational study duration period was 1 year in which 40 patients with ACL injury were treated with arthroscopic reconstruction using hamstring autograft from January 2020 to December 2020 with 6 months follow up after surgery. On the femoral side, an endobutton was used to secure the graft, while the tibial end was secured using a bioabsorbable screw. The International Knee Documentation Committee (IKDC) scoring system was used for prospective evaluation. According to subjective IKDC scoring, 20(50.0%) results were very good, 14(35.0%) were good, 4(10.0%) were satisfactory and 2(5.0%) were bad. In 95.0% patients the state of knee joint is very good compared to preoperative state. Of all the 40 patients underwent ACL reconstruction, 38(95.0%) patients are satisfied with the results of the operation.

Compliance to Antihypertensive Medication: A Tertiary Care Study.

Hypertension is a global health problem and affects more than one billion people worldwide. Long term hypertension is associated with grave complications and therefore maintaining blood pressure within normal range is essential and ensuring patient's drug compliance is an important sector of patient care. Therefore, the purpose of our study was to find out the causes of poor compliance to antihypertensive medications. This cross sectional study was carried out in Medical Department of Ayub Teaching Hospital Abbottabad, Pakistan from 1st September 2017 to 30th October 2018. One hundred ninety three (193) patients were included through non probability consecutive sampling and were divided into two groups on the basis of compliance. The data was collected with the help of a structured questionnaire and analyzed using SPSS 20. Out of 193 hypertensive patients, 88(45.6%) were male while 105(54.4%) were females, with minimum age of 24 years and maximum age of 95 years and mean age of 61.98±12.81SD. Minimum duration of hypertension was 5 months and maximum was 30 years with mean duration of hypertension and standard deviation (SD) of 6.26±6.51 years. One hundred & Twenty (62.2%) patients were non-compliant, while 73(37.8%) were compliant to medication. Forgetfulness of medicine 85(70.8%) and non-affordability 62(52.5%) were the most common causes of noncompliance. This study documented a significantly higher proportion of medication non-adherence among hypertensive patients, with drug forgetfulness and affordability being found as the most common cause.

Oesophageal stents for the treatment of radiation and anastomotic oesophageal strictures.

Benign oesophageal strictures can arise in the treatment of oesophageal cancer as a result of radiation therapy, or at anastomotic sites, post-oesophagectomy. Data on the benefit of stenting of these types of stricture is limited. We analyzed the effects of oesophageal stents on such benign esophageal strictures. In this retrospective study, data was obtained from consecutive patients, 18 years and above from January 2000 to May 2016. Inclusion criteria comprised of oesophageal stenting in post-radiation strictures and anastomotic strictures, without any malignant residual disease. 17 patients had 22 stents inserted. 11 of these were female. 17 stents were self-expanding metallic stents (SEMS) and five were biodegradable (BDS). 12 strictures occurred post-radiation, while five were anastomotic strictures. Technical and clinical success rates were 100% and 86.4% respectively. Overall longterm clinical success was 45.5% (47% for BDS, 40% for SEMS). Minor, short-term complications, including pain and/or vomiting, were observed in 54.6% (n=12). The overall mean dysphagia score pre- and post-stenting was 2.95 and 1.36 (p=0.0001). Comparison of the dysphagia free survival for anastomotic and post-radiation strictures was statistically similar (p=0.22), as was the dysphagia free survival comparison between BDS and SEMS (p=0.055). BDS and SEMS are a safe and effective treatment modality for oesophageal strictures arising post-radiation or at the site of anastomoses. Retrospective study design and a low number of patients remain limiting factors of the study.

Factors affecting formulation characteristics and stability of ascorbic acid in water-in-oil creams.

OBJECTIVE: The present investigation is based on the formulation of water-in-oil (w/o) cream preparations of ascorbic acid (AA) at pH 4-6 using different emollients and humectants. METHODS: The preparations were stored in the dark at 30°C for a period of 3 months and were studied for their chemical and physical stability. RESULTS: The pH of the creams appeared to influence the stability of AA as the degradation was found to increase with an increase in pH. The degradation of AA in w/o creams followed an apparent first-order kinetics. Among all the preparations, the creams containing castor oil as emollient and glycerine as humectant showed highest viscosity and minimum degradation as compared with the creams containing other excipients. This indicated that higher the viscosity of the medium lower will be the degradation of AA. Citric acid (CT) was found to decrease the rates of degradation of AA in all the cream preparations. CONCLUSION: The physical mixtures of AA and CT showed no interaction between the two compounds by FTIR spectrometry indicating that the reduction in rates of degradation is due to the antioxidant activity of CT which protected AA to some extent from the atmospheric oxygen.

Staging laparoscopy in gastroesophageal and gastric adenocarcinoma: first experience from Pakistan.

CONTEXT: Current NCCN guidelines do not consider staging laparoscopy mandatory for detection of metastasis in gastroesophageal junction (GEJ) and gastric cancer. AIMS: To determine the rate of detection of metastasis on staging laparoscopy in GEJ and gastric cancer in Pakistani population and determine the prognostic significance of cytology versus biopsy positive metastatic disease. SETTINGS AND DESIGN: Retrospective study conducted from January 2005 to June 2013. MATERIALS AND METHODS: Demographics, clinicopathological characteristics and laparoscopic findings of 149 patients were compared. STATISTICAL ANALYSIS USED: Categorical variables were represented as frequencies and percentages and significance was determined using Chi square test. Overall survival was calculated from the date of staging laparoscopy to the date of death/last follow-up. Survival for cytology versus biopsy positive metastatic disease was calculated using Kaplan Meier curves and significance determined with Log rank test. RESULTS: Overall, metastases were detected in 40% of patients on staging. Laparoscopy detected metastasis in significantly high number of gastric cancers (48% versus 28%) (P = 0.01). Peritoneal nodules were more frequent with gastric tumors (40% versus 23%) and also were more likely to be malignant (58% versus 35%). Expected one year survival in patients with positive cytology (peritoneal washing/ascitic fluid) was significantly higher than patients with a positive peritoneal nodule biopsy (29% versus 0) (P = 0.04). On univariate analysis this was the only significant factor for increased risk of death (P = 0.03, HR = 2.5, CI = 1.04-5.98). CONCLUSIONS: Staging laparoscopy detects metastatic disease in a significant number of patients deemed non metastatic on preoperative imaging. Prognostically, cytology positive metastatic cancer may be different from biopsy positive cancer.

Kinetics of thermal degradation of betamethasone valerate and betamethasone dipropionate in different media.

The effect of pH, media, phosphate concentration and ionic strength on the kinetics of thermal degradation of betamethasone valerate and betamethasone dipropionate has been investigated. A validated HPLC method has been used to determine the parent compounds and their major thermal degradation products identified in the reaction. Betamethasone-17-valerate gave rise to two major products, namely, betamethasone-21-valerate and betamethasone alcohol, and betamethasone dipropionate degraded into three major products, namely, betamethasone-17-propionate, betamethasone-21-propionate and betamethasone alcohol, in different media. Betamethasone valerate showed maximum stability at pH 4-5 while betamethasone dipropionate was maximally stable at pH 3.5-4.5. The degradation of betamethasone valerate and betamethasone dipropionate was found to follow first-order kinetics and the apparent first-order rate constants (k(obs)) for thermal degradation in different media range from 0.399-9.07×10(-3) h(-1) and 0.239-1.87×10(-3) h(-1), respectively. The values of the rate constants decrease with increasing solvent polarity, phosphate concentration and ionic strength. The second-order rate constants (k΄) for the phosphate ion inhibited reactions lie in the range of 3.02-1.30×10(-6) M(-1) s(-1).

Fulminant myocarditis: a rare but life-threatening association of Crohn disease.

Myocarditis is an uncommon association of Crohn disease. It has been reported to occur independently of inflammatory bowel disease activity. The case history is presented of a young woman admitted to hospital with acute small bowel obstruction as a presentation of active Crohn disease, which was further complicated by fulminant myocarditis leading to cardiogenic shock. This could have proved fatal if not recognised and managed appropriately. Myocarditis is rare, but it can be a life-threatening association of inflammatory bowel disease that needs early recognition and prompt treatment.

Novel insights into the flexibility of cell and positional identity during urodele limb regeneration.

The ability of diverse metazoans to regenerate whole-body structures was first described systematically by Spallanzani in 1768 and continues to fascinate biologists today. Given the current interest in stem cell biology and its therapeutic potential, examples of vertebrate regeneration garner strong interest. Among regeneration-competent vertebrates such as the fish, frog, and salamander, the salamander is particularly impressive because it can regenerate the entire limb and tail as well as various internal organs as an adult (Goss 1969). This spectacular natural phenomenon leads us to ask what cellular properties allow regeneration and what prevents this phenomenon in other vertebrates. From this perspective, it is imperative to know whether the stem cells in regenerating limbs harbor particularly special traits such as a higher plasticity in cell fate compared to tissue stem cells in other organisms. Flexibility in cell fate needs to be considered with respect not only to tissue identity, but also to patterning because limb amputation causes cells in a particular limb segment to form more distal limb elements. How positional identity is encoded in stem cells and how it is controlled to produce only the missing portion of the limb are also questions of fundamental importance.

Fulminant myocarditis: a rare but life-threatening association of Crohn's disease.

Myocarditis is an uncommon association of Crohn's disease. It has been reported to occur independently of inflammatory bowel disease activity. The case history is presented of a young woman admitted to hospital with acute small bowel obstruction as a presentation of active Crohn's disease which was further complicated by fulminant myocarditis leading to cardiogenic shock. This could have proved fatal if not recognised and managed appropriately. Myocarditis is rare, but it can be a life-threatening association of inflammatory bowel disease which needs early recognition and prompt treatment.

Effects of LAAM and methadone utilization in an opiate agonist treatment program.

The development and approval of levo-alpha-acetylmethadol (LAAM) as a pharmacotherapeutic agent in opioid agonist therapy provided an alternative to methadone. Clinicians recognized the potential benefits that LAAM, a synthetic mu agonist with pharmacological properties which differ from those of methadone,could have in the treatment management of addicts in opioid agonist therapy. We report our experience utilizing LAAM from 1995 to 1999 at the Hines VA opioid agonist therapy clinic. The addition of LAAM to the clinic's treatment armamentarium has resulted in management options that have improved the areas of patient recruitment, patient retention, patient traffic, take-home medication, detoxification, and treatment outcomes.

A randomized prospective crossover trial of amlodipine in pediatric hypertension.

Amlodipine has potential advantages in children since it can be dissolved into a liquid preparation and has a long elimination half-life, allowing for once-daily administration. The objective of this study was to compare the efficacy and compliance of amlodipine with that of standard long-acting calcium channel blockers (felodipine or nifedipine) in hypertensive children. A randomized, prospective, crossover study of 11 hypertensive children (9-17 years of age, 10 renal transplant patients) was performed with electronic monitoring of compliance. Each treatment arm was 30 days. No significant differences were observed in mean systolic (SBP) and diastolic blood pressures (DBP) between amlodipine and the other calcium channel blockers. Using 24-h blood pressure monitoring there were no significant differences over each drug treatment period in both mean day-time and night-time SBP and DBP. Patient compliance was similar in both the amlodipine and the nifedipine/felodipine treatment periods. These data suggest that amlodipine is as effective in pediatric nephrology patients as nifedipine and felodipine. Amlodipine may be optimally suited for treatment of young children because at present it is the only calcium channel blocker which can be administered once daily as a liquid preparation.

Risk factors for long-term outcome of ifosfamide-induced nephrotoxicity in children.

Ifosfamide is widely used in the treatment of pediatric solid tumors. Its main adverse effects are various forms of renal tubular and glomerular damage. The authors sought to determine factors that predict the risk for the development and severity of ifosfamide-induced nephrotoxicity in children and to examine the long-term outcome of this complication. A total of 174 children who had received ifosfamide for various cancers were studied. Nephrotoxicity was assessed by laboratory markers of glomerular and tubular function and a grading score (none, mild, moderate, severe). Patients were assessed 4 to 12 weeks after each ifosfamide course, 3 months after completion of chemotherapy, and 5 years later. Of 174 children, 72 (41.4%) developed tubular dysfunction, whereas only 11 (6.3%) demonstrated glomerular dysfunction; 40 (23.0%) demonstrated mild toxicity, 16 (9.2%) demonstrated moderate toxicity, and 16 (9.2%) developed severe nephrotoxicity. The four severity subgroups (none, mild, moderate, severe) received comparable doses/m2/cycle of ifosfamide and mesna. Children exhibiting severe toxicity were significantly younger compared to those with moderate, mild, or no nephrotoxicity (median age: 2.2, 7.0, 8.2, and 10.5 years, respectively; p < 0.001) and received significantly higher cumulative doses of ifosfamide (49.6 +/- 12.3, 46.0 +/- 13.1, 36.2 +/- 9.7, and 33.8 +/- 7.6 g/m2, respectively; p < 0.001). Cumulative doses of cisplatin were higher among children with severe nephrotoxicity compared to those with moderate, mild, or no toxicity, although this difference did not reach statistical significance. Of all risk factors analyzed by multiple regression analysis, age was the most significant predictor for the grade of nephrotoxicity (p < 0.001), followed by the cumulative dose of ifosfamide (p = 0.005). Seven out of 16 children (44.0%) with severe nephrotoxicity and 4 out of 16 children (25.0%) with moderate nephrotoxicity demonstrated severe chronic tubular toxicity over a follow-up period of 5 years. Since severe ifosfamide-induced renal toxicity tends to be chronic in a substantial number of treated children, it should be balanced carefully against efficacy. Cumulative ifosfamide doses of 45 g/m2 and above should be carefully considered, especially in children younger than age 3.

Pregnancy outcome following gestational exposure to organic solvents: a prospective controlled study.

CONTEXT: Numerous women of childbearing age are exposed occupationally to organic solvents. Previous retrospective studies have reported conflicting results regarding teratogenic risk. OBJECTIVE: To evaluate pregnancy and fetal outcome following maternal occupational exposure to organic solvents. DESIGN: A prospective, observational, controlled study. SETTING: An antenatal counseling service in Toronto, Ontario. PATIENTS: One hundred twenty-five pregnant-women who were exposed occupationally to organic solvents and seen during the first trimester between 1987 and 1996. Each pregnant woman who was exposed to organic solvents was matched to a pregnant woman who was exposed to a nonteratogenic agent on age (+/-4 years), gravidity (+/-1), and smoking and drinking status. MAIN OUTCOME MEASURE: Occurrence of major congenital malformations. RESULTS: Significantly more major malformations occurred among fetuses of women exposed to organic solvents than controls (13 vs 1; relative risk, 13.0; 95% confidence interval, 1.8-99.5). Twelve malformations occurred among the 75 women who had symptoms temporally associated with their exposure, while none occurred among 43 asymptomatic exposed women (P<.001). (One malformation occurred in a woman for whom such information was missing.) More of these exposed women had previous miscarriage while working with organic solvents than controls (54/117 [46.2%] vs 24/125 [19.2%]; P<.001). However, exposed women who had a previous miscarriage had rates of major malformation that were similar to exposed women who had no previous miscarriage. CONCLUSIONS: Occupational exposure to organic solvents during pregnancy is associated with an increased risk of major fetal malformations. This risk appears to be increased among women who report symptoms associated with organic solvent exposure. Women's exposure to organic solvents should be minimized during pregnancy. Symptomatic exposure appears to predict higher fetal risk for malformations.

Efficacy of amlodipine in pediatric bone marrow transplant patients.

The calcium antagonist amlodipine may have the potential for expanded use in children owing to its physiochemistry and pharmacokinetic profile that facilitates once-daily dosing in a liquid formulation. Its safety and efficacy have not been previously evaluated in children. A retrospective analysis of 15 pediatric bone marrow transplant patients who had amlodipine incorporated into their antihypertensive drug regimen reveals significantly lower blood pressure as compared with baseline therapy (123.5+/-2.1 mmHg and 117.2+/-2.2 mmHg, systolic blood pressure before and during amlodipine, P<0.05; 81.5+/-1.8 mmHg and 75.5+/-2.6 mmHg, diastolic blood pressure before and during amlodipine, P<0.05). Amlodipine provided improved blood pressure control in this cohort and may provide a valuable pharmacologic alternative for treatment of pediatric hypertension.

Bronchial artery aneurysm in hyperimmunoglobulinemia E syndrome.

A 2-year-old girl presented with a large right middle lobe cavitating lesion, complicated by life-threatening hemoptysis secondary to hyperimmunoglobulinemia E (hyper IgE) syndrome (Job's syndrome). This proved to be a bronchial artery pseudoaneurysm which was successfully embolized.

Growth failure and bony changes induced by deferoxamine.

We reviewed the linear growth and growth plate morphology in all children with homozygous beta thalassemia followed in Toronto, for whom monthly height percentiles were available before, and for a 36-month period after, the initiation of nightly subcutaneous deferoxamine therapy. All patients were less than 7 years of age when begun on deferoxamine, and had received nightly deferoxamine for a minimum of 36 months. Marked abnormalities of the metaphyseal growth plate were readily observed in the distal ulnar, radial, and tibial metaphyses in 11 of 37 patients in whom a significant decline in mean height percentile was also noted. (In 10 of these 11 patients, height was less than the 15th percentile after 36 months.) These 11 patients had received a significantly greater (p less than 0.025) initial and average daily dose of deferoxamine, and had maintained a significantly lower (p less than 0.025) mean serum ferritin concentration over the 36 months, than the remainder of the cohort. To determine whether deferoxamine played a causative role in growth failure, growth in patients who began deferoxamine before the age 2 years was compared to that of patients who began after age 5 years, for the period between 2 and 5 years of age. Only patients begun on deferoxamine prior to age 2 years demonstrated a significant (p less than 0.01) decline in height percentile by the third year, implicating deferoxamine therapy as the cause of growth failure. We conclude that both the decline in height percentile and the bony changes observed in well-chelated patients are directly related to deferoxamine therapy.(ABSTRACT TRUNCATED AT 250 WORDS)