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Environmental Science and Pollution... Jun 2024Groundwater is widely regarded as being among the freshwater natural resources with the lowest levels of contamination. Nevertheless, the saltwater intrusion has...
Groundwater is widely regarded as being among the freshwater natural resources with the lowest levels of contamination. Nevertheless, the saltwater intrusion has resulted in the contamination of groundwater in coastal regions with lower elevation. The rationale of the present work is to investigate the chemistry of groundwater, to identify the various facies of groundwater, to identify the processes that influence groundwater chemistry and saltwater intrusion, and to evaluate the groundwater's aptness for use in drinking and farming. In order to gain an understanding of the groundwater quality as well as the salinization process that occurs in coastal aquifers as a result of hydrogeochemical processes, a total of 108 groundwater samples (54 each in pre- and post-monsoon) were taken and analyzed for several physiochemical parameters in the southern part of the Puri district in the Indian state of Odisha. The data has undergone analysis and examination to identify the factors (such as hydrological facies, potential solute source in water, and salinization process) that contribute to groundwater salinity. The result showed the chemistry controlling processes of rock-water interaction as per Gibbs diagram. The majority of shallow aquifers exhibit the Na-Cl type of facies as per the Piper plot. A total of 37% pre-monsoon and 33% post-monsoon samples having Na/Cl ratio below the threshold of 0.86 indicating the influence of saltwater intrusion. In both seasons, it was observed that 74% of the samples exhibited a Na concentration that exceeded the permissible limit set by the World Health Organization (WHO) for drinking purposes. The findings indicate that most groundwater failed to pass safe drinking water and irrigation standards due to saltwater intrusion. Consequently, the monitoring of coastal aquifer quality has become imperative in order to ensure the sustainability of aquifers and the development of groundwater resources. This is because coastal aquifers are highly vulnerable to saltwater intrusion, primarily as a result of the extensive extraction of groundwater for diverse purposes.
Topics: Groundwater; India; Environmental Monitoring; Salinity; Water Pollutants, Chemical
PubMed: 38483718
DOI: 10.1007/s11356-024-32833-w -
The Journal of Trauma and Acute Care... Jul 2024Delays in initiating venous thromboembolism (VTE) prophylaxis in patients suffering from traumatic brain injury (TBI) persist despite guidelines recommending early...
BACKGROUND
Delays in initiating venous thromboembolism (VTE) prophylaxis in patients suffering from traumatic brain injury (TBI) persist despite guidelines recommending early initiation. We hypothesized that the expansion of a Trauma Program Performance Improvement (PI) team will improve compliance of early (24-48 hours) initiation of VTE prophylaxis and will decrease VTE events in TBI patients.
METHODS
We performed a single-center retrospective review of all TBI patients admitted to a Level I trauma center before (2015-2016,) and after (2019-2020,) the expansion of the Trauma Performance Improvement and Patient Safety (PIPS) team and the creation of trauma process and outcome dashboards. Exclusion criteria included discharge or death within 48 hours of admission, expanding intracranial hemorrhage on CT scan, and a neurosurgical intervention (craniotomy, pressure monitor, or drains) prior to chemoprophylaxis initiation.
RESULTS
A total of 1,112 patients met the inclusion criteria, of which 54% (n = 604) were admitted after Trauma PIPS expansion. Following the addition of a dedicated PIPS nurse in the trauma program and creation of process dashboards, the time from stable CT to VTE prophylaxis initiation decreased (52 hours to 35 hours; p < 0.001) and more patients received chemoprophylaxis at 24 hours to 48 hours (59% from 36%, p < 0.001) after stable head CT. There was no significant difference in time from first head CT to stable CT (9 vs. 9 hours; p = 0.15). The Contemporary group had a lower rate of VTE events (1% vs. 4%; p < 0.001) with no increase in bleeding events (2% vs. 2%; p = 0.97). On multivariable analysis, being in the Early cohort was an independent predictor of VTE events (adjusted odds ratio, 3.74; 95% confidence interval, 1.45-6.16).
CONCLUSION
A collaborative multidisciplinary Trauma PIPS team improves guideline compliance. Initiation of VTE chemoprophylaxis within 24 hours to 48 hours of stable head CT is safe and effective.
LEVEL OF EVIDENCE
Therapeutic/Care Management; Level IV.
Topics: Humans; Venous Thromboembolism; Retrospective Studies; Guideline Adherence; Female; Male; Middle Aged; Trauma Centers; Brain Injuries, Traumatic; Adult; Quality Improvement; Patient Care Team; Anticoagulants; Practice Guidelines as Topic
PubMed: 38437527
DOI: 10.1097/TA.0000000000004294 -
Cureus Jan 2024Seizures are the most common neurological disorder in pediatrics, and their initial approach aims at clinical stabilization. A thorough patient evaluation may provide...
Seizures are the most common neurological disorder in pediatrics, and their initial approach aims at clinical stabilization. A thorough patient evaluation may provide important clues for the etiological diagnosis. A 12-month-old female child was observed in the emergency department after experiencing her first apyretic seizure. She had a history of congenital alopecia and, on physical examination, presented subtotal alopecia and milia. Initial investigation revealed hypocalcemia; therefore, intravenous calcium correction was started with a partial response. The analytical study was extended, revealing hypophosphatemia, elevated parathormone, and 1,25(OH) vitamin D with normal 25(OH) vitamin D. The genetic analysis confirmed hereditary vitamin D-resistant rickets (HVDRR). The integration of the findings was crucial to diagnostic reasoning and to guide further investigation. HVDRR is a rare disorder, with more severe clinical presentations associated with alopecia. Early diagnosis and treatment are fundamental to minimize the impact on growth and the development of other comorbidities.
PubMed: 38425628
DOI: 10.7759/cureus.53233 -
Trauma Surgery & Acute Care Open 2024Optimal venous thromboembolism (VTE) enoxaparin prophylaxis dosing remains elusive. Weight-based (WB) dosing safely increases anti-factor Xa levels without the need for...
INTRODUCTION
Optimal venous thromboembolism (VTE) enoxaparin prophylaxis dosing remains elusive. Weight-based (WB) dosing safely increases anti-factor Xa levels without the need for routine monitoring but it is unclear if it leads to lower VTE risk. We hypothesized that WB dosing would decrease VTE risk compared with standard fixed dosing (SFD).
METHODS
Patients from the prospective, observational CLOTT-1 registry receiving prophylactic enoxaparin (n=5539) were categorized as WB (0.45-0.55 mg/kg two times per day) or SFD (30 mg two times per day, 40 mg once a day). Multivariate logistic regression was used to generate a predicted probability of VTE for WB and SFD patients.
RESULTS
Of 4360 patients analyzed, 1065 (24.4%) were WB and 3295 (75.6%) were SFD. WB patients were younger, female, more severely injured, and underwent major operation or major venous repair at a higher rate than individuals in the SFD group. Obesity was more common among the SFD group. Unadjusted VTE rates were comparable (WB 3.1% vs. SFD 3.9%; p=0.221). Early prophylaxis was associated with lower VTE rate (1.4% vs. 5.0%; p=0.001) and deep vein thrombosis (0.9% vs. 4.4%; p<0.001), but not pulmonary embolism (0.7% vs. 1.4%; p=0.259). After adjustment, VTE incidence did not differ by dosing strategy (adjusted OR (aOR) 0.75, 95% CI 0.38 to 1.48); however, early administration was associated with a significant reduction in VTE (aOR 0.47, 95% CI 0.30 to 0.74).
CONCLUSION
In young trauma patients, WB prophylaxis is not associated with reduced VTE rate when compared with SFD. The timing of the initiation of chemoprophylaxis may be more important than the dosing strategy. Further studies need to evaluate these findings across a wider age and comorbidity spectrum.
LEVEL OF EVIDENCE
Level IV, therapeutic/care management.
PubMed: 38420604
DOI: 10.1136/tsaco-2023-001230 -
Dermatology Practical & Conceptual Jan 2024Pigmented eccrine poroma (PEP) is a unique variant of a benign adnexal tumor known as eccrine poroma. Distinguishing PEPs from other pigmented lesions can be challenging...
INTRODUCTION
Pigmented eccrine poroma (PEP) is a unique variant of a benign adnexal tumor known as eccrine poroma. Distinguishing PEPs from other pigmented lesions can be challenging due to overlapping clinical and dermoscopic features.
OBJECTIVES
To provide a comprehensive analysis of the dermoscopic, confocal (RCM), and histological features of PEPs.
METHODS
We undertook a retrospective study of the clinical, dermoscopic, RCM and histopathological features of PEPs that were surgically excised and histopathologically recognized. Data on epidemiological, clinical, dermoscopic, RCM and histopathological features were collected from the databases of the Skin Cancer Unit, IRCCS Policlinico di Sant' Orsola, between January 2021 and May 2023.
RESULTS
The study population consisted of 61 patients, including 34 females (55.7%) and 27 males (44.3%). Dermoscopic examination of 61 PEPs revealed the presence of irregular borders (55.7%), milia-like cysts (50.8%), brown pseudo-network (41%), cerebriform pattern (34.4%), comedo-like openings (29.5%), atypical vessels (26.2%), glomerular vessels (18%), fingerprint-like perifollicular structures (8.2%), dots (4.9%) and dotted vessels (4.9%). RCM imaging was collected from 11 cases and showed mostly well-defined tumor nests with small cells in 100% of cases, bright structures in the upper dermis representing melanocytes and melanophages (63.6%), dark round spaces within the tumor nests (54.5%), well-demarcated borders of the nest (45.5%) and dilated and prominent vessels in upper dermis (27.3%). Histopathological pattern analysis revealed PEP sensu stricto (PEPss) as the most frequent (54.1%).
CONCLUSIONS
The distinctive dermoscopic patterns, along with the confocal features aid in the differentiation from other pigmented lesions.
PubMed: 38364398
DOI: 10.5826/dpc.1401a88 -
Journal of Cutaneous Medicine and... Feb 2024
PubMed: 38362906
DOI: 10.1177/12034754241227801 -
PloS One 2024We investigate the dynamic volatility connectedness of geopolitical risk, stocks, bonds, bitcoin, gold, and oil from January 2018 to April 2022 in this study. We look at...
We investigate the dynamic volatility connectedness of geopolitical risk, stocks, bonds, bitcoin, gold, and oil from January 2018 to April 2022 in this study. We look at connectivity during the Pre-COVID, COVID, and Russian-Ukraine war subsamples. During the COVID-19 and Russian-Ukraine war periods, we find that conventional, Islamic, and sustainable stock indices are net volatility transmitters, whereas gold, US bonds, GPR, oil, and bitcoin are net volatility receivers. During the Russian-Ukraine war, the commodity index (DJCI) shifted from being a net recipient of volatility to a net transmitter of volatility. Furthermore, we discover that bilateral intercorrelations are strong within stock indices (DJWI, DJIM, and DJSI) but weak across all other financial assets. Our study has important implications for policymakers, regulators, investors, and financial market participants who want to improve their existing strategies for avoiding financial losses.
Topics: Humans; COVID-19; Gold; Ukraine; Gap Junctions; Russia
PubMed: 38359034
DOI: 10.1371/journal.pone.0286963 -
Pediatric Dermatology Feb 2024An 11-year-old boy presented generalized eruptive syringomas (ESs) associated with multiple milia-like whitish palmar papules corresponding to dermal calcium deposits. A...
An 11-year-old boy presented generalized eruptive syringomas (ESs) associated with multiple milia-like whitish palmar papules corresponding to dermal calcium deposits. A relationship between calcium deposits distribution to an underlying eccrine duct was noted on pathology. The observation of dermal calcium deposits and its association with generalized ESs may support a possible sweat duct origin of this uncommon and peculiar form of superficial calcinosis cutis.
PubMed: 38342575
DOI: 10.1111/pde.15534 -
Cutis Dec 2023In low-resource settings, dermatologists may not have the preferred tools needed to evaluate a patient or perform a procedure. Commonplace affordable supplies can be...
In low-resource settings, dermatologists may not have the preferred tools needed to evaluate a patient or perform a procedure. Commonplace affordable supplies can be substituted when needed. We describe the use of a blood glucose testing lancet and a paper clip for milia extraction.
Topics: Humans; Blood Glucose; Epidermal Cyst
PubMed: 38290074
DOI: 10.12788/cutis.0897