Cricoarytenoiditis: CT assessment in rheumatoid arthritis

The cricoarytenoid (CA) joint is a true diarthrodial joint that can be affected by rheumatoid disease. Its strategic location in the airway anatomy makes its evaluation of clinical importance. Direct fiberoptic laryngoscopy (DFL) and high-resolution computerized tomography (HRCT) were used to assess the larynx in 32 rheumatoid patients. Abnormalities were seen in 75% of patients at endoscopic examination. HRCT studies showed abnormalities in 72%. Erosion-luxation of the CA joint and surrounding soft-tissue swelling can be demonstrated on HRCT scans. A radiologic grading of the rheumatoid larynx is proposed, stressing that accurate evaluation of the larynx should be part of the diagnostic evaluation of every rheumatoid arthritic patient, given the high frequency of occurrence of rheumatoid laryngitis.     

Gender-based barriers to primary health care provision in Pakistan: the experience of female providers

In common with several countries in South Asia, the Pakistan government health system has introduced cadres of community-based female health and family planning workers as a response to gender-based constraints on women's access to services. However, the recruitment, training and retention of such female workers has been difficult. This finding points to the obvious but neglected fact that female health workers must operate within the same gender systems that necessitate their appointment in the first place. The present study used qualitative methods to increase our understanding of the experience of female staff working at the community level and in particular the gender-based constraints that they face. Important problems identified include: abusive hierarchical management structures; disrespect from male colleagues; lack of sensitivity to women's gender-based cultural constraints; conflict between domestic and work responsibilities; and poor infrastructural support. The findings highlight the interconnectedness of women's public and private lives and the interplay of class and gender hierarchies in the patterning of women's employment experiences. The study's conclusions suggest ways in which the organizational functioning of the government health services might be modified to better facilitate the work of female staff.     

American Red Cross experience with routine testing for hepatitis B core antibody

The implementation of routine testing of blood donations for hepatitis B core antibody (anti-HBc) has allowed the characterization of the performance of the test in a large number of samples from apparently healthy individuals. This study reports the experience of the American Red Cross in testing 2.3 million donors for anti-HBc. The test protocol reproducibly identified a distinct population of donors. The anti-HBc-positive rate varied by region of the continental United States and by the time of year. In a case-control study, 85 percent of subsequent donations from anti-HBc-positive donors were anti-HBc positive. The predictions made in an earlier pilot study regarding the performance and impact of the test were borne out.     

阿司匹林、布他比妥和咖啡因联用对小鼠的镇痛作用及其急性毒性的定量分析

目的 :应用配方均匀设计法 ,定量分析阿司匹林、布他比妥和咖啡因联用对小鼠的镇痛作用及其急性毒性 ,并探讨该法在多药物联用分析中的应用。方法 :设置 7个水平联用比例和剂量 ,用小鼠甩尾法作镇痛试验 ,综合数理分析结果和专业知识 ,由验证性试验确定理论预期结果 ,并参考配伍对小鼠行为的影响 ,确定最优配方 ;用参数法定量分析 3药联用的急性毒性作用。结果 :阿司匹林 4 1mg/kg ,布他比妥 6.4mg/kg和咖啡因 5mg/kg联用对小鼠的镇痛有协同作用 ,对小鼠的行为影响较小 ;其联用的合适比例为 8.1∶1 .2 5∶1 ;联用时其急性毒性的相互作用表现为相加 (无协同作用 )。结论 :阿司匹林、布他比妥和咖啡因 3药联用效果增强 ,但急性毒性未增 ;配方均匀设计法可用于多药物联用的定量分析 ,但有一定的局限 ,其结果需经实验确证     

Clinical outcomes of moderate to severe COVID-19 patients receiving invasive vs. non-invasive ventilation

Objective:To evaluate the in-hospital outcome of moderate to severe COVID-19 patients admitted in High Dependency Unit(HDU)in relation to invasive vs.non-invasive mode of ventilation.Methods:In this study,the patients required either non-invasive[oxygen≤10 L/min or>10 L/min through mask or nasal prongs,rebreather masks and bilevel positive airway pressure(BiPAP)]or invasive ventilation.For analysis of 30-day in hospital mortality in relation to use of different modes of oxygen,Kaplan Meier and log rank analyses were used.In the end,independent predictors of survival were determined by Cox regression analysis.Results:Invasive ventilation was required by 15.1%patients while 84.9%patients needed non-invasive ventilation.Patients with evidence of thromboembolism,high inflammatory markers and hypoxemia mainly required invasive ventilation.The 30-day in hospital mortality was 72.7%for the invasive group and 12.9%for the non-invasive group(1.8%oxygen<10 L/min,0.9%oxygen>10 L/min,3.6%rebreather mask and 4.5%BiPAP).The median time from hospital admission to outcome was 7 days for the invasive group and 18 days for the non-invasive group(P<0.05).Age,presence of co-morbidities,number of days requiring oxygen,rebreather,BiPAP and invasive ventilation were independent predictors of outcome.Conclusions:Invasive mechanical ventilation is associated with adverse outcomes possibly due to ventilator associated lung injury.Thus,protective non-invasive ventilation remains the necessary and safe treatment for severely hypoxic COVID-19 patients.     

Deposition of Aluminide Coatings onto AISI 304L Steel for High Temperature Applications

The nickel aluminides are commonly employed as a bond coat material in thermal barrier coating systems for the components of aeroengines operated at very high temperatures. However, their lifetime is limited due to several factors, such as outward diffusion of substrate elements, surface roughness at high temperatures, morphological changes of the oxide layer, etc. For this reason, inter-diffusion migrations were studied in the presence and absence of nickel coating. In addition, a hot corrosion study was also carried out. Thus, on one set of substrates, nickel electrodeposition was carried out, followed by a high activity pack aluminizing process, while another set of substrates were directly aluminized. The microstructural, mechanical, and oxidation properties were examined using different characterization techniques, such as SEM-EDS, optical microscopy, XRD, optical emission spectroscopy, surface roughness (Ra), and adhesion tests. In addition, the variable oxidation temperatures were employed to better understand their influence on the roughness, degree of spallation (DoS), and morphology. The results show that AISI 304L substrates do not respond to aluminizing treatment, i.e., no aluminide coating was formed; rather, a nearly pure aluminum (or alloy) was observed on the substrate. On the contrary, successful formation of an aluminide coating was observed on the nickel-electrodeposited substrates. In particular, a minimum amount of migrations were noted, which is attributed to nickel coating. Moreover, the scratch test at 10 N load revealed neither cracking nor peeling off, thereby indicating good adhesion of the aluminide coating before oxidation. The as-aluminized samples were oxidized between 700 °C to 1100 °C in air for 8 h each. The degree of spallation showed an incremental trend as temperatures increased. Likewise, oxide morphologies showed temperature dependence. On the other hand, average surface roughness (from Ra = 2.3 µm to 5.8 µm) was also increased as temperatures rose. Likewise, the mass gain showed linearity as temperatures increased during oxidation. The hot corrosion responses of electrodeposited-aluminized samples were superior among all specimens. An extensive discussion is presented based on the observations noted above.     

Understanding gendered influences on women's reproductive health in Pakistan: Moving beyond the autonomy paradigm

Recent research and policy discourse commonly view the limited autonomy of women in developing countries as a key barrier to improvements in their reproductive health. Rarely, however, is the notion of women's autonomy interrogated for its conceptual adequacy or usefulness for understanding the determinants of women's reproductive health, effective policy formulation or program design. Using ethnographic data from 2001, including social mapping exercises, observation of daily life, interviews, case studies and focus group discussions, this paper draws attention to the incongruities between the concept of women's autonomy and the gendered social, cultural, economic and political realities of women's lives in rural Punjab, Pakistan. These inadequacies include: the concept's undue emphasis on women's independent, autonomous action; a lack of attention to men and masculinities; a disregard for the multi-sited constitution of gender relations and gender inequality; an erroneous assumption that uptake of reproductive health services is an indicator of autonomy; and a failure to explore the interplay of other axes of disadvantage such as caste, class or socio-economic position. This paper calls for alternative, more nuanced, theoretical approaches for conceptualizing gender inequalities in order to enhance our understanding of women's reproductive wellbeing in Pakistan. The extent to which our arguments may be relevant to the wider South Asian context, and women's lives in other parts of the world, is also discussed.     

Meanings of blood, bleeding and blood donations in Pakistan: implications for national vs global safe blood supply policies

Contemporary public policy, supported by international arbitrators of blood policy such as the World Health Organization and the International Federation of the Red Cross, asserts that the safest blood is that donated by voluntary, non-remunerated donors from low-risk groups of the population. These policies promote anonymous donation and discourage kin-based or replacement donation. However, there is reason to question whether these policies, based largely on Western research and beliefs, are the most appropriate for ensuring an adequate safe blood supply in many other parts of the world. This research explored the various and complex meanings embedded in blood using empirical ethnographic data from Pakistan, with the intent of informing development of a national blood policy in that country. Using a focused ethnographic approach, data were collected in 26 in-depth interviews, 6 focus group discussions, 12?key informant interviews and 25 hours of observations in blood banks and maternity and surgical wards. The key finding was that notions of caste-based purity of blood, together with the belief that donors and recipients are symbolically knitted in a kin relationship, place a preference on kin-blood. The anonymity inherent in current systems of blood extraction, storage and use as embedded in contemporary policy discourse and practice was problematic as it blurred distinctions that were important within this society. The article highlights the importance-to ensuring a safe blood supply-of basing blood procurement policies on local, context-specific belief systems rather than relying on uniform, one-size-fits-all global policies. Drawing on our empirical findings and the literature, it is argued that the practice of kin-donated blood remains a feasible alternative to the global ideal of voluntary, anonymous donations. There is a need to focus on developing context-sensitive strategies for promoting blood safety, and critically revisit the assumptions underlying contemporary global blood procurement policies.