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BACKGROUND:A inverse correlation has been found between changes in ionized calcium concentrations and the addition of albumin in vitro, which may explain adverse cardiovascular effects attributed to exogenous albumin in vivo. The purpose of this investigation was to determine the interaction (if any) between exogenous 25% albumin administration (100 ml given over < 30 min) and calcium concentrations in patients, all but one of whom were in an intensive care unit.RESULTS:There were no significant differences in the ionized calcium concentrations obtained before, at the end and 6 h after the administration of albumin (1.09 +/- 0.23, 1.06 +/- 0.22, 1.06 +/- 0.21 mmol/l, respectively). Similarly, there were no significant differences in the total calcium concentrations between these same time periods (2.03 +/- 0.18, 2.05 +/- 0.20, 2.08 +/- 0.23 mmol/l, respectively).CONCLUSIONS:In patients receiving infusions of 25% albumin, it appears that circulating calcium concentrations are well regulated by homeostatic mechanisms. Albumin infusions had no effect on calcium concentrations, although it is possible that temporary changes of questionable clinical importance may have occurred between measurement periods.

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Class of 2010 Abstract / OBJECTIVES: To comprehensively review medical literature and report angiotension converting enzyme inhibitors (ACE-­‐I) adverse drug reactions including, incidences, mechanism of action, predisposing conditions, and report prevention and treatments. METHODS: This was a descriptive retrospective study of data related to ACE-­‐I adverse drug reactions other than ACE-­‐I induced cough. It was to review the ADR that accompany with the use of ACE-­‐I. Literature obtained through search engines MEDLINE and OVID SP available through the Arizona Health and Science Library at the University of Arizona. RESULTS: This comprehensive literature review looked at angioneurotic edema, orthostatic hypotension, hyperkalemia, and increased risk of bleeding and anaphylaxis with tPA and to a minor extent Elevated serum creatinine, and Teratogenicity. Angioneurotic edema (angioedema) reports initially estimated an incidence of 0.1 to 0.7%. A comprehensive review suggested the incidence was even lower at 0.1 to 0.2%, but the OCTAVE trial that specifically looked at angioedema as an endpoint estimated an incidence of ~0.7% although the study only had a 24-­‐week follow up. Most patients that discontinued treatment due to angioedema experienced symptom relief within 72 hours. The incidence of orthostatic hypotension from a study that followed patients on lisinopril was only 0.25%;moreover, a meta-­‐analysis by Agusti et al included 51 RCT that reported a relative risk of developing OH on an ACE-­‐I alone was 1.95. Hyperkalemia incidence reporeted varied from 1.1% to 10%; the more recent literature suggests a value near the lower end of this range. Elevated serum creatinine appears to occur early in ACE-­‐I treatment with discontinuation resolving in resolution. ACE-­‐I have been shown to be teratogenic during any trimester and should generally be avoided in pregnancy. There appears to be an increased risk of bleeding and anaphylactoid typer reactions when alteplase and ACE-­‐I are used simultaneously. Muravyov et al reported the viscosity of whole blood and plasma to be decreased after only three weeks of ACE-­‐I administration. CONCLUSIONS: With the continued increasing use of ACE-­‐Is and the drug class' ability to achieve therapeutic outcomes in a wide array of patient populations, it is important to better understand the processes and mechanisms behind the ADRs associated with ACE-­‐I therapy. A basic understanding of incidence rates and physiologic mechanisms will allow clinicians to properly assess the probability of causation and better treat patients who have experienced an ACE-­‐I induced ADR. However, an in-­‐depth level of understanding can help guide clinicians in making decisions that will hopefully decrease the amount of ADRs their patients experience or prevent their patients from developing ACE-­‐I related ADR altogether. It is important to note that, in most of the aforementioned ADR situations, treatment consists of ACE-­‐I discontinuation and avoidance of future exposures.

Although gas turbine engines are designed to use dry air as the working fluid, the great demand over the last decades for air travel at several altitudes and speeds has increased aircraft’s exposure to inclement weather conditions. Although, they are required to perform safely under the effect of various meteorological phenomena, in which air entering the engine contains water, several incidents have been reported to the aviation authorities about power loss during flight at inclement weather. It was understood that the rain ingestion into a gas turbine engine influences the performance of the engine and particular the compressor and the combustor. The effects of water ingestion on gas turbine engines are aerodynamic, thermodynamic and mechanical. These effects occur simultaneously and affect each other. Considering the above effects and the fact that they are timedependent, there are few gas turbine performance simulation tools, which take into account the water ingestion phenomenon. This study is a new research of investigating theoretically the water ingestion effects on a gas turbine performance. It focuses on the aerodynamic and mechanical effects of the phenomenon on the compressor and the combustor. The application of Computational Fluid Dynamics (CFD) is the basic methodology to examine the details of the flow in an axial compressor and how it is affected by the presence of water. The calculations of water film thickness, which is formed on the rotor blade, its motion (direction and speed) and the extra torque demand, are provided by a code created by the author using FORTRAN programming language. Considering the change in blade’s profile and the wavy characteristics of the liquid film, the compressor’s performance deterioration is calculated. The compressor and combustor’s deterioration data are imported to a gas turbine simulation code, which is upgraded to calculate overall engine’s performance deterioration. The results show a considerable alteration in engine’s performance parameters and arrive at the same conclusions with the relevant experimental observations.

The teratogenic effects of prenatal alcohol exposure can significantly influence the development of a child, which may result in a range of structural, cognitive and behavioural abnormalities. The severity of these effects can vary and fall under the fetal alcohol spectrum disorder (FASD). South Africa hosts the highest prevalence rate (12%) of this disorder in the world. All conditions included in the FASD spectrum are completely preventable through maternal abstinence of alcohol during pregnancy. At present, very limited information is available regarding how much pregnant women in South Africa know about adverse effects caused by prenatal alcohol exposure. This study aimed to determine pregnant women’s awareness of alcohol’s potential teratogenic effects on pregnancy and their knowledge of the features and characteristics associated with fetal alcohol syndrome (FAS), the most severe of the FASD conditions. Additionally, the study compared the awareness and knowledge of pregnant women attending private antenatal centres, to those attending an antenatal clinic at Charlotte Maxeke Johannesburg Academic Hospital, a state hospital in the Johannesburg area. Participants (n=211) completed a self-administered questionnaire at their private antenatal class or state clinic. A total of 211 questionnaires were analysed; 107 questionnaires from the state antenatal clinic and 104 from the private antenatal centres. The awareness levels regarding alcohol use in pregnancy were found to be very similar amongst the private (52%) and state (55%) participants. However, results indicated that significantly more private participants (19%), compared to state participants (3%) could be classified as having knowledge of the condition FAS. Overall, this study found that pregnant women from various backgrounds have limited knowledge of the harms caused by alcohol use during pregnancy. Misconceptions about the acceptable levels of maternal alcohol consumption and the effects thereof were also evident. The results of this research highlights that prevention strategies and awareness campaigns regarding alcohol use during pregnancy should incorporate information on the severity and permanent nature of FAS, as well as highlighting the fact that all types of alcoholic beverages can result in this condition. Also, these campaigns should focus on informing women that no level of alcohol is acceptable during pregnancy, as any amount may have potentially teratogenic effects on the developing fetus.

Previous research has demonstrated a significant impact of trainee participation on outcomes in a broad surgical patient population. With the current project, we aim to identify if a similar effect exists in emergency general surgery. A total of 141,010 patients who underwent emergency general surgery procedures were identified in the 2005-2010 National Surgical Quality Improvement Program database. Due to the non-random assignment of the more complex cases to resident participation, patients were matched (1:1) on known risk factors [age, gender, inpatient status, preexisting comorbidities (obesity, diabetes, smoking, alcohol use, steroid use, coronary artery disease, chronic renal failure, pulmonary disease)] and on preoperatively calculated probability for morbidity and mortality. Clinically relevant outcomes were compared with a t- or chi-squared test. The impact of resident participation on outcomes was quantified with multivariable regression modeling, adjusting for both the aforementioned risk factors and operative time. The most common procedures in the matched cohort (n=83,790) were appendectomy (39.9%), exploratory laparotomy (8.8%) and adhesiolysis (6.6%). Our findings suggest that trainee participation in emergency general surgery procedures prolongs operative time, increases intraoperative transfusions, and is independently associated with adverse postoperative outcomes, including wound, pulmonary, and venous thromboembolic complications, as well as urinary tract infections. This effect appears to be independent of the total intraoperative time, case complexity, and preexisting comorbid conditions. We also demonstrate that operative time is another important factor independently associated with intra- and post-operative transfusions, unplanned reoperations, longer hospital stays, infections, as well as wound, pulmonary, and venous thromboembolic complications, when baseline comorbidities and resident participation were adjusted for. Remediation strategies could include increased use of simulation training and increased faculty supervision of residents.

Aim To assess current methods of prediction of adverse pregnancy outcomes, develop a prediction model and assess diet and life style in preventing preeclampsia. Methods Meta-analyses performed to assess the role of abnormal 1st trimester biomarker levels in predicting PE and the predictive accuracy of 2nd trimester UAD indices for stillbirth. A prospective observational study was performed to assess the efficacy of maternal characteristics, biomarkers, arteriography and UADs for predicting adverse pregnancy outcomes. Previously published 1st trimester PE prediction models were validated using data collected from the observational study. A systematic review on the effect of diet and life style based metabolic risk modifying interventions on PE was performed. Results The review of biomarkers found that abnormal levels were particularIy associated with early onset PE. The stillbirth review demonstrated a three-four fold increased risk of still birth with abnormal UAD. 1045 women were included for analysis in the prospective observational study. Our models' detection rate (false positive rate of 15%) was 72% for PE; 48% PIH; 30 % SGA < 10th centile; 57% SGA < 5th centile and 67% stillbirth. In the validation study the observed discrimination ability in the derivation studies ranged from 0.70 to 0.954. When validated against the study cohort, the AUC varied importantly, ranging from 0.504 to 0.833. Dietary interventions were shown to reduce the risk of PE by 33%, with no reduction in risk with mixed interventions or fatty acid supplementation. Conclusion The high heterogeneity of studies in the systematic reviews makes it difficult to draw firm conclusions regarding the use of biomarkers or UADs in screening for pregnancy complications. Our prospective study showed a role for haemodynamics as part of routine 1st trimester screening for assessing the risk of hypertensive disease in pregnancy.

Introduction: Poultry workers have an increased risk of respiratory symptoms associated with various irritant and allergenic exposures causing airway inflammation. This study investigated the levels of (1-3)-β-D glucan exposure in several poultry farming processes. The objectives involved categorising the different tasks undertaken in the poultry industry. After which a method was established and validated to detect and quantify the levels of (1-3)-β-D glucan using the Glucatell assay. This assay was used to measure the amount of (1-3)-β-D glucan poultry farm workers were exposed to using personal sampling. Thereafter, general respiratory symptoms were described briefly via the administration of a respiratory questionnaire. Method: A total of 308 personal air samples were collected from several poultry farming processes (rearing, laying, hatchery, broilers, catching) of a large poultry farm in the North West Province. A walkthrough checklist was used to obtain information on various exposure determinants such as farm size, number of chickens, ventilation system, bedding material used and poultry feed used. The Glucatell assay (Associates of Cape Cod, East Falmouth, MA, USA) was used to quantify the concentration of (1-3)-β-D glucans in the air samples. Results: The geometric mean concentrations of (1-3)-β-D glucans ranged from 24.38 to 645.98 ng/m3 across the various poultry farming processes investigated. Workers in the broiler farms were exposed to two times higher levels of (1-3)-β-D glucans compared to those in the breeding farms. The sizes of the broiler farm houses as well as the age of the chickens were among the main determinants of exposure. The larger broiler farm houses (GM=5.2 ng/m3, GSD=3.74) had significantly (p<0.05) lower levels than the smaller broiler farm houses (GM=6.4 ng/m3, GSD=2.14) whilst houses with older chickens had higher (1-3)-β-D glucan levels (G=5.8 ng/m3,

Adverse childhood experiences (ACEs) are related to a variety of detrimental outcomes, including psychopathology and criminal activity. Adolescents and other youth who have engaged in sexually abusive behaviors are a high-risk population in which ACEs are exceptionally common and interrelated. However, the experiences of adversity faced by these youth are not homogenous, and exploring further aspects and details of ACEs may assist in better understanding the etiology of problematic outcomes such as psychopathology and criminal activity in these populations. The deleterious impact of polyvictimization may be one facet of adversity worth considering, as the persistence of maltreatment, presence of multiple perpetrators, and relationship to perpetrator(s) have been linked to poorer outcomes. Regression analyses were used to examine the relationship between ACEs and psychopathology and criminal activity in a sample of adolescents who have engaged in problematic sexual behavior. Incorporating facets of polyvictimization better explained several of such outcomes.