Design optimization and validation of UV-C illumination chamber for filtering facepiece respirators.

In this study, we constructed an UV-C illumination chamber using commercially available germicidal lamps and other locally available low-cost components for general-purpose biological decontamination purposes. The illumination chamber provides uniform illumination of around 1 J/cm2 in under 5 min across the chamber. The control mechanism was developed to automate the on/off process and make it more secure minimizing health and other electrical safety. To validate the decontamination efficacy of the UV-C Illumination Chamber we performed the Geobacillus spore strip culture assay. Additionally, we performed the viral load measurement by identifying the COVID-19-specific N-gene and ORF1 gene on surgical masks. The gold standard RT-qPCR measurement was performed to detect and quantify the COVID-19-specific gene on the mask sample. The biochemical assay was conducted on the control and test group to identify the presence of different types of bacteria, and fungi before and after exposure under the illumination chamber. The findings of our study revealed satisfactory decontamination efficacy test results. Therefore, it could be an excellent device in healthcare settings as a disinfection tool for biological decontamination such as SAR-CoV-2 virus, personal protection equipment (PPE), (including n95, k95 respirators, and surgical masks), and other common pathogens.

Interleukin gene polymorphisms and alopecia areata: A systematic review and meta-analysis.

BACKGROUND: Alopecia areata (AA) is an autoimmune disease which results in non-scarring hair loss on the scalp or any surface with hair. Several genetic polymorphisms of the interleukin genes have been linked with this disease but the results are inconsistent. This systematic review and meta-analysis were done to find the association between rs3118470, rs2275913, rs3212227, and rs10889677 of the IL2RA, IL17A, IL12B, and IL23R genes, respectively, of the interleukin family with alopecia areata. METHODS: A comprehensive search for relevant research articles was conducted in Pubmed, Google Scholar, and Embase databases. Our search yielded 8 relevant articles with 1940 cases and 1788 controls. The odds ratio with 95% confidence intervals was calculated using fixed effect and random effect models. Heterogeneity was determined using the Q-test and I2 test. Publication bias was determined and funnel plots were used to adjust the odds ratio. RESULTS: We found a significant risk effect for rs3118470 of the IL2RA gene with alopecia areata in the dominant model (CC + CT vs TT; OR = 1.54, 95% confidence interval = 1.05-2.26, P < .05, I2 = 69.03%) and homozygous model (CC vs TT; OR = 2.00, 95% confidence interval = 1.07-3.71, P < .05, I2 = 72.84%). For the other single nucleotide polymorphisms, we could not find any statistically significant association with the disease. CONCLUSION: Our analysis showed that mutation of rs3118470 of IL2RA gene possesses a significant risk effect for alopecia areata. Future studies with larger sample sizes and ethnic backgrounds are warranted to confirm our findings.

Association of CD58 rs12044852 and rs2300747 polymorphisms with the risk of multiple sclerosis: A systematic review and meta-analysis.

OBJECTIVE: Multiple sclerosis is a serious neurodegenerative disorder that causes disability in young adults. Genetic predisposition of multiple sclerosis is well documented and several single nucleotide polymorphisms (SNPs) of the CD58 were found to be associated with this disease. This systematic review and meta-analysis were done with the aim of finding the association between CD58 gene SNPs (rs12044852 and rs2300747) and the risk of multiple sclerosis (MS). METHOD: A comprehensive search was done in PubMed, Google Scholar, Embase, and MSGene.org to find the relevant data. Our search yielded 13 relevant publications which were included for meta-analysis consisting of 5194 cases and 5766 controls. All the statistical analysis was conducted using meta and metafor packages in R studio. The odds ratio (OR) along with 95 % confidence intervals and p values were determined using the fixed effects and random effects model. The I2 test was done to measure heterogeneity. Subgroup analysis was performed along with analysis for publication bias. RESULTS: We found significant association for both rs12044852 (allelic, dominant, over-dominant, heterozygous, and homozygous models) and rs2300747 (allelic, dominant, over-dominant, heterozygous models) with multiple sclerosis. Both the SNPs provided a protective effect for multiple sclerosis. Subgroup analysis indicated that rs12044852 polymorphism provided a protective effect in both Asians and Caucasians. However, for rs2300747, the Asian population showed no statistically significant association with the risk of MS. CONCLUSION: Polymorphism of rs12044852 and rs2300747 of the CD58 gene provided a protective effect for multiple sclerosis. The protective effect is more prominent in Caucasian populations compared to Asians.

Recent advances in dynamic modeling and control studies of biomass gasification for production of hydrogen rich syngas.

The conversion of biomass through thermochemical processes has emerged as a promising approach to meet the demand for alternative renewable fuels. However, these processes are complex, labor-intensive, and time-consuming. To optimize the performance and productivity of these processes, modeling strategies have been developed, with steady-state modeling being the most commonly used approach. However, for precision in biomass gasification, dynamic modeling and control are necessary. Despite efforts to improve modeling accuracy, deviations between experimental and modeling results remain significant due to the steady-state condition assumption. This paper emphasizes the importance of using Aspen Plus® to conduct dynamics and control studies of biomass gasification processes using different feedstocks. As Aspen Plus® is comprising of its Aspen Dynamics environment which provides a valuable tool that can capture the complex interactions between factors that influence gasification performance. It has been widely used in various sectors to simulate chemical processes. This review examines the steady-state and dynamic modeling and control investigations of the gasification process using Aspen Plus®. The software enables the development of dynamic and steady-state models for the gasification process and facilitates the optimization of process parameters by simulating various scenarios. Furthermore, this paper highlights the importance of different control strategies employed in biomass gasification, utilizing various models and software, including the limited review available on model predictive controller, a multivariable MIMO controller.

Adverse Outcomes in Hospitalizations for Amyloid-Related Heart Failure.

Transthyretin amyloid cardiomyopathy is being increasingly recognized as an important cause of heart failure (HF). In this study, we looked at adverse outcomes in hospitalizations with amyloid-related HF. This study was a retrospective analysis of the National Inpatient Sample data, collected from 2016 to 2019. Patients ≥41 years of age and admitted for HF were included in the study. In these hospitalizations, amyloid-related HF was identified through the International Classification of Diseases, Tenth Revision, Clinical Modification codes for amyloidosis. The primary outcome of the study was in-hospital mortality, whereas secondary outcomes were prolonged length of stay, mechanical ventilation, mechanical circulatory support, vasopressors use, and dispositions other than home. From 2016 to 2019, there were 4,705,274 HF hospitalizations, of which 16,955 (0.4%) had amyloid cardiomyopathy. In all HF hospitalizations, amyloid-related increased from 0.26% in 2016 to 0.46% in 2019 (relative increase, 76.9%, P for trend <0.001). Amyloid-related HF hospitalizations were more common in older, male, and Black patients. The odds of in-hospital mortality (odds ratio [OR], 1.29; 95% confidence interval [CI]: 1.11 to 1.38), prolonged hospital length (OR, 1.61; 95% CI: 1.49 to 1.73) and vasopressors use (OR, 1.59; 95% CI: 1.23 to 2.05) were significantly higher for amyloid-related hospitalizations. Amyloid-related HF hospitalizations are increasing substantially and are associated with adverse hospital outcomes. These hospitalizations were disproportionately higher for older, male, and Black patients. Amyloid-related HF is rare and underdiagnosed yet has several adverse outcomes. Hence, healthcare providers should be watchful of this condition for early identification and prompt management.

Corrigendum: Effects of breathing re-education on endurance, strength of deep neck flexors and pulmonary function in patients with chronic neck pain: A randomised controlled trial.

[This corrects the article DOI: 10.4102/sajp.v78i1.1611.].

Applications of Metformin in Dentistry-A review.

Metformin is a versatile drug with numerous medical uses. It is known primarily as an anti-hyperglycemic drug that has become the main oral blood-glucose-lowering medication for managing type 2 diabetes mellitus globally. Its use has been reported in a variety of oral conditions and dentistry in general. Recent clinical trials have indicated the effectiveness of adjunct topical application of metformin in improving the periodontal parameters of patients with diabetes and periodontitis. Additionally, studies have suggested that metformin stimulates odontogenic differentiation and mineral synthesis of stem cells in the tooth pulp. Metformin also stimulates osteoblast proliferation, decreases osteoclast activity and exerts regenerative effects on periodontal bone, thus making it a viable candidate for periodontal regeneration. Metformin monotherapy significantly enhances osseointegration of endosseous implants and has been reported to have anti-cancer effects on oral squamous cell carcinoma by impeding tumor progression. Animal studies have indicated that metformin improves orthodontic tooth movement and resists orthodontic appliance corrosion. This narrative review aims to provide a current summary of research highlighting the prospective uses of metformin in dentistry.

Incidence of Dengue fever, serotypes, clinical features, and laboratory markers: a case study of 2019 outbreak at district Shangla, KP, Pakistan.

Background: Dengue is a widely spread mosquito-borne infection in humans, which in recent decades declared is public health problem globally. The dengue virus contains 4 different serotypes (DENV-1, DENV-2, DENV-3, and DENV-4) which belong to the genus Flavivirus. Aims: A descriptive experimental study was conducted to determine the epidemiology, types of Dengue serotypes, clinical features, laboratory probe, and markers for primary diagnosis of dengue virus infection in hospitalized patients. Methodology: A total of 691 suspects were diagnosed from August to October 2019 in district Shangla KP, Pakistan. Serological tests were used for nonstructural protein-1 antigen (NS1), and antibodies (immunoglobulin-M (IgM) & Immunoglobulin-G (IgG)) while real-time PCR was used to confirm the cases. The data was statistically analyzed using IBM-SPSS Statistics 20 version. Results: The dengue virus infection was more prevalent in the male group (68.09%) than the female group (31.1%). A large number of patients were from rural areas (63.5%) while from urban areas were (36.4%), whereas Besham tehsil was found the most affected compared to other regions. The most prevalent serotype observed in our study was DENV-3 (56.60%) while DENV-4 was the least prevalent serotype (1.88%). Among the age-wise analysis of dengue-virus-infected individuals, the age group of 19-37 years (64.07%) was found the most affected group. The month-wise analysis revealed that the highest number of infections (49.8%) were recorded in September. Significant differences were noticed among blood parameters. Conclusion: The possible reasons for the dengue overwhelming in the study area could be less or lack of awareness particularly regarding the transmission of viral infections, improper sewage management, and no effective vector control strategies that lead the dengue outbreaks in the study population.

Role of virtual reality and active video games in motor and executive functions in cerebral palsy: A systematic review.

OBJECTIVE: To explore current evidence on the role of virtual reality and active video games in motor and executive functions compared to conventional physical therapies in cerebral palsy patients. METHODS: The systematic review was conducted at the University Institute of Physical Therapy, Lahore, Pakistan, and comprised search on MEDLINE via PubMed, Pedro and Cochrane Central related to randomised and clinical controlled trials published from 2005 to 2020. For critical appraisal of the studies, the Pedro tool was used, while methodological quality assessment was done using the Cochrane risk of bias tool. RESULTS: Of the 15 articles reviewed, 14(93.3%) reported significant effect of virtual reality and active video games on motor functions. Critical appraisal found the quality of the studies from fair to high. Low risk was found in 4(26.7%) articles in terms of selection, 3(20%) allocation, 6(40%) detection, and 8(53.3%) had attrition bias. Unclear risk was reported in the performance and reporting bias domain in all the 15(100%) articles. CONCLUSIONS: Virtual reality games cannot be used as a substitute for therapy, but along with the conventional physical therapy, they are very effective and produce significant changes in motor functions in cerebral palsy patients. As for executive functions, more research needs to be done to determine the impact of these games at a higher level of brain.

Digital technologies in management of chronic pain - a systematic review.

OBJECTIVE: To determine the effectiveness of digital health technologies in the management of chronic pain. METHODS: The systematic review comprised search for randomised controlled trials and controlled clinical trials involving patients with chronic pain published between 2010 and 2020. The search was conducted on PubMed, Google Scholar, MEDLINE, National Centre for Biotechnology Information, and National Library of Medicine databases. Risk bias tool was used to evaluate the biasness in the studies and Pedro scale was used to assess the quality of the included articles. RESULTS: Of the 33 articles fully assessed, 14(42.42%) were analysed. All the studies analysed were randomised controlled trials and scored 6-10 on the Pedro scale which showed high quality of methodology. The studies typically reported statistically significant benefits of digital health technologies in the management of chronic pain. One of the main benefits was enhanced pain coping skills of the patients. Additionally, majority of the studies included increased adherence to exercise as an essential advantage. CONCLUSIONS: All the studies analysed reported favourable conclusions regarding the use of digital intervention for chronic pain management.

Effects of breathing re-education on endurance, strength of deep neck flexors and pulmonary function in patients with chronic neck pain: A randomised controlled trial.

Background: People with chronic neck pain show decreased endurance and strength of cervical muscles with compromised respiratory function. There is little evidence that improvement in breathing function of people with neck pain can help in enhancing cervical muscle strength and pulmonary function. The objective of this our clinical trial was to examine the effects of breathing re-education combined with physiotherapy on endurance and strength of deep neck flexors, and pulmonary function in patients with chronic neck pain. Methods/design: In this double blind randomised clinical trial, 30 patients with chronic neck pain (25-50 years old) were randomly allocated to two groups. Group A, physiotherapy (n = 15), and Group B, breathing re-education (n = 15). The duration of intervention was eight weeks with treatment five days a week. The endurance was measured with the craniocervical flexion test, strength with a handheld dynamometer (Baseline USA) and pulmonary functions with the Spiro lab 4 (USA) at baseline, at week four and at week eight of the intervention. Discussion: There was a significant between group improvement in the strength of deep neck flexors and forced vital capacity (FVC) in Group B p = 0.0001 and p = 0.0200 (p ˂ 0.05) respectively. Intergroup comparisons showed no significant differences for endurance, cervical extensor strength, Forced Expiratory Volume in one second (FEV1), and FEV1/FVC percentage. Conclusion: Our study concluded that breathing re-education combined with other physiotherapy management is effective for improving the strength of neck flexors and increasing FVC in people with chronic neck pain. Clinical implication: Breathing re-education may be part of physiotherapy management in patients with chronic neck pain. Trial Registration: Iranian Registry of Clinical Trials, IRCT20200226046623N1, https://www.irct.ir/trial/46240.

Conversion of biomass blends (walnut shell and pearl millet) for the production of solid biofuel via torrefaction under different conditions.

The torrefaction of lignocellulose biomass was conducted to produce biochar with properties compatible with coal. Two lignocellulose biomasses, pearl millet (PM) and walnut shell (WS), were torrefied at different process temperatures (230-300 °C), residence times (30-90 min), and different compositional biomass blends to improve the characteristics of the biochar product. The resulting biochar product exhibited favorable changes in their properties. The pure biomasses and their blends obtained a high biochar yield (41-91%). The gross calorific value (GCV) ranged from 22 to 27 MJ/kg, showing an increase of 22-59% compared to the raw biomass. The torrefaction temperature had the most notable effect on the biochar quantity and quality. The biochar samples obtained from the torrefaction of different blends showed a higher GCV and other physicochemical characteristics than the pure biomasses. Scanning electron microscopy showed that these products might also be used for other applications.

Role of tele-rehabilitation in patients following total hip replacement: Systematic review of clinical trials.

OBJECTIVE: Tele-rehabilitation to explore current evidence on the effectiveness of tele-rehabilitation compared to face-to-face rehabilitation for patients after total hip replacement. METHODS: The systematic review of clinical trials comprised search of Cochrane, Medline, Embase and PEDro databases from 2000 to date for English-language, human studies dealing with postoperative rehabilitation of total hip replacement patients. A thorough search was performed to retrieve articles missed through databases as well as unpublished grey literature. Methodological quality assessment was done using the Cochrane risk of bias tool, and the studies were critically appraised using the PEDro scale. RESULTS: Of the 150 studies initially found on the databases, 11(7.3%) were subjected to detailed review; 4(36.4%) randomised trials, 3(27.3%) randomised controlled protocols, 3(27%) randomised pilot studies, and 1(9%) prospective cohort study. Overall, 8(72.7%) studies were of 'high' quality and 3(27.3%) fell under the category of 'fair'. CONCLUSIONS: Tele-rehabilitation group reported similar improvement in terms of activities of daily living and quality of life as did those exposed to traditional rehabilitation.

Sustainable valorization of algae biomass via thermochemical processing route: An overview.

Biofuels have become an attractive energy source because of the growing energy demand and environmental issues faced by fossil fuel consumption. Algal biomass, particularly microalgae, has excellent potential as feedstock to be converted to bio-oil, biochar, and combustible syngas via thermochemical conversion processes. Third-generation biofuels from microalgal feedstock are the promising option, followed by the first-generation and second-generation biofuels. This paper provides a review of the applications of thermochemical conversion techniques for biofuel production from algal biomass, comprising pyrolysis, gasification, liquefaction, and combustion processes. The progress in the thermochemical conversion of algal biomass is summarized, emphasizing the application of pyrolysis for its benefits over other processes. The review also encompasses the challenges and perspectives associated with the valorization of microalgae to biofuels ascertaining the potential opportunities and possibilities of extending the research into this area.

Estimation of the healthcare waste generation during COVID-19 pandemic in Bangladesh.

COVID-19 pandemic-borne wastes imposed a severe threat to human lives as well as the total environment. Improper handling of these wastes increases the possibility of future transmission. Therefore, immediate actions are required from both local and international authorities to mitigate the amount of waste generation and ensure proper disposal of these wastes, especially for low-income and developing countries where solid waste management is challenging. In this study, an attempt is made to estimate healthcare waste generated during the COVID-19 pandemic in Bangladesh. This study includes infected, ICU, deceased, isolated and quarantined patients as the primary sources of medical waste. Results showed that COVID-19 medical waste from these patients was 658.08 tons in March 2020 and increased to 16,164.74 tons in April 2021. A top portion of these wastes was generated from infected and quarantined patients. Based on survey data, approximate daily usage of face masks and hand gloves is also determined. Probable waste generation from COVID-19 confirmatory tests and vaccination has been simulated. Finally, several guidelines are provided to ensure the country's proper disposal and management of COVID-related wastes.

Effects of intensive multiplanar trunk training coupled with dual-task exercises on balance, mobility, and fall risk in patients with stroke: a randomized controlled trial.

OBJECTIVE: We determined whether an exercise regime comprising high-intensity training, multiplanar trunk movements, and dual-task practice could improve trunk control, balance, functional mobility, and reduce fall risk in patients with hemiplegic stroke. METHODS: In this randomized controlled trial, 74 patients (mean age 61.71 years) were randomly assigned to the experimental and comparison groups. Primary outcome was trunk impairment scale (TIS) scores. Secondary outcomes were scores on the Berg balance scale, 10-meter walk test, Timed-up-and-go test, timed-Up-Go-cognitive, and Stroke Impact Scale-16 to measure between-group changes from baseline. We used linear mixed modeling to identify changes over time within and between groups on each scale and whether changes persisted at 6- and 12-month follow-ups. RESULTS: We observed significantly increased mean TIS scores from baseline to 3 months post-treatment (7.74); the increased scores were maintained at 6- and 12-month follow-ups (8.60 and 8.43, respectively). In the experimental group, all secondary outcomes showed significant and clinically meaningful results. Fall risk between groups was significantly reduced at 6 and 12 months. CONCLUSIONS: Intensive multiplanar trunk movements coupled with dual-task practice promoted trunk control, balance, and functional recovery in patients with stroke, reduced fall risk, and improved independent mobility.Trial registration: #IRCT20200127046275N1.

Systematic Assessment of Visible-Light-Driven Microspherical V2O5 Photocatalyst for the Removal of Hazardous Organosulfur Compounds from Diesel.

The organosulfur compounds present in liquid fuels are hazardous for health, asset, and the environment. The photocatalytic desulfurization technique works at ordinary conditions and removes the requirement of hydrogen, as it is an expensive gas, highly explosive, with a broader flammability range and is declared the most hazardous gas within a petroleum refinery, with respect to flammability. The projected work is based on the synthesis of V2O5 microspheres for photocatalytic oxidation for the straight-run diesel (SRD) and diesel oil blend (DOB). The physicochemical properties of V2O5 microspheres were examined by FT-IR, Raman, UV-vis DRS, SEM, and Photoluminescence evaluations. The as-synthesized photocatalyst presented a trivial unit size, a narrow bandgap, appropriate light-capturing capability, and sufficient active sites. The desulfurization study discovered that the anticipated technique is substantial in desulfurizing DOB up to 37% in 180 min using methanol as an interfacing agent. Furthermore, the outcome of employing a range of polar interfacing solvents was examined, and the 2-ethoxyethanol elevated the desulfurization degree up to 51.3%. However, the anticipated technology is constrained for its application in sulfur removal from SRD. Additionally, the mechanism for a photocatalytic reaction was seen in strong agreement with pseudo-first-order kinetics. The investigated photocatalyst exhibited a compromised recyclability and regeneration tendency.

Effects of dry needling in lower extremity myofascial trigger points.

OBJECTIVE: To explore the current evidences on effects of trigger point dry needling as a treatment strategy on pain and range of motion among subjects with lower extremity myofascial trigger areas. METHODS: The systematic review was conducted at the University Institute of Physical Therapy, Lahore, Pakistan, from February to August 2019, and comprised search of studies on Cochrane Library, PubMed, SPORTDiscus and PEDro databases published in the English language from 2000 to July 2019. The search terms used were 'Dry needling', 'Trigger points', 'Myofascial trigger points', 'Trigger area', 'Acupuncture therapy', 'Lower extremity' and 'Acupuncture'. Cochrane Risk of Bias tool was used to assess the randomised and non-randomised controlled trials. Methodological assessment was performed using Physiotherapy Evidence Database 10-point scale. Data synthesis was performed through vote counting method. RESULTS: Of the 564 articles initially found, 30(5.3%) were shortlisted for full-text assessment. Of them, 10(33.3%) were selected for final assessment; with 7(70%) scoring high and 3(30%) fair on the PEDro scale. All the 10(100%) studies documented improvement in the pain over time with dry needling strategy. None of the studies targeted any other outcome, like anxiety and sleep disturbances, related with myofascial trigger points. CONCLUSIONS: On basis of the best evidences available, dry needling seemed to be effective in pain reduction related to lower extremity myofascial trigger points. Evidence also suggested that there was not much positive effect of myofascial trigger point dry needling on depression, anxiety, muscular strength and quality of life.

A comprehensive numerical design of firefighting systems for onshore petroleum installations.

Petroleum facilities containing welded steel bulk flammable liquid product storage tanks possess sundry fire hazards inherent to the facility. These installations urgently require indigenous efficient firefighting systems. So, the efficient design of firewater and firefighting foam system is dynamic in controlling fire-related emergencies. The paper deals with the in-depth conceptualization of the design and analysis of firefighting systems for a typical petroleum handling, processing and storage facility in compliance with international standards. The study is aimed to formulate the elementary technique for designing an optimized firefighting system. The proposed objective was achieved by considering an ideal tank farm site that is most commonly located in a range of terminal stations, pumping stations, petroleum refineries, well sites, etc. Sufficient illumination was enumerated on the standardized classification of the liquid fuel product with respect their flammability range. Special guidelines regarding firefighting system design basis were defined and an optimized firefighting and foam system design was developed. Moreover, sufficient limitations that must be considered during the firefighting of huge tank fires are discussed. This comprehensive numerical design philosophy offers a simple and wide-ranging guide to industrial practitioners by formulating the principles for industrial firefighting system design.

How frequent should the radiographic examination be to monitor magnetically controlled growing rods? A retrospective look two to seven years postoperatively.

PURPOSE: Magnetically controlled growing rods (MCGR) allow more frequent outpatient lengthenings to better mimic the physiological growth. The assessment of distractions with radiographs raised concerns regarding ionizing radiation exposure in growing children. The aim was to assess the necessity of radiographs after every lengthening of MCGR. METHODS: A retrospective analysis of 30 consecutive patients (19F, 11 M) treated in a single institution between 2011 and 2017. Planned radiographs were taken based on a protocol, updated over the years to involve less frequent acquisitions. Unplanned radiographs were obtained after a patient complaint or a significant clinical examination finding. Outcome measures were preoperative and postoperative radiographic measurements, and complications such as proximal and distal junctional kyphosis and failure, rod or actuator breakage, collapse of previously achieved height or failure to lengthen and worsening of deformity. RESULTS: Mean age at surgery was 7.5 (4-11) years. Mean follow-up was 45 (24-84) months. Mean number of lengthenings and radiographs per patient were 14.4 (8-23), and 13.2 (5-46), respectively. Nine patients (30%) experienced a total of 13 mechanical complications. Almost all complications were detected in unplanned radiographs. The probability of detecting a mechanical complication was significantly lower (p < 0.00001) in planned radiographs. CONCLUSIONS: Radiographs taken after routine lengthenings of MCGR are not likely to reveal any significant finding, since only 0.9% of planned radiographs displayed a mechanical complication. Exposing growing children to radiation with an intention of checking the MCGR device after every lengthening could not be justified. Obtaining post-lengthening radiographs with a decreased frequency and after a significant complaint or clinical finding may be considered.