The evaluation of primordial radionuclide concentrations in rapidly urbanized and concrete-laden areas through the importation of construction materials from various regions of Nepal is both important and essential. This study utilized a portable gamma-ray spectrometer (PGIS 2) to analyze the distribution of three natural radionuclides: uranium (238U), thorium (232Th), and potassium (40K) in Tarakeshwor Municipality, Kathmandu, Nepal. The measured dose rates ranged from 70.22 nSv hr-1 to 163.66 nSv hr-1, with an average of 124.65±20.29 nSv hr-1, surpassing the global average of 59 nSv hr-1. The activity concentrations of 40K, 238U, and 232Th exceeded global averages, indicating relatively higher natural radioactivity concentrations in the region. Specifically, the average values for 40K, 238U, and 232Th were 935.26±172.30 Bq kg-1, 80.47±15.53 Bq kg-1, and 80.44±18.58 Bq kg-1, respectively. The calculated radium equivalent (Raeq) ranged from 132.26 to 351.22 Bq kg-1, and the annual gonadal equivalent dose (AGED) varied from 372.61 to 1028.81 µSv yr-1. The annual effective dose rates for indoor and outdoor environments were 0.54±0.09 mSv yr-1 and 0.15±0.03 mSv yr-1, respectively, both exceeding the global average. The representative level index (RLI) within the study area averaged 1.96±0.32, indicating an elevated radiation risk. The excess lifetime cancer risk (ELCR) values for outdoor and indoor environments were 0.52×10-3 ±0.09 ×10-3 and 1.87 ×10-3 ±0.31×10-3, respectively, surpassing the world average. Additionally, external hazard indices (Hex) ranged from 0.36 to 0.59, while internal hazard indices (Hin) ranged from 0.38 to 1.20, both indicating values higher than UNSCEAR recommendations. These findings underscore the necessity for further experimental analysis employing ex-situ equipment. The data generated in this study can provide a valuable baseline for future assessments and interventions in radiation risk management guidelines within the country.
Soil samples from vegetable farmland in densely populated wards of Nepal were analyzed for natural radionuclide levels, employing a NaI(Tl) 3" [Formula: see text] 3" gamma detector. The study aimed to evaluate the causes of radiation risk, attributing it to soil contamination resulting from the rapid urbanization and concretization that followed the earthquake in 2015. The activity concentration of radium-226, thorium-232, and potassium-40 and the ranges observed are 2.080±0.084-33.675±1.356 Bq kg[Formula: see text], 17.222±0.198-119.949±1.379 Bq kg[Formula: see text], and 11.203 ± 0.325-748.828±21.716 Bq kg[Formula: see text], respectively. The average values obtained for hazard indices are as follows: radium equivalent activity (82.779 Bq kg[Formula: see text]), absorbed dose rate (36.394 nGy h[Formula: see text]), annual effective dose equivalent (0.045 mSv yearr[Formula: see text]), gamma index (0.291), external hazard index (0.224), internal hazard index (0.253), excess lifetime cancer risk (0.159), annual gonadal dose equivalent (243.278 mSv year[Formula: see text]), alpha index (0.054), and activity utilization index (0.716). However, in most places, thorium-232 concentration is greater than those of the world average and recommended values. In specific locations such as Ward 4 in Baluwatar, the soil was found to have concentrations of Ra[Formula: see text] and K[Formula: see text] exceeding recommended limits. Despite this localized concern, the overall analysis of hazard indices across the studied areas revealed that most values were within permissible limits. This suggests that, on a broader scale, radiation exposure may not be a significant concern in the investigated regions. Nonetheless, the study recommends regular monitoring in additional locations to ensure a comprehensive and ongoing assessment of radiation levels.
Earthquakes , Environmental Monitoring , Thorium , Soil , Risk Assessment
OBJECTIVE: To determine if the efficacy of biologics differ based on magnetic resonance imaging (MRI) and C-reactive protein (CRP) findings. METHODS: We compared four subgroups (MRI+/CRP+, MRI+/CRP-, MRI-/CRP+, MRI-/CRP-) from randomized controlled trials (RCTs). A comprehensive database search was performed to include axial spondylarthritis (axSpA; both radiographic axSpA [r-axSpA] and nonradiographic axSpA [nr-axSpA]) RCTs with treatment efficacy reported by different MRI and CRP subgroups. Study-specific disease activity scores (at 12-16 weeks) were pooled using a random-effects model and compared between the four subgroups. RESULTS: Five trials (all nr-axSpA) were included: three with tumor necrosis factor inhibitors (TNFi, N = 729) and two with interleukin-17 inhibitors (IL-17i, N = 794). TNFi and IL-17i showed efficacy based on the Assessment of Spondyloarthritis International Society 40 (ASAS40) and Bath Ankylosing Spondylitis Disease Activity Index 50 (BASDAI50) in all MRI and CRP subgroups, except the CRP-/MRI- subgroup, which had a single study with only 39 patients. There was no statistically significant difference between the four subgroups in terms of patients achieving ASAS40 (P = 0.60, I2 = 0%) or BASDAI50 (P = 0.27, I2 = 23.9%). The number needed to treat was three for the CRP+/MRI+ and CRP+/MRI- subgroups and six for the CRP-/MRI+ and CRP-/MRI- subgroups. All trials had a low risk of bias. Between-study heterogeneity was low to moderate. Sensitivity analyses comparing TNFi or IL-17i versus placebo similarly showed no difference between subgroups in terms of ASAS40 (TNFi, P = 0.57; IL-17i, P = 0.28) and BASDAI50 (TNFi, P = 0.37; IL-17i, P = 0.18). CONCLUSION: In this systematic review, there was no statistically significant difference between the four subgroups in terms of efficacy based on ASAS40 or BASDAI50.
Upper airway hematoma (UAH) is a rare but life-threatening complication of oral anticoagulants requiring early recognition. However, no consensus exists regarding the best approach to treatment. We therefore, sought to systematically review the published literature on UAH to elaborate its demographic and clinical characteristics, treatment, complications, and outcomes. A systematic electronic search of PubMed and EMBASE for case reports, case series, and related articles of UAH related to warfarin published from inception (November 1950) to March 2015 was carried out. Categorical variables were expressed as percentage and continuous variables as mean ± standard deviation (SD). Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 20.0. All cases were reported to have UAH as a complication of anticoagulation therapy with warfarin. Demographic and clinical characteristics, treatment, complications and outcomes of UAH were studied. Thirty-eight cases of UAH were identified from 34 reports in the literature. No gender preponderance (male = 52.78%) was seen and the average age of presentation was 60.11 ± 12.50 years. Dysphagia, sore throat, and neck swelling were the most common symptoms and the mean international normalized ratio (INR)at presentation was 8.07 ± 4.04. Most cases had sublingual hematoma (66.57%) followed by retropharyngeal hematoma (27.03%). Of the cases, 48.65% were managed conservatively while the rest underwent either cricothyrotomy or intubation with the time to resolution being 7.69 ± 5.44 days. UAH is a rare butpotentially serious complication of warfarin therapy. It is more common in the elderly population with supratherapeutic INR; inciting events were present in many cases. Overall, it has a good prognosis with significant morbidity present only if concomitant respiratory compromise is present. Reversal of anticoagulation with low threshold for artificial airway placement in the event of airway compromise leads to a favorable outcome in most cases.
Association between sarcoidosis and antiphospholipid syndrome (APS) is rare with few reported cases. We sought to systematically review the published cases of APS with sarcoidosis to better characterize the demographics, clinical characteristics, treatment, and the outcome of this association. Systematic electronic search for case report, case series, and related articles published until May 2014 was carried out and relevant data were extracted and analyzed. Four cases of APS with sarcoidosis were identified exclusively in females. These cases were seen in the sixth decade of life. Pulmonary embolism and central retinal artery occlusion were the presenting thrombotic events. All the patients were treated with lifelong anticoagulation with warfarin. During the median follow-up period of 5.5 months, additional thrombotic events were not observed. Although rare, sarcoidosis may be associated with APS. Further reporting of the cases will help to better establish this association, elucidate pathogenesis, and define clinical characteristics and outcomes.
The diagnosis of heparin-induced thrombocytopenia (HIT) is a challenge in post-cardiac surgery patients because of the high incidence of non-immune thrombocytopenia and heparin-platelet factor 4 antibodies in these groups. We present a case of HIT in a post coronary artery bypass surgery patient, which was successfully treated with prompt recognition and discontinuation of heparin products.
Acquired methemoglobinemia is a medical emergency, and its prompt recognition and treatment can avoid catastrophic complications including death. However, in mild asymptomatic cases without any comorbid conditions, it would be reasonable to simply observe and treat symptomatically to avoid severe treatment-related complications, especially in patients with suspected glucose-6-phosphate dehydrogenase (G6PD) deficiency. We present a case of mild methemoglobinemia in occult G6PD deficiency in which the patient developed hemolysis after treatment with intravenous methylene blue, requiring transfusion.
Embolism/etiology , Foreign-Body Migration/etiology , Heart Diseases/etiology , Prosthesis Failure , Vena Cava Filters/adverse effects , Adult , Device Removal/methods , Embolism/diagnosis , Embolism/therapy , Endovascular Procedures , Foreign-Body Migration/diagnosis , Foreign-Body Migration/therapy , Heart Diseases/diagnosis , Heart Diseases/therapy , Humans , Male , Phlebography/methods , Prosthesis Design , Tomography, X-Ray Computed , Treatment Outcome
Uterine fibroid, one of the most common tumors in women, is estrogen dependent, which commonly regresses after menopause. Fibroid degeneration after menopause, therefore, is rare. Here the authors report a case of 56-year-old postmenopausal woman who presented with acute abdominal pain, low grade fever, and leukocytosis as a result of fibroid degeneration.
