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The transitional phase of climate change is becoming a threat worldwide. Fluctuations in temperature are frequently observed in the life cycles of field crops. The current study was intended to evaluate heat stress (HS) at sensitive stages on four wheat cultivars’ growth, grain yield, and quality traits during two consecutive seasons. The experiment included four spring wheat cultivars that were exposed to HS durations (i.e., 0, 48, 96 and 144 h) at booting and anthesis stages. Pots were kept in an open-air, and labeled pots were moved to the glasshouse at the respective growth stage. After HS treatments, pots were moved from the glasshouse to the original position in the open air. The results showed that the cultivars differed in yield and grain quality traits, but their collective mean effect was significantly expressed with HS and HS duration (HSd) on the measured traits. Spike length was significantly affected by HS at the anthesis in comparison to those obtained from the control. However, the increase in HSd did not cause a significant effect on spike length compared to other treatments. Spike weight was significantly decreased in plants exposed to HS at booting and anthesis as well as by increasing HSd. In addition, grain weight and numbers were decreased in plants exposed to HS at booting and anthesis stages with a similar pattern by increasing HSd. Moreover, a reduction in amylose content was observed in grains of plants exposed to HS at booting and anthesis stages or when plants as exposed to a longer period of HSd. Nonetheless, amylopectin, wet gluten (WG) and grain N (GN) showed an increase in plants exposed to HS at booting and anthesis stages and/or extending HSd. This study concludes that plants exposed to different HS treatments during the life cycle had lower values for spike length, grains weight, and grains number per spike including amylose content in comparison to those obtained from the control. The decrease was significantly noted in the yield and grain quality of wheat when plants were exposed to HS at the booting stage in comparison to those exposed to HS at anthesis.

BackgroundWraparound referrals are a cornerstone of hospital-based violence intervention programs, which have proven to be an effective public health approach for mitigating violence and recidivism. We hypothesized that replacing a manual referral process with an electronic referral application would increase the number of generated referrals and improve compliance with follow-up visits.Study DesignThe population for this single center quantitative study was a convenience sample of firearm-injured patients. Data from 74 patients were collected using the electronic health record, the electronic referral application, and the trauma registry before and after the intervention.ResultsPost-implementation of the electronic referral application showed an increased number of generated referrals, increased emergency department and inpatient utilization of trauma recovery center services, and an increase in second follow-up visit compliance.ConclusionThis study demonstrated an increase in the number of referrals and greater likelihood of completion of post-injury follow-up visits after implementing the electronic referral system.

Introduction: Post-operative analgesia is an important part of Total Knee Arthroplasty (TKA) to facilitate early mobilization and patient satisfaction.

Background and objective Cardiotocography (CTG) has been used more frequently in recent decades to reduce intrapartum fetal mortality rates. The purpose of this study was to determine whether pathological or non-reactive CTG could predict a low Apgar (Appearance, Pulse, Grimace, Activity, and Respiration) score. An abnormal trace would indicate a distressed fetus, whereas a normal trace would indicate a well-oxygenated fetus. Methods This study included a total of 470 women with a gestational period of more than 37 weeks. Based on the results of their CTGs, they were divided into three groups. An emergency cesarean section (CS) was performed if there was any sign of fetal distress on CTG. The Apgar scoring for newborns was recorded in the proforma following delivery. Results The study was carried out at two major tertiary-care hospitals in Pakistan. A reactive CTG was found in more than one-third (39.36%) of the 470 patients. An Apgar score above 8 was obtained by 34.26% of the newborns, while an Apgar score below 8 was obtained by more than half (63.40%). Only 2.34% of newborns had an Apgar score below 6. A third (30.64%) of the patients had grade-1 meconium-stained liquor (MSL), 24.89% had grade-2 MSL, 19.79% had grade-3 MSL, and 24.68% had no MSL. One-third (32.34%) of the neonates were admitted to the neonatal intensive care unit (NICU) shortly after birth. When CTG was pathological or non-reactive, the odds of securing a higher Apgar score decreased by 70.45% (OR: 0.30; 95% CI: 0.20-0.44; p

Since the SARS-CoV-2 (COVID-19) outbreak, health-care workers (HCWs) have had to create personal protective equipment (PPE) due to the worldwide demand and thus ensuing shortage. To address the dearth of available PPE, HCWs have quickly explored options to repurpose in-hospital equipment to provide alternative PPE to caregivers. We report the modification of a Stryker T5

We highlight the case of a 12 year old male who presented after sustaining a gunshot injury to the scrotum resulting in testicular, prostatic, and urethral transection in addition to pelvic fracture, extra peritoneal bladder injury, and transmural injury to recto sigmoid and ileum. The patient underwent a left orchiectomy, primary repair of the bladder and urethra, placement of universal plate on superior pubic rami, and segmental rectosigmoid and ileum resection. These findings illustrate the collaborative efforts of trauma surgery and urology to treat complex lower genitourinary (GU) injuries and how the direct prioritization of surgical efforts provides acceptable outcomes.

The use of electronic cigarettes (ECs) has been on the rise with increased number of battery explosions causing burns. This study is a retrospective review of patients who presented with burns caused by EC explosions.Here, we present a case series of eight patients sustaining burns from EC explosions, within a year, to elucidate the pattern of such burns and to provide a treatment guideline.All of them were males. Five patients had partial-thickness burns and three had full-thickness burns. TBSA ranged from 4 to 16% (burns to lower extremity [n = 7], hand [n =3], scrotum/penis [n =2], chest [n = 1]). None had inhalation injuries. Two patients (29%) required skin grafting. EC explosion is predominantly attributed to its lithium-ion battery. Several types of injuries can occur, including chemical and thermal burns, inhalation injuries, metal poisoning, etc. There are currently no specific guidelines on the management of burns due to lithium-ion battery exposure. Herein, we recommend the following: Initial assessment of injuries should accompany the Advanced Trauma Life Support guidelines; serum levels of lithium, cobalt, and manganese should be checked and elevated levels should be monitored; patients should be monitored for signs of metal toxicity; wound should be extensively debrided and irrigated to remove any residual materials; and litmus test should be performed to check for alkali pH prior to irrigation with water or other aqueous solutions.

Background Conventional coagulation tests do not provide an accurate representation of the complex nature of trauma induced coagulopathy. Thrombelastography provides a prompt global overview of all dynamic sequential aspects of trauma induced coagulopathy. The objective of this study was to evaluate the impact of using thrombelastography on blood products utilization, crystalloids utilization, hospital, and intensive care using length of stay, and cost savings. Methods We retrospectively reviewed 134 patients (May of 2012 to February of 2015) meeting Class I trauma activation. Outcome data was compared between two groups: patients prior to thrombelastography implementation (n = 87) and patients with thrombelastography guided trauma resuscitation (n = 47). Blood product usage was compared for three time periods: first 4 h, the next 20 h, and first 24 h. Results For the first 24 h of treatment, patients with thrombelastography guided trauma resuscitation had lower packed red blood cells (p = 0.0022) and fresh frozen plasma (p = 0.0474), but higher jumbo pack platelets (p = 0.0476) utilization when compared to the patients prior to thrombelastography implementation. There was no statistical significant difference in the utilization of crystalloids for any of the three time intervals. Patients with thrombelastography guided trauma resuscitation had a shorter hospital length of stay (p = 0.0011) and intensive care unit length of stay (p = 0.0059) than the patients prior to thrombelastography implementation. Cost savings in blood products transfusion were most pronounced in patients with penetrating injuries. Discussion Using visco-elastic tests to guide blood transfusion was first used for liver transplant patients and then applied to cardiovascular surgery and trauma. Similar to other studies, this study showed using visco-elastic tests for trauma patietns corresponded to an overall reduction in the use of packed red blood cells and fresh frozen plasma during the first 24 hours of resuscitation. In addition, this study showed using visco-elastic tests corresponded to a significant reduction in both hospital and intensive care unit length of stay. Conclusion This study demonstrates that Thrombelastography guided trauma resuscitation decreases the overall transfusion requirements of packed red blood cells and fresh frozen plasma. However, given the nature of under-recognized jumbo pack platelets dysfunction in the conventional laboratory parameters, jumbo pack platelets utilization is higher when following Thrombelastography directed resuscitation. The utilization of Thrombelastography corresponded to a reduction in hospital length of stay, intensive care unit length of stay and cost of transfused blood products. Electronic supplementary material The online version of this article (10.1186/s13049-017-0443-4) contains supplementary material, which is available to authorized users.

Background Hyperglycemia is a frequent and important metabolic derangement that accompanies severe sepsis and septic shock. Matrix-Metalloproteinase 9 (MMP-9) has been shown to be elevated in acute stress hyperglycemia, chronic hyperglycemia, and in patient with sepsis. The objective of this study was to examine the clinical and pathogenic link between MMP-9 and blood glucose (BG) levels in patients with early severe sepsis and septic shock. Methods We prospectively examined 230 patients with severe sepsis and septic shock immediately upon hospital presentation and before any treatment including insulin administration. Clinical and laboratory data were obtained along with blood samples for the purpose of this study. Univariate tests for mean and median distribution using Spearman correlation and analysis of variance (ANOVA) were performed. A p value ≤ 0.05 was considered statistically significant. Results Patients were grouped based on their presenting BG level (mg/dL): BG 201 (n = 84). Rising MMP-9 levels were significantly associated with rising BG levels (p = 0.043). A corresponding increase in the prevalence of diabetes for each glucose grouping from 6.3 to 54.1 % (p = 0.0001) was also found. As MMP-9 levels increased a significantly (p

A study was conducted in tomato using an 8 × 8 diallel set excluding reciprocals to quantify the magnitude of heterosis for yield and its five yield components: number of flowers per cluster, number of fruits set per cluster, fruit length, fruit width, fruit weight and fruit yield per plant. Seven accessions and one locally approved variety were crossed in half diallel fashion and the resulting F1 progeny along with their parents were evaluated in a 6 × 6 Tripple Lattice Design at Agricultural Research Institute, Mingora (NWFP), Pakistan during 2007 - 2008 crop season. Highly significant differences were observed among the genotypes for all the studied traits. Highly significant heterosis of positive nature was foundfor flowers per cluster (53.1 and 37.2%), fruits per cluster (38.9%), fruit length (32.7 and 15.5%), fruit weight (48.7 and 45.0%) and yield per plant (34.9%) over the mid and better parents, respectively. Positive significant heterosis was observed for flowers per cluster (7.4%), fruits per cluster (10.0 and 10.0%), fruit length (8.9%), fruit width (8.7 and 7.9%), fruit weight (14.3 and 12.5%), yield per plant (24%) over the mid and better parents, respectively. Four hybrids possessed significantly usefulheterobeltiosis for fruit weight. Three single cross hybrids and four of the parental genotypes were selected for use in subsequent tomato breeding programmes.