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Background: Cosmetics have been a part of routine body care not only for the upper classes but also for the middle and lower classes since the dawn of civilization. Cosmetic formulations are in more demand as the public's interest in skin whitening grows. The contamination of cosmetics with heavy metals is a major concern as they containing heavy metals and pose a major risk to human health. This study looks in to the effects of Lead on human skin. Methods: in this cross-sectional study different products were examined. The matrices (scalp hair, blood, serum and nails) of reference and dermatitis cosmetic female patients (seborrhoeic dermatitis, rosacea, allergic contact dermatitis, and irritant contact dermatitis) and cosmetic samples were used in a 2:1 mixture of HNO3 (65%) and H2O2 (30%), and oxidation was performed using a microwave. The oxidized beauty and biological specimen underwent electrothermal atomic emission spectrophotometry after microwave-assisted acid digestion. The validity and precision of the methodology were verified using certified reference materials. Cosmetic products (lipstick, face powder, Eye Liner and Eye shadow) of different brands contain Pb concentrations in the ranges of 50.5–120 μg/g, 14.6–30.7 μg/g, 2.87–4.25 μg/g and 15.3–21.6 μg/g, respectively. Results: In the present study, cosmetic products (lipstick (N=15), face powder (N=13), eye liner (N=11), eye shadow (N=15) and female patients with dermatitis (N=252) residing in Hyderabad city, Sindh, Pakistan, was investigated. The outcome of this investigation showed significantly higher levels of Pb in biological samples (blood and scalp hair) of different types of female dermatitis patients than in reference subjects (p

Sex differences in morbidity and mortality associated with cardiovascular disease have been recognized by the medical community for decades. Investigation into the underlying biological basis of these differences was largely neglected by the scientific community until a report released by the Institute of Medicine in the United States in 2001 "Exploring the Biological Contributions to Human Health: Does Sex Matter?" Recommendations from this report included the need for more accurate use of the terms "sex" and "gender", better tools and resources to study the biological basis of sex differences, integration of findings from different levels of biological organization and continued synergy between basic and clinical researchers. Ten years after the Institute's report, this review evaluates some of the sex differences in cardiovascular disease, reviews new approaches to study sex differences and emphasizes areas where further research is required. In the era of personalized medicine, the study of the biological basis of sex differences promises to optimize preventive, diagnostic and therapeutic strategies for cardiovascular disease in men and women, but will require diligence by the scientific and medical communities to remember that sex does matter.

Peripheral arterial disease is a common but underdiagnosed and undertreated disorder with substantial morbidity and mortality. The pathophysiology of peripheral arterial disease and the risk factors for developing it are similar to those for atherosclerotic disease occurring at other sites. Peripheral arterial disease can be diagnosed accurately with simple, noninvasive, office-based tests that measure the severity of the disease and provide valuable prognostic information. Optimal medical therapy includes a supervised exercise program, tobacco cessation, and modification of treatable risk factors. Cilostazol can improve pain-free and peak walking distances in patients with intermittent claudication. As a general rule, patients with lifestyle-limiting claudication who do not respond to medical management or those with critical limb ischemia should be referred to a vascular specialist for consideration of revascularization.

This paper describes the development of the knowledge-based decision support system (KBDSS) for management of variation orders for institutional buildings in Singapore. The KBDSS consists of two main components, i.e., a knowledge-base and a decision support shell for selecting appropriate controls. The database is developed by collecting data from the source documents of 79 institutional building projects, questionnaire survey, literature review and in-depth interviews with the professionals who were involved in these projects. The knowledge-base was developed through initial sieving and organization of the data from the database. The decision support shell provided decision support through a structured process consisting of building the hierarchy between the main criteria and the suggested controls, rating the controls, and analyzing the controls for selection through multiple analytical techniques. The KBDSS is capable of displaying variations and their relevant details, a variety of filtered knowledge, and various analyses of the available knowledge. This would eventually lead the decision maker to the suggested controls for variations and assist in selecting the most appropriate controls. The KBDSS is able to assist project managers by providing accurate and timely information for decision making, and a user-friendly system for analyzing and selecting the controls for variation orders for institutional buildings.

The study identifies the causes of inconsistencies between the design and construction of large building projects. To achieve the study objectives, a questionnaire survey was carried out to collect information on potential causes of inconsistencies at the project design and construction interface. Responses from 27 contractors were analyzed. The results suggest that the involvement of designer as consultant, communication gap between constructor and designer, insufficient working drawing details, lack of coordination between parties, lack of human resources in design firm, lack of designer's knowledge of available materials and equipment, and incomplete plans and specifications were considered as the most important causes of the project design and construction interface inconsistencies. On the other hand, project management as a professional service, weather conditions, nationalities of participants, involvement of the contractor in design conceptual phase, unforeseen problems, involvement of the contractor in design development phase, and government regulations were the least important causes of inconsistencies between professionals at the project design and construction interface in large building projects.

A 66-year-old white man presented to the emergency department with a 4-day history of progressive dyspnea, cough, and hemoptysis. The patient was known to have mitral valve prolapse confirmed by transthoracic echocardiogram, performed 9 months before his present admission. The transthoracic echocardiogram had shown a myxomatous mitral valve with prolapse of the P2 scallop and severe eccentric mitral regurgitation (MR) that was anteriorly directed. The mitral regurgitant fraction using the volumetric method was 69%. The left ventricular (LV) end diastolic dimension was 4.8 cm, and the LV end systolic dimension was 3.3 cm, both within normal limits. The LV systolic function was normal with ejection fraction (modified Simpson’s rule) of 58%. The right ventricular dimensions were normal (apical 4-chamber view: long axis, 7.2 cm; midshort axis, 2.2 cm; inflow short axis, 2.5 cm). The right ventricular systolic function was normal. The peak pulmonary artery systolic pressure was 30 mm Hg, with estimated right atrial pressure of 5 mm Hg. The patient had a transrectal prostate biopsy done to rule out carcinoma a few weeks before his presentation to the emergency department. On examination, he was hypotensive (blood pressure, 96/61 mm Hg), tachycardic (heart rate, 122 beats per minute), and in respiratory distress (36 breaths per minute with oxygen saturation of 86% on room air and 98% on facemask). Cardiovascular examination was remarkable for grade 5 of 6, holosystolic murmur along the left sternal border, and the presence of significant bibasilar rales. There were numerous palpable petechial lesions on the skin (Figure 1). After admission to the coronary care unit, the …

Objectives This study sought to compare survival of patients with poorly compressible arteries (PCA) to those with a normal ankle-brachial index (ABI) and those with peripheral arterial disease (PAD). Background Limited data are available regarding survival in patients with PCA identified in the clinical setting by noninvasive lower extremity arterial evaluation. Methods We conducted a historical cohort study of consecutive patients who underwent outpatient, noninvasive lower extremity arterial evaluation at the Mayo Clinic, Rochester, Minnesota, from January 1998 through December 2007, and who were followed for a mean duration of 5.8 ± 3.1 years. An ABI 1.00 to 1.30 was considered normal, PAD was defined as a resting or post-exercise ABI ≤0.90, and PCA defined as an ABI ≥1.4 and/or an ankle systolic blood pressure >255 mm Hg. Patients were followed for all-cause mortality through September 30, 2009. Results Of 16,493 individuals (mean age 67.8 ± 13.0 years, 59% male); 29% had normal ABI, 54% had PAD, and 17% had PCA. During follow-up (mean duration 5.8 ± 3.1 years), 4,365 patients (26%) died. The percent alive at the end of the study period was 88%, 70%, and 60% for normal ABI, PAD, and PCA, respectively. After adjustment for age, sex, cardiovascular risk factors, comorbid conditions, and medication use, the hazard ratios (95% confidence intervals) of death associated with PCA were 2.0 (1.8 to 2.2) and 1.3 (1.2 to 1.4) compared with the normal ABI and PAD groups, respectively. Conclusions Patients identified by noninvasive vascular testing to have poorly compressible leg arteries have poor survival, worse than those with a normal ABI or those with PAD.

Sex differences in morbidity and mortality associated with cardiovascular disease have been recognized by the medical com006Dunity for decades. Investigation into the underlying biological basis of these differences was largely neglected by the scientific community until a report released by the Institute of Medicine in the United States in 2001 “Exploring the Biological Contributions to Human Health: Does Sex Matter?” Recommendations from this report included the need for more accurate use of the terms “sex” and “gender”, better tools and resources to study the biological basis of sex differences, integration of findings from different levels of biological organization and continued synergy between basic and clinical researchers. Ten years after the Institute’s report, this review evaluates some of the sex differences in cardiovascular disease, reviews new approaches to study sex differences and emphasizes areas where further research is required. In the era of personalized medicine, the study of the biological basis of sex differences promises to optimize preventive, diagnostic and therapeutic strategies for cardiovascular disease in men and women, but will require diligence by the scientific and medical communities to remember that sex does matter.

Objective We investigated whether markers of inflammation—white blood cell (WBC) count, C-reactive protein (CRP), and lipoprotein-associated phospholipase A2—are associated with mortality in patients referred for noninvasive lower-extremity arterial evaluation. Methods Participants (n = 242, mean age 68 years, 54% men) were followed for a median of 71 months. Ankle-brachial index (ABI), WBC count, plasma CRP, and lipoprotein-associated phospholipase A2 were measured at the start of the study. Factors associated with all-cause mortality were identified using Cox proportional hazards. Results During the follow-up period, 56 patients (25%) died. Factors associated with higher mortality were greater age, history of coronary artery disease/cerebrovascular disease, lower ABI, higher serum creatinine, and higher WBC count/plasma CRP. In stepwise multivariable regression analysis, ABI, serum creatinine, WBC count, and CRP were associated significantly with mortality. Patients in the top tertile of WBC count and CRP level had a relative risk of mortality of 3.37 (confidence interval [CI], 1.56-7.27) and 2.12 (CI, 0.97-4.62), respectively. However, only the WBC count contributed incrementally to prediction of mortality. Inferences were similar when analyses were limited to patients with peripheral arterial disease (ABI Conclusion WBC count, but not plasma CRP level, provides incremental information about the risk of death in patients referred for lower-extremity arterial evaluation and in the subset of these patients with peripheral arterial disease.