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J. Riordian, M.A., M.D.

Associate Professor, University of California, Merced School of Medicine

Author Manuscript Author Manuscript Author Manuscript Author Manuscript Sukumaran et al. Finally, we were sufficiently powered for our outcomes of hospitalizations and hospitalizations from respiratory causes but underpowered for the outcome of death. This is the first study in which infant hospitalizations and mortality in the first 6 months of life after maternal influenza vaccine and Tdap vaccines are evaluated. In this large casecontrol study, we found no increased risk of infant hospitalization and death after vaccination in pregnancy. Our findings support the safety of influenza and pertussis vaccinations during pregnancy for infants of vaccinated mothers. Author Manuscript Author Manuscript Author Manuscript Author Manuscript Biography Supplementary Material Refer to Web version on PubMed Central for supplementary material. The Vaccine Safety Datalink Project is funded by the Centers for Disease Control and Prevention. Influenza activity - United States, 2013­14 season and composition of the 2014­15 influenza vaccines. Safety and immunogenicity of tetanus diphtheria and acellular pertussis (Tdap) immunization during pregnancy in mothers and infants: a randomized clinical trial. Monovalent H1N1 influenza vaccine safety in pregnant women, risks for acute adverse events. Neonatal outcomes after antenatal influenza immunization during the 2009 H1N1 influenza pandemic: impact on preterm birth, birth weight, and small for gestational age birth. Tetanus, diphtheria, acellular pertussis vaccine during pregnancy: pregnancy and infant health outcomes. Association of Tdap vaccination with acute events and adverse birth outcomes among pregnant women with prior tetanus-containing immunizations. Safety of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis and influenza vaccinations in pregnancy. Perinatal survival and health after maternal influenza A(H1N1)pdm09 vaccination: a cohort study of pregnancies stratified by trimester of vaccination. Association between pandemic influenza A(H1N1) vaccination in pregnancy and early childhood morbidity in offspring. Maternal vaccination against H1N1 influenza and offspring mortality: population based cohort study and sibling design. Infant outcomes after exposure to Tdap vaccine in pregnancy: an observational study. Vaccine attitudes and practices among obstetric providers in New York State following the recommendation for pertussis vaccination during pregnancy. Factors associated with intention to receive influenza and tetanus, diphtheria, and acellular pertussis (Tdap) vaccines during pregnancy: a focus on vaccine hesitancy and perceptions of disease severity and vaccine safety. Understanding factors influencing vaccination acceptance during pregnancy globally: a literature review. Kotelchuck M An evaluation of the Kessner adequacy of prenatal care index and a proposed adequacy of prenatal care utilization index. Influenza vaccination during pregnancy: influenza seasons 2002­2012, Vaccine Safety Datalink. Receipt of pertussis vaccine during pregnancy across 7 Vaccine Safety Datalink sites. Pregnancy outcomes after antepartum tetanus, diphtheria, and acellular pertussis vaccination. Maternal and infant outcomes among women vaccinated against pertussis during pregnancy. Effectiveness of prenatal versus postpartum tetanus, diphtheria, and acellular pertussis vaccination in preventing infant pertussis. Effectiveness of prenatal tetanus, diphtheria, and acellular pertussis vaccination on pertussis severity in infants. A case-control study to estimate the effectiveness of maternal pertussis vaccination in protecting newborn infants in England and Wales, 2012­2013. A meta-analysis of the association between adherence to drug therapy and mortality. Although there is evidence that these vaccines are safe in pregnant women, there are limited long-term data on infants born to mothers vaccinated during pregnancy. Our findings contribute to the knowledge of the long-term safety of vaccination during pregnancy.

It is, therefore, important that there is sufficient, "clear space" between the bucket and the structure surrounding it. The flight surgeon must play a critical role here in educating fleet aircrew on these systems. Currently the H-46, H-53, and H-3 use conventional noncrashworthy stowable seats in their aft compartments. These seats do not possess the structural integrity to withstand a crash load exceeding -2 Gz on a 95th percentile occupant. Training Navy policy presently does not require aviation personnel to perform actual parachute jumps. Aircrew personnel are required, however, to undergo training in order to learn the proper techniques and procedures for dealing with emergency situations. Even with high performance aircraft equipped with zero-zero ejection seats, there are takeoff and landing emergencies on the deck which require split second decisions as to whether to eject or stay with the aircraft. Historical, survival rates for on deck emergencies were very similar for both those who ejected and those who chose to remain with the aircraft (Rice & Ninow, 1971). Studies of military and commercial aircraft mishaps (Pollard & Klotz, 1971), reveal that most fatalities are not due to crash trauma but to the inability to get out of the aircraft. However, since helicopter airframes are generally less substantial, it is expected that structural damage to hatches would be even greater following helicopter impact. It is recommended that drills be initiated either immediately after crew members have embarked and are strapped in, or immediately following aircraft engine shutdown. Crews are scored on the basis of following correct procedures and exiting the aircraft within a prescribed time. Regularly scheduled drills will correct faulty procedures and considerably shorten the time required to abandon the aircraft. Records are normally maintained by the squadron safety officer to ensure that drills are held periodically, and that exit time is within the alloted limit. Lectures on egress should include complications due to fire, smoke, injury, panic, jammed hatches, etc. These drills are most effective when no forewarning has been given to the crew members. At some activities, the squadron safety officer or his/her representative will meet an arriving aircraft and give a prearranged signal to the pilot who in turn will announce "emergency egress" or "ditching drill" to the crew. This permits immediate discussion of problem areas and also serves as an indication of errors to all crews. Times could even be analyzed, trends established, and improvements could be recommended. Dilbert Dunker and Helicopter Escape Trainer the Dilbert Dunker consists of a simulated aircraft cockpit section mounted on rails which extend into a swimming pool. The trainee, after receiving proper indoctrination, is seated in the cockpit with shoulder harness and lap belt secured. The cockpit assembly is released and slides into the water, and the forward section (nose) is rotated down until the cockpit is inverted and completely immersed. After all motion stops, the trainee releases the restraints, exists the cockpit, and surfaces. As a safety precaution, specially trained scuba-equipped swimmers are located in close proximity to observe the actions of the trainee and lend assistance if necessary. A number of these devices have been distributed to various Navy and Marine Corps activities. Parachute Harness Release Training Two devices are used to demonstrate problems associated with parachute harness release. One device, the Para-Drag, allows students to experience problems in releasing parachute harness fittings under conditions simulating those which would be found when an aviator is dragged across the surface of the water by the parachute canopy. With this device, the student can experience problems with shroud line entanglement, and become acquainted with the difficulties involved in locating and operating the seat pan release mechanism during parachute descent.

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Once the irritation has caused swelling of the nerve then the nerves and encompassing tissues above or below the sheath. A Radiofrequency Treatment Pathway for Cluneal Nerve Disorders occasion the symptoms were so marked that there was local allodynia over the pelvic rim and buttock. Whilst pain was the predominant feature, paraesthesiae into the limb was a frequent symptom and even extended into the foot. On 04 Patients with radicular sensory or motor deficit were excluded from this study although in wider practice the combination is found the combination of Medial and Superior Cluneal Nerve trigger point irritation can symptoms radiating over the buttock, posterior the superior and lateral leashes of the Cluneal nerves can produce pain and paraesthesiae radiating along the anterolateral thigh and on rarer occasions the symptoms pass into the shin and foot. The Medial Cluneal Nerve trigger point pain is frequently mis-diag- ting, getting out of a chair (mimicking the "instability catch"), or be aggravated by walking or turning in bed and often causes difficulty in Diagnostic therapeutic pathway neal pain sources, the diagnostic therapeutic pathway shown in Figure 3 was adopted. To determine the relative contribution to the predominant presenting symptoms of low back pain and buttock pain from axial or Clu- Because Cluneal Nerve irritation is usually linked to pelvic malposture (anteversion or retroversion) the pain can increase when sit- Figure 3: Diagnostic Therapeutic Pathway. However, such displacement irritates the nerve in the foramen where the locus of the pain may really exist. If displacement of the facet joint reproduced the predominant presenting symptoms, then it might be considered a progenitor of the 05 ners may choose to inject the facet joint with steroids. Following the chosen injection, Figure 4 demonstrates the subsequent therapeutic protocol. But if this pathway fails then the patient becomes a candidate for Transforaminal Endoscopic Lumbar Decompression and Citation: Martin Knight. An "Excellent" result was defined as complete improvement in pain scores and restoration of functionality. The skin was sterilised, and each provocative site injected with subdermal lignocaine 1% both locally and horizontally in line with the nerve. A 22-gauge needle was then advanced to the evocative points and inance Physiotherapy was recommended to consolidate the benefit. Cluneal nerve radiofrequency ablation tion with the patient standing in 200 of flexion. Where trigger points were intensely tender then 40mg of Kenalog was added to the Depomedrone for more effective relief. The patient was mobilised and completed a pain diary three times a day until review at 6 weeks. During this period the patient participated in Muscle Balance Physiotherapy and postural alignment re-training. The line of anaesthesia is ideally placed above or medial to the the presumed point where the nerve was exiting the fascial tunnel or area of soft tissue tethering. The skin was sterilised with Betadine (or Hibitane), where the patient was allergic to iodine) and draped. The anaesthetist pro- the patient was placed prone on a Knight Sheffield radiolucent table (Royal Hallamshire Hospital Bioengineering Department, Shef- iliac crest rim. Ablation may A Radiofrequency Treatment Pathway for Cluneal Nerve Disorders also be required where the nerves emerge under the gluteal fascia to achieve adequate control of the trigger point sensitivity. The efficacy of the ablation was monitored by applying pressure to the previously provocative zone after ablation had been effected and questioning whether pain still persisted. Ablation was deemed sufficient once the target trigger point was no longer painful. It is necessary to be aware that this nerve splits into multiple groups on either the medial Superior Cluneal nerve leashes usually split to pass on either side of a palpable "tell-tale" lipoma. Feeling for this may assist 08 Figure 5: Cluneal Nerve Ablation probe positioned at points on either side of the "Guideline" lipoma around which pass the superior Cluneal nerves. It is time conserving to insert up to 4 probes thus allowing for synchronous ablation of all 4 sites at once. Figure 6: Radio frequency ablation probes stimulating the medial Cluneal nerves bilaterally. A Radiofrequency Treatment Pathway for Cluneal Nerve Disorders manoeuvring the probe in the trigger point zone. Again, ablation needs to address the Cluneal nerves along their course through the provocative zone.

Although renal tubular dysfunction has been suggested, it has not been described in detail. Case report: A 5-year-old boy consulted a previous doctor for polydipsia, polyuria, and viciousness, and was admitted to the Department of Pediatrics at Fujita Health University Hospital. Parekh Sir H N Reliance Foundation Hospital & Research Centre, Mumbai - India Introduction: Bedwetting is common but underestimated & lesser understood problem in children. It has psychosocial implications & causes significant stress in the child and family. Aim: To evaluate clinical profile of children presenting with bedwetting Materials Study design: Coss sectional observational study Subjects: Successive children beyond 5 y age presenting with bedwetting to paediatric nephrology clinic in last one year. Monosymptomatic enuresis in 07/32(22%); non-monosymptomatic enuresis in 25/32(78%). Commonest pattern of functional daytime incontinence was overactive bladder in 21/32(65%). Conclusion: Abnormal daytime voiding symptoms (78%), holding manoeuvres (75%), psychosocial issues (56%) and constipation (37. Addressing these issues is crucial to successful management of bedwetting & sleep disorders. Methods: Patients were prospectively recruited through two tertiary paediatric centres in Australia. Following review by a multidisciplinary team consisting of a nephrologist, clinical geneticist and genetic counsellor, patients underwent genomic sequencing with analysis for a pre-determined phenotype specific list of genes of interest. We measured the diagnostic yield and the effect on short term clinical management. This included the avoidance of immunosuppression, avoidance of renal biopsy, initiation of surveillance for extra-renal disease and facilitating transplant decisions. In addition, at least 26 patients (32%) had a clinically relevant negative result with management implications. Conclusions: To our knowledge this is the first study to report diagnostic and clinical utility of genomic sequencing in a pragmatic clinical setting. Severe tubular atrophy, glomerulosclerosis and cellular /fiibrocellular crescents were found to be predictors of poor response with p value of <0. Follow-up biopsy was done in 5 patients, tacrolimus nephrotoxicity was found in one patient. However we need close follow-up and monitoring for progression of disea se and neprotoxicity Keywords: dense deposit disease. Levels of serum creatinine, serum protein and urinary protein/ creatinine ratio as well as treatment with immunosuppressive drugs and plasmapheresis were registered during the follow-up. Results: Maintenance therapy consisting of calcineurin inhibitors, antiproliferative agents, and prednisone was administered. Rituximab infusion and plasmapheresis sessions were performed with transient clinical improvement in the first patient and no apparent response in the second patient. Both patients were treated with two ofatumumab infusions, which induced in patient #1 a complete and stable remission for more than 12 months and in patient #2 a partial remission with a progressive reduction of proteinuria and normalization of serum protein levels. However, it can be also released into circulation, where it remodels glycans with a process termed "extrinsic sialylation". The aim of this study was to evaluate the relationship between these concentrations. Part of the data was used to train the model, and the rest of the data was used to verify the accuracy of the model. Methods: We report 8 cases in whom appropriate-sized polyurethane catheters were inserted intraperitoneally at the bedside through a left hypochondrial approach, a modified Seldinger technique and a 3-4 cm tunnel using the vessel dilator as the tunneling device. Two patients died from unrelated causes with functioning catheters, one recovered with no further need for dialysis and 5 were successfully converted to other forms of dialysis after improvement and establishment of a new/ definitive access. Pediatr Nephrol (2019) 34:1821­2260 Conclusion: There is a correlation between renalase deficiency and increased left ventricular mass index. However, the oscillometric (automated) method is used more frequently in the health care system due to ease of use. This study aimed at assessing the impact of cuff size on the accuracy of the automated compared to the manual method. Method: 117 children aged 5-18 years old who attended a tertiary pediatric hospital were studied. Bayrakci 2 1 University of Health Sciences, Ankara Child Health and Diseases, Hematology Oncology Training and Research Hospital, Department of Pediatrics, Ankara - Turkey, 2 University of Health Sciences, Ankara Child Health and Diseases, Hematology Oncology Training and Research Hospital, Department of Pediatric Nephrology, Ankara Turkey, 3 University of Health Sciences, Ankara Child Health and Diseases, Hematology Oncology Training and Research Hospital, Department of Pediatric Cardiology, Ankara - Turkey, 4 University of Health Sciences, Ankara Child Health and Diseases, Hematology Oncology Training and Research Hospital, Department of Clinical Microbiology, Ankara - Turkey Objective: Left ventricular hypertrophy is the most commonly studied index for hypertension related target organ damage due to the wide usage of echocardiography.