DOCSLIB.ORG

Hyperbaric Oxygen Therapy INDICATIONS 14TH EDITION

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text

Load more

UNDERSEA AND HYPERBARIC MEDICAL SOCIETY Hyperbaric Oxygen Therapy INDICATIONS 14TH EDITION Richard E. Moon MD Chair and Editor Undersea and Hyperbaric Medical Society 631 US Highway 1, Suite 307 North Palm Beach, FL 33408 USA No responsibility is assumed by the publisher or editor for any injury and or damage to persons or property as a matter of product liability, negligence or otherwise, or from any use or operation of any methods, product, instructions, or ideas contained in the material herein. No suggested test or procedure should be carried out unless, in the reader’s judgment, its risk is justified. Because of rapid advances in the medical sciences, we recommend that the independent verification of diagnoses and drug dosages be made. All rights reserved. No part of this book may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Copyright © 2019 Undersea and Hyperbaric Medical Society ISBN: 978-1-947239-16-6 Library of Congress Catalog Number: 2019940027 Published by: Best Publishing Company 631 U.S. Highway 1, Suite 307 North Palm Beach, Florida 33408 Printed and bound in the United States of America Table of Contents Preface . v Members of the Hyperbaric Oxygen Therapy Committee. vii I. Background . ix II. Hyperbaric Oxygen: Definition . x III. Utilization Review For Hyperbaric Oxygen Therapy . xii IV. Acceptance (Addition) of New Indications for Hyperbaric Oxygen Therapy . xii V. List of Abbreviations . xiii VI. Author Biographies . xvi PART I. Indications 1. Hyperbaric Treatment of Air or Gas Embolism: Current Recommendations . 1 2. Arterial Insufficiencies A. Central Retinal Artery Occlusion . 15 B. Hyperbaric Oxygen Therapy for Selected Problem Wounds . 31 3. Carbon Monoxide Poisoning . 81 4. Clostridial Myonecrosis (Gas Gangrene) . .105 5. The Effect ofyperbaric H Oxygen on Compromised Grafts and Flaps. 117 6. The oleR of Hyperbaric Oxygen for Acute Traumatic Ischemias. 135 7. Decompression Sickness. 153 8. Delayed Radiation Injuries (Soft Tissue and Bony Necrosis) and Potential for Future Research . 163 9. Sudden Sensorineural Hearing Loss . .203 10. Intracranial Abscess . .231 11. Necrotizing Soft Tissue Infections . 239 12. Refractory Osteomyelitis . .263 13. Severe Anemia . .293 14. Adjunctive Hyperbaric Oxygen Therapy in the Treatment of Thermal Burns . 301 PART II. Additional Considerations 15. Mechanisms of Action of Hyperbaric Oxygen Therapy . 325 16. Side Effects of Hyperbaric Oxygen Therapy . .335 17. Oxygen Pretreatment and Preconditioning. 343 18. Randomized Controlled Trials in Diving and Hyperbaric Medicine . 351 19. Hyperbaric Oxygen for Symptoms Following Mild Traumatic Brain Injury . 379 Appendix A. Approved Indications for HBO2 Therapy. 393 Index . .399 Preface The application of air under pressure (hyperbaric air) dates back to 1667, when Nathaniel Henshaw proposed a hypo-hyperbaric room pressurized and depressurized with an organ bellows.1 In the nineteenth century, Simpson wrote a treatise on the use of compressed air for certain respiratory diseases.2 The medicinal uses of oxygen were first reported by Beddoes in 1794,3 while the first article describing adjunctive uses of hyperbaric oxygen therapy 4 (HBO2) was written by Fontaine in 1879, who constructed a mobile operating room which could be pressur- ized. He observed that pressurized patients were not as cyanotic after the use of nitrous oxide during induction of anesthesia as compared to patients anesthetized at atmospheric pressure. In addition, he noted that hernias were much easier to reduce. Also around that time, the work of Paul Bert5 and J. Lorrain-Smith6 showed that oxy- gen under pressure had potentially deleterious consequences on the human body with side effects that included central nervous system and pulmonary toxicity. The efforts of Churchill-Davidson and Boerema in the 1950s and 1960s spurred the modern scientific use of clinical hyperbaric medicine. In 1967, the Undersea Medical Society was founded by six United States Naval diving and submarine medical officers with the explicit goal of promoting diving and undersea medicine. In short order, this society expanded to include those interested in clinical hyperbaric medicine. In recognition of the dual interest by members in both diving and clinical applications of compression therapy, the society was renamed The Undersea and Hyperbaric Medical Society in 1986. It remains the leading not for profit organization dedicated to reporting scientifically and medically efficacious and relevant information pertaining to hyperbaric and undersea medicine. In 1972, an ad hoc Medicare committee was formed to evaluate the efficacy of hyperbaric oxygen therapy for specified medical conditions. The focus was to determine if this treatment modality showed therapeutic benefit and merited insurance coverage. The growth of the body of scientific evidence that had developed over the pre- ceding years supported this endeavor and recognition for the field. In 1976, the Hyperbaric Oxygen Therapy Committee became a standing committee of what was then the UMS. The first Hyperbaric Oxygen Committee Report was published in 1977 and served as guidance for practitioners and scientists interested in HBO2. The report is usually published every three to five years and was last published in 2014. Additionally, this document continues to be used by the Centers for Medicare and Medicaid Services and other third party insurance carriers in determining payment. The report, currently in its 14th edition, has grown in size and depth to reflect the evolution of the literature. To date, the committee recognizes 14 indications for which scientific and clinical evidence supports the use of HBO2. The Undersea and Hyperbaric Medical Society continues to maintain its reputation for its expertise on hyper- baric therapy. With leading experts authoring chapters in their respective fields, this publication continues to provide the most current and up to date guidance and support for scientists and practitioners of hyperbaric oxygen therapy. Richard E. Moon MD Editor, UHMS Committee Chair v Copyright © 2019 Undersea and Hyperbaric Medical Society, Inc. References 1. Henshaw N. Aero-Chalinos or a register for the air for the better preservation of health and cure of diseases, after a new method. London. 1677. 2. Simpson A. Compressed Air as a Therapeutic Agent in the Treatment of Consumption, Asthma, Chronic Bronchitis and Other Diseases. Edinburgh: Sutherland and Knox; 1857. 3. Beddoes T, Watt J. Considerations of the Medicinal Use of Factitious Airs, and on the Manner of Obtaining Them in Large Quantities, First Edition, part II. Bristol: Bulgin and Rossier; 1794. 4. Fontaine JA. Emploi chirurgical de l’air comprime. Union Med. 1879;28:445. 5. Bert P. Barometric Pressure [Hitchcock MS, Hitchcock FA, translation]. Bethesda, MD: Undersea Medical Society; 1978. P. 579. 6. Lorrain-Smith J. The pathological effects due to increase of oxygen tension in the air breathed. J Physiol. 1899; 24:19-35. vi ~ Hyperbaric Oxygen Therapy Indications Copyright © 2019 Undersea and Hyperbaric Medical Society, Inc. Members of the Hyperbaric Oxygen Therapy Committee Richard Moon MD (Chair) Dirk Bakker MD Robert Barnes MD Michael Bennett MD Enrico Camporesi MD Paul Cianci MD James Clark MD William Dodson, MD John Feldmeier DO Laurie Gesell MD Neil B. Hampson MD Brett Hart MD Enoch Huang MD Irving Jacoby MD Robert Marx DDS Heather Murphy-Lavoie MD Richard Roller MD Ben Slade MD Michael Strauss MD Stephen Thom MD, PhD Keith Van Meter MD Lindell Weaver MD Wilbur T. Workman MS vii Copyright © 2019 Undersea and Hyperbaric Medical Society, Inc. I. Background The Undersea and Hyperbaric Medical Society (UHMS) is an international scientific organization which was founded in 1967 to foster exchange of data on the physiology and medicine of commercial and military diving. Over the intervening years, the interests of the Society have enlarged to include clinical hyperbaric oxygen therapy. The society has grown to over 2,000 members and has established the largest repository of diving and hyperbaric research collected in one place. Clinical information, an extensive bibliographic database of thousands of scientific papers, as well as books, and technical reports which represent the results of over 100 years of research by military and university laboratories around the world are contained in the UHMS Schilling Library, holdings are now part of the Duke University Library, Durham, NC. The results of ongoing research and clinical aspects of undersea and hyperbaric medicine are reported annually at scientific meetings and inUndersea and Hyperbaric Medicine published bi-monthly. Previously the society supported two journals, Undersea Biomedical Research and the Journal of Hyper- baric Medicine. These two journals were merged in 1993 into Undersea and Hyperbaric Medicine. UHMS headquarters is located at: 631 US Highway 1, Suite 307 North Palm Beach, FL 33408 Phone: 561-776-6110 / 1-877-533-UHMS (8467) FAX: 919-490-5149 Email: [email protected] Internet: www.uhms.org I. Background ~ ix Copyright © 2019 Undersea and Hyperbaric Medical Society, Inc. II. Hyperbaric Oxygen: Defi nition Th e UHMS defi nes hyperbaric oxygen (HBO2) as an intervention in which an individual breathes near 100% oxygen intermittently while inside a hyperbaric chamber that is pressurized to greater than sea level pressure (1 atmosphere absolute
Recommended publications
  • Pediatric Trauma Imaging from Head To

    Pediatric Trauma Imaging from Head To

    High yield pediatric imaging Pediatric Trauma and other Pediatric Emergencies Lynn Ansley Fordham, MD, FACR, FAIUM, FAAWR UNC School of Medicine Department of Radiology Division Chief Pediatric Radiology Overview • Discuss epidemiology of pediatric trauma • Discuss unique aspects of skeletal trauma and fractures in children • Look at a few example of fractures • Review other common pediatric emergencies • Some Pollev Pollev.com\lynnfordham • Lots cases Keywords for PACs case review • PTF • TUBES AND LINES • Pre call cases peds Who to page for peds 2am Thursday morning? Faculty call shift 5pm to 8 am, for midnight to 8am, use prior day schedule Etiology of Skeletal Trauma in Children Significance of pediatric injuries • injuries 40% deaths in 1-4 year olds • injuries 90% deaths in 5-19 year olds Causes of Mortality in Childhood • MVA most common in all age groups • pedestrian (vs. auto 5-9) • bicycle • firearms • fires • drowning/ near drowning Causes of Morbidity in Childhood • falls – most common cause of injury in children • non-fatal MVAs • bicycle related trauma • trampolines • near drowning • other non-fatal injuries Trends over time • Decrease in death rates due to unintentional injuries – Carseats – Bicycle helmets • Increase in homicide rate • Increase in suicide rate MVA common injuries • depends on impact and seatbelt status • spine – craniocervical junction – thoracolumbar spine • pelvis • extremities • sternum rare in children Pediatric Fractures • Fractures related to the physis (growth plate) – Use Salter Harris classification
  • Septoplasty, Rhinoplasty, Septorhinoplasty, Turbinoplasty Or

    Septoplasty, Rhinoplasty, Septorhinoplasty, Turbinoplasty Or

    Septoplasty, Rhinoplasty, Septorhinoplasty, 4 Turbinoplasty or Turbinectomy CPAP • If you have obstructive sleep apnea and use CPAP, please speak with your surgeon about how to use it after surgery. Follow-up • Your follow-up visit with the surgeon is about 1 to 2 weeks after Septoplasty, Rhinoplasty, Septorhinoplasty, surgery. You will need to call for an appointment. Turbinoplasty or Turbinectomy • During this visit any nasal packing or stents will be removed. Who can I call if I have questions? For a healthy recovery after surgery, please follow these instructions. • If you have any questions, please contact your surgeon’s office. Septoplasty is a repair of the nasal septum. You may have • For urgent questions after hours, please call the Otolaryngologist some packing up your nose or splints which stay in for – Head & Neck (ENT) surgeon on call at 905-521-5030. 7 to 14 days. They will be removed at your follow up visit. When do I need medical help? Rhinoplasty is a repair of the nasal bones. You will have a small splint or plaster on your nose. • If you have a fever 38.5°C (101.3°F) or higher. • If you have pain not relieved by medication. Septorhinoplasty is a repair of the nasal septum and the nasal bone. You will have a small splint or plaster cast on • If you have a hot or inflamed nose, or pus draining from your nose, your nose. or an odour from your nose. • If you have an increase in bleeding from your nose or on Turbinoplasty surgery reduces the size of the turbinates in your dressing.
  • Rhinoplasty and Septorhinoplasty These Services May Or May Not Be Covered by Your Healthpartners Plan

    Rhinoplasty and Septorhinoplasty These Services May Or May Not Be Covered by Your Healthpartners Plan

    Rhinoplasty and septorhinoplasty These services may or may not be covered by your HealthPartners plan. Please see your plan documents for your specific coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. Administrative Process Prior authorization is not required for: • Septoplasty • Surgical repair of vestibular stenosis • Rhinoplasty, when it is done to repair a nasal deformity caused by cleft lip/ cleft palate Prior authorization is required for: • Rhinoplasty for any indication other than cleft lip/ cleft palate • Septorhinoplasty Coverage Rhinoplasty is not covered for cosmetic reasons to improve the appearance of the member, but may be covered subject to the criteria listed below and per your plan documents. The service and all related charges for cosmetic services are member responsibility. Indications that are covered 1. Primary rhinoplasty (30400, 30410) may be considered medically necessary when all of the following are met: A. There is anatomical displacement of the nasal bone(s), septum, or other structural abnormality resulting in mechanical nasal airway obstruction, and B. Documentation shows that the obstructive symptoms have not responded to at least 3 months of conservative medical management, including but not limited to nasal steroids or immunotherapy, and C. Photos clearly document the structural abnormality as the primary cause of the nasal airway obstruction, and D. Documentation includes a physician statement regarding why a septoplasty would not resolve the airway obstruction. 2. Secondary rhinoplasty (30430, 30435, 30450) may be considered medically necessary when: A. The secondary rhinoplasty is needed to treat a complication/defect that was caused by a previous surgery (when the previous surgery was not cosmetic), and B.
  • Natural Coral As a Biomaterial Revisited

    Natural Coral As a Biomaterial Revisited

    American Journal of www.biomedgrid.com Biomedical Science & Research ISSN: 2642-1747 --------------------------------------------------------------------------------------------------------------------------------- Research Article Copy Right@ LH Yahia Natural Coral as a Biomaterial Revisited LH Yahia1*, G Bayade1 and Y Cirotteau2 1LIAB, Biomedical Engineering Institute, Polytechnique Montreal, Canada 2Neuilly Sur Seine, France *Corresponding author: LH Yahia, LIAB, Biomedical Engineering Institute, Polytechnique Montreal, Canada To Cite This Article: LH Yahia, G Bayade, Y Cirotteau. Natural Coral as a Biomaterial Revisited. Am J Biomed Sci & Res. 2021 - 13(6). AJBSR. MS.ID.001936. DOI: 10.34297/AJBSR.2021.13.001936. Received: July 07, 2021; Published: August 18, 2021 Abstract This paper first describes the state of the art of natural coral. The biocompatibility of different coral species has been reviewed and it has been consistently observed that apart from an initial transient inflammation, the coral shows no signs of intolerance in the short, medium, and long term. Immune rejection of coral implants was not found in any tissue examined. Other studies have shown that coral does not cause uncontrolled calcification of soft tissue and those implants placed under the periosteum are constantly resorbed and replaced by autogenous bone. The available porestudies size. show Thus, that it isthe hypothesized coral is not cytotoxic that a damaged and that bone it allows containing cell growth. both cancellous Thirdly, porosity and cortical and gradient bone can of be porosity better replacedin ceramics by isa graded/gradientexplained based on far from equilibrium thermodynamics. It is known that the bone cross-section from cancellous to cortical bone is non-uniform in porosity and in in vitro, animal, and clinical human studies.
  • St. Mary's Catholic Church Cemetery Record of Mt. Calvary Cemetery, Grand Rapids, MI

    St. Mary's Catholic Church Cemetery Record of Mt. Calvary Cemetery, Grand Rapids, MI

    St. Mary's Catholic Church Cemetery record of Mt. Calvary Cemetery, Grand Rapids, MI. Last name First name Lot # Block Grave # Date of Burial Owner Comments Abram Joseph J. SE E 1 7.31.1950 Mary Abram Paid $75 Aug 1, 1950 Abram Mary SE E 2 1.18.1954 Mary Abram Paid $75 Aug 1, 1950 Absmeir Carl 30 E 1 10.18.1956 Absmeir C. Absmeir Marie 30 E 2 6.9.1955 Absmeir C. Absmeir Baby 144 C 1 4.13.1924 Absmeir, Elsie 1 grave Adams Baby 1 1 6.4.1942 Adams Row 3 Grave 5 Adrian Mary B. 54 C 1 8.12.1930 Adrian, Miss North East Quarter 3 graves Albers Louis 79 D 1 5.15.1928 Albers, Louis Albers Margaret 79 D 2 10.5.1937 Albers, Louis Albert Thersea 198 D 4 10.16.1956 Alberts, Thersea West Half Albert 1453 4th St. To last owner Parrett by Albert Margaret 188 1 3 11.2.1949 Leitelt, Joseph & Dora Albert, Margaret wiever (Noterized) of all other heirs Alberts Patricia 198 D 1 1.24.1931 Alberts, Thersea West Half E Alberts Katherine 262 1 1 11.12.1910 Alberts, Adam East Half Lot is full. Alberts Adam 262 1 2 5.3.1930 Alberts, Adam East Half Lot is full. Alberts Emma 262 1 3 10.3.1906 Alberts, Adam East Half Lot is full. Alden Jr. Charles Robert 328 D 1 2.24.1941 Alden, Chas. Robt. 1 Grave Aldrich Ella B. 79 3 2 7.12.1941 VanHoeven, Helen South Half Aleszkiewicz Frances 26 3 2 7.16.1937 Graczyk, Frank Aleszkiewicz Vincent 26 3 3 5.29.1929 Graczyk, Frank Alexzkrewicz Joseph S.
  • Venous Air Embolism, Result- Retrospective Study of Patients with Venous Or Arterial Ing in Prompt Hemodynamic Improvement

    Venous Air Embolism, Result- Retrospective Study of Patients with Venous Or Arterial Ing in Prompt Hemodynamic Improvement

    Ⅵ REVIEW ARTICLE David C. Warltier, M.D., Ph.D., Editor Anesthesiology 2007; 106:164–77 Copyright © 2006, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. Diagnosis and Treatment of Vascular Air Embolism Marek A. Mirski, M.D., Ph.D.,* Abhijit Vijay Lele, M.D.,† Lunei Fitzsimmons, M.D.,† Thomas J. K. Toung, M.D.‡ exogenously delivered gas) from the operative field or This article has been selected for the Anesthesiology CME Program. After reading the article, go to http://www. other communication with the environment into the asahq.org/journal-cme to take the test and apply for Cate- venous or arterial vasculature, producing systemic ef- gory 1 credit. Complete instructions may be found in the fects. The true incidence of VAE may be never known, CME section at the back of this issue. much depending on the sensitivity of detection methods used during the procedure. In addition, many cases of Vascular air embolism is a potentially life-threatening event VAE are subclinical, resulting in no untoward outcome, that is now encountered routinely in the operating room and and thus go unreported. Historically, VAE is most often other patient care areas. The circumstances under which phy- associated with sitting position craniotomies (posterior sicians and nurses may encounter air embolism are no longer fossa). Although this surgical technique is a high-risk limited to neurosurgical procedures conducted in the “sitting procedure for air embolism, other recently described position” and occur in such diverse areas as the interventional radiology suite or laparoscopic surgical center. Advances in circumstances during both medical and surgical thera- monitoring devices coupled with an understanding of the peutics have further increased concern about this ad- pathophysiology of vascular air embolism will enable the phy- verse event.
  • Avascular Necrosis As a Part of ‘Long COVID-19’ Sanjay R Agarwala,1 Mayank Vijayvargiya,2 Prashant Pandey2

    Avascular Necrosis As a Part of ‘Long COVID-19’ Sanjay R Agarwala,1 Mayank Vijayvargiya,2 Prashant Pandey2

    Case report BMJ Case Rep: first published as 10.1136/bcr-2021-242101 on 2 July 2021. Downloaded from Avascular necrosis as a part of ‘long COVID-19’ Sanjay R Agarwala,1 Mayank Vijayvargiya,2 Prashant Pandey2 1Orthopaedics, PD Hinduja SUMMARY I or II, 92%–97% of the patients do not require National Hospital, Mumbai, ’Long COVID-19’ can affect different body systems. At surgery and can be managed with bisphosphonate Maharashtra, India present, avascular necrosis (AVN) as a sequalae of ’long therapy. Hence, it is crucial to diagnose AVN early 2Orthopaedics, PD Hinduja COVID-19’ has yet not been documented. By large- scale to decrease the morbidity and the requirement of National Hospital and Medical surgery. Research Centre, Mumbai, use of life- saving corticosteroids in COVID-19 cases, Here, we report three cases of symptomatic AVN Maharashtra, India we anticipate that there will be a resurgence of AVN cases. We report a series of three cases in which patients of the femoral head after being treated for COVID- Correspondence to developed AVN of the femoral head after being treated 19. This is the first case report of AVN as sequalae Dr Sanjay R Agarwala; for COVID-19 infection. The mean dose of prednisolone of ‘long COVID-19’. drsa2011@ gmail.com used in these cases was 758 mg (400–1250 mg), which is less than the mean cumulative dose of around 2000 CASE PRESENTATION Accepted 23 May 2021 mg steroid, documented in the literature as causative for Case 1 AVN. Patients were symptomatic and developed early A- 36- year old male patient was diagnosed with AVN presentation at a mean of 58 days after COVID-19 COVID-19 on 6 September 2020, for which the diagnosis as compared with the literature which shows patient was admitted in intensive care at another that it generally takes 6 months to 1 year to develop AVN hospital because of dropping saturation.
  • Stage-Related Results in Treatment of Hip Osteonecrosis with Core-Decompression and Autologous Mesenchymal Stem Cells

    Stage-Related Results in Treatment of Hip Osteonecrosis with Core-Decompression and Autologous Mesenchymal Stem Cells

    Acta Orthop. Belg., 2015, 81, 406-412 ORIGINAL STUDY Stage-related results in treatment of hip osteonecrosis with core-decompression and autologous mesenchymal stem cells Pietro PERSIANI, Claudia DE CRISTO, Jole GRACI, Giovanni NOIA, Michele GURZÌ, Ciro VILLANI From Universitary Department of Anatomic, Histologic, Forensic and Locomotor Apparatus Sciences, Section of Locomotor Apparatus Sciences, Policlinico Umberto I, Sapienza University of Rome Our aim is to analyse the clinical outcome of a series thetic hip replacement. Therapy with glucocorti- of patients affected by avascular necrosis of the femo- coids and alcohol abuse are some of the main known ral head and treated with core-decompression tech- causative factors (21). Several pathophysiological nique and autologous stromal cells of the bone mechanisms were formulated about this pathology, marrow. including fat emboli, microvascular occlusion of We enrolled in our study 29 patients with 31 hips in epiphysis vessels and micro fracture of trabecular total affected by avascular necrosis of the femoral 13,18 head. bone ( ). An early diagnosis and a continuous The clinical and radiological outcome has been monitoring of patients with risk factors (corticoste- assessed through self-administered questionnaires roids therapy, alcoholism, or irradiated patients) are (HHS, VAS and SF12) X-ray and Magnetic Reso- very important in order to highlight the AVNFH nance. typical alteration as early as possible. Of all the examined hips, 25 showed a relief of the The treatment of osteonecrosis is one of the most symptoms and a resolution of the osteonecrosis, 11 of controversial subjects in the orthopaedic literature. these were at Stage I and 14 at Stage II.
  • Rhinoplasty ARTICLE by PHILIP WILKES, CST/CFA

    Rhinoplasty ARTICLE by PHILIP WILKES, CST/CFA

    Rhinoplasty ARTICLE BY PHILIP WILKES, CST/CFA hinoplasty is plastic become lodged in children's noses.3 glabella, laterally with the maxilla, surgery of the nose Fortunately, the art and science of inferiorly with the upper lateral car- for reconstructive, rhinoplasty in the hands of a skilled tilages, and posteriorly with the eth- restorative, or cos- surgical team offers positive alter- moid bone? metic purposes. The natives. The nasal septum is formed by procedure of rhmo- Three general types of rhino- the ethmoid (perpendicular plate) plasty had its beginnings in India plasty will be discussed in this arti- and vomer bones (see Figure 5). The around 800 B.c.,as an ancient art cle. They include partial, complete, cartilaginous part is formed by sep- performed by Koomas Potters.' and finesse rhinoplasties. tal and vomeronasal cartilages. The Crimes were often punished by the anterior portion consists of the amputation of the offender's nose, Anatomy and Physiology of the medial crus of the greater alar carti- creating a market for prosthetic sub- Nose lages, called the columella nasi? stitutes. The skill of the Koomas The nose is the olfactory organ that The vestibule is the cave-like area enabled them to supply this need. In projects from the center of the face modem times, rhinoplasty has and warms, filters, and moistens air developed into a high-technology on the way to the respiratory tract. procedure that combines art with Someone breathing only through the latest scientific advancements.' the mouth delivers a bolus of air During rhinoplastic procedures, with each breath. The components surgeons can change the shape and of the nose allow a thin flow of air size of the nose to improve physical to reach the lungs, which is a more appearance or breathing.
  • Investigating the Inhibition Mechanism of L,D-Transpeptidase 5 from Mycobacterium Tuberculosis Using Computational Methods

    Investigating the Inhibition Mechanism of L,D-Transpeptidase 5 from Mycobacterium Tuberculosis Using Computational Methods

    INVESTIGATING THE INHIBITION MECHANISM OF L,D-TRANSPEPTIDASE 5 FROM MYCOBACTERIUM TUBERCULOSIS USING COMPUTATIONAL METHODS BY: GIDEON FEMI TOLUFASHE 216076453 Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy in Pharmaceutical Chemistry School of Health Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa. 2018 PREFACE The work described in this thesis was conducted at the Catalysis and Peptide Research Unit, Westville Campus, University of KwaZulu-Natal, Durban, South Africa, under the supervision of Dr Bahareh Honarparvar, Prof. H.G. Kruger and Dr G.E.M. Maguire. This work has not been submitted in any form for any degree or diploma to any institution, where use has been made of the work of others, it is duly acknowledged in the text. Supervisors: Dr B. Honarparvar Date 30/10/2018 Prof. H. G. Kruger________________ Date ___________ Dr. G.E.M Maguire_______________ Date ___________ As candidate’s supervisor I agree to the submission of this thesis. i DECLARATION DECLARATION I- PLAGIARISM I, Gideon Femi Tolufashe declare that (i). The research reports in this thesis, except where otherwise indicated, is my original work. (ii). This thesis has not been submitted for any degree or examination at any other university. (iii). This thesis does not contain other person’s data, pictures, graphs or other information, unless specifically acknowledged as being sourced from other persons. (iv). This thesis does not contain other person’s writing, unless specifically acknowledged as being sourced from other researchers. Where other written sources have been quoted, then: a. Their words have been re-written, but the general information attributed to them has been referenced.
  • Tufts Health Unify 202 0 List of Covered Drugs (Formulary)

    Tufts Health Unify 202 0 List of Covered Drugs (Formulary)

    Tufts Health Unify 202 0 List of Covered Drugs (Formulary) Effective: 12/01/2020 Tufts Health Plan P.O. Box 9194 Watertown, MA 02471-9194 Phone: 855.393.3154 Seven days a week, from 8 a.m. to 8 p.m. TuftsHealthUnify.org Formulary ID: 20533 Version: 20 H7419_6507B Approved DISCRIMINATION IS AGAINST THE LAW Tufts Health Plan complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Tufts Health Plan does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. Tufts Health Plan: . Provides free aids and services to people with disabilities to communicate effectively with us, such as: — Written information in other formats (large print, audio, accessible electronic formats, other formats) . Provides free language services to people whose primary language is not English, such as: — Qualified interpreters — Information written in other languages If you need these services, contact Tufts Health Plan Member Services at 855.393.3154. If you believe that Tufts Health Plan has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Tufts Health Plan Attention: Civil Rights Coordinator, Legal Dept. 705 Mount Auburn St. Watertown, MA 02472 Phone: 888.880.8699 ext. 48000, [TTY number— 711 or 800.439.2370] Fax: 617.972.9048 Email: [email protected] You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, the Tufts Health Plan Civil Rights Coordinator is available to help you.
  • Cavendish the Experimental Life

    Cavendish the Experimental Life

    Cavendish The Experimental Life Revised Second Edition Max Planck Research Library for the History and Development of Knowledge Series Editors Ian T. Baldwin, Gerd Graßhoff, Jürgen Renn, Dagmar Schäfer, Robert Schlögl, Bernard F. Schutz Edition Open Access Development Team Lindy Divarci, Georg Pflanz, Klaus Thoden, Dirk Wintergrün. The Edition Open Access (EOA) platform was founded to bring together publi- cation initiatives seeking to disseminate the results of scholarly work in a format that combines traditional publications with the digital medium. It currently hosts the open-access publications of the “Max Planck Research Library for the History and Development of Knowledge” (MPRL) and “Edition Open Sources” (EOS). EOA is open to host other open access initiatives similar in conception and spirit, in accordance with the Berlin Declaration on Open Access to Knowledge in the sciences and humanities, which was launched by the Max Planck Society in 2003. By combining the advantages of traditional publications and the digital medium, the platform offers a new way of publishing research and of studying historical topics or current issues in relation to primary materials that are otherwise not easily available. The volumes are available both as printed books and as online open access publications. They are directed at scholars and students of various disciplines, and at a broader public interested in how science shapes our world. Cavendish The Experimental Life Revised Second Edition Christa Jungnickel and Russell McCormmach Studies 7 Studies 7 Communicated by Jed Z. Buchwald Editorial Team: Lindy Divarci, Georg Pflanz, Bendix Düker, Caroline Frank, Beatrice Hermann, Beatrice Hilke Image Processing: Digitization Group of the Max Planck Institute for the History of Science Cover Image: Chemical Laboratory.