The phenotypic manifestation of congenital adrenal hyperplasia (CAH) is variable, and this largely depends on the extent of 21-Hydroxylase enzyme deficiency. In non- classic CAH (NCCAH), the clinical features predominantly reflect the androgen excess rather than adrenal insufficiency. In boys, the condition may not present until much later in childhood, where the diagnosis is made following presentation with precocious puberty, features of aldosterone insufficiency, or this condition may be detected during fertility workup Imaging is generally not used in the evaluation of CAH, but may be helpful for the diagnosis, management, and follow-up of these patients. CAH can result in adrenal enlargement in both classic and non-classic forms of adrenal hyperplasia. The so-called adrenal rest tissue may be seen at several sites throughout the body, including the celiac plexus region, broad ligaments, normal ovaries, and testes. Sustained elevation of adrenocorticotropic hormone (ACTH) in patients with CAH has been postulated to cause adrenal rest cells to grow and become functionally active. The discovery of bilateral adrenal enlargement during radiologic evaluation for unrelated disease processes might serve as a mode of presentation for clinically not apparent or non- classical congenital adrenal hyperplasia (NCCAH).
The European Society of Cardiology (ESC) and the European Society of Hypertension (ESH) jointly developed a series of hypertension guidelines in the years 2003, 207 and 2013. The most recent guidelines were issued by the two societies in August this year (2018) and were published in the European Heart Journal. The new guidelines are printed in more than 90 pages and cover almost all aspects of hypertension based on extensive review of literature giving highest priority to data from randomized controlled trials and well conducted meta-analysis. In important areas where there is inadequate or no evidence, guidelines authors resort to expert opinion. The text was developed over approximately 24 months and was reviewed by representatives of ESC and ESH national hypertension societies. Although it is less than five years since the last hypertension European guidelines in 2013, the recent 2018 guidelines show important differences in diagnosis and treatment strategies with the addition of new sections and recommendations on management of hypertensive emergencies, hypertension in women and pregnancy, different ethnic groups, chronic obstructive pulmonary disease, cancer therapies, peri-operative management, sexual dysfunction and perioperative management.
Introduction: High blood pressure is a major cardiovascular risk factor. In hypertension, non-compliance is frequent. The objective of this work is to evaluate the therapeutic observances and to identify the predictive factors of poor compliances in Chadian hypertensive patients.
Patients and Methods: It was a prospective cross-sectional study over a six-month period from January 15 to July 15, 2019. This was performed in the outpatient Cardiology and Nephrology units at the Renaissance Hospital of N’Djamena. We included all follow-up patients who had hypertension who consulted during the study period. However, dialysis patients and children were excluded from this study. The parameters studied were demographic characteristics, economic and therapeutic data and the rate of therapeutic compliance.
Results: Eighty-seven patients were included. The average age was 50 years old. The sex ratio was 2.5. Sixty-seven percent (n = 58) of the patients were from urban areas. The predominant cardiovascular risk factors were smoking in 25% (n = 22) and diabetes in 23% (n = 20). Hypertension was uncontrolled in 76% (n = 66) patients. Adherence was poor in 66% (n = 57) of patients. The monthly cost of treatment was respectively 10,000 and 20,000 FCFA in 52% (n = 45) of cases. Combination therapy was observed in 70% of cases (n = 61) and 56% (n = 49) of patients had more than one drug intake. The adherence rate was 93% (n = 28) in the urban population (p < 0.001). All patients (n = 30) who were observing their treatment were educated (p < 0.001). The adherence rate was 20% (n = 6) in patients who had a monthly income less than 100,000 FCFA (p = 0.004). The adherence rate was 60% (n = 18) when the monthly cost was less than FCFA 10,000 (p = 0.003). The adherence rate was 77% (n = 23) in patients receiving monotherapy (p < 0.001).
Conclusion: This study showed a low level of adherence in Chadian hypertensive patients. The complexity and cost of antihypertensive therapy, poor knowledge of hypertension, and ignorance of its severity have been the main factors of poor compliance.
Background: Cerebral small vessel disease and extracranial atherosclerotic carotid disease are manifestations of silent cerebrovascular disease (CVD). Information on these two pathologies in hypertensive population with low cardiovascular risk (CVR) is scarce.
Objective: To explore frequency and characteristics of silent CVD in hypertensive adults and cognitive repercussion of these alterations.
Methods: 39 hypertensive patients (mean age: 53.5 years) were studied. Cerebral magnetic resonance imaging (3T), doppler ultrasound of the carotid artery and neuropsychological studies were obtained.
Results: 79% of patients presented white matter lesions (WML), 18% showed only cerebral atrophy and/or enlarged perivascular spaces, 60% presented hyperplasia of intimal media complex (IMC) and/or atheroma plaques. In women, a significant correlation was observed between IMC thickness and bifrontal index, and WML was greater in patients with carotid plaques. A non-significant decrease in neuropsychological performance was observed in the groups of patients with intra and/or extracerebral injury and a negative correlation with the bifrontal index in men was found.
Conclusion: Frequency of intra and extracerebral silent CVD was high in hypertensive adults with low to moderate CVR. WML and brain atrophy were partially related with carotid lesions. Age significantly influenced the appearance of intra and extracerebral lesions. Cognitive performance did not decrease significantly due to the presence of these lesions.
Introduction: Hypertension is the leading remediable risk factor for cardiovascular disease, affecting more than 1 billion people worldwide, and is responsible for more than 10 million preventable deaths globally each year. Hypertension can be described as the ‘Sleeping snake’, which bites when it wakes up.
Objectives: To detect hypertension and its associated factors among staffs of Dessie town government schools from December 10, 2018 to February 15, 2019 G.C.
Methods and materials: An institution-based cross-sectional study design was conducted among 225 Dessie town government school staffs whose age of 35 years and above. Systematic random sampling technique to select sample size of participants. Data was cleaned manually, coded and entered into Epi-info and analyzed by SPSS version 22 software. Multivariable logistic analysis AOR, 95% CI and p - value < 0.05 was used to identify variables which have significant association.
Results: From the total of 225 study participant’s 31(13.8%) of them diagnosed with hypertension. Multivariable logistic analyses had shown that 1st degree holders AOR (CI) = 3.05 [0.91,13.43], source of information from news AOR(CI) = 2.1 [0.816, 4.89], being protestant in religion AOR (CI) = 5.65 [0.74, 42.86], age from 41-60 years AOR (CI) = 1.96 [0.18,18.90], being divorced AOR (CI) = 2.35 [0.91,5.84], and teachers AOR (CI) = 3.4 [1.2, 9.825] maintain their significant association with detection of hypertension.
Conclusion and Recommendation: From this study significant numbers of respondents have hypertension. Educational status, source of information, marital status, occupation, religion and age of respondents were predictors for the occurrence of hypertension. Newly diagnosed hypertension on this was high among government school staffs which have no information about their blood pressure; which shows there was poor coverage of health screening.
Our research aimed to check the impact of some significant risk variables on diabetes growth and the specific goal of this study was to evaluate the connection of industrial fields with diabetes risk variables. The current research also informs us about the most important risk factor for male and female people with diabetes. A cross-section and convenient sample of 100 people, male and female, without discernment of risk factors and diabetes mellitus (Meta-Analysis on the effect of major risk factors on the diabetic patients form Jinnah Hospital Lahore). The risk factors in the general assessment i.e. lack of exercise, kidney problems, high ranges of tests and residence in industrial areas are found to be significant. Assessment of these factors is helpful in early diagnosis and in prognosis of diabetes.
Background: An event involving drug therapy that actually or potentially interfers with the desired health outcomes is known as drug therapy problem.
Objective: The study aimed to identify and resolve potential drug related problems encountered among adult hypertensive patients receiving care in a Nigerian Tertiary Hospital. Methods: This was a prospective cross sectional study. The data were collected from the patients’ medical records using the Pharmaceutical Care Network Europe (PCNE) Classification tool Version 6.2 (PCNE, 2010). For each of the 171 medical records, the DTPs experienced within the study period were identified. Data were analyzed using the IBM Statistical Product and Service Solutions (SPSS) for Windows, Version 21.0 (IBM Corp, Version 21.0, and Armonk, NY, USA).
Results: Majority of the patients were above 65years of age 64(37.4%), while about half of the patients were females. A total of 644 drug therapy problems were identified. The major cause of DTP was prescribing error 189(29.3). Other causes of drug therapy problem identified in this study were inappropriate drug selection 122(18.9), no indication for drugs 52(8.1), inappropriate drug combination 87(13.6), new indication presented 61(9.5), dose too high 62(9.6), dose too low 44(6.8), wrong drug taken/administered 27(4.2). Majority of the interventions made were accepted 586(91.0%) while only 3(0.5%) of the interventions made were not accepted.
Conclusion: This study demonstrates that a pharmacist, with adequate training and support can play a vital role in identifying and resolving drug therapy problems. Also, there is a need for an educational intervention among prescribing physicians to update them regularly on hypertension guidelines.
The measures put in place by many governments around the world to fight the spread of COVID-19 have drastically reduced visits to diabetes centres. To keep providing people with diabetes the professional support they need and reduce the inconvenience caused by the interruption of traditional assistance, the typical control visit can be carried out by virtual visit, telemedicine (TM) that should have the necessary characteristics to provide a correct execution. Especially this is important for pregnant women first diagnosed with gestational diabetes mellitus (GDM), they have the necessity to frequent checks in a short time due to the pregnancy.
Tyrosine kinase inhibitors (TKIs) are widely used in Oncology practice. Hypertension may develop during cancer treatment and TKIs are well known drugs that are associated with drug related hypertensive toxicity. TKI related hypertensive toxicity is not always the indicator of worse clinical outcomes and it may be the sign of treatment efficacy.
Background: Meclizine is a commonly prescribed medication for patients discharged from the Emergency Department (ED) with a diagnosis of peripheral vertigo, however it is on the Beers list of medications to avoid in elderly patients.
Objectives: This study aims to determine the correlation between use of meclizine and return visits to the ED within 1 week in patients > 65 years old.
Methods: This is a retrospective observational study conducted at 2 urban tertiary care EDs over 5 years. Inclusion criteria included patients > 65 years who were given meclizine in the ED or discharged with a prescription. Charts were reviewed for diagnosis, prescriptions and return visits within 7 days.
Results: There were a total of 1608 patients over 65 years of age who met inclusion criteria, 669 patients identified as receiving meclizine in the ED and 962 who received no meclizine (ED or ED plus home prescription). Of the meclizine patients, 548 (84.8%) were given home prescriptions, of which there were 36 (6.6%) return visits within 7 days. Patients who were given meclizine while in the ED without home prescriptions (121) had 16 return visits (13.2%). Among the non-meclizine group, 102 patients (10.6%) had a return visit within 7 days.
Conclusion: There was no increase in return visits in elderly patients discharged from the ED with a prescription for meclizine after a diagnosis of benign dizziness. Meclizine prescriptions at discharge were associated with fewer return visits to the ED within 1 week. Ongoing dizziness was the most common reason for return visits; there were no documented chief complaints of weakness, syncope/falls, or hypotension.
SARS-CoV2 can induce multiple immunological and endocrinological changes. We report the case of a COVID-19 associated hyperthyroidism in a young female.
Per definition the patient – because of having given birth six weeks previously - had a postpartum thyroiditis. However thus no antibodies were detected, the thyroiditis ceased without medication after the dissolving of the virus disease and the fT3/fT3-ratio proved a destructive thyreopathy as well as there was a close time link onset of the symptoms with the novel corona virus infection we argue it to be a COVID-19 induced thyrotoxicosis.
This proves the ability of SARS-CoV-2 to alter thyroid function, therefore all COVID-19 patients should be monitored regarding endocrinological changes and TSH, fT3, fT4 should be assessed.
NAFLD is characterized by accumulation of fat in the liver that can lead to health complications. Previous studies have found the obesity phenotype and its components to be risk factors for the development of NAFLD. This study aims to examine the relationship between the obesity phenotype and NAFLD among each racial-ethnic group. We analyzed data from the NHANES III survey (1988-1994). The obesity phenotype was defined based on BMI and metabolic syndrome. NAFLD was defined by abdominal ultrasounds among non-alcoholics with no infection or taking drugs affecting the liver. A higher prevalence of NAFLD was found among the metabolically unhealthy obese group (43.1%) and the metabolically unhealthy overweight (29.4%) than the metabolically unhealthy normal weight (11.8%). Mexicans-Americans had higher odds of NAFLD relative to whites (adjusted odds ratio (AOR) = 1.3, 95% confidence interval (CI) = 1.01-1.9, p = 0.04). The metabolically healthy obese phenotype was associated with NAFLD (p > 0.05) in the overall sample and in Whites. The metabolically healthy overweight was associated with NAFLD only among Mexican-American (p < 0.05). Metabolically unhealthy overweight or obese had higher odds of NAFLD relative to the metabolically healthy normal weight and this relation is consistent in all the racial/ethnic groups (p < 0.05). Metabolically healthy overweight and obese individuals had a high chance of NAFLD and it varied by race/ethnicity. Healthcare providers should pay more attention to care for those who are part of the metabolically healthy overweight or obese group especially among the Mexican-American population.
MgAl based layered double hydroxide (MgAl-LDH) was used as adsorbent for the removal of chromium oxyanion from an aqueous solution. MgAl-LDH was synthesized successfully using co-precipitation method, and was characterized by X-Ray Diffractometer (XRD), Scanning electron microscopy with energy dispersive X-ray spectroscopy (SEM-EDX). MgAl-LDH was thermally treated for improving the chromium adsorption. Samples were treated at 220°C and 450°C. A negligible difference of total chromium adsorption capacities was observed between MgAl-LDH000 and MgAl-LDH220 as 12.56 mg/g and 11.01 mg/g. The maximum chromium adsorption capacity of MgAl-LDH was 88.07 mg/g at 500g/l chromium concentration for MgAl-LDH which has been thermally treated at 450°C (MgAl-LDH450). The results indicated that memory effects of thermally treated MgAl-LDH at certain temperatures were retained and enhanced chromium removal efficiency.
Papillary thyroid cancer (PTC) is the most common subtype of thyroid cancer and a highly curable malignancy [1]. However, despite its excellent prognosis, cervical lymph node metastases (CLNMs) are present in a significant percentage of patients with papillary thyroid cancer (PTC) (upto 50% - 60%) [2].
Thermal stress of a continuous rigid frame bridge, based on the temperature gradient in Chinese bridge gauge, using a finite element analysis (FEA) method was investigated. First of all, the temperature effect of the whole bridge was analyzed, and the correlation of the improved amplitude of temperature gradient and temperature effect were studied. It was found that there was a linear relationship with temperature stress and improved temperature. And then, the temperature effect of zero block was analyzed and the details of box girder temperature stress distribution investigated by utilizing the FEA method. It was concluded that temperature stress mainly distributed in the body surface; under the condition of the improvement of temperature field, the center temperature stress of zero block was improved about 60% and the end temperature stress of zero block was improved about 75%.
Introduction: Obesity defined as increased fatty mass is progressively rising in recently, even though its affects begins to all systems in childhood and adolescence periods, the most important morbidity and mortality reason of obesity is its effects on the cardiovascular system. Researches point out endothelial dysfunction and atherosclerosis as the reason of the cardiovascular system disease in obesity. The studies conducted on childhood period related to this subject are highly limited and the results of these are also controversial. Therefore in our study the effects of obesity on endothelial functions in children and adolescents was assessed by flow mediated dilation (FMD) method. In addition to that, effects of epidemiological, biochemical, hormonal and clinical features of cases to FMD were investigated.
Material and method: A total number of 104 cases were cover in this study. Obese group (group 1) was consisted of 59 children whose body mass index (BMI) was ≥ 95th percentile and mean age was 12 ± 2.8 years old. The control group (group 2) consisted of 45 children whose body mass index (BMI) was between 25th -84th percentil and mean age was 11.4 ± 2.9 years old. The detailed history, epidemiological data and physical examination were performed. The population classified three groups according to sport activities. 97th percentile and higher values were accepted as morbid obesity. The blood pressure was measured with a mercury sphygmomanometer with utilizing the proper size cuff in compliance with the criterion used by the “National High Blood Pressure Education Program Working Group”. The complete blood count and biochemistry tests (renal and liver function tests, electrolytes, lipids, hsCRP) of the cases were analysed with biochemistry Roche Cobas Integra 800 and hormon assays of the cases (thyroid function tests, diurnal cortisol, ACTH, 17 OHP, prolactin, DHEA-S) were analysed by ECLIA method on Roche Elecsys 2010 device in the laboratory of our hospital. IR-HOMA values > 2.5 in prepuberal and > 4 in pubertal were defined as the insulin resistance. Bone ages of cases were evaluated with left hand wrist X-ray by using Greulich and Pyle Bone Age Atlas. flow mediated dilation (FMD) was used to assess the endothelial functions of all cases. The brachial artery was evaluated with SPG 12 MHz surface probes by using GE voluson ultrasound system in this method. FMD was expresses as percent (%) increase according to the basal vein dimension. 7% mean value was taken as the limit in the comparisons.
Results: The ratio of male and female was 20/39 in group 1 and 14/31 in group 2. 32.3% of the cases in group 1 and 47.6% of the cases in group 2 were prepubertal. The waist and hip circumferences ratio of the group 1 (0.86 ± 0.05) was significantly higher than group 2 (0.80 ± 0.07). While there was no difference between groups 1 and 2 in terms of the birth weight, using duration period of vitamin D and beginning time to additional nutrition, breastfeeding duration of group 1 (10.6 ± 7.8 months) was significantly shorter than group 2 (14 ± 7.4 months). BMIs of the mothers in group 1 were statistically higher than the mothers in group 2 (27.5 ± 4.8 kg/m² and 24.3 ± 3.2 kg/m² respectively. The mean of IR-HOMA was 4 ± 2.9 in group 1 and 1.9 ± 0.8 in group 2 and there was the insulin resistance in 51% of the obese cases. The dyslipidemia was diagnosed in 38.5% of the cases in group 1. The systolic and diastolic blood pressures in group 1 (117 ± 12.2 mmHg and 73.7 ± 9.4 mmHg respectively) were significantly higher than in group 2 (107.5 ± 9.1 mmHg and 68.2 ± 7.1 mmHg respectively). Hypertension was determined in 25% of the cases included in group 1. The minimum values of FMD in groups 1 and 2 were 1.01% and 3.1% respectively. The maximum values of FMD in groups 1 and 2 were 9.7% and 15% respectively. The mean values of FMD was %5 ± 2.3 in group 1 and %8.1 ± 3.5 in group 2. Compared with group 2, group 1 demonstrated significantly impaired FMD. There was no association between FMD and the birth weight, breastfeeding duration, physical exercises in two groups. A negative correlation was found between FMD and BMI (p < 0.01, r = -0.402). The correlation was determined between FMD and BMI of the mother (p = 0.017, r = -0.305) and the presence of obese individuals in the family (p = 0.021, r =-0.413). It was found that a significant negative correlation between FMD and waist-hip circumference ratio (p = 0.003, r = -0.421). When each groups were assessed in terms of biochemical and hormonal characteristics, there was low negative correlation between FMD and uric acid level and strong negative correlation between FMD and ALT level were determined in group 1.
Conclusion: In our study showed that the obesity begins in the childhood period may cause to the endothelial dysfunction. For this reason, according to our opinion, recognition prior indicators of endothelial dysfunction in early time may be helpful both to take the precautions required and to prevent cardiovascular complications in childhood and influences to the adult period.
The rising sizes of the waist and hip circumferences, positive family history for obesity and obesity of the parents were determined as the most important parameters negative affecting FMD. Unlike the literature, the association between endothelial dysfunction and GGT level the indicator of the hepatosteatosis in obese children was also found as well as FMD and ALT have also a close association independent from BMI in this study. Thus, a different point of view was formed since ALT may possibly have a predictor value in the assessment of the endothelial functions and it is also found as a highlighted risk factors for the endothelial dysfunction in this study. Because of this reason, it can be recommended that when the liver function tests carry out in obese children it does not show only hepatosteatosis but also can be used as an early indicator of the cardiovascular complications of obesity. Another important subject to be emphasize that the ALT level in the childhood period may be an early cardiovascular risk indicator in both obese and nonobese children.
Background: The main cause of adrenal insufficiency (AI) in paediatric patients is prolonged treatment with corticosteroids. Determination of plasma cortisol (PC) during ACTH test is the most used adrenal function indicator in clinical practice. However, determination of salivary cortisol (SC), a simple test especially useful in children in order to avoid invasive procedures, can be used as an alternative technique for the diagnosis of adrenal disease.
Methods: A two-year prospective study (January 2014-January 2016) in paediatric patients (2-18 years of age) treated with corticosteroids for more than fifteen days, who were investigated for suspected AI. Low-dose ACTH test was used to determine adrenal function and samples for SC and PC were obtained simultaneously in basal situation and during the test (at 30, 60 and 90 minutes).
Results: 230 samples (118 PC-112 SC) of 30 studies belonging to 20 patients (4 males), mean age 10.93 years ± 3.69 SD. Pearson’s correlation coefficient showed a positive correlation between PC and SC (r = 0.618, p < 0.001). All the studies with some determination of PC higher than 18 μg/dL (n = 8) had a SC peak higher than 0.61 μg/dL with a specificity of 66.67% and a sensitivity of 93.94% (ROC analysis).
Conclusion: Measurement of SC is a less invasive, easier and quicker test than PC to measure plasma free cortisol levels. In our study, a SC peak in low-dose ACTH test higher than 0.61 μg/dL was able to discriminate patients without AI, and proved to be a useful tool in the initial evaluation of children with suspected AI.Introduction
The activation of the hypothalamic-pituitary-adrenal axis in response to critical illness and the resulting release of cortisol from the adrenal cortex are essential to stress adaptation. Adrenal insufficiency (AI) is described as the inability of adrenal glands to produce an appropriate hormonal secretion not only under stress but also in basal situation. Therefore, a low baseline plasma cortisol (PC) (< 5 μg/dL) and a poor cortisol response to stimulation with exogenous adrenocorticotropic hormone (peak < 18 μg/dL) are some of the defining criteria of this condition [1,2]. It is well known that the main cause of AI in paediatric patients is prolonged treatment with exogenous corticosteroids, which is an iatrogenic cause derived from the increasing complexity of paediatric pathologies and the increased use of prolonged high-dose corticosteroid therapy.
In clinical practice, adrenal function is usually assessed by the total PC (determined by low-dose ACTH test). This implies the placement of a vascular access which is often a traumatic experience for children.
PC includes protein-bound fraction and serum-free cortisol. The latter constitutes the biologically active form of the hormone and is responsible for glucocorticoid activity on peripheral organs. Most of the circulating cortisol is bound to plasma proteins (over 90%), such as cortisol-binding globulin (CBG) and albumin, whereas only about 10% of circulating cortisol is free. Hence, the measurement of plasma-free cortisol level has been considered more representative of adrenal function (especially in critically ill adults and children) [1,2], because some conditions, such as hypoalbuminaemia or hypoproteinaemia (frequent in critically ill patients or in patients with cirrhosis), may lead to misinterpretation of adrenal function with an overestimation of the prevalence of AI. But the direct measurement of free PC is a laboratory-dependent and time-consuming procedure that is not available for routine use. Salivary cortisol (SC) is one of the several indirect methods available to determine free PC [3], as SC levels accurately reflect free PC [4] even in cases of hypoalbuminaemia or CBG abnormality [1,5]. For this reason, in the last years, this technique (SC) has been introduced as a non-invasive tool in the diagnosis of adrenal cortical disorders, for its simplicity and applicability in the paediatric population. However, few studies to date have evaluated the usefulness of SC as a diagnostic method in children with AI. No interactions between exogenous corticoids and SC have been described [6].
The aim of the present study was to assess the usefulness of determining salivary cortisol levels as a diagnostic tool in children with suspected secondary iatrogenic AI.
The actions exerted by waves on a coastal structure very much depend upon hydrodynamic processes that originate on shallow waters; even though significant progresses have been made in the last few years towards a full understanding of wave breaking, design work is still largely based on classical stability formulas. The recent availability of reliable models based on the numerical integration of full Navier-Stokes equations provides an important tool, but the evaluation of forces on vertical structures in shallow waters is still a particularly delicate application because of the complex hydrodynamic issues involved.
The paper presents deals with the numerical simulation of wave effects on front of a vertical obstacle on a sloping bottom, with the objective of clarifying some physical issues which are relevant towards the applicability of numerical Navier-Stokes simulation as a design tool.
SARS-CoV-2 infection is associated with thyroid disorders. It has been reported that myxedema coma (MC) can be complicated with COVID-19. COVID-19-related thyroid disorders consist of a broad spectrum of thyroid dysfunction, from thyrotoxicosis to decompensated hypothyroidism. It is possible that both primary and central thyroid disorders are induced by COVID-19 due to systemic inflammatory and immune responses. We experienced two cases in which patients with COVID-19 developed MC with central hypothyroidism. It is likely that MC affected the severity of COVID-19. It is necessary to consider the existence of MC during SARS-CoV-2 infection. We propose the potential mechanisms.
This paper presents a laboratory experiment for the formation of hydraulic jump in a rectangular open channel flume to accurately explore the effect of flow structures on water resources. This experiment illustrates the behavior of super-critical flow under sluice gate for various flow rates and downstream depths. Several runs are carried out using Armfield Model No. C4-MKII-5.0-11 to investigate the former computations concerning both the downstream conjugate depth and the critical depth resulting within the jump. Moreover, the model is examined to explore the sensitivity of Froude number by adjusting the flow-meter and over-shot weir in the flume. Also, the type of jump attributed to flow velocity can thus be obtained. Furthermore, both location of hydraulic jump and energy dissipated are discussed under the influence of different gate openings
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