<h2>Abstract</h2><p>Five experimental feeding trials were conducted to investigate the performance of Heterobranchus bidorsalis fingerlings to graded levels (0, 25, 50,75 and 100%) of Sphenostylis stenocarpa seed meal diets. Complete randomized design with triplicate groups of fingerlings was used for the study for ten weeks. The proximate, anti-nutritional factor and amino acid profile of the S. stenocarpa was analysed. The study showed that treatment C with 50% inclusion of Sphenostylis stenocarpa meal was significantly different (<em>p</em> < 0.05) and performed best among other treatments in terms of the net weight gain, standard growth rate, and survival. The feed conversion ratio was best in treatment C but not significantly different (<em>p</em> > 0.05) to other treatments.</p>
<h2>Overview</h2><p>Bariatric Surgery (BS) from the Greek bari = weight and iatrein = cure) treats obesity and began in Spain in 1973. Its greatest development occurs after the founding of SECO (Spanish Society of Obesity Surgery) in 1997. The purpose of this work is to reflect the changes that have occurred in these 22 years.</p>
<h2>Abstract</h2><p>The present study examined the effect of the European-Based ‘Alive and Kicking’ exercise program on the health-related physical fitness of individuals with (Experimental Group: EG) and without (Control Group: CG) (Intellectual Disability: ID). The Self-Determination Theory: SDT, guided both the 6-month preparatory phase and the 9-month exercise program, which was conducted in five separate European countries (Cyprus, France, Greece, Portugal and Spain). The total sample (<em>n</em> = 200, 54% males and 46% females) comprised of 168 individuals with ID (age: 26.54 years, + 7.78) and 32 individuals without ID (age: 25.81 years, + 8.73) respectively. The statistical analyses revealed that the ID group’s performance (EG) improved significantly in a range of health-related physical fitness variables (sit & reach, pushups, sit ups, long jump, ½ mile walk/ run). In turn, the participants from the CG improved mainly in muscular endurance (sit ups and pushups). The results are discussed in accordance with SDT and the dairies kept from the staff involved (coaches and psychologists) during the 9–month intervention. The present findings, although subjective to certain limitations, are encouraging, given the large-scale, real-world nature of the research design, and provide evidence supporting the integration of theoretical strategies enhancing motivation into traditional coaching programs for individuals with ID.</p>
Rakotomalala Nivoarimelina Zoly*, Rakotozanany Besaina, Razafindraibe Andriatompoina Felanarivo, Ramarokoto Malalafinaritra Patrick Marco, Rafamatanantsoa Jean Florent, Kapche Wato Edith and Randriambololona Domoina Malala Aurelia
<h2>Abstract</h2><p><strong>Objective:</strong> Pregnancy after age 40 remains a concern as it exposes to particular obstetrical complications. Our study aims to determine the risks of complications related to pregnancy and childbirth of women aged 40 and over.</p><p><strong>Study design:</strong> We carried out a cross-sectional analytical study of a historical cohort comparing the progress and the outcome of pregnancy in women 40 years of age and over to those aged 20 and 35 who gave birth at the University Hospital of Obstetrics and Gynecology in Befelatanana, from 1st January 2010 to 31 December 2013.</p><p><strong>Results:</strong> The prevalence of childbirth among 40 years old and over was 0.61%. They were multiparous and large multiparous in 88% of the cases. The analysis showed that parturients aged 40 years and older were at significant risk for caesarean section, with three times the risk of emergency caesarean section. The frequency of this emergency caesarean section increased with parity (<em>RR</em> = 3.04 [2.15-4.30], <em>p</em> = 10-10). Among their neonates, 23.42% were hypotrophic, 22.86% premature, 12% asphyxiated at birth, 13.14% admitted to neonatal resuscitation and 5.71% died in utero, but without significant difference with the group unexposed. Perinatal death was 7.43% in women aged 40 and over vs 4% in 20 to 35 year olds (<em>RR</em> = 1.85 [0,89-3,86]; <em>p</em> = 0.052).</p><p><strong>Conclusion: </strong>We found that pregnancies after 40 years were not exposed to pregnancy-related pathologies or specific fetal complications. The use of an emergency cesarean is, however, frequent.</p>
Márta Zsoldos, Márton Vezér, Henriette Pusztafalvi, Bianka Pencz, Dora Hargitai and Attila Pajor*
<h2>Summary</h2><p>Sexual activity during healthy pregnancy is safe. There are little data on how coital activity affects outcome of the high-risk pregnancies. Hereby we report a case demonstrating that orgasmic coitus triggered placental abruption resulting in preterm stillbirth.</p><p>A 38-year-old 8-para, 12-gravida woman lived unmarriedly with a constant partner in low socioeconomic conditions. Her previous pregnancies included 7 deliveries without complication, two early miscarriages and two pregnancy terminations. Her present pregnancy was complicated with gestational hypertension successfully treated with nifedipine. She had coitus 2 to 4 times a month, mostly without orgasm. The last coitus which happened in side-by-side position was accompanied by orgasm which continued in uterine hypertonicity and massive vaginal bleeding at 29 weeks gestation. Two hours subsequently, on admission to hospital, placental abruption and fetal demise were diagnosed. At the emergency cesarean section, a dead female infant weighing 1,510 g was born. Fetal pathology was not discovered. Placental histopathology showed retroplacental hematoma, intervillous and decidual hemorrhages, focal distal villous hypoplasia and avascular villuses. Patient’s recovery rapidly occurred after intensive care.</p><p>Placental abruption complicates 0.4% - 1.0% of deliveries. It is known that most cases of abruption cannot be predicted and prevented. Our report suggests that orgasmic coitus may be a trigger for placental abruption in those women who have gestational hypertension and multiple risks for placental abruption. We infer from the above case that sexual intercourse is advised to avoid during pregnancy of such women in order to prevent placental abruption.</p>
Brijesh Gaud, Amrita Singh, Sandesh Jaybhaye and Himanshu Narayan*
<h2>Abstract</h2><p>Carbon Nano fibers (CNFs) have recently attracted a lot of attention due to their widespread range of technological applications attributed to their unique physical and chemical properties, such as, small size, high strength, high adsorption linked with their high specific surface area, high temperature tolerance and corrosion resistance. CNFs have been used in energy conversion and storage, reinforcement of composites and self-sensing devices. The complete removal of entrapped metallic impurities and amorphous carbon incorporated with CNFs has been a long-standing issue. We have developed a new approach for preparing graphitic CNFs and its activation of surface area by purification. This approach entails Thermal Decomposition (TD) based synthesis of CNFs from organic solid waste, such as, stems of rice plants. CNFs are synthesized from organic waste precursor (Rice Stems) at 900 oC under inert atmosphere. The active surface area was measured using a Surface Area Analyzer. Morphology of CNFs was studied with using SEM and XRD. The SEM image shows that the synthesized CNFs have diameter ranging within 45-60 nm.</p>
Maydelín Frontela-Noda*, Eduardo Cabrera-Rode, Maite Hernández-Menéndez and Raquel Duran-Bornot
<h2>Abstract</h2><p>The role of human papillomavirus infection as etiological factor for cervical squamous intraepithelial lesions and cervical cancer is well established. However, the presence of this virus is not sufficient condition for developing of cervical cancer. Currently, the contribution of other viral, environmental and host cofactors in triggering of this neoplasm is being investigated. Some metabolic risk factors have been associated with the development of several gynecological cancers such as endometrium, ovary and cervix. However, the mechanisms through which these factors contribute to carcinogenesis are complex and not fully elucidated. Few interventions regarding host metabolic factors have been performed on women at risk of developing cervical cancer. Some specific treatments and or changes in lifestyles could be carried out to avoid or delay progression to this kind of cancer. This paper aims to enlarge and update this topic based on the article ¨Association between components of the metabolic syndrome and degree of cervical squamous intraepithelial lesions in Cuban women¨, with emphasis on possible mechanisms that explain the link between central adiposity, insulin resistance and dyslipidemia with risk of premalignant lesions and cervical cancer.</p>
<h2>Abstract</h2><p><strong>Background:</strong> We report our experience with management and treatment of pregnant women who were admitted at our institution for snake envenomation.</p><p><strong>Methods:</strong> We reviewed the charts and recorded the management, treatment, and outcome of 51 pregnant women admitted to our high-risk obstetric service with a diagnosis of snakebite.</p><p><strong>Results:</strong> One patient experienced spontaneous abortion, 2 had intrauterine fetal death due to placental abruption, 2 delivered malformed babies, 1 had premature birth of twins with low birthweight. There were no maternal deaths.</p><p><strong>Conclusion:</strong> Snake-venom poisoning in pregnancy is a complex medical emergency that involves complications at the site of the bite and may also involve dysfunction of multiple organ systems in both mother and fetus.</p>
Yosberto Cárdenas-Moreno*, Luis Ariel Espinosa, Julio Cesar Vieyto, Michael González-Durruthy, Alberto del Monte-Martinez, Gilda Guerra-Rivera and Maria Isabel Sánchez López
<h2>Abstract</h2><p>Laccase catalyzes oxidation of lignin and aromatic compound with similar structure to this one. Their low substrate specificity results on degradation of similar phenolic compounds. In this context, Molecular Docking was performed with different ligands suggesting potential bio-degradation. Binding active-sites prediction of fungal laccase (access number uniprotkb: A0A166P2X0), from Ganoderma weberianum was performed using machine learning algorithm based on Deep Convolutional Neural Networks (DeepSite-CNNs chemoinformatic tool). Herein, ligands like 2,4 - dichlorophenol, benzidine, sulfisoxazole, trimethoprim and tetracycline were analyzed and two additional reference controls which were 2,2 – azinobis 3 – ethylbenzothiazoline – 6 - sulfonic acid (ABTS) and 2,6 - dimetoxyphenol (2,6 DMP) were used in comparison with the other former mentioned ligands based on high laccase affinity. The five ligands were carried out because their potential biotechnological interest: the antibiotics sulfisoxazole, trimethoprim and tetracycline, and xenobiotics 2,4 - dichlorophenol and benzidine. Molecular docking experiments returned Gibbs free energy of binding (FEB or affinity) for laccase-ligand complexes. The best docking binding-interaction from each laccase-ligand conformation complexes suggest great ability of these ligands to interact with the laccase active-binding site. Herein, FEB values (kcal/mol) were obtained with higher affinity values for reference controls like 2,6 - dimethoxyphenol with -4.8 Kcal/mol and ABTS with -7.1 Kcal/mol. Furthermore, the FEB values were -4.7, -6.5, -6.8, -5.2 and -6.5 Kcal/mol, for 2,4 - dichlorophenol, benzidine, sulfisoxazole, tetracycline and trimethoprim respectively with high prevalence of hydrophobic interaction with functional laccase binding residues. Lastly, this study presents for first time at the bioinformatics field a molecular docking approach for the prediction of potential substrate of laccase from Ganoderma weberianum towards biotechnological application.</p>
Hasan Hosainzadegan*, Parviz Vahedi and Mortaza Hosainzadegan
<h2>Abstract</h2><p>In recent years, stem cells technology have been used widely in basic and clinical science researches LIPUS (low-intensity pulsed ultrasound) is another technique commonly used in conjunction with stem cells that can have complications after applications. One of the important issues in using this modern technique is the occurrence of opportunistic infections and inflammatory reactions in the rejection or destruction of these cells and in turn making ineffective of its applications, which have been reviewed in the following.</p>
Assontsa Kafack Carole*, Essiben Felix, Tumasang Florence, Meka Esther Juliette, Tongo Sedrick Fofack and Mbu Robinson Enow
<h2>Abstract</h2><p><strong>Background:</strong> Pre-eclampsia is a frequent and serious pregnancy complication contributing for the increasing maternal morbi-mortality rates. This study was designed to evaluate the effect of calcium supplementation during pregnancy, on the incidence of pre-eclampsia and eclampsia among primigravid women.</p><p><strong>Method:</strong> In a hospital-based, opened, randomized and controlled clinical trial carried out in the city of Yaounde, 70 women were randomized to either 1.5 g daily calcium supplements (<em>n</em> = 35) or vitamins at the same time (<em>n</em> = 35) from 20 weeks gestation till delivery. Were included all singleton healthy, primigravid women who offered their signed inform consent and were excluded, all women with any chronic condition. Primary outcomes were pre-eclampsia and eclampsia.</p><p><strong>Results:</strong> No significant difference was observed between the two study groups with respect to the baseline characteristics obtained at enrollment. We recorded a sevenfold decrease in the incidence of preeclampsia in the calcium group (<em>RR</em> = 0.26, CI 0.06 – 0.44, <em>p</em> = 0.024). The onset of pre-eclampsia was delayed 3 weeks in the calcium group. Meanwhile the mean diastolic blood pressure at delivery was of no significant difference (<em>p</em> = 0.126), the mean systolic blood pressure at delivery however, presented a significant difference between both groups (<em>p</em> = 0.009).</p><p><strong>Conclusion:</strong> A 1.5 g daily calcium supplementation of healthy normotensive primigravid women during pregnancy seems to be effective in reducing the incidence of pre-eclampsia.</p>
Raquel M Moreira, Géssica SB Barbosa*, Cristiane B Dias, Luis Yu, Viktoria Woronik and Lívia B Cavalcante
<h2>Text</h2><p>A 61-year-old Brazilian black woman consulted with a nephrologist due to proteinuria identified on a routine urine test. She has a personal history of thymoma resection five years ago, followed by multiple episodes of pulmonary infections including mycobacteriosis, recurrent mucocutaneous candidiasis, and paraneoplastic pemphigus. Physical examination showed no edema or hypertension and laboratory tests identified proteinuria of 2.43 g/day without hematuria, serum creatinine of 0.69 mg/dl, urea 34 mg/dl, serum albumin of 2.4 g/dl, hemoglobin 10.9 g/dl, platelets 292,000/mm3, leukocytes 4950/mm3, lymphocytes 594/mm3 and neutrophils 3910/mm3. The hemolysis tests were negative and serum iron was low. Analysis of glicemia and serum lipids levels were normal as well as serum complement and imunoglobulins, except for an IgM level of 283 mg/dl (normal values 40 to 230 mg/dl) and undetectable IgE. Serologies for Syphilis, HIV, hepatitis B, C and antibodies for autoimmune diseases were negative.</p>
MAM El-Saedy, Sandy E Hammad and Sherin FA Awd Allah*
<h2>Abstract</h2><p>The nematicidal efficacy of abamectin, boron, chitosan, hydrogen peroxide, Bacillus thuringiensis and oxamyl 24% SL against citrus nematode, Tylenchulus semipenetrans were examined on Valencia orange trees under field condition for two successive seasons (2017 and 2018). The experiment was conducted in a Valencia orange orchard infested with citrus nematode at Nubaria, El-Behera governorate, Egypt. The obtained results showed that all the tested treatments reduced nematode final population (Pf) and reproduction factor (Rf) compared with that obtained from the untreated trees. The highest percentages of Pf reductions (74.5-83.4 %) and (70%-82%) were recorded with oxamyl, boron, abamectin, chitosan and H2O2 in the 1st and the 2nd tested seasons, respectively. Whereas, B. thuringiensis had the least nematode Pf reduction with 60.7 and 55.8% in the 1st and 2nd seasons, respectively. Additionally, all treatments significantly improved orange yield (30.9-83.2% increase), physical fruit parameters and orange juice properties. The highest orange yield increase (83.2%) was recorded with boron treatment followed by oxamyl (70.3%). Also, boron increased total soluble solids (TSS) by 13.6%, volume of orange juice (36.4%) and vitamin C (19.7%) and decreased juice acidity (A) by (16.7%). It is concluded that abamectin, boron and the other tested compounds have potential as non-chemical control strategy tools in managing the citrus nematode. These bioagents reduced the amount of traditional chemical nematicides and are considered to be environmentally safe.</p>
Irami Araújo-Neto, Amália Cinhtia Meneses Rêgo and Irami Araújo-Filho*
<h2>Abstract</h2><p><strong>Introduction:</strong> Intense Pulsed Light (IPL) is the therapeutic tool implemented in the treatment of dry eye, characterized by the emission of waves of 500-1200nm in the region of the upper and lower eyelids. Dry eye is a recurring complaint in ophthalmology offices and has an impact on the patient’s quality of life. It results from dysfunction of the meibomian glands, duct obstruction, and quantitative and qualitative changes in glandular secretion. It is manifested by dryness and irritation, foreign body sensation, burning, tearing, and eye fatigue. The available treatments are short term palliative with unsatisfactory results.</p><p><strong>Objective:</strong> To determine through a literature review, the benefit of using intense pulsed light for dry eye treatment. Methodology: We searched the Cochrane database, PubMed, Embase, Scopus, Web of Science, and Google Scholar (gray literature) using the keywords for an independent, blinded, peer-reviewed selection of articles to be met following pre-established criteria.</p><p><strong>Results and discussion: </strong>Studies evaluated the use of IPL in patients with dry eye, despite the benefit found, focus on the objective and subjective assessment of the eye more frequently.</p><p><strong>Conclusion:</strong> Evidence-based clinical guidelines are required for the use of intense pulsed light in the treatment of Meibomian Gland Dysfunction (MGD), as well as a device and algorithm for indications of therapeutic use.</p>
<p>Actinic keratosis (AK) are scaly lesions caused by chronic ultraviolet-induced damage to the epidermis which are a proxy for excessive sun-exposure [1] that may evolve into squamous cell carcinoma [2-7]. Therefore, there is a need or continuous surveillance of such patients along with adapted information for an effective photo-protection, practical couselling on photoprotection towards the defined population, i.e. elderly with actinic keratosis. Thus, patient observance and adhesion to the dermatologist recommendations become a real public health issue. In this context, we aimed to evaluate through a non-interventional, real-life observational study, the impact of photoprotection counseling by the dermatologist on patients attitude towards sun exposure.</p>
<h2>Abstract</h2><p><strong>Introduction:</strong> Desmoplastic Malignant Mesothelioma (DMM) is a rare histological subtype of sarcomatoid malignant mesothelioma arising most frequently in the pleura or peritoneum and less frequently in the lung parenchyma.</p><p><strong>Patient concerns:</strong> A 52-year-old female with no apparent asbestos exposure was referred for consultation in our center after 1 month of cough and no concomitant symptoms of chest.</p><p><strong>Diagnosis:</strong> Chest computed Tomography (CT) revealed a localized mass measuring 4.5 x 3.9 cm in the right lung middle lobe with inhomogeneous enhancement following injection of contrast, and without pleural lesions, considered a primary intrapulmonary desmoplastic mesothelioma.</p><p><strong>Interventions:</strong> Surgical intervention was performed.</p><p><strong>Outcomes:</strong> Following complete tumor resection, the patient declined to receive chemotherapy or radiotherapy. The final diagnosis of intrapulmonary desmoplastic mesothelioma was confirmed by pathological and immunohistochemical examination. In addition, no local tumor recurrence was observed within 10 months of follow-up.</p><p><strong>Conclusion:</strong> Even elderly female patients with localized pulmonary masses without significant pleural lesions should not excluded the possibility of malignant mesothelioma in the lungs.</p>
<h2>Letter to Editor</h2><p>Experience with allogeneic hematopoietic stem cell transplantation (HSCT) in mycosis fungoides/Sezary syndrome (MF/SS) is limited to a small number of case reports and case series [1,2]. The advantage of allogeneic HSCT has been indicated in progressive disease in the review of CIBMTR study groups [3]. A consensus is still not available about the intensity and the content of the conditioning regimen due to the rarity of the disease and heterogeneous patient groups.</p>
Faysal Gok*, Cengiz Zeybek, Ayse Balat and Olcay Y Jones
<h2>Abstract</h2><p>Infantile cystinosis is a lysosomal storage disease leading to end stage kidney disease at early ages. There is no effective treatment and patients require long term dialysis or kidney transplant for survival. We present our experience on three affected children who received HLA matched allogeneic stem cell transplant. The protocol used was novel and designed to promote engraftment. The primary endpoint was safety for treatment related mortality or morbidity; All three children survived without serious adverse effects during extended follow up for over 4 years. Although we could not prove engraftment, all three children met secondary end point of sustained target functions over a 6 month follow-up. Further studies are warranted to further evaluate safety and efficacy of MSC treatment for infantile cystinosis.</p>
Abu Omar Y*, Wang Y, Agrawal R, Randhawa T, Majeed M, Attar BM, Demetria MV and Simons-Linares CR
<h2>Abstract</h2><p><strong>Introduction:</strong> Fluid management is the cornerstone of treatment for acute pancreatitis (AP), but the proper rate and volume is still controversial. We aim to evaluate the role of aggressive hydration in AP patients.</p><p><strong>Methods:</strong> We retrospectively reviewed and analyzed 279 hospitalized patients of AP. Severity was determined by the Revised Atlanta classification; validated clinical scores were also calculated based on clinical information upon presentation. We extracted amount of fluid received by at 6, 12, 24 and 48 hours after presentation. Aggressive hydration was defined as amount higher than 10 ml/kg bolus followed by infusion at 1.5 ml/kg/h. After direct comparison between aggressive versus non-aggressive hydration groups, propensity-score match was performed to control severity, APACHE II and BISAP score. Post-match comparison as well as a subgroup comparison were conducted.</p><p><strong>Results: </strong>At 24 hours, 125 (44.8%) patients received aggressive hydration averaged at 5.1 L (2-18 L), while 154 (55.2%) patients received non-aggressive hydration averaged at 2.5 L. Post-match comparison showed that aggressive hydration group had longer hospital stay (MAP: 5.3 vs 4.5, <em>p</em> = 0.145, MSAP/SAP: 8.3 vs 4.8 d, <em>p</em> = 0.007), and higher rate of intensive care unit admission (mild: 12.9% vs 4.4%, <em>p</em> = 0.042, moderately severe or severe: 36.8% vs 3.1%, <em>p</em> = 0.001), while showed no difference in rate of mortality or re-admission by 1 year. In patients who presented without organ failure, aggressive hydration did not change the rate of development of organ failure (14.1% vs 12.5%, <em>p</em> = 0.731), but the aggressive hydration group had a trend towards longer hospital stay (5.5 vs 4.6 d, <em>p</em> = 0.083) and higher rate of MICU admission (12.1% vs 4.8%,<em> p</em> = 0.051).</p><p><strong>Conclusion:</strong> Our study did not find mortality or morbidity benefit in patients who received aggressive hydration. The optimal strategy for fluid hydration in AP remains to be elucidated and studies focusing on early non-invasive accurate hemodynamic assessment and fluid resuscitation responsiveness prediction are needed.</p>
Mirella Ejiugwo, Georgina Shaw, Frank Barry, Janusz Krawczyk and Veronica McInerney*
<h2>Abstract</h2><p><strong>Background:</strong> With the advancement of cell therapy research, there is an increasing need for healthy volunteers (HV) to donate small volumes (30 ml) of human bone marrow (BM). The BM procedure required to procure small volumes is invasive, although short-lived (25 seconds), is not without risk. To ensure a sustainable supply of BM for research and cell therapy, greater information of the risks and factors that motivate HV to donate small volumes of BM will help optimize the procedure and HV enrolment, ensuring donors are fully informed of the potential risks.</p><p><strong>Objective:</strong> To identify the adverse events (AE) experienced by HV during and after small volume BM procedure and understand the motivating factors that influence HV to donate BM for research.</p><p><strong>Method:</strong> HV (<em>n</em> = 55) who donated BM (30 ml) for scientific research and provided informed consent were administered a questionnaire to identify the type, duration and severity of AE experienced during and post-BM aspiration; and to determine the motivating factors that influenced their willingness to donate BM.</p><p><strong>Results:</strong> Pain was experienced by 89% of participants during the BM procedure with moderate grade reported by 40%. One/more of the following AE were experienced by 73% of the volunteers post-BM procedure: pain, fatigue, site reaction, nausea and transient hypotension. AE resolved within an average of three days. The reported motivational factors ranked in the following order: first, to advance research for the benefit of future patients; compensation for participation; free medical check-up; lastly, the research question was interesting.</p><p><strong>Conclusion:</strong> Young HV, motivated primarily by altruism and financial compensation, risk the occurrence of transient AE following donation of small-volume BM for research.</p>
<h2>Abstract</h2><p>A 56-year-old man was admitted to our hospital because of sudden onset of right-sided thoracic pain. The ECG showed inferior ST segment elevations. He has been treated with aspirin, clopidogrel, unfractionated heparin and tenecteplase, and his symptoms resolved after 30 minutes. About half an hour later, the patient developed again left-sided thoracic pain and the signs of an anterior myocardial ST-segment elevation infarction. 90 minutes after receiving the initial medications, the performed coronary angiography revealed a long dissection of a large ramus circumflexus. Furthermore, the left anterior descending coronary artery was occluded at about the mid-level. The left ventriculography showed a reduced ventricular function and a Stanford type A aortic dissection. Immediate patient transfer for emergency surgical intervention was arranged. However, ventricular fibrillation occurred during transport and he required endotracheal intubation and prolonged cardiopulmonary resuscitation. Unfortunately, he died during further transport.</p><p>In a patient with massive thoracic pain of initially uncommon localization in combination with fluctuation of ST-segment elevations, aortic dissection should be seriously taken into the differential diagnosis as well as into therapeutic management decisions (in particular antiplatelet and thrombolytic therapy).</p>
John Kenneth Mensah*, Amina Ibrahim and Yakubu Jibira
<h2>Abstract</h2><p><strong>Background:</strong> Combination of extracts from multiple plants are typically used in ethnomedicine to putatively offer more potent chemotherapeutic and chemopreventive effects than that of individual extracts from single plants. Aqueous extracts from two multipurpose plants Strophanthus hispidus (roots) and Aframomum meleguta (seeds) are topically co-administered in the nasal cavities for the ethnomedicinal management of chronic sinusitis.</p><p><strong>Aim:</strong> This study assessed the potential phytochemical synergy between constituent extracts of Strophanthus hispidus (roots) and Aframomum meleguta (seeds) in its anti-inflammation, anti-microbial and anti-oxidant effects.</p><p><strong>Methods and Materials: </strong>Broth dilution assay assessed anti-microbial activities. DPPH radical scavenging assay examined the scope of anti-oxidant activities and inhibition of carrageenan-induced 7-day old chick feet oedema revealed anti-inflammatory activities.</p><p><strong>Results:</strong> Anti-microbial activities of individual plant extracts in broth dilution assay showed comparable potency to that of the co-extract mixture. Similarly, individual extracts showed levels of DPPH radical scavenging activities in anti-oxidant assay that was comparable to those found for the co-extract mixture. In contrast to these two effects, inhibition of carrageenan-induced 7-day old chick feet oedema revealed an anti-inflammatory activity evoked by co-extract mixtures that was greater than the sum of the individual potencies of the two extracts.</p><p><strong>Conclusion:</strong> The potential phytochemical synergy of the two plants extracts in its anti-inflammatory response largely validates ethnomedicinal practice and generally confirms growing literature reports that ascribe the net pharmacological activities of herbal extracts to the combined multi-activities of unique phytochemical entities at multiple target sites.</p>
Kwesi Boadu Mensah* and Paa Kofi Tawiah Adu-Gyamfi
<h2>Summary</h2><p><strong>Background:</strong> Although illegal, Ghana has a long history of cannabis use. With changing perceptions, advocacy for legalization has increased globally. This study exams pharmacological evidence on the prospects and challenges of decriminalization and /or legalization of cannabis in Ghana.</p><p><strong>Results:</strong> Cannabis and cannabinoids are a “pharmacological enigma” with unique ability to activate at least 3 of the 4 drug receptor super families. This include; inotropic Transient Receptor Potential Vanilloid 1 (TRPV1), metabotropic Cannabinoid Receptors (CB) and nuclear Peroxisome Proliferator Activator Receptors (PPAR). Cannabinoid receptors also dimerize with other receptors creating distinctly new signaling pathways. Cannabis and cannabinoids show good anti- nociceptive, anti-inflammatory, immunosuppressant anti-emetogenic activity and variable anticonvulsant activity. It can play important role in palliative care, some rare intractable epilepsy, multiple sclerosis, cachexia and Opioid Use Disorder. Cannabis precipitates psychosis in individuals with underlying genetic susceptibility. Chronic cannabis use alter the neurobiology of adolescent brain, predisposing them to amotivational syndrome characterized by depersonalization and inhibited motivation for goal directed behavior. Cannabis is also a “gateway drug”; ushering users to “harder” substances of abuse and reinstating extinguished drug seeking behaviours. The recent tramadol abuse in Ghana may have been precipitated by previous and concurrent cannabis use. Furthermore, Ghana’s cannabis may have a higher propensity to induce detrimental effects because of preferential accumulation the psychotropic delta-9-Tetrathydrocannabinol as a result of the high tropical temperature and humidity.</p><p><strong>Conclusion:</strong> There is not sufficient pharmacological evidence supporting criminalization of medical cannabis in Ghana. However, the same evidence does not support legalization of recreational cannabis.</p>
<h2>Abstract</h2><p><strong>Objective:</strong> The liver is the second most common site of distant metastases from breast cancer. We investigated the risk factor liver metastasis in patients with breast cancer.</p><p><strong>Methods:</strong> We studied Age, Menopausal status, Histologic Type, Tumor size, Number of cancerous axillary lymph nodes, in two groups with liver metastases with logistic regression to identify independent liver metastasis risk factors in breast cancer patients.</p><p><strong>Results:</strong> Age, menopausal status, number of cancerous axillary lymph nodes and tumor size are the independent risk factors liver metastases in patients with breast cancer.</p><p><strong>Conclusion:</strong> The increase number of cancerous axillary lymph nodes and tumor size may be diagnostic markers for liver metastases from breast cancer.</p>
<h2>Abstract</h2><p>In this article different numerical techniques for solving optimal control problems is introduced, the aim of this paper is to achieve the best accuracy for the Optimal Control Problem (OCP) which has the objective of minimizing the size of tumor cells by the end of the treatment. An important aspect is considered, which is, the optimal concentrations of drugs that not affect the patient’s health significantly. To study the behavior of tumor growth, a mathematical model is used to simulate the dynamic behavior of tumors since it is difficult to prototype dynamic behavior of the tumor. A tumor-immune model with four components, namely, tumor cells, active cytotoxic T-cells (CTLs), helper T-cells, and a chemotherapeutic drug is used. Two general categories of optimal control methods which are indirect methods and direct ones based on nonlinear programming solvers and interior point algorithms are compared. Within the direct optimal control techniques, we review three different solutions techniques namely (i) multiple shooting methods, (ii) trapezoidal direct collocation method, (iii) Hermit- Simpson’s collocation method and within the indirect methods we review the Pontryagin’s Maximum principle with both collocation method and the backward forward sweep method. Results show that the direct methods achieved better control than indirect methods.</p>
Christian Castillo Latorre*, Mariela Rivera Agosto, Ilean Lamboy Hernandez, Mariana Mercader Perez, Dominic Sanchez Paredes, Marisol Santiago Irizarry, Jose Gutierrez Nuñez Onix, Cantres Fonseca, Alfonso Torres Palacios and William Rodriguez Cintron
<h2>Abstract</h2><p>Septic Iliac vein thrombophlebitis with associated psoas abscess is a rare and severe entity, which diagnosis is challenging when no risk factor is clearly present. We are presenting a case of severe septic cavitary pulmonary emboli complicated with Acute Respiratory Distress Syndrome (ARDS) that evolved rapidly to respiratory distress and multi organ failure.<br />A 61-year-old Hispanic male, had multiple emergency department visits due to back pain, being most of them intramuscular pain medications and steroids. In the history, he had back pain that worsened accompanied by poor mobility, generalized malaise, fever and chills. Computed tomography (CT) scan showed a paravertebral psoas abscess with L5 - S1 diskitis/spondylitis inflammatory changes, which was then later evidenced by a gallium study. Further imaging studies were done, showed bilateral cavitary lung lesions, consistent with septic emboli. Subsequent blood cultures were positive for Methicillin Resistant Staphylococcus Aureus (MRSA), for which a successful combined therapeutic regimen was used. Transthoracic and transesophageal echocardiogram were not suggestive of endocarditis. Staphylococcus aureus (SA) bacteremia is one of the most common serious bacterial infections with a high risk of metastatic complications, which makes this pathogen a unique one. The combination of factors iliac vein thrombophlebitis, psoas muscle abscess, diskitis/spondylitis with ARDS makes cavitary pulmonary disease a challenging perspective. After a 6-week antimicrobial treatment, full anticoagulation, his clinical condition and image findings improved, and he was recently admitted for physical rehabilitation. Major vessels thrombophlebitis should always be considered, when primary source of septic pulmonary emboli is not clear. This case illustrates the complexity of illness and complications that may arise from a source of infection as the one in this patient. Further therapeutic strategies were tailored accordingly.</p>
<h2>Introduction</h2><p>Brain stem death is when a person has permanently lost the potential for consciousness and the capacity to breathe. When this happens, a machine called a ventilator keeps oxygen circulating through the person’s bloodstream - a person confirmed as being dead when their brain stem function is permanently lost [1].</p>
Malomo Adefolarin O*, Kafayat Bolaji Aminu, Adeolu Augustine A, Adeleye Amos O, Balogun James A, Badejo Oluwakemi A, Shokunbi Mathew T and Jegede Ayodele S
<h2>Summary</h2><p><strong>Objective:</strong> The importance of understanding the perceptions of medical students to their training environment cannot be overemphasized. The study evaluated the wet lab training organized for Senior Registrars in the Neurosurgery, Division of the University College Hospital, Ibadan.</p><p><strong>Aim: </strong>The purpose of this study is to assess the experiences of postgraduate students during wet-lab training with the aim of improving the course content and introducing evidence-based and student-centered changes.</p><p><strong>Methodology:</strong> The study made use of a cross-sectional design and data were collected using the qualitative research approach. Information was elicited from all the Senior Registrars who participated in the training through in-depth interviews.</p><p><strong>Result:</strong> All the postgraduate students who participated in the training were satisfied with the course content and the method of delivery appropriated during the training. They also found it relevant to their practice. However, certain shortcomings were observed such as high cost of training, poor standard of equipment/tools, tight work schedule and short training duration.</p><p><strong>Conclusion:</strong> Hands-on training plays an important role in enhancing the quality of care and high performance in health-care service delivery. The shortcomings and suggestions for improving future trainings as reported by the residents should be addressed in order to maximize the gains of the hands-on training experience.</p>
Hailemariam Gezie, Emebet Leta, Fikrte Admasu, Sisay Gedamu*, Abebe Dires and Debrnesh Goshiye
<h2>Abstract</h2><p><strong>Introduction: </strong>Contact of health care workers and patient at health facility lead to the transmission of pathogenic organisms to each other. Hospital acquired infection prevention is standardized guide lines contain multitude protocols needed to be implemented by health care workers to reduce hospital acquired infections.</p><p><strong>Objective:</strong> To assess health care workers knowledge, attitude and practice towards hospital acquired infection prevention at Dessie referral hospital.</p><p><strong>Method:</strong> Institutional based cross sectional study was conducted among health care workers. The subjects were selected by proportional allocation in each respective department and simple random sampling method was employed. Statistical package for social sciences (SPSS) was used to analyze the data and presented in frequency tables and graph.</p><p><strong>Results:</strong> 191 study subjects were participated in the study which gives a response rate of 90.5% from 211 total sample sizes. The study subjects had given their response according to self-administered questioner. The result indicates that 86.4%, 76.4% and 77% of respondents had good knowledge and favorable attitude and poor practice towards hospital acquired infection prevention respectively.</p><p><strong>Conclusion:</strong> Even though the majority of the health care workers had good knowledge and favorable attitude, more than two third of them had poor practice towards hospital acquired infection prevention. Therefore health workers should strictly follow hospital acquired infection prevention guidelines. Improving sustainable supplies like personal protective equipment, water supply and hand washing facilities at patient care site is vital to correct the poor practice of infection prevention.</p>
<h2>Text</h2><p>Vitamin D has immunomodulatory and antifibrotic properties, and therefore used for treatment of many of chronic liver disease [1]. Although there are many reports on the relationship between serum 25-hydroxyvitamin D3 levels and chronic liver diseases, but the relationship between hepatitis B virus e antigen (HBeAg) and vitamin D level is still unclear.</p>
Andreas Suhartoyo Winarno*, Lukas Schloesser, Frederic Dietzel, Percy Balan, Thomas Hoehn, Monika Hampl and Tanja Natascha Fehm
<h2>Abstract</h2><p>Deliveries prior to 28 weeks’ gestation (extreme preterm birth) pose a global health concern, according to the World Health Organization (WHO). Extreme preterm birth is associated with several complications in the newborn and management in neonatal intensive care unit would incur high expenses. In parallel, advancements in in vitro fertilization will give an opportunity for women to conceive in cases of ovarian failure. At the same time, health providers also encourage patients to receive more than one embryo simultaneously during an embryo transfer. Here we report a case of a patient in coma condition of triplet pregnancy, post ovum donation with three-embryo transfer. Following stabilization, cranial computed tomography (CCT) was performed. The result showed bleeding in the brainstem and into intraventricular spaces at 25+4 gestation weeks. Furthermore, ICH during pregnancy is considered as a rare case in obstetrical field, especially involving the brainstem. This could lead to life-threatening conditions and serious disability in the future. On the fifth day of hospitalization, she suffered from pneumonia and pulmonary edema. On the eight day (26+5 gestations weeks), an emergency caesarean section was performed due to fully dilated of the cervix with breech presentation of all fetuses. Mother and the children survived with some non-life-threatening disabilities.</p><p>This is the very first case reported of intracerebral hemorrhage in the brainstem in triplet pregnancy after receiving ovum donation. Heterologous conception could be an iceberg phenomenon of gestational complications among the population. Reproductive tourism could still become greater in the future.</p>
<h2>Introduction</h2><p>Drug addiction is one of the burning problems in the modern society. Annually there is a steady increase in the level of drug abuse. United Nations Office on Drugs and Crime publishes “World Drugs Report 2018”, where it was reported that about 275 million people (almost 5.6% of the world population) aged 15-64 used drugs at least once in their lives, and opium production increased by 65% in 2016-2017 [1-3]. Therefore, the question of studying the influence of drugs on the structural organization of organs remains open and relevant [4,5].</p>
<h2>Abstract</h2><p>The demand for materials and devices that are capable of controlling heat flux has attracted many interests due to desire to attain new sources of energy and on-chip cooling. Excellent properties of DNA make it as an interesting nanomaterial in future technologies. In this paper, we aim to investigate the thermal flow through two sequence combinations of DNA, e.g, (AT)4 (CG)4 (AT)4 (CG)4 and (CG)8 (AT)8. Two interesting phenomena have been observed respectively. In the first configuration, an oscillatory thermal flux is observed. In this way, an oscillating heat flux from a stationary spatial thermal gradient is provided by varying the gate temperature. In the second configuration, the system behaves as a constant heat current source. The physical mechanism behind each phenomenon is identified. In the first case, it was shown that the transition between thermal positive conductance and negative differential conductance implies oscillatory heat current. In the latter, the discordance between the phonon bands of the two coupled sequences results in constant thermal flow despite of increasing in temperature gradient.</p>
<p>Natural killer cells represent the first line of defense against infections and tumors and can be derived from various sources including: bone marrow, peripheral blood, specific types of human stem cells, and certain cell lines. The functions of natural killer cells are influenced by: several cytokines, activating and inhibitory receptors, as well as other immune cells such as dendritic cells and mesenchymal stem cells.</p><p>Natural killer cells are attractive candidates for adoptive cellular therapy in patients with hematologic malignancies and solid tumors in addition to recipients of various forms of hematopoietic stem cell transplantation as they enhance antitumor effects without causing graft versus host disease. Several clinical trials have shown safety and efficacy of natural killer cell products obtained from autologous as well as allogeneic sources and used in conjunction with cytotoxic chemotherapy, monoclonal antibodies and novel agents.</p><p>The following review, which includes extensive literature review on several aspects of natural killer cells, will give particular attention to: the rising role of natural killer cell therapies in patients with malignant hematological disorders, solid tumors and in recipients of stem cell therapies; preparation and manufacture of natural killer cell products; challenges facing the utilization of this form of cellular therapy including evolution of resistance; and maneuvers that can be employed to enhance the efficacy of natural killer cell therapies as well as suggested solutions to resolve the remaining challenges.</p>
Del Prete Salvatore, Marasco Daniela1, Del Prete Antonio, Meloni Marisa, Capaldi Roberto, Grumetto Lucia and Russo Giacomo*
<p><strong>Purpose:</strong> This work is aimed at demonstrating that scraping cytology and scanning electron microscopy can successfully assist in the diagnosis of nontuberculous mycobacteria infection. For this purpose, we report the use of both these techniques in the diagnosis of cornel ulcer in a previously healthy young man.</p><p><strong>Methods:</strong> Cytological samples were achieved by scraping technique on the mucosa, both sub palpebral and temporal area of the eye tarsal conjunctiva. The obtained sample was affixed to a sanded rectangular slide, stained with the Pappenheim method, washed in bidistilled water, treated in Giemsa solution, washed again and subsequently dried on a hot plate and observed with a microscope at various magnifications.</p><p><strong>Results:</strong> After a therapy based on a 500 mg clarithromycin tablet administered every 12 hours for 30 days as systemic therapy, a complete recovery of the patient from left eye inflammation was observed and SEM cytology showed that NTM colonies had disappeared.</p><p><strong>Conclusion:</strong> Conjunctival cytology scraping and SEM technologies can be therefore exploited as new tools in diagnosis and fast identification of these newly discovered mycobacteria. In fact, they have a new way for studying ocular pathology, because of the simple execution and remarkable accuracy in the diagnosis. In fact, this technique allows to gather valuable information about all pathogens expression and the cellular action involved in pathology. As a further plus, this technique provides clinicians with the opportunity to repeat the SEM cytology for monitoring patients during therapy, hence leading to evaluate the efficacy of the pharmaceutical regimen in real time.</p>
<h2>Case Report</h2><p>We wish to present our case of the rare Meckel-Gruber syndrome, diagnosed prenatally at 18 weeks’ gestation. Informed consent was obtained from both parents for publishing this case and including photos.</p>
Wen Yang#, You Nie#, Shujuan Wang, Hongwei Wang, Enfeng Zhao and Na Dou*
<h2>Abstract</h2><p>The incidence of recurrent vulvovaginal candidiasis (RVVC) is extremely high. RVVC is likely to have a greater impact on patients. The aim of the study was to explore the risk factors of recurrent vulvovaginal candidiasis (RVVC) in the tropical coastal area. In this case-control study, a questionnaire survey was conducted in patients with VVC in the Sanya area from July 2014 to December 2016. The data included demographic characteristics, host factors, and behavioural characteristics. According to the maximum number of symptomatic episodes per year, the participants were classified into a non-recurrent VVC (NRVVC; < 4 episodes/year, including the current one) group or a RVVC group (≥ 4 episodes/year, including the current one). Crude odds ratios were calculated for potential risk factors and were adjusted using logistic regression. All vaginal secretions of patients with RVVC were cultured. Of the 728 cases of VVC, 69.0% (502/728) were NRVVC, and 31.0% (226/728) were RVVC. Previous antibiotic treatment (adjusted OR: 4.41, <em>p</em> < 0.01), repeat abortion (<em>p</em> < 0.05), and vaginal lavage (adjusted OR: 1.62, <em>p</em> < 0.05) were significantly associated with RVVC. A total of 230 yeasts isolates were obtained from 226 patients. <em>C. albicans</em> were the predominant Candida species (194 strains) in all patients of VVC. Our results demonstrate that in the tropical coastal area, a significant association was found between previous antibiotic treatment and incident RVVC. Host factors may be the most important factors in the occurrence of RVVC.</p><p> </p>
<h2>Introduction</h2><p>Microchimerism is a bidirectional exchange of fetal and maternal cells during pregnancy (Figure 1). Pregnancy is the most common and natural cause of chimerism, and bi-directional trafficking of hematopoietic cells occurs through the placenta. Therefore, we are all born as microchimera [1,2]. Although there are many unanswered questions it is thought that chimerism has an important role in human health. For many years, the clinical effects of maternal microchimeric cells (MMcCs) in organ repair and cancer therapy have just begun to be understood. While the mission of chimerism is straight forward, the subject is profound. Chimerism carries the potential for disease as well as for health benefits. Recent studies have shown that maternal stress and infections in pregnancy affect fetal neuro development and increased the risk of neurological or psychiatric disorders in the future life of the fetus. This article describes the role of Mc in the etiology of psychotic disorders.</p>
Maha Oudrhiri*, Toualouth L, Houda Oubejja, Fouad Ettayebi and Hicham Zerhouni
A 3-month-old girl presented to the surgical consultation room with bilateral cleft lip incomplete. A girl weighing 4205 g, was born at term after an uneventful pregnancy with a birth weight of 2500 g. There was no family history. On examination, a congenital, linear, erythematous cutaneous anomaly on the left side of her neck was highlighted with ocular anomalies (strabismus and the eyes are widely spaced) and a broad nose with a flattened tip. The examination of the other systems was unremarkable. In front of the association of these different anomalies BOFS was suspected but molecular diagnosis has not been made. The child benefited surgery to correct cleft lip with tennisson procedure with a good postoperative result.
Afework Edmealem*, Yabebal Asfaw, Sewunet Ademe and Belachew Tegegne
<h2>Abstract</h2><p><strong>Introduction:</strong> A patient satisfaction is considered as one of the desire outcomes of health care and it is directly related with utilization of health services. However, its level is falls at the fundamental level in developing countries including Ethiopia.</p><p><strong>Objective:</strong> To assess the level of patients’ satisfaction and its associated factors at Dessie Referral Hospital, Northeast Ethiopia.</p><p><strong>Methods and Materials:</strong> An institutional based cross-sectional study design was employed from May 1 to June 1 2019. A total of 374 patients were selected by using systematic sampling technique and interviewer administer structured questionnaire was used to collect data. After data collection, the data were checked for its completeness and entered into Epi data version 3.1. The data were presented in frequency distribution tables and graphs. Both bivariable and multivariable logistic regression were applied to identify factors at a <em>p</em> < 0.05.</p><p><strong>Result:</strong> Among total study participants, 220 (58.8%) patients were satisfied with nursing care service. Patients who had particular nurse for nursing care were more likely satisfied than those who didn’t have particular nurse for nursing care (AOR = 2.01, 95% CI: 1.212 - 3.334). Patients who had other diseases in addition to current health problem were more likely satisfied (AOR = 0.45 & 95% CI: 0.196 - 1.031) compared with patients who had not.</p><p><strong>Conclusion:</strong> In this finding, the level of patients’ satisfaction towards nursing care was low. Having specific or particular nurse and presence of comorbid disease were factors associated with patients’ satisfaction towards nursing care. Health institutions should assign particular nurses for patients to improve their satisfaction and quality of care. In addition, nurses should give great attention to their patients who have co-morbid illnesses.</p>
<h2>Abstract</h2><p>Present piece of idea exhibits to divert attention towards automated high precision Life Support System (LSS) instead of manual one using medical intelligence devices while treating and diagnosis to the patient, where Ventilator, inhaler and respiratory control is most important factor during operation, surgeries and in other likewise medical emergency situations to maintain proper saturation in patient lungs to sustain their lives. This work gives idea, how we can design A.I based Inhaler System for the same.</p>
Hendrik Kosslick, Hermann Sauer, Tino Just, Ursula Vick, Gerhard Fulda and Ludwig Jonas*
<h2>Abstract</h2><p>Biodegradation of implanted gold in human tissue. TEM images reveal markedly biodegradation of implanted gold and re-crystallization of dissolved gold as nanoparticle of different size, shape and crystallinity. Highly crystalline icosahedral Au nanoparticle and the corresponding power spectrum are shown on top.<br /><strong>Background:</strong> Despite the importance of biodegradation for the durability of metal prosthesis and the widely use of gold implants, there exist a lack of knowledge regarding the stability of pure gold in tissue.</p><p><strong>Methods:</strong> We studied biodegradation of grids of pure gold, nickel, and copper as well as middle ear prosthesis of gold, platinum or titanium. Metals were implanted into rat skin and humans. Dissolution and re-crystallization process of the metals was analysed using SEM, TEM, power spectra as well as elemental analysis by EDX and EELS/ESI.</p><p><strong>Results:</strong> Biodegradation of gold was detected, presumably by solving and re-precipitation of gold around implants. Gold cluster, nanoparticles, and mesostructures were detected, formed by dissolution and re-crystallization process. This process results into a migration of gold into the farer off tissue. Cellular filaments as biomolecular templates facilitate the formation of mesostructures. Loss of function of middle ear prosthesis by biodegradation is caused by chronic inflammation and fibrosis. Indeed, similar processes were detected with platinum, but in a very lower level.</p><p><strong>Conclusion:</strong> Noble metal implants undergo biodegradation in oxidative environment in tissue. The dissolution – recrystallization process can be explained by enzyme catalysed redox processes comprising reactive oxygen species and reduction agents as ascorbic acid present in cells and body tissue. Enymes like myeloperoxidase inside lysosomes of inflammatory cells produce hypochloride ions and H2O2 which can dissolve the gold.</p><p><strong>General significance:</strong> The crucial role of the specific chemical environments of gold implants in tissue for their chemical stability and durability of function has been demonstrated. Due to widely use and importance of gold implants, this finding is of general interes.</p>
Vitantonio Guglielmi*, Mario Correale and Gioacchino Leandro
<h2>Abstract</h2><p><strong>Background:</strong> This article reviews current knowledge of Gaucher’s disease (GD) and liver involvement and reports our experience: how many patients with chronic liver disease of unknown origin could be affected by Gaucher’s disease.</p><p><strong>Patients and methods:</strong> Over 24 months, we tested 75 sine causa chronic liver disease patients (30 women and 45 men, mean age 55 years, range 15 to 77).</p><p><strong>Results:</strong> None of the 75 patients was affected by Gaucher’s disease.</p><p><strong>Conclusion:</strong> We believe that the chronic liver disease patient is unlikely to be affected by Gaucher’s disease. Probably this disease is to be found in cases of coexistence of hepatic disease and other symptoms of Gaucher’s disease (bone, neurological, bone marrow involvement).</p>
Danilo Cafaro, Felipe Celedon, Alessandro Sturiale and Stefania Sinicropi*
<h2>Introduction</h2><p>Inflammation is a complex biological reaction induced by the alteration of tissue homeostasis, which occurs in response to the presence of a biological, chemical or physical agent in the body [1]. The acute inflammatory response is composed of an elaborate cascade of both proinflammatory and anti-inflammatory mediators, and balance between these mediators often determines the outcome after injury [2]. Generally during acute inflammation, cellular and molecular events and interactions reduce the risk of eventual injuries or infections. However, acute inflammation can become chronic, contributing to a variety of chronic inflammatory diseases [3]. Major micro circulatory events that occur during the inflammatory process include changes in vascular permeability, leukocyte recruitment and accumulation, and inflammatory mediator’s release [4].</p>
<h2>Abstract</h2><p>The incorporation of tellurium into metal carbonyl using tellurium transfer/ extrusion reaction is presented in this work. The results bring one of the new ways to incorporate tellurium by transferring it from one molecule to another molecule, in comparison to the work so far where either insertion or extrusion reactions were shown. The reactions of PhC2TeC2Ph with the metal carbonyl cluster produced thermodynamically stable metal carbonyl tellurium clusters.</p>
William S Ragalie, Nilto C de Oliveira, Richard Cornwell, Keith Meyer and James D Maloney*
<p><strong>Background:</strong> Adoption of the Lung Allocation Score (LAS) has led to increased listing of older patients and those with idiopathic pulmonary fibrosis (IPF) for lung transplantation (LTX). Older patients and those with IPF have higher prevalence of coronary artery disease (CAD), a relative contraindication for LTX. The impact of the LAS on CAD prevalence and cardiovascular morbidity in LTX recipients is unknown.</p><p><strong>Methods:</strong> Retrospective review of single institution database from January 2000 to December 2010. Patients with and without CAD were compared by age, gender, LAS, single vs double LTX, and transplant indication. Survival was calculated by Kaplan-Meier method, and statistical significance determined by log-rank method. Survival analysis was performed on all patients and by 3:1 propensity matching. Differences in CAD, gender, and indication were determined by Chi-squared test. Differences in LAS and age were calculated with a two-tailed <em>t</em> - test.</p><p><strong>Results:</strong> In the pre-LAS era, 6.2% (9/145) recipients had CAD vs. 9.2% (17/184) in the post-LAS era (<em>p</em> = 0.411). Among all patients, recipients with CAD had a worse long term survival as estimated by Kaplan-Meier method (<em>p</em> = 0.001), although there was no statistically significant difference after propensity matching ((<em>p</em> = 0.14). Although more recipients in the post-LAS era had a diagnosis of IPF [15/145 vs. 71/184 patients, (<em>p</em> < 0.001)], there was no difference in the prevalence of CAD in the IPF cohort compared to others. There were no differences in cardiovascular deaths among recipients with CAD, with IPF, or in the post-LAS era. Patients with a pre-transplant diagnosis of CAD had an descreased risk of new onset postoperative atrial fibrillation (AF) (<em>p</em> = 0.007; HR:0.133; CI:0.030-0.583).</p><p><strong>Conclusion:</strong> Adoption of the LAS was not associated with a significant change in proportion of recipients with CAD who underwent LTX at our institution, despite an increase in recipients with IPF. Recipients with CAD had a higher risk of developing new postoperative AF and worse survival than patients without CAD. Differences in survival, however, could not be attributed directly to CAD based on propensity matched analysis.</p>
<p><strong>Objectives:</strong> Cardioembolic etiology is a frequent source of ischemic stroke. Echocardiogram is the mainstay of cardioembolic source detection with regard to plan secondary stroke management, however it remains unclear how often clinically actionable findings are provided hereby. In addition, it is uncertain whether echocardiography should be performed transthoracic or transesophageal (TEE). In a monocenter study, we evaluated the frequency of pathological findings from TEE evaluation in patients with ischemic stroke with suspected cardioembolic and cryptogenic source and determined whether there was an associated adjustment in the prescribed administration of antithrombotic therapy.</p><p><strong>Materials and Methods:</strong> Over a 21-month period (2012-2013), we enrolled 143 patients in a prospective monocenter study (mean age ± standard deviation, 70 ± 12 years; females, 44.1%) who were admitted to the Department of Neurology at the University of Lübeck due to ischemic stroke and who underwent TEE due to supposed cardiac embolism. We assessed the presence of atrial fibrillation; days from admission to TEE; and TEE findings, including atrial septal aneurysm, thrombogenic aortic arch, valve failure, presence of left atrial thrombus, and patent foramen ovale. Demografic information and medical history were drawn from patient records and the hospital information system.</p><p><strong>Results:</strong> On average, TEE was performed 4 days after admission to the hospital. Left atrial thrombus was detected in 3 patients (2.1%), patent foramen ovale (PFO) in 27 (18.9%), atrial septum aneurysm in 17 (11.9%), and thrombogenic aortic arch in 29 (20.3%). Findings from TEE were commonly associated with therapeutic adjustment; antiplatelet therapy increased from 30.1% to 80.4%, oral anticoagulation therapy increased from 2.8% to 27.3%.</p><p><strong>Conclusion:</strong> Findings from TEE for the evaluation of ischemic stroke lead to frequent adjustment of prior antithrombotic therapy, antiplatelet as well as anticoagulation.</p>
Duc Dang*, Lory Trevisan, Jérôme Bouet and Jérôme Taieb
<p>Wegener’s granulomatosis is a systemic granulomatous focus on small to medium sized vessels. It typically affects sinuses, lungs and kidneys due to necrotizing granulomatous vasculitis. Less commonly, cardiac involvement is reported up to 8%-44% of cases [1-3]. It often rises to supraventricular arrhythmia, left ventricular systolic dysfunction, pericarditis, myocarditis, and valvulitis [4,5].</p>
Taís Salvi Sipriani, Robson Augusto Souza dos Santos and Katya Rigatto*
<p>Idiopathic Pulmonary Fibrosis (IPF) is a chronic and progressive disease without treatment that leads to death. Therefore, to control its progression to pulmonary hypertension is still a challenge. Moreover, there is no study that has investigated the Renin-Angiotensin System in patients with IPF.</p><p><strong>Objective: </strong>Verify the plasma concentrations of Angiotensin I, Angiotensin II (AngII), Angiotensin-(1-7) [Ang- (1-7)] and Alamandine in patients with IPF.</p><p><strong>Methods:</strong> Ten IPF patients, with or without PH, were included, and ten controls matched by sex and age. Quantitative plasma peptide concentrations (PPC) were expressed as mean and standard deviation or median and interquartile range. The Student Newman-Keuls t test was used for parametric data, Mann-Whitney for nonparametric data and, to compare proportions, the Fisher exact test was performed. The associations between clinical variables and the PPC were evaluated by Pearson or Spearman correlation coefficients. A <em>p</em> ≤ 0.05 was considered statistically significant.</p><p><strong>Results:</strong> The Alamandine plasma concentration was significantly (365%) lower in the IPF group and positively associated (<em>r</em> = 0.876) with pulmonary artery pressure (PAP). In addition, only in control group, the forced expiratory volume (FEV1%) was positively associated (<em>p</em> = 0.758) with Ang-(1-7).</p><p><strong>Conclusion:</strong> This study showed, for the first time, that there is a decrease in Alamandine participation in patients with IPF. The ACE-AngII-AT1 axis may be more active in this disease. In addition, our results suggest that Alamandine might be compensating the increase in PAP, as well as the Ang-(1-7) is improving the forced expiratory volume.</p>
Raphaella Costa Moreira Simen*, Alan Araújo Vieira, Maria Elisa Vieira da Cunha Ramos Miterhof and Armanda de Oliveira Pache de Faria
<h2>Abstract</h2><p><strong>Objective:</strong> To evaluate whether the occurrence of maternal pathologies, mainly Diabetes Mellitus and Hypertensive Syndromes in the gestational or pre-gestational period may be related to hearing impairment in postpartum women.</p><p><strong>Methods:</strong> Observational, prospective study including 361 puerperal women who had their deliveries at a reference University Hospital for pregnant women with clinical history of risk. Auditory evaluation was performed by Distortion Product Otoaccoustic Emissions (DPOAE) within 14 days after delivery. Measures of central tendency and absolute and relative frequencies were used to describe the sample and the chi-square test and binary logistic regression to assess the correlation among variables. Significance higher than 95% was observed and the study was approved by the Research Ethics Committee.</p><p><strong>Results:</strong> A total of 361 postpartum women were studied and 7.5% had hearing impairment. The frequency of gestational hypertension was 13.9%, that of gestational diabetes was 8.6% and that of pre-pregnancy diabetes mellitus was 5.8%. The presence of hearing impairment was significantly correlated with the occurrence of pre-pregnancy diabetes mellitus (OR: 4.5 - CI: 1.51-1.47), and maternal age greater than 29 years (OR: 3.72 - 1, 58-8.76); A correlation was also found between maternal age and the presence of pre-pregnancy diabetes mellitus (OR: 3.84 - CI: 1.45-10.15).</p><p><strong>Conclusion:</strong> In the population of postpartum women evaluated, having Diabetes Mellitus prior to pregnancy and belonging to the age group older than 29 years increases the chance of having hearing loss.</p>
Sydney M Thayer*, Rachel A Pilliod, Emmanuelle Pare, Amber Vandehey, Hannah Raszka, Kelly Thomas and Rinathia Hachmon
<h2>Introduction</h2><p>Triploidy is one the most common chromosomal abnormality in humans, complicating about 1% of all human pregnancies. Most affected conceptions undergo spontaneous abortion in the first trimester, making the prevalence of second trimester triploidy low. Viable triploidy is associated with high rates of maternal morbidity, including hypertensive disorders, hemorrhage, and persistent trophoblasic disease, as well as fetal and neonatal severe adverse outcomes. Given these complications, early identification of triploidy in ongoing pregnancies may inform patient counseling and management.</p>
Ramnath Elangovan*, Ramakrishnan Theyagarajan, Ebenezer Mani and Mejalla Muthiah Amaladhas
<h2>Abstract</h2><p>Gingival recession is defined as apical migration of the gingival epithelium leading to the exposure of root surface. There are many surgical procedures for treating gingival recessions and the main goal is to cover the exposed tooth surface by soft tissue augmentation. The surgical techniques performed for root coverage has their own advantages and limitations. The surgical technique used for managing the gingival recession is the major factor that determines the outcome and the long term result of the procedure. The most common surgical technique in treating the isolated gingival recession is the lateral pedicle graft and the surgical technique with highest percentage of root coverage is the connective tissue graft. This case report deals with the management of an isolated gingival recession with lateral pedicle and connective tissue graft. The outcome of the procedure was excellent having complete root coverage.</p>
Fibrous dysplasia is an osteolytic lesion in which bone is replaced by an instable fibrous osseous tissue. The aim of this case report is to highlight dental rehabilitation (bone grafts to allow dental implant) on patients suffering of this condition.
A 39-year-old female with a hard-traumatic event in childhood desired a dental implant rehabilitation on her teeth 19 and 30 after an orthodontic alignment. A Cone-Beam Computed Tomography (CBCT) was performed showing a massive radiopaque lesion of the anterior mandible. The bone grafts and dental implants were successfully managed. A non-invasive treatment with regular follow up was chosen for this case. No evolution was noticed twenty-four month later at the follow up CBCT.
Malomo Adefolarin O*, Aminu, Kafayat, Adeolu Augustine A, Adeleye Amos O, Balogun James A, Badejo Oluwakemi A, Shokunbi Mathew T and Jegede Ayodele S
<h2>Summary</h2><p>Catheter-associated urinary tract infection (CAUTI) is among the most common nosocomial infections especially in acute care settings. Its economic and unanticipated health implications make it burdensome for the healthcare providers and patients. The paper examined the perceived causes and mode of preventing urinary tract infections in patients with spinal cord injury. Qualitative research approach was utilized; the study site was a Tertiary Hospital in Nigeria. Eight (8) in-depth interviews (IDI) were conducted with healthcare providers managing patients with spinal cord injured in the hospital. The major risk factors causing urinary tract infection identified include financial problems, organization of care, human error, hospital environment and patient-related factors. To prevent urinary tract infections among patients in the hospital, a number of suggestions were made by the participants such as training of caregivers and educating patients and relations. The authors concluded that the incidence of CAUTI could be reduced in the hospital if the opinions of stakeholders are fairly considered.</p><p> </p>
Mélanie Gallot, Nathalie Rieth and Alexandre Ganea
Many side effects, in addition to those of the pathology itself, have occurred with hemodialysis treatment but existing literature have shown that physical activity is beneficial to hemodialysis patients. Nevertheless, our parameters have not been studied enough with a resistance training program. In our study we have observed the effect of a 12-week intradialytic resistance training program (T0 vs T12) on the quality of life using the KDQOL-SF questionnaire, blood samples biological parameters and sleep using the Epworth scale and the International restless legs syndrome study group scale. The resistance training program consists of 3 sessions per week and involved lower extremities thanks to elastic band and soft ball. After the training program, the quality of life score trend to the increase at T12 compared to T0. Among the biological parameters, the only trend decrease observed was in the C-reactive protein and a trend increase was observed in urea at T12. Dialysis efficiency presented no changes and no significant results were observed for sleep. Some trends were observed as a result of our program. The type of exercise seems to have different effects on measured parameters. Nevertheless, exercise was beneficial to chronic hemodialysis patients and seemed to improve their health.
José Agapito Fonseca*, Sofia Jorge, Joana Gameiro, José António Lopes and José Oliveira Guerra
The authors present the case of a 45-year-old female patient with diabetes and chronic kidney disease (CKD). She had unsatisfactory glycemic control, and showed some intellectual limitations. Her urine exam was unremarkable, and her renal ultrasound revealed single right kidney with aspects suggesting ureteropelvic junction syndrome. Her mother had also suffered from diabetes and CKD G5D presenting in the sixth to seventh decade.
An hereditary cause for CKD was considered, which led the authors to investigate an autosomal dominant cause for CKD with a tubulointerstitial phenotype, taking into account the personal and family history for diabetes and also the renal imaging; a large deletion in the HNF-1β gene was identified through Multiplex Ligand Probe Assay (MLPA) analysis, explaining the phenotype.
Genetic causes of CKD should be considered in the presence of positive family history for CKD, and the coexistence of diabetes with bland urine sediment should raise the possibility of a syndromic cause of the phenotype, namely involving HNF-1β gene mutations or deletions.
Garcia Gubern C, Colon Rolón L, Ruiz Mercado I, Oliveras Garcia C, Caban Acosta D, Muñoz Pagán J, Iriarte I, Bolaños Ávila G Peguero Rivera J, Sánchez Gaetan F, Oneill Castro J, Cordero Colón Paola N, Garcia-Colon Carlos A and Romero-Vazquez Ana M*
Objective: To describe the presenting clinical findings of patients with acute appendicitis and compare them with those described in the medical literature. To corroborate a common medical myth among Hispanic physicians regarding the presentation of acute appendicitis.
Methods: This was a retrospective multicenter chart review of patients diagnosed post-operatively with appendicitis after presenting to five different Emergency Departments in Southern Puerto Rico (PR).
Results: A total of 1,540 patients with pathologically confirmed cases of appendicitis were enrolled in our study. Of the study population, 45% were female, and 55% were male, and 43% were over 21 years old. Reported symptoms in our study showed that 98% of the patients had abdominal pain, 47% had nausea, and only 17.6% presented with anorexia.
Conclusion: It was our main objective to compare the presenting signs and symptoms of patients with acute appendicitis in our Hispanic population in southern PR with those found in primary medical textbooks and literature. We gathered information regarding signs and symptoms, as well as laboratory and radiographic data of patients with positive pathologic exams for appendicitis. Of the 1,540 patients with confirmed appendicitis, only 17.6% presented with anorexia. Our findings demonstrate that the rate of anorexia in the studied population is significantly lower when compared to current literature. The absence of anorexia, once considered a hallmark of appendicitis, must not lead the physician to rule out this diagnosis in the Hispanic population.
Acute cholecystitis is a common general surgery disease which may require hospital admission. Delayed or early cholecystectomy is the definitive treatment. Availability of theatre slots may postpone cholecystectomy for weeks. I am writing this letter to explain the importance of early cholecystectomy programme and the necessity of support such programme by hospital managers. I will rationalize the concept of such program and its clinical and economic benefits.
Katya Rigatto*, Denielli Da SG Bós, Renata Fernandes, Rodrigo B Jaenisch and Pedro Dal Lago
Objective: To investigate in an animal model of Pulmonary Hypertension (PH) by monocrotaline whether a lower exercise intensity, which has lower potential to provoke dyspnea symptoms, could prevent the increase the right ventricle pressure and the decrease in respiratory compliance. Setting: A research laboratory. ANIMALS: twenty-one Wistar rats were randomized to the groups: Control (CO; saline solution); PH-sedentary; PH-low and PH-moderate intensity of exercise training (ET). Interventions: They received a single saline or monocrotaline subcutaneous injection (50 mg/kg). The exercise program was performed during 3-weeks. Main Outcome Measures: Rats were evaluated by their morphometric and hemodynamic changes and by the respiratory mechanic responses induced by the exercise protocols. Results: Both protocols of ET significantly (p < 0.05) attenuated the increase in the right ventricular systolic pressure. However, the lower intensity was more effective to prevent the impairment in the respiratory and quasi-static compliance. Conclusion: Collectively, our results showed for the first time the benefits of ET to the respiratory system mechanics. We also demonstrated that intensity is crucial in PH, probably due to the difficulty to match VO2 capacity and O2 demand during exercise. The improvement in quasi-static compliance not only might improve the ability to breathe, and capture oxygen, but also welfare.
Marcus Taylor*, Muhammad Asghar Nawaz, Ozhin Karadakhy, Denish Apparau, Kandadai Rammohan and Paul Waterworth
Background: Pulmonary artery bleeding secondary to iatrogenic injury is a troublesome intraoperative complication. The likelihood of encountering this complication is significantly higher in redo surgery for a number of reasons, including distortion of anatomical structures, adhesions and loss of tissue planes. Significant blood loss, although rare, remains a concern, and can occasionally be life-threatening. When significant bleeding from the pulmonary artery occurs, it can be a challenging situation to manage. Case Report: A 65 year old female was undergoing redo thoracic surgery in the setting of a completion lobectomy for biopsy-proven primary adenocarcinoma of the lung. Iatrogenic injury to the pulmonary artery resulted in significant bleeding that could not be managed by gaining proximal control due to dense adhesions. The novel decision to utilize a Foley catheter for balloon tamponade was taken, in order to provide sufficient haemostasis for definitive surgical repair of the defect to be undertaken Conclusion: The increased technical difficulties of redo thoracic surgery are well recognised. We describe the first case of Foley catheter balloon tamponade being utilized in the context of iatrogenic pulmonary artery bleeding during thoracic surgery.
Juan P Ovalle, Estefanía M Orozco, Laura C Pedraza, María C Barrera, Renato A Guzmán* and Dormar D Barrios M
In this article, we describe the case of a fifty-year-old patient with autoimmune hemolytic anemia (AIHA) with constitutional symptoms, jaundice, unquantified fever and progressive dyspnea. The patient had history of smoking and Hepatitis A and following a physical exam she was found in a regular condition, icteric but with no other further signs. Her laboratory tests revealed hemolytic anemia with a hemoglobin of 8.5 g/dL, an increase of total and indirect bilirubin, an elevated ferritin, a decreased transferrin and haptoglobin and a positive result for direct Coomb’s test. Considering this, an immune profile was ordered finding a negative result of ANAs and ENAs and a decrease of complement C3 and C4. The patient was diagnosed with AIHA and as an initial step a corticosteroid treatment was administrated however the patient showed no clinical nor chemical improvement. At her third day of hospitalization, she was unstable hemodynamically requiring transfer to Intensive Care Unit (ICU) to optimize management. After 24 hours on ICU, due to persistence of deterioration of the patient, it was decided to manage with erythropoietin (EPO). In the following days, the patient showed a rise in her hemoglobin and an overall improvement made possible the transfer to hospitalization service. The AIHA is an uncommon disease and is not the first option that comes to mind with these symptoms, currently there are not controlled studies to the treatment due to its complexity and the heterogeneity of the results. We strongly support the use of EPO in refractory cases of this pathology.
Mohammed Shabeer*, Nasir Muzaffar and Sameh Abdalla
We describe a rare case of patellar fracture in a seven year old girl. The case was reviewed for various aspects such as clinical diagnosis, imaging tests and most suitable treatment.
Rasha Mokhtar Abdelkareem*, Afaf T Elnashar, Khaled Nasser Fadle and Eman MS Muhammad
Background: Gliomas represent the most frequent primary tumors of central nervous system (CNS), contributing to more than half of the incidence of brain tumors. Cancer stem cell markers (CSC) identify a group of patients at high risk for progression. Nestin is an intermediate filament (IF) protein was first described as a neural stem cell/progenitor cell marker. Nestin-positive neuroepithelial stem cells are detected in the subventricular zone of the human adult brain and they remain mitotically active throughout adulthood. The expression of Nestin in gliomas has been suggested to be related to dedifferentiation, improved cell motility, invasive potential and increased malignancy. This study aims to investigate Nestin immunohistochemical expression in different types of glioma and its correlation with different clinicopathological parameters. Materials and Methods: Nestin immunostaining was studied in 60 specimens of glioma using avidin-biotin peroxidase method. Results: Nestin was strongly expressed in 11/60 (18.33%), moderately expressed in 29/60 (48.33%) and weekly expressed in 15/60 (25%) of studied gliomas. A significant positive correlation was found between Nestin expression and histologic type (p < 0.001) and increasing grade of gliomas (p < 0.001). Conclusion: Increased Nestin expression is correlated with tumor progression, increasing grade and poor prognostic parameter of glioma. Nestin is a useful marker for detection of CSC in high-grade glioma which is responsible for resistance to chemo-radiotherapy and may serve as a predictor for patient outcomes.
Hepatitis C Virus (HCV) infection is usually treated with direct acting antivirals (DAAs) for 12 weeks. In treatment naive patients with genotype (GT) 1 infection without cirrhosis and baseline viral load <6 million, 8 weeks of Ledipasvir/Sofosbuvir (LDV/SOF) is an option. Eight weeks with Glecaprevir/Pibrentasvir (GLE/PIB) is an option for patients with GT 1 through 6 without cirrhosis. Our objective was to evaluate achievement of Sustained Virologic Response (SVR) after 8 weeks of LDV/SOF or GLE/PIB in our HCV-infected veterans. Patients with HCV infection that received GLE/PIB or LDV/SOF for a planned 8 weeks of therapy in the past four years were reviewed (January 2015-September 2018). Treatment outcomes were evaluated through medical record review. Two hundred sixty-five veterans were initiated on 8 weeks of therapy with either GLE/PIB or LDV/SOF. Of these, 231 (87%) were initiated on 8 weeks of LDV/SOF and 34 (13%) were initiated on 8 weeks of GLE/PIB. The majority of patients had GT 1 (93%) infection. One hundred and ninety-five veterans who completed 8 weeks of LDV/SOF and 30 veterans on GLE/PIB had follow-up viral loads. The overall SVR was 95%. Treatment with GLE/PIB resulted in a higher SVR rate (100%) compared to LDV/SOF (95%). Elderly patients had similar SVR rates. Treatment with 8 weeks of DAA is effective in our veteran population and showed an SVR rate similar to literature reports. The SVR for patients treated with 8 weeks LDV/SOF was slightly lower than the SVR for GLE/PIB; however, the GLE/PIB population was smaller.
Firas Ajam, Obiora Maludum, Nene Ugoeke, Hetavi Mahida, Anas Alrefaee, Amy Quinlan DNP, Jennifer Heck-Kanellidis NP, Dawn Calderon DO, Mohammad A Hossain* and Arif Asif
Background: Contrast-induced acute kidney injury (CI-AKI) is an important cause of increasing the hospital stay and in-hospital mortality. By increasing intra-renal vasoconstriction, left ventricular ejection fraction (LVEF) can increase the risk of CI-AKI. We sought to investigate whether LVEF can impact the incidence of CI-AKI after cardiac catheterization and whether it can be used to predict CI-AKI. Methods: Patients underwent cardiac catheterization from December 2017 to February 2018 at Jersey Shore University Medical Center were enrolled in the study. Contrast-induced acute kidney injury (CI-AKI) was defined as an increase in serum creatinine of ≥ 0.5 mg/dL or an increase of ≥ 25% from the pre-procedure value within 72 hours post-procedure. The maximum allowable contrast dose was calculated using the following formula: (5* (weight (kg)/creatinine level (mg/dL)). A multivariable logistic regression analyses, controlling for potential confounders, were used to test associations between LVEF and CI-AKI. Results: 9.6% had post catheterization CI-AKI. A total of 18 out of 44 (44%) of patients who had CI-AKI also had ongoing congestive heart failure. No statistically significant association found neither with maximum allowable contrast (p = 0.009) nor ejection fraction (p = 0.099) with the development of CI-AKI. Conclusion: In spite of the fact that no statistically significant relationship found between the percentage maximum contrast dose and the ejection fraction with the post-procedure CI-AKI, we heighten the essential of employing Maximum Allowable Contrast Dose (MACD) and ejection fraction in patients undergoing PCI to be used as a clinical guide to predict CI-AKI.
Avishek Bagchi, Rajendra Kumar Agarwal and Kewal Kishan Talwar*
Background: Subclavian venous access for pacemaker lead insertion is a common procedure and is normally considered safe in the hands of an expert. However, subclavian venepuncture is not without complications, starting from mild subcutaneous hematoma to pneumothorax. We here present a case of hemoptysis occurring after difficult subclavian vein puncture, which subsequently improved on conservative management only. Case Summary: A 65-year-old gentleman, post aortic valve replacement had persistent high-grade AV block and was taken up for a dual chamber pacemaker implantation. Immediately following venous access, he had a bout of hemoptysis, which recovered on its own. Post procedure chest x-ray was suggestive of alveolar hemorrhage which cleared gradually in next three-four days. Discussion: Post subclavian venepuncture hemoptysis is known; but it is a rare complication, arising either because of lung parenchyma injury or arterial injury. This is mostly benign and improves on conservative management only; however rarely it may be massive and life threatening where transcatheter arterial embolization may be required.
Nathanielly de Lima Silva, Danilo Nobre, Josiel Nascimento dos Santos, Márcia Santos Rezende, Lúcio Henrique Sousa Pinheiro, Carlos Arthur Cardoso Almeida and Dulce Marta Schimieguel*
Summary: Myelodysplastic Syndrome (MDS) is a heterogeneous group of clonal hematopoietic malignancies characterized by progressive cytopenias, ineffective hematopoiesis, bone marrow hypercellularity and transformation to acute myeloid leukemia (AML). Objectives: Identify plasma proteins from MDS patients and from two healthy controls groups (young and elderly) by SDS-Page. Methods: Plasma from 08 healthy young, 08 healthy elderly and 08 MDS patients were used for this study. Proteins were fractionated, precipitated, used for SDS-PAGE gel analysis, stained with comassie brilliant blue, scanned and bands were analyzed. Results: It was possible to identify in both, 20% fraction and supernatant, proteins that were differentially expressed in each group. The ones that have showed some clinical relevance. Fibronectin was highly expressed only in the young control group. α2-Macroglobulin was also expressed in both control groups, but it was not expressed in the MDS group. Haptoglobin was highly expressed only in the elderly control and SMD groups. Conclusion: Protein expression in plasma can be a biomarker for MDS, and may play a key role in the process of aging and hematologic malignancies development.
Clinical physicians believe they are drowning . . . because they are! Between complying with an ever-changing landscape of time-wasting federal regulations, avoiding Health Insurance Portability and Accountability Act violations, plus the entire billing process, who can keep up with the literature, study a patient’s medical history, or even talk with a patient?!?
Precis: This Literature review is intended to provide dental practitioners with an update of the implications that Alcoholism poses to them.
Statement of the problem: Alcoholism raises several distinct problems for dental professionals.
Purpose of the study: The focus of this review has been to primarily identify and critically appraise the associations between alcoholism and the various difficulties that have been derived from the literature.
Materials and methods: A structured review of the literature was undertaken using PubMed, Google Scholar and the Cochrane library, additional searching of reference lists was also undertaken. A number of articles were critically analyzed which included Cochrane and systematic reviews, meta-analyses and a number of cross-sectional studies. The data was compared under several headings and tabulated in certain instances.
Results: Alcoholism raises various implications that dental professionals should be aware of including increased incidences of caries, periodontal disease, pathological tooth wear & oral cancer. Chronic Alcohol intake interacts with the pharmacodynamics and kinetics of many routinely prescribed medications in routine dental practice. In addition, there are problems related to access to care and during acute episodes of intoxication abusers may participate in antisocial behavior in the healthcare environment.
Conclusion: Alcoholism has several implications for the dental team, however, dentists who are familiar with the manifestations of the illness, as well as the challenges raised in dental practice can confidently offer these patients a full range of dental treatment.
<p>A key platform underpinning the traditional understanding of the cardiovascular system, with respect to the behavior of large arterial vessels, is Otto Frank’s Windkessel Hypothesis [1]. This hypothesis posits simply that the smooth muscle walls of large arteries do not undergo rhythmic contractions in synchrony with the heartbeat but, rather, behave as passive elastic tubes undergoing distension from pulsatile pressure waves. The Windkessel Hypothesis is elegant, well described for over a century, ingrained in the understanding of cardiovascular medicine and physiology, and simply wrong.<br /> </p>
Introduction: Hypertension is a silent pathology in a way that affects all four spheres to be considered as such; magnitude, transcendence vulnerability, and feasibility. The World Health Organization estimates that 45% of deaths from heart disease and 51% of deaths from stroke globally are caused by hypertension. Material and method: A longitudinal, descriptive and quantitative observational study was carried out on the personnel of high-risk public service providers. Results: The total population sampled was 550 people where it was possible to determine the sex where the disease predominates, since 92% of the hypertensive population belong to the male sex, while 8% of the female population. 57% of the total population were classified as normotensive, while 21% were classified as High Normal, Grade I Hypertension, and Grade II Hypertension. Discussion: AHT is the result of a series of interactions between endogenous and exogenous factors in an organism that tries to adapt to the increase of the cardiac output and the peripheral resistance of the blood vessels, which is manifested by the increase in blood pressure figures. Physical activity has been shown to have a lower risk of hypertension compared to sedentary individuals. The daily stress these workers face predisposes them to suffer their manifestations as headache, muscle pain, fatigue, digestive disorders and constant elevations of blood pressure.
Rashi K Jain*, Devashree Vakil, Corey Cunningham and Kuldip Sidhu
Mesenchymal stem cells (MSCs) conditioned medium (CM) has a promising prospect towards skin regeneration. Therefore, human dental pulp and adipose stem cells (DPSCs and ADSCs) were isolated, propagated and evaluated for their stemness and genetic stability over time in culture before making CM. We aimed to characterize the applicability of lyophilized ADSCs and DPSCs derived CM (AD-CM and DP-CM) at 5 mg, 10 mg and 20 mg for wound healing process. The ability of wound closure was assessed by direct human dermal fibroblast cell scratch assay, treated with variable concentrations of AD-CM and DP-CM in vitro. Additionally, we also assessed the expression of different cytokines and growth factors secreted from ADSCs and DPSCs in the CM relevant to the wound healing by cytokine array analysis. Our data demonstrates a significant effect of both the AD-CM and DP-CM in wound healing within 24 hrs compared to that in control.
The purpose of this study is to highlight the drug abuse hazards and preventive aspects. From a public health perspective, substance abuse has long been a source of major concern, both for the individual’s health and for wider society as a whole. The UK has the highest rates of recorded illegal drug misuse in the western world. In particular, it has comparatively high rates of heroin and crack cocaine use. Substances that are considered harmful are strictly regulated according to a classification system that takes into account the harms and risks of taking each drug. The adverse effects of drug abuse can be thought of in three parts that together determine the overall harm in taking it. Some addictive substances are more damaging to the skeletal system along with the others. In this review article, an effort has been taken to elaborate the effects of addictive drugs on human highlighting these most problematic substances for bones and also the promising potential prevention aspects of drug abuse.
Biological membranes present an essential constituent of living cells. Their main role is to separate the interior of a cell from its surrounding, however allowing the selective transfer of specific material through it. Configuration changes of membranes are often correlated with important biological processes [1-7]. For example, they might trigger divisions of cells [4], adaptation of red blood cells [1] to temporal conditions during their transport to different parts of biological tissues, they might be involved in cancerous [5] and cell death [6] processes... Membrane structures are in general extremely complex, however, their key properties are often dominated by geometry.
Sahadev T Reddy, Antonio T Paladino, Nackle J Silva, Mark Doyle, Diane A Vido and Robert WW Biederman*
Background: Hypertrophic cardiomyopathy (HCM) patients have a predisposition for malignant VT/VF and consequently, sudden cardiac death (SCD). In single center studies, late gadolinium enhancement (LGE) defined fibrosis has been linked to VT/VF. However, despite innumerable investigations, SCD has not been definitely attributable to LGE. Explanations for these are believed to be related to insufficient statistical power. Methods: We performed an electronic search of MEDLINE, PubMed: and CMR abstracts for original data published or presented between Jan 2001 to Mar 2011. Key search terms: HCM, LV fibrosis, SCD and LGE. Studies were screened for eligibility based on inclusion criteria: referral for CMR exam with LGE for HCM; and follow-up for incidence of VT/VF and SCD. Categorical variables were evaluated between patient groups via Chi-square test. Results: A total of 64 studies were initially identified. Of these, 4 (6.3%) were identified and included (n = 1063 patients). Three prospective and one retrospective study were included. LGE was detected in 59.6% of patients. As expected, the presence of myocardial fibrosis was associated with VT/VF (x2 = 6.5, p < 0.05; OR 9.0, (95% CI 1.2 to 68.7). Moreover, myocardial fibrosis strongly predicted SCD (x2 = 6.6, p < 0.05; OR 3.3 (95% CI 1.2 to 9.7). Conclusion: Despite single center CMR studies, LGE has consistently predicted VT/VF while prediction of SCD has remained paradoxically unlinked. Although the lack of studies meeting our criteria limited our ability to perform a comprehensive meta-analysis, we have been able to demonstrate for the first time that LGE-defined fibrosis is a predictor of SCD in patients with HCM.
Chronic heart failure has been extensively characterized as a disorder arising from a complex interaction between impaired ventricular performance and neurohormonal activation. Since beta adrenoceptor blocking agents are currently considered an integral component of therapy for the management of patients with severe chronic heart failure; several well designed clinical trials have been conducted to determine the morbidity and mortality benefits of these agents these studies, however did not yield the same results in terms of morbidity and mortality benefits. Currently only Bisoprolol, Carvedilol and sustained release metoprolol succinate have clinically proven and convincing morbidity and mortality benefits the current list of approved medicines of the National Health Insurance Scheme (NHIS) of the republic of Ghana does not provide coverage for these lifesaving therapeutic agents. The objective of this review was to collate the relevant scientific evidence that will convince the authorities at the National Health Insurance Authority (NHIA) of the Republic of Ghana to include at least one of the evidence based beta adrenoceptor blocking agents in the list of approved medicines. A thorough search on the internet was conducted using Google scholar to obtain only the clinically relevant studies associated with the benefits of beta adrenoceptor blocking agents in patients with chronic heart failure published in the English language. The phrases beta adrenoceptor blocking agents and chronic heart failure were used as search engines. The search engine yielded several studies that met the predefined inclusion criteria. However, only the Cardiac Insufficiency BIsoprolol Studies (CIBIS-I and CIBIS-II), Carvedilol Prospective Randomized Cumulative Survival Study (COPERNICUS) and Metoprolol CR/XL Randomized Intervention Trial (MERIF-HF) because of the clinical relevance of their findings Beta adrenoceptor blocking agents such as atenolol and propranolol have been used in the management of patients with chronic heart failure. However, their efficacy and optimal dose in reducing mortality have not been scientifically established not all beta adrenoceptor blocking agents scientifically studied provide the same degree of clinically meaningful and convincing morbidity and mortality benefits in patients with chronic heart failure.
Cavia MM*, Moreno A, Fernández-Trabanco B, Carrillo C and Alonso-Torre SR
<h2>Abstract</h2><p>The anthropometric characteristics are decisive for an optimal physical level and, therefore, a good level in the game; and they can be different depending on the game position.</p><p>The aim of this study was to identify the physical characteristics, body composition and somatotype of professional soccer players and to verify differences according to their playing positions: goalkeepers, defenders, forwards and midfielders.</p><p>The measurements were performed on 57 male players of a soccer team of the Spanish Football League One. Twenty seven anthropometric variables were measured (height and body weight, four bone breadths, eleven girths and ten skinfolds) and the Bioelectrical Impedance Analysis was also performed. The percentage of body fat has been determined from 11 different equations.</p><p>Goalkeepers showed the highest weight (80.2 ± 3.2 kg), supraespinal (10.5 ± 3.8 mm) and abdominal (15.6 ± 3.5 mm) skinfolds than others positions. In relation to body fat percentages, similar results were obtained from the equations of Jackson-Pollock (from 3 and 7 skinfolds), Carter, Withers, and Heyward and Stolarczyk (mean value 7.8 ± 1.5%). Higher results were obtained from the other equations applied. Differences among positions were also found concerning body composition; goalkeepers showed the highest body fat percentage (9.4 ± 1.4%). Mean somatotype was also different among positions; goalkeepers and forwards presented a balanced mesomorph somatotype while defenders and midfielders showed an ecto-mesomorph one.</p><p>The differences in morphological characteristics according to the team position were notice only in goalkeepers, especially regarding their weight, abdominal and supraespinale skinfolds and the percentage of fat tissue.</p>
Maria Pilar Barretina-Ginesta, Jaume Galceran*, Helena Pla, Cristina Meléndez, Anna Carbo Bague, Alberto Ameijide, Marià Carulla, Jordi Barretina, Angel Izquierdo and Rafael Marcos-Gragera
<h2>Abstract</h2><p><strong>Background:</strong> Breast cancer (BC) is one of the most prevalent malignancies. BC survivors have higher risk of second primary cancers than the general population. There is an increased interest in BC survivor management, including the prevention of these second cancers. The aim of this study was to assess the risk of gynaecological malignancy (GM) as second neoplasm among BC patients in our population.</p><p><strong>Methods:</strong> Patients with invasive BC diagnosed from 1980 to 2014 included in the Girona Cancer Registry were included. The incidence of second GM in these patients was compared to those in the general population. Second primary cancer was stated as a tumour diagnosed after 2 months from the BC diagnosis. Standardized incidence ratios (SIR) and absolute excess of risk (AER) were calculated.</p><p><strong>Results:</strong> 9,717 patients were diagnosed with invasive BC during this period, with a median age at diagnosis of 61 years, and a median follow-up of 7.9 years. 117 of them developed a second GM. By tumour type, the only statistically significant higher SIR was observed for corpus uteri cancer (SIR:2.28 95% CI 1.82-2.83; AER:6.43 95% CI 4.13-9.14). After reviewing the histology of the CUC cases, we found that 71.4% were type I (endometrioid adenocarcinoma), 15.5% type II (serous adenocarcinomas and clear cell carcinomas), 10.7% carcinosarcomas, 2.4% sarcomas and there were no unspecified malignant neoplasms.</p><p><strong>Conclusion:</strong> BC survivors have an increased risk of corpus uteri cancer, with an increase in unfavourable histologies compared to the general population. Lifelong primary and secondary prevention interventions should be recommended for these patients.</p>
Romero MP Brandao-Costa*, Juanize Matias S Batistaa, Thiago Pajeu Nascimento and Ana LF Porto
Physicochemical and pharmacological studies indicated that Filicium decipiens seeds contained various specialized metabolites, including saponins. The aim of this work is to reveal the nephrotoxicity of FDS, a saponin isolated from Filicium decipiens seeds on male Wistar rats histopathological and biochemical parameters. Rats were submitted to oral ingestion of FDS (6.0 mg/kg) and crude extract (120.0 mg/kg) and were observed high levels of urea and creatinine in blood analyses of all animals followed by an acute renal failure by glomerular retraction. In the present study, FDS and crude extract when administered in Wistar rats induced an increase of serum levels of Urea and Creatinine, biochemical markers of kidney function. Table 1 shows Urea concentration at Test group with FDS (54.3 ± 1.80 mg/ml) and Test group with crude extract (49.7 ± 2.00 mg/ml), were 47% and 34.7% higher, respectively, when compared to control group (36.9 ± 2.00 mg/ml), and Creatinine at the test group with FDS (2.1 ± 0.03 mg/ml) and test group with crude extract (1.6 ± 0.09 mg/ml) presented a value 3.5 and 2.8 times higher, respectively, than control (0.6 ± 0.08 mg/ml). Based on these results, our data demonstrate a significant effect in renal function of rats treated with F. decipiens saponin.
Lava Krishna Kannappa*, Muhammad Sufian Khalid, May Hnin Lwin Ko, Mohsin Hussein, Jia Hui Choong, Ameer Omar Rawal-Pangarkar, Danaradja Armugam and Yahya Salama
We present a 54-year-old male with abdominal pain, Vomiting and weight loss since 5 months. Perforation was noted at recto-sigmoid junction and underwent Hartman’s procedure with end colostomy. Histology of sigmoid colon confirmed a Stercoral perforation without any evidence of dysplasia or malignancy. Patient had chemotherapy for squamous cell carcinoma (SCC) of epiglottis a year ago and was on codeine phosphate and Oromorph as and when required since his treatment for SCC for pain. Patient also had been suffering from constipation since he finished chemotherapy. Stercoral perforation always need to kept in mind in patients who present with constipation and need to take all patients who present with chronic constipation and initiate measures we encounter commonly in everyday practice. We present a brief review about Stercoral perforation and its management.
The biological changes caused by oxidative stress (OS) are known to be involved in the etiology of neurodegenerative disorders, including Alzheimer’s disease, amyotrophic lateral sclerosis, Huntington’s disease, and Parkinson’s disease. The brain is particularly vulnerable to OS due to its high lipid content and extensive consumption of oxygen. OS processes, particularly the excessive production of reactive oxygen species (ROS), play a critical role in how neurodegenerative disorders develop. This is evidenced by in vivo studies investigating various biomolecules related to OS, such as products of lipid and DNA oxidation. Accordingly, ROS can also cause oxidative-related damage in neurodegenerative disorders, including dopamine auto-oxidation, mitochondrial dysfunction, glial cell activation, α-synuclein aggregation, excessive free iron, and changes in calcium signaling. Furthermore, excessive levels of cellular oxidants reduce antioxidant defenses, which in turn propagate the cycle of OS. As such, it is increasingly important to determine the linkage between a high intake of antioxidants through dietary interventions and a lower risk of developing neurodegenerative diseases. Indeed, in addition to modulating the immune system, optimal nutritional status is capable of changing various processes of neuroinflammation known to be involved in the pathogenesis of neurodegeneration. Accordingly, a better understanding of the role ROS plays in the etiology of neurodegeneration is needed, along with the identification of dietary interventions that may lead to improved therapeutic strategies for both the treatment and prevention of neurodegenerative disorders. Therefore, this review presents a comprehensive summary of the role of ROS in the pathogenesis of neurodegenerative disorders. In addition, nutrients believed to be useful for mitigating and counteracting ROS are discussed.
Nour Karra#, Samer Ganam#, Amitai Bickel, Maxim Bez, Ibrahim Abu Shakra, Doron Fischer and Eli Kakiashvili*
Pyogenic liver abscess (PLA) is a life-threatening infection that may develop as a result of an underlying hepatobiliary disease. A possible complication of PLA is metastatic spread, resulting in distant seeding of infection in other organs, and occasionally in the epidural space. Spinal epidural abscess (SEA) is a rare infection with severe potential complications. We describe a 71-year-old patient who presented with ascending cholangitis that was complicated by micro PLA, with a subsequent Escherichia coli bacteremia and metastatic SEA. An emergent surgical intervention with laminotomy and drainage of the epidural collection was performed. The patient was treated with a prolonged antibiotic regimen, with uneventful recovery and no neurologic sequelae. To our knowledge, this is the first reported case of a SEA following E. coli PLA.
Hallfríður Kristinsdóttir, Þórður Þórkelsson, Hildur Harðardóttir and Gylfi Óskarsson*
Critical congenital heart defects (CCHDs) are preferably diagnosed prenatally or soon after birth. Late diagnosis has been related to poorer prognosis. The aim of this study is to assess when CCHDs are diagnosed in Iceland and whether late diagnosis is a problem. All live born children in Iceland and foetuses diagnosed with CCHDs during the years 2000-2014 were included. CCHD was defined as a defect requiring intervention or causing death in the first year of life, or leading to abortion. The total number of pre- and postnatal diagnosis of CCHDs was 188. Prenatal diagnosis was made in 69 of 188 (36.7%). Of 69 diagnosed prenatally 33 were terminated due to CCHD. Of the 155 live born children with CCHD, 36 (23.2%) had a prenatal diagnosis and 100 (64.5%) were diagnosed shortly after birth, before discharge from birth facility. 19 children (12.3%) were diagnosed late, that is after discharge from birth facility. Coarctation of the aorta was the most common CCHD diagnosed late (6/19). Prenatal screening and newborn examination give good results in diagnosis of CCHDs in Iceland. Late diagnosis are relatively few, but both the number of prenatally diagnosed CCHDs and CCHDs diagnosed shortly after birth can be further improved.
Objective: The aim of this study was to estimate the predictive clinical value of CHA2DS2-VASc score for no-reflow phenomena in patients having ST-segment elevation myocardial infarction (STEMI) who applied to primary percutaneous coronary intervention (PCI).
Subjects and Methods: Three-hundred STEMI patients underwent primary PCI. They were classified into: group (1) included 27 patients with no-reflow and group (2) included 273 patients without no-reflow (control). CHA2DS2-VASc risk score was computed for each patient.
Results: This study found statistically significant difference (p < 0.05) in multivariate analysis of the association between CHA2DS2-VASc score and no-reflow phenomenon. The predictive power of individual components in CHA2DS2-VASc score for no-reflow was statistically significant difference (p < 0.05). So, significantly higher CHA2DS2-VASc score is connected with higher risk of no-reflow and in-hospital mortality rate.
Conclusion: Significantly higher CHA2DS2-VASc score is associated with higher risk of no- reflow phenomenon and in-hospital mortality rates in patients with STEMI who underwent primary PCI.
Age estimations process is not standardized worldwide. However, there is a wide agreement about the most suitable methods currently available. Up until now, the procedure of creating expert reports and to implement quality assurance in age estimation are variable.
Aim: The aim of this paper was to examine expert age estimation reports from around the world and identify the similarities and shortcomings present, which will help in providing recommendations to improve the reporting to reach standardization in expert age estimation reports.
Methods and Material: A questionnaire was developed to explore whether there is a universal consensus in writing age estimation reports. Countries participated in the survey were: Afghanistan, Australia, France, Indonesia, Italy, New Zealand, Norway, Paraguay, Saudi Arabia, Spain, Switzerland, United Arab Emirates, United Kingdom, and the United States of America. Areas investigated by the survey included: Information about the individual in question and the entity requesting the assessment, if age interval is given along with if statistics were described in the report, if population reference data are used and reported and finally if the format of the report is standardized within each country.
Results: The results of this survey suggest that there is a high degree of individual variation in age estimation reports, sometimes even within the same country. While the majority of participants report the main findings, some important information is still missing. The statistical information remains extremely varied.
Conclusion: Although a resolution is not obvious, it is hoped that this study will promote further research and discussion on reporting age estimation. International guidelines on quality assurance in age estimation reports are urgently needed. Information to be reported should be specified on an international level and the exact report format to be used could be left to the national societies.
Radiofrequency proves to be a useful tool for snoring sleep apnoea cases. Its advantage includes relative precision in incision making, relative bloodless fields if used appropriately, decrease postoperative pain and excellent healing with fibrosis which aids in stiffening tissues.
Radiofrequency is high frequency alternating current used to ablate (cut/coagulate) tissues. It can be applied to nasal turbinates, soft palate, tongue base, tonsils etc. and it can be used to perform various procedures in the cutting mode to improve obstructive sleep disordered breathing.
The objective/aim was to assess efficacy of radiofrequency as a tool for procedures/surgeries for snoring/ sleep apnoea.
The parameters assessed were post-op pain, post- op blood loss, reduction in subjective snoring sounds by patients and partner, reduction in AHI post operatively.
Sanjeev Kumar Jha*, Kuldeep Saharawat, Ravi Keshari, Praveen Jha, Shubham Purkayastha and Ravish Ranjan
Background: Even with current standard treatment after variceal bleeding which includes combination of nonselective b-blockers and repeated endoscopic variceal ligation, the risk of rebleeding and mortality are high. Statins exhibit an antifibrotic effect and improves HVPG. We evaluated whether addition of simvastatin to carvedilol plus EVL therapy reduces variceal rebleeds or death in patients with cirrhosis.
Method: Patients with a variceal bleed 5 to 10 days before were randomly assigned to groups A [carvedilol (n = 69)] or group B [carvedilol (maximum dose - 12.5mg), and simvastatin (40mg/day) (n = 65)]. Primary end points were variceal rebleeding or death. Secondary end points were new complications of portal hypertension and serious adverse effects of drugs.
Results: During a mean follow-up of 49.05 ± 25.74 weeks, composite end point i.e. rebleeding or death developed in 23 patients (33.3%) in group A and 12 patients (18.5%) in group B [HR for simvastatin = 0.512; 95% CI: 0.254 – 1.030; p = 0.06]. In subgroup analysis by excluding patients of Child C class, 18 patients (34.6%) in group A and 7 patients (13.6%) in group B developed composite end point [HR for simvastatin = 0.369; 95% CI: 0.154 – 0.887; p = 0.026]. 17.4% and 15.4% patients in group A and B developed additional secondary complication [HR = 0.86; 95% CI: 0.345-2.161; p = 0.75). No simvastatin induced significant adverse effects were found.
Conclusion: Addition of simvastatin to carvedilol and EVL may reduce the rebleeding and death in patients with less advance liver disease.
Adam Ahamat Ali*, Guillaume Mahamat Abderraman*, Zeinabou Maiga Moussa Tondi and Hissein Ali Mahamat
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.
<h2>Abstract</h2><p>Broad-spectrum sunscreens are now widely used worldwide as an adjunct to help prevent sunburn, skin cancers and premature skin aging. In the United States, all persons older than 6 months are recommended to apply sunscreen to all sun-exposed skin from toes to head except eyes and mouth even on cloudy days. Such a recommendation is apparently based on concepts that exposure to sunlight damages the skin, the damage is cumulative and hence any sun exposure should be minimized or prevented. This communication raises several questions suggesting that the above recommendation may need to be reconsidered. For example, numerous previous studies have indicated many potential health benefits from non-burning sun exposure including protection against sunburn, melanoma, colorectal cancer, breast cancer and prostate cancer, increasing vitamin D synthesis, helping sleep, reducing blood pressure, heart attack and stroke. Recent studies suggested that regular lifetime non-burning sun exposure may not result in premature skin aging and the skin aging is mainly caused by the intrinsic factor. Skin aging or whole-body aging has been recently postulated to be mainly attributed to a gradual reduction in cardiac output/index with age and a new anti-aging or age-reversing nutritional theory has been proposed. An apparent lack of long-term cumulative sunray damage was also supported by reported age independence in incidences of sunburn and skin cancers. It is of interest that the current US policy is different from that of World Health Organization and Australia recommending the need of sun protection only when UV Index is 3 or greater. In view of the above, some general guidelines regarding when to best apply sunscreen are proposed.</p>
Marta Alberich Prats*, Ricard Frago Montanuy and Sebastiano Biondo Aglio
A 36-year-old man without previous medical history presented to the emergency department with abdominal pain and vomiting of acute onset. His vital signs were stable and he had no fever. Abdominal exploration revealed distention with pain at palpation. Laboratory tests were normal. Abdominal X-Ray showed gastric and small intestine distention.A nasogastric tube was placed and fluid therapy started. Computed tomography showed an intestinal malrotation, without the duodenum crossing the midline and with the colic frame arranged in the left hemiabdomen (Figure 1), complicated with a midgut volvulus as demonstrated by the whirlpool sign (Figure 2, arrow). Ladd’s procedure was performed using a midline open approach. Mesenteric lymphadenopathy and chylous ascites was found (Figure 3). The volvulus was reduced by counter-clockwise detorsion without need of intestinal resection and Ladd’s bands division along with an extended Kocher manoeuvre (Figure 4) allowed a good position of the mesentery. Appendectomy was also conducted. Postoperative course was uneventful with the patient being discharged the fifth day, after resumption of bowel function. No alterations were detected at follow up one month later.
<h2>Abstract</h2><p><strong>Background:</strong> Colorectal cancer progresses without any symptoms early on, or those clinical symptoms are very discrete and so are undetected for long periods of time. The case reported is an unusual presentation of colorectal cancer.</p><p><strong>Case Report:</strong> A 60 year old man presented with right sided abdominal swelling. On examination, a well-defined, firm, tender swelling was noted. Computed tomography confirmed the presence of a mass arising from the right colon with infiltration of the right lateral abdominal wall and adjacent collection. An exploratory laparotomy with drainage of the subcutaneous abscess, resection of ascending colon, and ileotransverse colon anastomosis was performed.</p><p><strong>Conclusion:</strong> A differential diagnosis of carcinoma colon should be considered when an elderly patient presents with abdominal wall abscess accompanied by altered bowel habits or per rectal bleeding, even if there are no other significant clinical symptoms and a thorough investigative work up is required to confirm the diagnosis, to avoid untimely delay in treatment, and reduce mortality.</p>
Stopyra Artur*, Sobiech Przemyslaw, Pomianowski Andrzej, Zarczynska Katarzyna and Edyta Kaczorek
Respiratory tract infections in dogs pose a significant problem and often require prolonged treatment. The effectiveness of pharmacological therapy can be improved through the administration of nebulized compounds to liquidize mucus and promote its evacuation from the respiratory tract. The aim of this study was to evaluate the effectiveness of nebulized 0.9% NaCl in dogs with respiratory tract infections. Respiratory functions were assessed based on the results of arterial blood gas analyses, and the patients’ clinical status was determined by evaluating the severity of symptoms on a point grading scale. Inhalation of nebulized 0.9% NaCl significantly accelerated improvement in the patents’ clinical status (normalization of body temperature, decreased cough frequency, decrease/elimination of nasal and ocular discharge, improved appetite) and improved pulmonary gas exchange by reducing partial pressure and total content of carbon dioxide and increasing partial pressure and total content of oxygen in blood.
Steven D Culler*, Aaron D Kugelmass, David J Cohen, Matthew R Reynolds, Phillip P Brown, April W Simon and Marc R Katz
Purpose: This study reports resource utilization during a Medicare Beneficiary’s (MBs) Transcatheter Aortic Valve Replacement (TAVR) index hospitalization and all subsequent encounters for 12 months and compares data between MBs who did or did not receive a pacemaker implantation (PPM) during their index hospitalization.
Method: This retrospective study examined Medicare hospital claims from January 1, 2014 through June 30, 2015. 15,533 MBs who survived for 365 days were studied. Information from all encounters during the study period was combined to compare hospital resource utilization and outcomes.
Results: 14.8% of MBs had a PPM during the index hospitalization. 46.0% of MBs had at least one readmission to a hospital during the 365-day follow-up period. 54.6% of MB’s first hospital readmission occurred within 90 days of their TAVR discharge date. Average total Medicare reimbursement for all hospitalizations was $60,638 ± $28,974 associated with average total hospital length of stay of 11.2 ± 11.7 days. After adjusting for demographics and 47 comorbid conditions, MBs receiving a PPM during the index TAVR had significantly higher estimated Medicare reimbursement ($5,132) and longer total length of stay (1.8 days) for the entire study period than MBs not receiving a PPM.
Conclusion: Total Medicare reimbursement and hospital LOS were significantly higher among MBs that had a PPM implantation during their index admission; however, there were no significant differences in readmission rates, readmission length of stay, or days to first readmission during the follow-up period between the two study cohorts.
Betul Borku Uysal*, Feray Akbas, Esma Altunoglu, Gulhan Ipek Denız, Duygu Uysal, Harun Uysal, Hanife Usta Atmaca, Yasin Yuksel, Hale Aral, Guven Cetın, Cem Ar M and Fusun Erdenen
Background: Anemia is an accelerating problem among patients with heart failure (HF) and its presence is associated with more symptoms. In this study, we investigated whether anemia in heart failure was related to hepcidin concentration.
Methods: 50 patients with heart failure and 20 healthy subjects with no history of a chronic illness including heart failure as control group, were included in the study. Heart failure was verified by echocardiography in each subject and patients were defined as ones with reduced ejection fraction (HFrEF) if EF ≤ 40% and with preserved ejection fraction (HFpEF) if EF 40% - 50%. Blood samples were taken from all patients after 10-12 hours fasting. Anemia assessment was performed according to World Health Organization (WHO) criterias.
Results: There was a positive correlation between hepcidin concentration and urea, ferritin, hemoglobin, hematocrite, C-reactive protein (p < 0,05). Hepcidin concentrations of anemic heart failure patients were significantly lower than the non-anemic heart failure patients (p < 0,05).
Conclusion: We found that serum hepcidin concentration in anemic patients with heart failure was lower than in heart failure patients without anemia. We believe that iron defiency occurs as a result of inflammatory process in heart failure and therefore hepcidin concentrations decrease as a response. However, long-term follow up studies are needed.
Grigory Arzumanyan*, Dmitriy Linnik*, Kahramon Mamatkulov, Maria Vorobyeva, Anastasia Korsun, Valentina Glasunova and Anka Jevremovic
The present report highlights our results on synthesis of NaYF4:Yb,Er@SiO2@Ag core–shell nanoparticles (CSNPs) for plasmon-enhanced upconversion luminescence (UCL). Hydrophilic surface UCL nanoparticles (UCLNPs) as cores were obtained by precipitation of Rare Earth Elements (REE) chlorides from water-alcohol solutions. The formation of a hydrophobic surface of α-NaYF4:Yb,Er NPs was achieved by thermolysis method at 280 °C and β-NaYF4:Yb,Er by precipitation method in nonpolar medium at 320 °C. Silica shell was formed by the modified Stöber method on the surfaces of UCLNPs with different polarity and phase composition. A mixture of hexane-cyclohexane-isopropyl alcohol was used as a medium for the formation of mononuclear CSNPs on hydrophobic surfaces of cores with different thicknesses of the silica shell: 5 nm and 14 nm. Formation of a predetermined thickness of silica shell was carried out by introducing a precise quantity of TEOS taking into account the size of core NPs with molar ratio TEOS: H2O equal to 1:6. The morphology and phase composition of cores and CSNPs were examined by transmission electron microscopy and selected area electron diffraction, respectively. The insertion of Ag NPs into the structure of NaYF4:Yb,Er@SiO2 was carried out in parallel at the stage of shell formation, which made this synthesis a one-step process. The control of the size of Ag NPs was implemented through the use of a colloidal solution of NPs of the cluster structure by changing the polarity of the medium. The highest intensity enhancement of 85-fold with 5 nm and 29-fold with 14 nm shell thickness was recorded, respectively. For the first time, tests on bioimaging of neutrophil cells by those CSNPs are demonstrated.
Purpose: To investigate the suture-tourniquet technique for haemostasis in patients with acute thrombosis of native arteriovenous fistula (AVF) whom underwent manual aspiration thrombectomy using large-bore venous sheaths and high dose heparin.
Methods: Between January 2016 and May 2018, patients with acute AVF thrombosis performed successful manual aspiration thrombectomy by using large bore venous sheaths and high dose heparin were included in this retrospective study. Success rate for haemostasis, procedural complications clinical and imaging follow up was reported descriptively.
Results: A total of 52 patients with 64 procedures met the inclusion criteria. In 60(94%) of 64 procedures, successful haemostasis was achieved with suture-tourniquet technique. In 2(3.1%) of the 64 procedures, the suture broke while turning the tourniquet and haematoma occurred in another 3 procedures (4.7%) although suture-tourniquet technique was applied appropriately. Manual compression was performed in these patients. There were 3 major complications unrelated the suture-tourniquet technique.
Conclusion: The suture tourniquet technique can achieve haemostasis rapidly and can be safely used with low complication rates without fistulae thrombosis after large-bore venous sheath removal following treatment of AVF thrombosis.
Rebecca Renata Lapenda do Monte, Karina de Andrade Vidal Costa, Arnaldo Santiago Nunes Junior, Amalia Cinthia Meneses Rego and Irami Araujo-Filho*
Tamsulosin is used to treat Benign Prostatic Hyperplasia (BPH), prescribed annually to about 12.6 million patients worldwide. It is an alpha-adrenergic antagonist that reduces the tone of the prostate smooth muscle involved in the pathophysiology of BPH. By acting on alpha 1A receptors, predominant in the prostate, tamsulosin also acts on receptors present in the brain. This study consisted of a literature review aimed at disseminating scientific knowledge about the relationship between the use of tamsulosin and the onset of dementia. PubMed, Scopus, Scielo, Embase, and Web of Science studies involving dementia in patients using tamsulosin in the last five years were selected. The review showed a risk correlation and a higher incidence of dementia in treated patients. The risk ratio, when compared to other medicines, approached 1.20. In conclusion, it was identified the need for clinical trials with higher sampling power to increase relational significance due to the high prevalence of BPH and the extensive use of tamsulosin in elderly patients with the disease.
Agranulocytosis is one of the common reasons of consultation in hematology. It’s life-threatening because of an infection risk. The metamizole is a drug, known for its potential rare danger of inducing a severe agranulocytosis. However, it remains widely used because of its beneficial effect analgesic and antipyretic. We report in this study, a case of a girl who was 16 years old, referred for severe agranulocytosis, and appeared two weeks after treatment with Novalgin. The clinico-biological symptoms were dominated by Streptococcal septicemia with an infectious pulmonary and digestive focus. The blood cell count confirmed a severe agranulocytosis with total disappearance of neutrophils. Despite broad-spectrum antibiotic therapy and stimulation with hematopoietic growth factor, the clinical evolution was fatal in the short term. What motivates us to add this case to those of the literature in order to remind practitioners about the danger of this drug, and to promote has doubled of vigilance during use.
The proliferation and popularity of open source hardware and software, such as Arduino and Raspberry PI, together with IoT and Embedded System, has brought the health industry to rapid evolution, creating portable and low-cost medical devices for monitoring vital signals. Electrocardiographic (ECG) equipment plays a vital role for diagnosis of cardiac disease. However, the cost of this equipment is huge and the operation is too much complex which cannot offer better services to a large population in developing countries. In this paper, I have designed and implemented a low cost fully portable ECG monitoring system using android smartphone and Arduino. The results obtained by the device were tested comparing them with those obtained from a traditional ECG used in clinical practice on 70 people, in resting and under-activity conditions. The values of beats per minute (BPM), ECG waveform and ECG parameters were identical, and presented a sensitivity of 97.8% and a specificity of 78.52%.
Saroj Adhikari, Bhuvan Saud*, Govinda Paudel and Sunita Wagle
Trichosporonosis is a disease caused by Trichosporon spp. which are ubiquitous anamorphic yeast that commonly inhabit the soil. In human they are found in the skin, gastrointestinal tract and respiratory tract. Globally, Trichosporon spp. infection is rare and remains scantily reported in urinary tract infections and disseminated invasive infection amongst immunocompromised and cancer patients with neutropenia. Trichosporon asahii is the most commonly reported species. Virulence factors like proteinases, lipases, and phospholipases may be responsible for disease manifestation. We report a case of recurrent urinary tract infection due to Trichosporon spp. in a 62-year-old immunocompetent diabetic female which remained misdiagnosed for a long period of time. The patient was subsequently treated successfully by oral fluconazole drug.
This cross-sectional study was conducted to screen the presence of antibiotic residue in poultry. A total of 60 samples (30 Muscle and 30 Liver) were taken from local meat shops from different parts of Kathmandu valley. Disc assay method was used. Escherichia coli (ATCC 25922) and Staphylococcus aureus (ATCC 25923) were used as test organisms. The results revealed 8 positive samples (which is 13%). Among 30 Liver samples, 3 showed positive result, while only 2 muscle sample indicated positive result. Muscle has the highest percentage of positive results than liver. For S. aureus showed greater percentage of positive results than that of E. coli. The presence of antibiotic residue and its many pathological effects to public health demands the strict rules and regulations as well as surveillance from the concerned authorities.
Chronic prostatitis today show high level of relapses and recurrent pathological events even if using the best pharmacological therapy. A better understanding of physiopathological effect of ischemic hypoxic condition (pelvic, prostate tissue) and the lymphatic congestion in same body region contribute in evolution of a complex condition. The same focusing the strategy in biofilm reduction or in leukocyte infiltration can be a right way to reduce relapses and progression of the prostatic disease. Hypoxia is also related to prostatic cancer progression and prostatic biofilm if responsible of making a new micro- environment often drug resistance. A deep knowledge in this kind of phenomena can improve the clinical effect of drug therapy.
Letícia Raquel Baraky Vasconcelos, Paula Ferraz Rodrigues, Paula Liziero Tavares and Audryo Oliveira Nogueira*
Introduction: Disabling hearing loss refers to hearing thresholds superior than 40 dB in the better ear in the adults. The main cause of hearing loss in the elderly is the age-related hearing loss, also called presbycusis. This type of hearing impairment occurs as individuals grow older and is usually sensorineural hearing disorder greater for high-pitched sounds and affects both ears equally. It is estimated that 466 million people worldwide have disabling hearing loss, one third of which are over 65 years old.
Objective: To analyze the prevalence of disabling hearing loss in the elderly of Juiz de Fora.
Methods: Cross-sectional study with 122 patients. Pure tone audiometry was performed after meticulous physical examination of the external ear.
Results: Out of 122 older adults, 85 (69,6%) presented disabling hearing loss.
Conclusion: Hearing loss, specially disabling hearing loss, is a frequent condition in the elderly and has a big impact on their quality of life. For that it should be promptly diagnosed so treatment can be initiated.
Intraparenchymal cysts without communication to the ventricles or the subarachnoid space are named ependymal or epithelial cysts. The estimated ratio of their incidence compared with arachnoid cysts is 1:10. Neurologic deficit can occur when the cyst exerts mass effect on its surroundings. We report a case of cerebral ependymal cyst in a 75-year-old lady who presented with history of headache, vomiting and left incomplete homonymous hemianopsia. Neuroimaging studies showed a large right occipital cyst. She underwent the neurosurgical procedure of marsupialization. Histologic findings and the immunophenotype was consistent with a diagnosis of ependymal cyst. The patient made an excellent recovery after the procedure.
The use of enzyme linked immunosorbent assay (ELISA) for the detection of plant viruses is well documented. It proved to be a very valuable detection tools for the plant viruses. The efficiency of the ELISA technique was for practical purpose independent of the ratio of antibodies to antigen. This avoids the necessity of making specific enzyme conjugates for each antigen to be tested and eliminates the extreme specificity, thus allowing for quantitative evaluation of strain relationships. The advantages of indirect ELISA are sample. It needs only to be macerated and added to the plate. The crude antiserum could be used, although it should be cross absorbed before to prevent spurious host reaction. Single commercially available second antibody conjugate is utilized, thus eliminating the problems of preparing and storing many different conjugated antisera. Blotting technique has become widely used for specific identification of nucleic acid and proteins. This dot assay was modified to detect protein by spotting the antigen on a nitrocellulose membrane and incubating the membrane in test antibody followed by incubation in peroxidase-conjugated second antibody to the first antibody, and by development in 4-chloro-1-naphthol. The above procedure termed dot blot immunobinding assay (DBIA). The technique of tissue blotting on nitrocellulose membrane was described for detection of plant viruses in infected plants. Tissue blots were made by pressing with a firm and gentile force, the freshly cut tissue surface on nitrocellulose membranes. The possibility of using both sides of the nitrocellulose membrane (NCM) by tissue blot immuno assay (TBIA) for the detection plant viruses. In an effort to reduce the cost of virus assays, different types of regular paper were evaluated as possible replacements for the commonly used nitrocellulose membrane (NCM) as the solid phase in the tissue-blot immunoassay (TBIA) were used. Comparisons between different serological methods were demonstrated by many investigators Dot immunobinding was eight times more sensitive for detection of PVX and four times more sensitive for detection of PVS and PVY than DAS-ELISA.
Robert A Kerr*, Tatyana Zhebentyayeva, Christopher Saski and Lambert B McCarty
Goosegrass (Eleusine indica L. Gaertn.) is a troublesome weed in turfgrass systems throughout the world. The development of herbicide resistant ecotypes has occurred to multiple modes of action. Goosegrass is a prolific seed producer (~50,000 per plant), fast growing and diverse weed. Such growing attributes make it essential to have a better understanding of the genetic diversity of various ecotypes. The objectives of this study were to determine if morphologically distinct goosegrass ecotypes collected in Florida were phenotypically distinct and genetically different. Phenotypically, the goosegrass ecotypes can be classified as follows; dwarf, intermediate 1 (int_I), intermediate 2 (int_II) and wild. The dwarf had the least seedheads followed by the wild ecotype; 5 and 17 respectively, while int_I and int_II had highest number of seedheads; 22 and 34 respectively. The dwarf ecotype had lowest height of 6 cm and the wild ecotype had highest height of 36 cm. Dwarf and int_II ecotypes had shortest internode length of 0.2 cm and 1 cm, respectively, while the wild ecotype had longest internode length of 7 cm. The dwarf ecotype had lowest number of racemes per plant of 1, while the wild ecotype had highest number of racemes per plant of 7. Total biomass was lowest for the dwarf and int_II ecotype; 0.7 g and 1.5 g, respectively, and total biomass was highest for the wild ecotype at 5 g. Gene sequencing of two rice (Oryza) gene sequences (accession AP014964 (gene A) and AP014965 (gene B)) and subsequent phylogenetic analysis suggest the ecotypes are genetically different. Three single nucleotide polymorphisms (SNP) of interest were discovered indicating allelic differences between ecotypes.
Cowpea plants naturally infected with cowpea mosaic comovirus (CPMV) showed different mosaic, mottle, dwarfing, and vain clearing symptoms. Diseased plants were ollected from certain locations of Alexandria and El-Beheira governorates during the growing seasons from 2011 to 2012. CPMV was detected in infected sap at 8 to 24 days after inoculation by DBIA, indirect ELISA and tissue blot immunoassay (TBIA). Chlorotic local lesions were observed on Chenopodium amaranticolor in infectivity test. By using indirect ELISA and DBIA, CPMV were detected in infected plant sap of serial dilutions up to 1: 400. The incidence of CPMV in 21 day old cowpea seedlings grown from infected seeds was determined by ELISA and positive detection of virus antigen reached 65%. Nitrocellulose membrane and canson paper could be used as solid carriers in TBIA and DBIA for detection of CPMV in infected plant tissues. Results revealed that both faces of nitrocellulose membrane and canson paper could be used as solid carriers in TBIA for detection of CPMV in infected plant tissues. According to reverse transcription polymerase chain reaction (RT-PCR) assay of CPMV infected plant; the amplified product was approximately 800bp of partial coat protein gene. The nucleotide sequences accession number were LN606585 and LN606586. The phylogenetic tree was generated using sequences of CPMV isolates with the other CPMV records from GenBank.
Abamectin and emamectin are members of avermectin family which categorized as very effective but in the same time are toxic naturally. Most of products in this family are utilized as pharmaceuticals in both humans & animals and for crop protection.Despite avermectins are having complex chemical structures, but they are produced via synthesis in large scales for commercial use. Plant parasitic nematodes (PPNs) cause severe damages in all parts of their host plants, in addition to yield losses. The available strategies to control PPN include use of insecticides/nematicides but these have proved detrimental to environment and human health. Therefore, this scenario gave an opportunity for the utilization of avermectins (abamectin and emamectin) to control plant parasitic nematodes because of their chemical and biological properties, as well as relative safety. Avermectins have short half-lives and their residues can be eliminated easily through different food processing methods. Both abamectin and emamectin were very effective nematicides which proved capability of reducing PPNs significantly in various crops.
Panagiotis Korovessis*, Rania Antonaki, Spyridon Zacharatos and Vasileios Syrimpeis
<h2>Abstract</h2><p><strong>Study design:</strong> A consecutive case series study</p><p><strong>Purpose:</strong> To investigate whether Low Back Pain (LBP) in women with primary singleton pregnancy induces disability.</p><p><strong>Background:</strong> LBP is reported to be increased in pregnants than in non-pregnant women. Different outcome measures have been used to search for correlations between pain and disability.</p><p><strong>Methods:</strong> 167 pregnant women aged 30 ± 3.5 years participated. Two equal categorial age groups were constructed: Group A included women aged 23 - 29 years, and Group B women aged 30-39 years. Their weight was 76 ± 13 kg prepartum and the Body Mass index (BMI) was 28 ± 4 prepartum. Visual Analogue Scale (VAS) was used for LBP pain intensity and Oswestry Disability Scale (ODI) for disability estimation in the last three months prepartum and in the first three months postpartum.</p><p><strong>Results:</strong> The women weight was 67 ± 13 kg postpartum. The BMI was 24 ± 4 postpartum. There was no difference in VAS and ODI scores versus BMI, weight and height between the two age groups in both periods of observation: prepartum and postpartum. Prepartum, 81.4% of women claimed LBP that dropped to 55.5% postpartum. ODI score dropped from 19.5 ± 13.6% prepartum to 11 ± 12% postpartum. The ODI subscales that showed significant reduction postpartum were: Pain intensity (P = 0.002); working (P = 0.009); sitting (P = 0.004); standing (P = 0.003); sleeping (P = 0.008); and traveling (P = 0.006). VAS prepartum was increasing as the weight was increasing in both periods of observation (P = 0.015 and P=0.051) respectively. VAS prepartum was significantly correlated with BMI prepartum (P = 0.019) and postpartum (P = 0.028).</p><p><strong>Discussion:</strong> Physical disability in pregnant women was low and reduced following delivery. Disability was linked with LBP intensity, weight, BMI and height, but not with age or educational level.</p>
Natural killer (NK) cells, the third population of lymphoid cells, comprise 5%-25% of peripheral blood (PB) lymphocytes and represent the first line of defense against infections and tumors [1-7]. They can be derived from: bone marrow, PB, cryopreserved umbilical cord blood (UCB), human embryonic stem cells (hESCs), induced pluripotent stem cells (iPSCs), and various cell lines such as NK-92 and KHYG-1 [1].
Federica Frisina#, Giulia Valetti#, Giulia Zuccarini#, Luciano Conti# and Giorgio R Merlo*
Forebrain GABAergic neurons, the main inhibitory type of neuron in the cortex and hippocampus, represent a highly heterogeneous cell population that has been implicated in the predisposition to epilepsy and the onset of seizure. Earlier attempts to restore inhibition and reduce seizure in animal models of epilepsy have been carried out using embryonic basal forebrain tissue as source of immature GABAergic progenitors in cell-based therapies, with promising results. For therapeutic strategies this approach appears unrealistic, while the use of pluripotent stem cells to obtain immature GABAergic neurons opens new and promising avenues. Research on neural stem cells and pluripotent stem cells has greatly advanced and protocols have been established to efficiently direct progenitor cells to differentiate towards the GABAergic lineage. However, being highly heterogeneous, these neurons are difficult to be fully represented in vitro. Better knowledge on the expressed gene profiles, at single cell level, and the differentiation trajectory of these neurons will consent a more precise monitoring of the differentiation steps. Here we review the current literature about how to obtain and characterize genuine inhibitory neurons, how these can be grafted in animal models (and one day possibly in human) and which diseases could potentially be targeted and the efficiency of therapeutic outcome. The main obstacles that need to be overcome are: a) choice of an appropriate animal model, b) availability of human cells prone to GABA differentiation, c) the full representation of all IN subtypes, their proportions and their physiological activities, d) how to monitor them on the long-term after transplant.
Introduction: Sepsis is an important cause of morbidity and mortality among neonates. Neonatal sepsis can alter the glucose level and both hypoglycemia and hyperglycemia may occur. A high or low blood glucose level may have a significant effect on the outcomes in patients of neonatal sepsis. Aims: The aim of the study to see the glycaemic status and its effect on outcome of neonatal sepsis. Material and Methods: This hospital based prospective observational cross-sectional study was conducted in Neonatal Intensive Care Unit in Universal College of Medical Sciences, a tertiary care hospital over a period of 4 months, from May 2019 to August 2019. A total of 220 Neonates suspected sepsis under the age of 28 days admitted in NICU, were studied and included in our study. Clinically suspected neonatal sepsis cases were enrolled in the study. Venous blood was collected before giving any intravenous fluid, dextrose or antibiotics and blood sugar, complete blood counts, CRP levels and blood culture were send to laboratory within half hour of collection. All patients included in this study were treated accordingly and followed up strictly. Blood glucose level and mortality of neonates having hypoglycemia, hyperglycemia were analyzed among CRP and culture positive patients. Quantitative data were expressed as mean and standard deviation. Qualitative data were expressed as frequency and percentage and comparison carried by Chi-square (χ2) test. Results: A total of 220 patients clinically diagnosed as neonatal sepsis were studied. 118 (53.6%) patients were found CRP positive and 56 (25.5%) patients were blood culture positive. Glycaemic status was analyzed among CRP and culture positive patients. Majority (55.9%) patients were found normoglycemic, 35.5% were found hypoglycemic and 8.6% were found hyperglycaemic in this study. 182 (82.73%) patients were cured and 38 (17.27%) died. Mortality was high in hypoglycaemic patients (34.4%) compared with normoglycaemic patients (9.82%), but the difference was not statistically significant (p > 0.05) between two groups, the mortality was high in hyperglycaemic patients (58.33%) compared with normoglycaemic patients (9.82%) and the difference was statistically significant (p < 0.05) between two groups. Conclusion: Alteration of glycaemic status occurred in septic newborn. Mortality is higher among the septic newborn with hyperglycemia. The present study found that majority of neonate with sepsis had high mortality rate when blood glucose level were either more than 145 mg/dl or less than 45 mg/dl. This signifies the importance of meticulous blood glucose estimation in cases of neonatal sepsis to improve mortality outcome.
Evelyn Ngaithianven, JS Sehrawat* and Reetinder Kaur
Background: Nutritional status of expectant women is an important indicator of healthy pregnancy and an ideal birth weight of the infant. The present study is an attempt to understand food eating practices and related taboos among the Paite women and whether or how these practices influence weight gain among infants during their first year of life.
Methods: The longitudinal study was conducted for a period of 16 months between November 2010 and February 2012) among 186 Paite mother-infant pairs. Women who had completed 37 to 42 weeks of pregnancy were included. Infant’s weights were measured using standard technique and information on mothers’ food related practices was recorded during the house visit using a structured schedule. Standard statistical methods were used for description and analysis.
Results: A peculiar practice, ‘pica’ was observed among a few women. A number of food taboos were found to be followed by the ‘Paite’ women during course of their pregnancy.
Conclusion: No significant difference was noticed in the mean weight of babies from birth through the age of 1 year between mothers practicing and not practicing food taboos. However, it was found that the mean weight of the babies throughout the study period was comparatively higher among non-taboo mothers. It could be suggested that women must be counseled during their antenatal and postnatal visits to the maternity clinics and hospitals about dietary practices and their anticipated impact on health of the newborns.
Hesham Mohamed Aboul-Enein, Amr Elsayed El Naggar, Shereen Ibrahim Farag, Waleed Atef Ahmed Hassan*
Background and Objectives: Multi-slice computed tomography (MSCT) provides high accuracy for noninvasive assessment of coronary artery disease (CAD). The introduction of the latest computed tomography technology allows comprehensive evaluation of various aspects of CAD, including the coronary calcium score, coronary artery stenosis, bypass patency, and myocardial function. This study aimed to assess the effect of DM on coronary arteries evaluated by MSCT-CA Comparing Plaque Morphology in Diabetic patients with Non-Diabetic Whoever Controlled or not assessed by HbA1c. Methods: In this study we randomly assigned 150 adult patients were diagnosed with suspected coronary artery disease underwent MSCT-CA for evaluation their coronaries regarding luminal stenosis, Plaque analysis, Remodeling index, SSS, SIS and Ca score. Results: There was statistically significant difference between diabetics & non-diabetic groups in LM lesions with (P = 0.029). also, the results of multivariate logistic regression analysis after adjustment for age and sex, diabetics were shown a trend toward more mixed plaque with statistically significant {(OR): 3.422, 95% CI 1.66-7.023, P = 0.001}; whereas, after adjustment for age, sex, history of hypertension, smoking, and hypercholesterolemia, patients with diabetes also shown a trend toward more mixed plaque with statistically significant (OR: 3.456, 95% CI 1.668-7.160, P = 0.001). It means significant differences in coronary atherosclerotic plaque burden and composition between diabetic and non-diabetic patients, with a higher proportion of mixed plaques, a more vulnerable form of atherosclerotic plaque in diabetics (P < 0.001) otherwise No significant difference. Conclusion: MSCT angiography may be useful for the identification of CAD in diabetic and non-diabetic patients. There were statistically significant differences in coronary atherosclerotic plaque burden and composition, with a higher proportion of mixed plaques, between diabetic and nondiabetic patients. Furthermore, MSCT may give accurate information about plaque characteristics according to different coronary risk factors, thereby identifying high risk features warranting a more intensive anti-atherosclerotic treatment.
Laroussi Mohamed-Salem*, Tomas E Rodríguez-Locarno, Tatiana Moreno-Monsalve, Isabel Castellon-Sanchez, Jose F Contreras-Gutierrez and Antonia Claver-Valderas
Amyloidosis encompasses a heterogeneous group of disorders, characterized by extracellular deposition of insoluble abnormal amyloid aggregates, due to a failure in protein quality control. Cardiac amyloidosis is a disorder in which proteins misfold and deposit as amyloid fibrils that infiltrate the myocardial extracellular space [1].
Transthyretin (ATTR) and light chain (AL) are the most frequent types of cardiac amyloidosis. Transthyretin is a protein mainly synthesized by the liver, it may be hereditary or acquired from either wild-type (ATTRwt) or mutant (ATTRm) amyloid [2]. Cardiomyopathy is a common manifestation of ATTR amyloidosis with a particularly poor life expectancy of 2 to 6 years after diagnosis [3]. Although considered rare, the prevalence of this serious disease is likely underestimated because symptoms can be non-specific, and diagnosis largely relies on amyloid detection in tissue biopsies.
Ujuanbi Amenawon Susan*, Tabansi Petronilla Nnena, Otaigbe Barbara Edewele
Introduction: Congenital heart diseases (CHD) are leading causes of childhood morbidity and mortality especially in developing countries. Community-based studies are important in ascertaining the burden of the disease.
Objectives: The study was set out to determine the prevalence and types of CHD among primary school children in Port Harcourt Local Government Area (PHALGA) of Rivers State, Niger Delta, Nigeria.
Methods: A total of 1,712 primary school pupils were selected by multistage sampling from twelve schools in PHALGA. A questionnaire was used to obtain information from pupil’s parents on their child’s biodata and symptoms suggestive of heart disease. General physical and cardiovascular system examinations were carried out on each selected pupil, following which those with symptoms and/or signs suggestive of heart disease had echocardiographic confirmation of their cardiac status.
Results: The 1,712 subjects were aged 5-14 (mean 8.48 ± 2.30) years. 874 (51.1%) were females while males were 838 (48.9%). The study revealed that 31 pupils had congenital heart diseases confirmed by echocardiography, giving a prevalence of 18.1 per 1,000 pupils. The commonest cardiac defects seen were acyanotic CHD in 30 (96.8%) pupils while cyanotic CHD was seen in only one (3.2%) pupil. Among the acyanotic CHD, atrial septal defects (83.9%) followed by ventricular septal defects (9.7%) were the commonest. CHD occurred with higher frequency among females (64.5%) and among the younger age group of 5-9 years (61.3%) though these were not statistically significant (p > 0.005).
Conclusion: Cardiac examination as part of compulsory health screening at primary school entry will help detect children with CHD, reduce delay in diagnosis for intervention, avert debilitating morbidity and assure a better quality of life.
Erdem Cetin*, Celal Selcuk Unal, Aydın Keskin, Hakan Kartal
Objectives: We report our results regarding the use of BioPath™ paclitaxel-coated balloon catheters for superficial or distal external iliac artery revascularization via single retrograde popliteal access.
Methods: We included 105 prospective consecutive patients. Single retrograde popliteal access was achieved under ultrasound guidance with the patients laid prone. An over-the-wire atherectomy system was used if risk of distal embolization was high due to plaque intensity of the target lesion. A 4 to 7 mm-diameter BioPath™ 035 balloon catheter was used for all lesions. Follow-up at 6th month included doppler ultrasound examination for patency.
Results: Seventy-two patients (68.6%) had total SFA occlusion and 41 patients (39%) had concomitant external iliac artery involvement, out of whom 31 (29.5%) had total occlusion. Procedural success 90.5% for superficial femoral artery and 85.3% for external iliac artery. One-year patency rates in SFA and EIA were 84.8% and 80.4%, respectively
Conclusion: Single retrograde popliteal access and drug-coated balloon angioplasty may offer a useful alternative to known modalities in treatment of challenging superficial femoral artery and concomitant iliac artery lesions.
The natural history of chronic severe aortic valve regurgitation (AR) is characterized by a prolonged period of preserved global left ventricular (LV) systolic function and compensated eccentric hypertrophy, which insidiously gives way to myocardial decompensation [1].In its early stages, myocardial dysfunction may be reversible once implantation of a mechanical or bioprosthetic aortic valve eliminates the volume load. If left untreated, myocardial dysfunction becomes irreversible, a condition associated with high rates of morbidity and mortality [2]. The choice of optimal timing of aortic valve replacement (AVR) in patients with AR often poses a dilemma for clinicians. If AVR is performed at a time when LV function is normal, then the patient may be exposed unnecessarily to the potential hazards that accompany prosthetic valves. However, if surgical correction of the volume overload state is delayed excessively irreversible cardiac dysfunction may have already occurred and the outcome may be unsatisfactory [3]. The decision is to when to intervene for chronic AR depends primarily on the symptomatic status of the patient and the potential for normalization of ventricular and myocardial performance after AVR [4]. Measuring LVEF as a surrogate for myocardial performance is problematic in the setting of chronic AR because LVEF is augmented by increased preload and is therefore limited in detecting subtle myocardial dysfunction. Thus, there is a clinical need for quantitative noninvasive parameters to assess myocardial function in the setting of altered loading conditions and to predict postoperative LV systolic dysfunction [5]. The aim of the study is to assess the validity of new echo-Doppler indices for prediction of postoperative LV dysfunction 6 months after AVR.
<p>The problem of synchronization of oscillations of various physical nature is discussed. From the standpoint of the theory of synchronism, a model of the heart is considered as a system of four connected between self-oscillating links: two atria and two ventricles. The synchronous and asynchronous operating modes are considered at sinusoidal and relaxation oscillations. A computer program has been compiled that simulates the fluctuations in the heart using four differential equations. Four examples of calculation according to the program are given for asynchronous and synchronous operation modes. The possibility of evaluating the ablation procedure from the perspective of a computer model is discussed.</p>
Background: The treatment of chronic lymphoid leukemia currently uses news drugs which are more expensive in our countries. Its why, the results of chemotherapy remains a challenge in our sector.
Aims: To evaluate the place of polychemotherapy in the treatment of chronic lymphoid leukemia in black Africa.
Methods: It was a prospective, descriptive, analytic and non-comparative study, concerning the records of patients with chronic lymphoid leukemia treated and followed at the department of clinical hematology in Abidjan.
Results: We included 56 patients. The average age was 62 years with extremes of 38 and 84 years. The sex ratio was 0.8 in favor of female. The clinical signs noted a tumor syndrome among which splenomegaly, classified stage III (46, 43%) and adenopathy (64, 29%). Biologically, we observed a blood lymphocytosis (50%), an anemia (39.29%) and a thrombocytopenia (62.50%). The majority of patients were classified stage A of BINET (51.79%). The COP protocol (44.64%) and the monochemotherapy with chlorambucil (39.29%) were the most used. The therapeutic response of polychemotherapy was low (12.5%) compared to 35, 71% for monochemotherapy (p = 0.0001) with overall survival significantly better in monochemotherapy. The outcome of patients used polychemotherapy were more adverse that of patients used chlorambucil alone (p = 0,003). The overall probability of survival at 12 months was 90, 9% for patients who used monochemotherapy and 63, 4% for polychemotherapy.
Conclusion: Polychemotherapy in chronic lymphoid leukemia of black African has an adverse therapeutic response hence the interest of using new therapeutic possibilities.
The development of reproducible rodent models of coronary microvascular disease (MVD) is essential for the early detection, treatment, and mechanism study of the pathophysiology. We hypothesized that endothelial dysfunction and subsequent microthrombi in the coronary arterioles, two early events in clinical coronary MVD, could be reproduced by photochemical reaction (PCR) technology in mice hearts. After rose bengal (one of photosensitizers) was administrated systemically, a green light was locally used to activate the photosensitizer, inducing over-production of oxidative stress in the heart. Following PCR, animals demonstrated reproducible endothelial injury, occlusion in arterioles, focal ischemia, and infarct-let with preserved cardiac function. Our technique has proven to be a reliable and reproducible means of creating coronary MVD in mice. We believe that this is an ideal model for developing a novel molecular tracer for earlier detection of coronary MVD, for testing new anti-fibrinolytic drugs, and for investigating the complex pathophysiology of coronary MVD. The protocol for establishing this model takes about thirty to forty minutes.
Dioum M*, Sarr EM, Manga S, Mingou JS, Diack A, Diop AD, Bindia D, Diagne PA, Sarr AN and Diop IB
Anomalies of coronary artery origin are congenital malformations characterized by the abnormal birth of a coronary artery from the controlateral coronary aortic sinus (birth of the left coronary artery from the right sinus or birth of the right coronary artery from the left sinus).The artery concerned has an abnormal initial path between the aorta and the pulmonary artery; this segment is most often intramural, in the aortic wall. They are rare with a prevalence (0.1% to 0.3% of the population).
Introduction: Klippel-Feil syndrome (KFS), is a bone disorder characterized by the abnormal joining (fusion) of two or more spinal bones in the neck (cervical vertebrae), which is present from birth. Three major features result from this abnormality: a short neck, a limited range of motion in the neck, and a low hairline at the back of the head. In some individuals, KFS can be associated with a variety of additional symptoms and physical abnormalities which contribute in the deterioration and complication of the condition of the child.
Aim of presentation: Here, we report five children from Kosovo with KFS associated with different heart abnormalities, clinical presentation, diagnosis, management, and outcomes of selected conditions in resources-limited settings.
Methods: Retrospectively we analysed medical reports of five children, diagnosed at different age with congenital disease and clinical and lab signs of Klippel-Feil syndrome.
Conclusion: Basing on our cases, all diagnosed in a small country as a Kosovo, we can conclude that KFS is not such a rare condition. In addition, such syndrome is not so rarely associated with different congenital heart disease. In four cases cardiac surgery was indicated and successfully was done abroad Kosovo in the lack of such services in Kosovo.
Chadi Yazbeck*, Asma Boukadida, Christian Chauvin, Anne Laure Margulies and Segolene Falcone
<h2>Abstract</h2><p><strong>Background:</strong> The effect of salpingectomy on ovarian response is a matter of debate. Due to conflicting data, alternative techniques were developed to perform salpingectomy for treatment of hydrosalpinges in infertile patients. This study aims to evaluate the effect of salpingectomy on ovarian response after stimulation with gonadotropins.</p><p><strong>Methods: </strong>In a retrospective analysis, one hundred fifty-seven patients with tubal infertility were divided into three groups according to their surgical histories: bilateral salpingectomy (BS group); unilateral salpingectomy (US group); and no history of salpingectomy (NS group). Ovarian response and IVF outcomes were compared between groups by analysis of variance. Prognostic factors for ovarian response were estimated by linear regression models.</p><p><strong>Results: </strong>In the BS group, the total numbers of oocytes retrieved, and embryos obtained were significantly lower than those in the NS group (p = 0.02). Poor ovarian response was also more frequent in the BS group (p = 0.02). In the US group, follicle development was reduced on the operated side. This effect was more pronounced when salpingectomies were performed for hydrosalpinges than when performed for ectopic pregnancies, and significant decreases were observed in follicle recruitment (p = 0.005) and oocyte retrieval (p = 0.02) on the operated side.</p><p><strong>Conclusion:</strong> Salpingectomy could have a minor negative effect on ovarian response. This is particularly true with bilateral salpingectomies, in which the ovarian blood supply could be disrupted, with no possible compensation by the contralateral side.</p>
For over twenty years, following the creation of space stations, MIR first and then the ISS (International Space Station) men (3 to 6) live and succeed each other continuously about 300 - 400 km of altitude to make scientific experiments. For this reason sending men into space has become an activity “almost banal or regular “but this remains potentially a very dangerous environment for the adapted manon Earth and thus requires medical monitoring to ensure the health of astronauts and the persistence of their ability during their mission. In general, the medical benefits on Earth of space conquest go far beyond envy and the need for man to discover the cosmos but to develop many tools medicines to also offer solutions for all living beings on Earth!
Rique AM, Madeira M, Luis L, Fleius MLde F, Paranhos NF and Lima I*
This work aims to evaluate cortical porosity through a high-resolution peripheral quantitative micro-tomography in a group of 47 patients. All patients, in vivo, were subjected to the medical care protocol of the University Hospital Clementino Fraga, 020-213. Patients were women aged from 37 to 82 years old, who did not present fractures in their lower and upper limbs, all of them showing good health. During screening, they were required to have normal BMD (as determined by DXA; T-score ≥ 1.0) and no low-trauma fractures history. The exclusion criteria for all the individuals enrolled in this control study include, for example, alcoholism, chronic drug use, and chronic gastrointestinal disease. Male patients ranging from 42 to 79 years old presented the same health issues as women group. Results showed an increase in the amount of pores on the cortical bone of the evaluated patients over time; however, this increase was also observed in pore diameter, as well as a decrease in the border between the cortical and trabecular bone, indicating a deterioration in cortical bone quality over the years.
Erdem Cetin*, Celal Selcuk Unal, Aydın Keskin and Hakan Kartal
Objectives: We report our results regarding the use of BioPath™ paclitaxel-coated balloon catheters for superficial or distal external iliac artery revascularization via single retrograde popliteal access.
Methods: We included 105 prospective consecutive patients. Single retrograde popliteal access was achieved under ultrasound guidance with the patients laid prone. An over-the-wire atherectomy system was used if risk of distal embolization was high due to plaque intensity of the target lesion. A 4 to 7 mm-diameter BioPath™ 035 balloon catheter was used for all lesions. Follow-up at 6th month included doppler ultrasound examination for patency.
Mostafa A Abolfotouh*, Hallah Al-Anazi and Samar Hassan
<h2>Abstract</h2><p><strong>Background:</strong> Previous studies highlighted the negative effect of premature progesterone elevation (PE) during IVF cycles on the cycle outcomes. The aim of this study was to assess the validity of progesterone level on hCG day (P4) in the prediction of IVF/ICSI cycles’ outcome.</p><p><strong>Methods:</strong> In a retrospective cohort study, all fresh cycles of 256 patients who underwent IVF or ICSI cycles in 2017 at reproductive endocrinology & infertility unit/ Obg/Gyn department at King Abdulaziz Medical city, Riyadh, Saudi Arabia, were followed up. They were started on gonadotropin medications for ovarian hyperstimulation, followed by serial transvaginal U/S and serum estrogen levels each visit. Patients having 2 or more 18mm follicles were triggered by hCG 10,000 IU and ovum pickup was done 34-36 hrs after. Data were collected on patients’ characteristics [age, BMI infertility type], cycles’ characteristics [number of follicles and endometrium thickness on hCG day, P4 and estrogen levels], rates of pregnancy and pregnancy outcomes. Receiver operating characteristic curve was applied to determine the cut-off of P4 that corresponds with a negative pregnancy test. Logistic regression analysis was used and significance was considered at p - value of ≤0.05.</p><p><strong>Results: </strong>Pregnancy rate in the study sample was 36.7%. The mean P4 level in cycles with negative pregnancy tests was significantly higher than the mean in cycles with positive tests (p = 0.018). After adjusting for confounders, significant negative association between P4 and pregnancy rate was evident (p < 0.03). The optimum trade-off of P4 for prediction of a negative pregnancy test was 1.5nmol/L. This cut-off level had a 59% sensitivity, 51% specificity and 68% positive predictive value and 10% & 15% absolute and relative risk reductions respectively. Cycles with mean P4 of ≥1.5nmol/L were significantly associated with primary infertility (p = 0.011), lower mean BMI (p = 0.009) higher mean estrogen level (p < 0.001), lower live birth rate (p = 0.048), higher abortion rate (p = 0.039), and higher ovarian hyperstimulation rate (p = 0.027).</p><p><strong>Conclusion:</strong> Premature elevation of progesterone level on the hCG day in IVF/ICSI cycles may have adversely impacted the pregnancy rate and pregnancy outcome. The cutoff point of 1.5nmol/L for this P4 was not valid in predicting pregnancy outcomes.</p>
Naoufal Chouaib*, Said Jidane, Mounir Lekhlit, Ahmed Belkouch, Tahir Nebhani, Saad Zidouh and Lahcen Belyamani
Stroke following coronary interventions is a devastating and most dreaded complication with signiβicant morbidity and mortality. Various factors have been ascribed for this complication including the technical errors [1]. A small percentage of strokes are iatrogenic, including those associated with invasive cardiac procedures. According to the literature, it is a rare complication of left heart catheterization [2]. Percutaneous coronary intervention is increasingly used to treat patients with diffuse atherosclerosis, acute coronary syndromes and even high-risk patients such as low ejection fraction [1]. The authors describe a patient who underwent percutaneous coronary intervention in the context of inferior infarction, which was complicated by ischemic stroke during cardic catheterization.
Background: In this study, we aimed to investigate the role of prognostic factors on breast cancer survival in Iran.
Methods: This study was carried out using data from 500 participants with breast cancer. Data were gathered from medical records of patients referring to four breast cancer research centers in Esfahan, Iran, between 1990 – 2000. Age at diagnosis (year), size of tumor, Involve lymph nodes, tumor grade, and family history and married were the prognosis factors considered in this study. A Cox model was used.
Results: The median follow-up period was 29.71 months with the interquartile range of 19-61 months. During the follow-up period, 57 (10%) patients died from breast. The Cox model showed that number of lymph nodes involved, and the tumor size and grade tumor are the prognostic factors survival in breast cancer.
Conclusion: This study, confirmed the importance of early diagnosis of cancer before the involvement of lymph nodes and timely treatment could lead to longer life and increased quality of life for patients.
Aarudhra Premchander, Seema Channabasappa, Nischala Balakrishna* and Neha Nargis
<p><strong>Background:</strong> Corneal injuries are significant contributors to blindness. Cornea being the most anterior structure of eye is exposed to various hazards like airborne debris and blunt trauma. By understanding different types of injuries to which cornea is exposed, the practitioner maybe more capable in managing injuries to minimise structural and visual sequelae.</p><p><strong>Objectives:</strong> To study various patterns of corneal injuries and its visual outcome among patients of ocular trauma in a tertiary care hospital. <strong>Methods:</strong> Study of 100 cases of corneal injuries wherein patients were treated according to injury type and followed up for 4 months.</p><p><strong>Results:</strong> Majority of patients belonged to working population between age groups 21-65 years. Most patients suffered from corneal abrasions while the least common were perforating and lacerating injuries. Alkali injuries were more common than acid injuries. Most patient presented within 24 hours and had only epithelial defects. Therefore, the number of patients receiving conservative management was higher than those receiving surgical intervention.</p><p><strong>Conclusion: </strong>Most common causes of blindness and low vision in our study was full thickness corneal laceration and corneal abrasions, foreign body injuries affecting the pupillary area and involving anterior or mid stroma causing nebular or macular grade opacities hampering vision.</p>
Significance: Due to the limited number of reported cases little is known about the characteristics of unilateral retinitis pigmentosa. Information from additional case reports can aid in learning more about the condition. We report a case of retinitis pigmentosa that has remained unilateral for 28 years and review the available literature.
Case Report: A 40-year-old Caucasian female presented for an opinion as to the cause of her vision loss. Fundus autofluorescence demonstrated hypoautofluorescence in the midperipheral retina and a hyperautofluorescent ring surrounding the area of preserved photoreceptors in the macula. Optical coherence tomography showed disruption of the ellipsoid zone and the external limiting membrane. Electroretinography (ERG) showed severely reduced rod and cone function monocularly.
Discussion: Retinitis pigmentosa is typically bilateral and symmetric. Unilateral retinitis pigmentosa is a rare condition that manifests with only one eye having changes typical of retinitis pigmentosa. The unaffected eye can have no signs of retinitis pigmentosa and must have a normal ERG after long-term follow up. It is critical to rule out inflammatory, traumatic, toxic, and cancer associated retinopathy that can present with retinal pigmentary changes. Unilateral retinitis pigmentosa generally remains unilateral, but long-term follow up with ERG is important. There is currently no treatment that can stop the process of retinitis pigmentosa, but gene therapy shows promise.
Obesity has become a worldwide Epidemic affecting more than 300 million people. Overweight is defined as BMI (Body Mass Index) of 25-29.9 kg/m2. Obesity is defined as BMI greater than 30 kg/m2, and Morbid Obesity is a BMI of > than 35 kg/m2 [1].
Many Dialysis patients are overweight. Dialysis patients that are labeled morbidly obese based on BMI, may not be able to be listed on the Transplant list. Some Dialysis Clinics require a BMI less than 35 kg/m2 and some require a BMI < than 40 kg/m2. Hence, many obese dialysis patients are asked to lose weight, and we all know that Renal Transplant provides a better quality of life [2].
Because each transplant center may use different criteria for eligibility, patients and members of the dialysis team should be aware of the BMI criteria for the referral transplant center. Patients who are not eligible for the transplant due to obesity should receive counseling emphasizing a healthy lifestyle and weight loss [3].
Successful weight management requires a multidisciplinary approach encompassing health care team members. They consist of the following: Renal Dietitian, Social Workers, Nurse, Exercise Physiologist and a Physician [6].
Jose Osvaldo Barbosa Neto*, Joao Batista Santos Garcia, Thiago Alves Rodrigues and Camila Freitas de Andrade Rodrigues
Introduction: Erdheim-Chester disease (ECD) is a rare and diffi cult-to-treat non-Langerhans cell histiocytosis characterized by the excessive production and accumulation of histiocytes. This study reports a case of ECD, emphasizing both its diagnosis, assessment and treatment of the pain associated with the disease.
Case Report: Six years ago, a 39-year-old male patient presented with generalized pain of moderate intensity in the lower limbs that involved periods of greater intensity associated with ambulation. The diagnosis of histiocytosis associated with panhypopituitarism and adrenal insufficiency was proposed. For a specific diagnosis, a bone lesion biopsy was performed, revealing the presence of histiocytic proliferation that was CD1 negative, S100 protein positive, and CD68 negative. Therefore, the diagnosis of non-Langerhans histiocytosis known as ECD was confirmed. During the two years that followed, the patient presented with severe bone pain, particularly in the lower limbs and cranial vault, and the pain subsided to a certain extent with the use of tramadol and paracetamol. Because of the pain, the patient was unable to walk and became bedridden As the patient remained in severe pain, even after the administration of morphine, the opioid was changed from morphine (60mg/day) to oxycodone (30mg/day) for a convenient dosing schedule; furthermore, the oxycodone dosage was scheduled to increase to 40mg/day that same week. The patient experienced significant pain reduction, requiring rescue analgesia only once or twice a week.
Conclusion: To the best of our knowledge, this is the first case report on the characterization and treatment of pain specific to ECD, and we highlight that the patient had a good response to treatment.
Sardar Rezaul Islam*, Majedul islam, Shah Alam Sarkar and Shah Paran
<h2>Abstract</h2><p><strong>Background: </strong>Varicocele therapy is a controversial issue. No single approach is adopted as the best therapeutic option. Testes get blood supply from testicular artery, cremasteric artery and artery to the vas deference. So ligation of testicular artery in the abdomen do not cause ischemia to the testis. This was already demonstrated in many studies. Classical Palomo varicocelectomy also consists of open ligation of testicular vessels in the retroperitoneum. En mass ligation of testicular vein and artery is technically easy and fast in laparoscopic varicocelectomy (LV). Chance of missing some veins are also less. Henceforth recurrence is also less. Recurrence and post-operative complications are high when only testicular vein is ligated by laparoscopy in the retroperitoneum. We wanted to see the outcome of laparoscopic varicocelectomy by mass ligation technique.</p><p><strong>Methods:</strong> 56 patients of symptomatic varicoceles were included in the study from the outpatient services. Symptomatic varicoceles of grade 2 to grade 3 were operated from January 2012 till January 2019 over a period of 7(seven) years in Jahurul Islam Medical college Hospital. The patients were selected for dull pain and ugly veins not for infertility. All were operated by laparoscopy with en-mass ligation of testicular vein and artery in the retroperitoneum. They were followed up for a period of six months after surgery. We collected all the data in a retrospective manner.</p><p><strong>Results: </strong>The average operation time was 27±3 minutes. Average post-operative hospital stay was 32±7 hours. There were no technical failures requiring conversion to open varicocelectomy. There was no incidence of hydrocele formation nor testicular atrophy. One patient of bilateral varicocele had 50% reduction of his varicocele. We considered this a recurrence. All other patient had complete reduction of varicocele. One patient developed hemo-peritoneum due to dislodgement of hemo-clip, which required laparotomy. He did not require any further surgery for his varicocele.</p><p><strong>Conclusion: </strong>Laparoscopic varicocelectomy with mass ligation technique is safe, effective, less time consuming and easy to perform. Recurrence and post-operative complications are minimum. Plastic hemo-lock should be used rather than titanium heom-clip for ligation of testicular vessels. There is no incidence of testicular atrophy or any adverse effect on testis.</p>
Subhi Mansour, Sharbel Khouri, Maisa Andraous and Safi Khuri*
Hemangiomas are known as congenital vascular malformations that can affect almost any organ or tissue, with the liver being the most common intra-abdominal organ to be involved. It is well known that hemangiomas are the most common benign tumours of the liver, and develop in about 4-20% of people, mainly young adult females. Recently, due to the dramatic rise in the use of imaging studies for different purposes, a parallel increase in the incidence of these tumours has been noticed. Most liver hemangiomas are small (less than 4cm in diameter), asymptomatic and found incidentally during abdominal operation for other indication or on radiologic studies. Giant liver hemangioma is defined as hemangioma with a diameter of more than 5cm. This unique and uncommon type of haemangioma usually poses therapeutic challenges for the treating physician, especially hepatic surgeons, due to the unclear natural history, and due to the risk of life threatening complications is yet to be established. While it is already proved by several studies that conservative management of giant hepatic hemangioma is safe, it is not known whether observation of the extremely large hepatic hemangioma (tumours larger than 10cm) is safe as well.
The aim of this article is to review the English literature to find out if conservative management of the extremely giant liver hemangioma is safe and can be recommended.
Joana Ferreira*, Olinda Miranda, Alexandre Lima Carneiro, Sandrina Braga, Joao Correia Simoes, Celso Carrilho, Amílcar Mesquita and Jorge Cotter
The objective of this paper is to emphasis the AngioCT features of carotid dissection/mural hematoma. The image show an internal carotid artery with narrowly eccentric lumen surrounded by a crescent-shaped hypodense mural thickening, with a visibly enhancing vessel wall. The carotid hematoma is a hypodense mural thickening that leads to expansion of the arterial wall, compression of the lumen and release of thrombogenic factors by intimal damage. Hematoma between the intima and media causes vessel expansion diameter and a narrow eccentric lumen. Peripheral hyper density is due to the contrast enhancement of the vasa vasorum in the adventitial layer. The physician should be familiar with the imagiologic features of carotid arterial disease, due to the diferent treatment options.
Salem Y*, Omar Y, Dorsaf S, Sonia M, Samir B and Olfa B
Pierre Maria and Sainton syndrome or cleido-cranial dysplasia (CCD) is a rare syndrome presenting an autosomal pattern of inheritance, characterized by characterized by a triad: clavicular aplasia, delayed ossification of the fontanelles and sutures of the vault of the skull. To these may be added multiple dental inclusions.
Myriam Ben Salah*, Hafedh Abdelmelek and Manef Abderraba
Increased exposure to electromagnetic fields such as radio frequencies used by Wifi technology raise questions and concerns about their impact on health. For answer these questions, several scientifi c studies have carried out followed by results publication in prestigious scientifi c revues.
Vincenzo Accurso*, Santoro M, Contrino AD, Casimiro P, Raso S, Carlisi M, Sardo M, Perez A, Di Piazza F, Russo A and Siragusa S
Essential Thrombocythemia (ET) is currently classified as a Philadelphia negative myeloproliferative neoplasm (MPN) together with polycythemia vera (PV) and primary myelofibrosis (PMF); the latter can be further divided in pre-fibrotic primary myelofibrosis (pre-PMF) and overt myelofibrosis, as listed in the revised 2016 World Health Organization classification of myeloid malignancies (WHO 2016). Overall, respect to the others MPNs, ET is characterized by favorable prognosis, lower life expectancy if compared to the control population, increased risk of thrombohemorrhagic complications along with possible evolution in myelofibrosis and leukemic transformation. In this review the authors will review current knowledge on biology, clinical aspects, prognosis and stratification of thrombotic risk, therapeutic options and outcome in ET patients.
Daniel B Levin, Umar Malik, Ihab Ajaaj, Jon P Blaschke, Betty Skipper, Sandra L McClelland, Kathleen Fagan, Antonia M Harford, Philip G Zager and Veena Raizada*
<h2>Abstract</h2><p><strong>Introduction</strong>: Pulmonary hypertension (PH) is prevalent in hemodialysis (HD). In the general population, more women than men have PH due to left ventricular (LV) disease with preserved ejection fraction (EF). Little is known about the gender-specific prevalence of PH and associated LV abnormalities in patients with end stage renal disease (ESRD) on HD. Our aim was to evaluate gender differences and LV structural and functional changes in PH among ESRD patients on HD.</p><p><strong>Methods</strong>: Ninety-four patients (ages 23-77 years) underwent echocardiography after HD. Patients were divided based on estimated pulmonary artery systolic pressure (PASP) (Group A PASP < 40 mm Hg, Group B PASP ≥ 40 mm Hg). LV measurements included LV mass, LV internal dimensions, and LV ejection fraction (EF). LV diastolic function (LVDF) was assessed from mitral inflow deceleration time (DT) and E/A ratio.<br /><br /><strong>Results</strong>: Fifty-five patients (59%) had PH, including 32 of 49 men (65%) and 23 of 45 women (51%). LVEF was lower in Group B (46.4 ± 17.6 vs. 62.4 ± 14.4%, p < 0.001). Men with PH had higher LVIDd, cm (5.52 ± 0.89 vs 4.78 ± 0.75, p < 0.001), LVIDs, cm (3.75 ± 0.94 vs 3.14 ± 0.91, p = 0.03) LV mass, g (236 ± 74vs 189 ± 56, p = 0.02) and lower LVEF (40.0 ± 16.7 vs 52.0 ± 15.6, p = 0.008) than women.<br /><br /><strong>Conclusion</strong>: Patients on HD have a high prevalence of PH. PH was not associated with clear LV structural changes. There was a depression in LV systolic function without changes in LVDF. PH patients were more often men with hypertrophied LV with depressed LV systolic function.</p>
Aim and objective: Dentistry for children is not difficult but is different from what is practiced for adults. The children reacts to differently to people and places around them. Anxiety is an emotional state that helps normal individual defend themselves against a variety of threats and Dental anxiety refers to patients specific response towards dental suitation-associated stress. So the aim is to evaluate the anxiety related management of the children using intellectual mind game of the individual.
Study design: The background of the study is to evaluate and study the effectiveness of anxiety control of children using colour distraction between 5 and 12 yrs of age group as one part and the intellectual distraction of children between the same age group using buchanan facial imaging scale and intellectual coloured game chart
Results and conclusion: lowering of anxiety was noticed in the children obtained the favorite colours in the dental environment and easy distraction can be achieved using intellectual gamings.
Jennifer Miao, Joel Estis, Yan Ru Su, John A Todd and Daniel J Lenihan*
Background: Current guidelines for diagnosis and management of heart failure (HF) rely on clinical findings and natriuretic peptide values, but evidence suggests that recently identified cardiac biomarkers may aid in early detection of HF and improve risk stratification. The aim of this study was to assess the diagnostic and prognostic utility of multiple biomarkers in patients with HF and left ventricular systolic dysfunction (LVSD).
Methods: High-sensitivity cardiac troponin I (cTnI), N-terminal pro b-type natriuretic peptide (NT-proBNP), interleukin-6 (IL-6), endothelin-1 (ET-1), pro-matrix metalloproteinase-9 (pMMP-9), and tumor necrosis factor-alpha (TNF-α) were measured using single-molecule counting technology in 200 patients with varying stages of HF. Plasma detection with cross-sectional associations of biomarkers across all HF stages, and advanced-therapy and transplant-free survival were assessed using multivariate analysis and Cox regression analyses, respectively.
Results: NTproBNP, pMMP-9, IL-6 were elevated in early, asymptomatic stages of HF, and increased with HF severity. Higher circulating levels of combined IL-6, NTproBNP, and cTnI predicted significantly worse survival at 1500-day follow-up. Cox regression analysis adjusted for ACC/AHA HF stages demonstrated that a higher concentration of IL-6 and cTnI conferred greater risks in terms of time to death, implantation of left ventricular assist device (LVAD), or heart transplantation.
Conclusion: Biomarkers of inflammation, LV remodeling, and myocardial injury were elevated in HF and increased with HF severity. Patients had a significantly higher risk of serious cardiac events if multiple biomarkers were elevated. These findings support measuring NTproBNP, cTnI and IL-6 among patients with HF and LVSD for diagnostic and prognostic purposes.
Benlafqih C, Bouhdadi H*, Bakkali A, Rhissassi J, Sayah R and Laaroussi M
Blunt chest trauma leads to a wide range of lesions, relatively minor parietal injuries to potentially fatal cardiac lesions, making diagnosis and management difficult. The diagnosis is currently facilitated by imaging, however, these lesions may go unnoticed and be discovered late through complications.
We report the case of a neglected heart wound revealed by a heart failure. This case is notable due to a favourable outcome despite a delay in diagnosis due to a lack of pericardial effusion and the absence of cardiac symptoms, and a long delay from injury to appropriate treatment in the presence of a penetrating cardiac wound deep enough to cause a muscular ventricular septal defect and lacerate the anterior mitral leaflet.
Osteoarthritis is the most common form of arthritis, affecting millions of people worldwide.
Aim of our study was to assess the clinical and the cytogenetic characteristics in longlivers with osteoarthritis from Precarpathian region (Ukraine).
Methods: Cytogenetic, Clinical
Results: All of the subjects were separated into three groups: І group - 146 longlivers patients who had hypertension and osteoarthritis (ОА); II group - 93 longlivers patients only with ОА. The control (third) group included 130 patients aged 90-102 years without osteoarthritis and hypertension in anamnesis. In the age group more than 95 years, men and women of both groups were significant difference (p<0,05) to be compared with control.
Cytogenetic characteristics of the long-livers with on osteoarthritis showed that most there is a tendency for a higher frequency of chromosomal aberrations in male long-livers and tere are significant difference among control (p<0,05). The number of chromosomes associated in a single cell was significantly higher (p<0,05) in both groups compared to control.
Conclusion: The importance of this study resides, to the best of our knowledge, in the fact that the largest group of patients in Ukraine was analyzed and assessed.
Asthma is a chronic inflammatory disease of the airways characterized by airway inflammation, bronchial hyperresponsiveness, reversible airflow obstruction and recurrent symptoms. Patients often present with coughing, wheezing, dyspnea, and chest tightness, were they usually responds to the mainstay of treatment that relies on inhaled glucocorticoids (ICS), and long acting β2 agonist (LABA), along with leukotriene. In around 20% of the patient’s morbidity, mortality and cost of therapy increased because they fail to benefit from the existing gold standard therapy regimen. Both immunoglobulin-E (IgE), interlukin-5 (IL-5) had proven to play important major role in asthma pathogenesis. Over the past two decades biologic therapy that targeting IgE begins the era in treating severe asthma, and recently anti-IL-5, revealed major role in eosinophils maturation, activation, survival, and recruitment process of severe asthma. The different biologic therapy that is currently available in the market are supported by solid evidence from controlled randomized clinical trials, to guide the clinician on the type of patients that will benefit from the therapy, with an insight on the appropriate monitoring parameters and patient evaluation plans. This review was conducted by searching PubMed, EMBASE, and Google Scholar to identify peer-reviewed clinical trials, guidelines, and review articles published in English in the role of biologic therapy in severe asthma. The main aim from publishing this review is to summarize the current available evidence on the approved biologic therapy in treating patients with severe asthma.
Yvonne A Efebera*, Amy S Ruppert, Apollinaire Ngankeu, Sabrina Garman, Prasanthi Kumchala, Alan Howard, Steven M Devine, Parvathi Ranganathan and Ramiro Garzon
Allogeneic hematopoietic stem cell transplant (alloHSCT) is a curative treatment for many hematologic malignancies. Unfortunately, about 30-50% of all recipients undergoing alloHSCT develop acute graft-versus-host-disease (aGVHD), which is associated with high morbidity and mortality [1,2].Treatment of aGVHD involves the use of immune suppressive drugs such as high dose of steroids that leads to further immunosuppression and risk for opportunistic infections. Often patients are refractory to steroids therapy making the prognosis dismal. Thus, it is critical to identify robust biomarkers to detect aGVHD before onset of clinical symptoms so that therapeutic strategies can be implemented that may result in better treatment responses and less toxicity.
For last decades diabetes type 2, blood’s pressure (especially hypertension) and relating diseases are most serious problems for much people over the world. These diseases are not like other different diseases then for studying them very accuracy, this research choose sample from different societies a small city called “Al-Mejar Al-Kabeer” in south of Iraq. People of this city do same activities than other Iraqi cities and during the last twenty years the only change happened in this city is; they changed them drinking water from tap water to commercial water called it R.O. Population of this city is about 70000 persons and about 20000 from them have diabetes that means more than 28% from all people of this city have this disease, this ratio or may be more for hypertension.
Results of this research show that the main reason for diabetes type 2, blood’s pressure and relating diseases is civilization. It shows according good evidences that the right treatment for diabetes, hypertension and relating diseases is about 5g/day potassium ions (K+) with less amounts from sodium ions such as 2:1. In fact, insulin forming from known amino acids so each body need sufficient amounts from these acids therefore the right treatment for diabetes type 2 is not only potassium it must there sufficient amounts from proteins each day or each three days.
References of this research indicated; Diabetes and hypertension are well understood but this research find that these diseases need a chemist touch to be fully understood.
Objective: The present study aimed to evaluate the accuracy of the Omron HBP-9031C automated oscillometric upper-arm blood pressure (BP) measurement device for blood pressure monitoring, according to the ANSI/AAMI/ISO 81060-2:2013 protocol (ANSI/AAMI/ISO).
Participants and Method: The device evaluations were performed in 85 participants, who fulfilled the inclusion criteria of the protocol. The validation procedure and data analysis followed the protocol precisely.
Results: In the ANSI/AAMI/ISO 81060-2-2013 validation procedure (criterion 1), the mean ± SD of the differences between the test device and reference BP was 0.5 ± 7.84/-1.9 ± 6.30 mmHg (systolic/diastolic). The mean differences between the two observers and the Omron HBP-9031C were 0.5 ± 6.69 mmHg (range, −18 to 15 mmHg) for systolic BP and -1.9 ± 5.63 mmHg (range, −17 to 14 mmHg) for diastolic BP, according to criterion 2. The two criteria of the ANSI/AAMI/ISO were fulfilled.
Conclusion: The professional OMRON BP monitor, HBP-9031C fulfilled the requirements of the ANSI/AAMI/ISO validation standard and can be recommended for clinical use.
Background: The present study was conducted to assess effect of cigarette smoking on different denture base material.
Materials & Methods: The present study was conducted in the department of Prosthodontics. A total of sixty wax specimens in the shape of circular discs were prepared. These were divided into two groups. Group I (30) specimens were heat‑cured denture base materials and group II (30) specimens were flexible denture base materials. Both specimens were further divided into four subgroups of 15 each. Subgroup I was heat‑cured denture base material specimens (control group), subgroup II was flexible denture base material specimens (control group), subgroup III was heat‑cured denture base material specimens exposed to cigarette smoking (study group) and subgroup IV was flexible denture base material specimens exposed to cigarette smoking (study group). The initial (IRa) and final (FRa) surface roughness was measured before and after smoking test of the specimens.
Results: It was observed that in group I, mean IR (µm) value was 0.182 and FR value was 0.572. In group II, mean IR (µm) value was 0.265 and FR value was 0.831. In group III, mean IR (µm) value was 0.195 and FR value was 1.892. In group IV, mean IR (µm) value was 0.291 and FR value was 1.892. The difference was significant (P< 0.05).
Conclusion: The surface roughness of the specimens fabricated from the flexible denture base material was found to be more compared to heat‑cured denture base specimens after exposure to cigarette smoke. There is need to educate the patients regarding cleanliness of denture to avoid infection in the oral cavity.
Results: It was observed that in group I, mean IR (µm) value was 0.182 and FR value was 0.572. In group II, mean IR (µm) value was 0.265 and FR value was 0.831. In group III, mean IR (µm) value was 0.195 and FR value was 1.892. In group IV, mean IR (µm) value was 0.291 and FR value was 1.892. The difference was significant (P< 0.05).
Conclusion: The surface roughness of the specimens fabricated from the flexible denture base material was found to be more compared to heat‑cured denture base specimens after exposure to cigarette smoke. There is need to educate the patients regarding cleanliness of denture to avoid infection in the oral cavity.
Methods: Forty eyes were included in this prospective study divided in two groups: with contact lens (CL) and without contact lens (WCL). A line scan pattern of the corneal incisions were acquired using a Spectral domain OCT system immediately after the surgery, and at postoperative days 1, 7 and 30. Incisions were analyzed regarding length, location, angle, architecture, and anatomic imperfections.
Results: All incisions were located temporal or nasal superiorly. The average wound length was 1.28 + 0.18mm and the mean incision angle was 49 + 9 degrees. The average wound length of the WCL group mean was 1.24 + 0.17 mm and the mean incision angle was 51 + 8 degrees. Comparing groups for the length and the angle, the incisions measurements were not statistically significant. Anatomic imperfections were observed at the first day postoperative in 12 eyes for CL group and in 13 eyes for the WCL group. No patient presented endophthalmitis during the follow-up.
Conclusion: Epithelial imperfection was observed in two patients in the WCL group with spontaneous resolution. The CL group had the highest length and lowest angle of corneal incision. Using contact lens to prevent wound construction imperfection appears not to be a good option. Further studies using a greater number of patients with an architectural analysis of clear corneal incisions are needed to confirm these preliminary results.
Chinawa JM*, Adiele KD, Ujunwa FA, Onukwuli VO, Arodiwe I, Chinawa AT, Obidike EO and Chukwu BF
Background: Early diagnosis and improved facilities are necessary for determining the optimal timing of surgery and other interventions in children with congenital heart diseases in Nigeria. This is because late presentation, late diagnosis and delayed surgery can lead to mortality and affect the quality of life among these children.
Objectives: This review article is aimed at enumerating the timing of cardiac surgeries and other interventions and to seek if there is any factor associated with the timing of cardiac surgery.
Methods: A search on PubMed database, World Health Organization libraries, Google scholar, TRIP database, and reference lists of selected articles on timing of cardiac surgery in children was done. The Cochrane Database of Systematic Reviews was also searched. We noted few data from African setting. Key words such as timing of cardiac surgery; children, congenital heart defect were used.
Conclusion: Appropriate timing for cardiac surgery in children with congenital heart disease is very important as late surgical intervention could result in several morbidities and mortality.
Ayodeji Ayodele Fabunmi* and Samson Oluwaseyi Oladipupo
<h2>Abstract</h2><p>Patellofemoral pain syndrome is common among athletes who participate in jumping, running and pivoting sports. The aim of this study was to compare selected lower limb biomechanical variables between University of Ibadan students (athletes) with and without patellofemoral pain syndrome.</p><p>The research design for this study was a case control survey and a purposive sampling technique was used to recruit participants. Two hundred and twenty two (191(85.8%) males and 31 (14.2%) females) sportsmen participated in this study. The participants’ age was between 20-29 years. Fourty sportsmen tested positive to Clarke’s test while 27 sportsmen tested positive to Eccentric step test. Measurements of static quadriceps angle, hamstring tightness and navicular height were taken for all participants.</p><p>Data were analyzed using descriptive statistics of mean, standard deviation, percentages and inferential statistics of Independent ‘t’ test.</p><p>The mean lower limb biomechanical variables of participants with patellofemoral pain syndrome were 13.18 ± 2.37°, 106.46 ± 16.11° and 1.21 ± 0.61 cm while those without were 13.65 ± 2.46°, 128.95 ± 25.36° and 1.03 ± 0.58 cm for static quadriceps angle, hamstring tightness and navicular height respectively. There was no significant difference (<em>p</em> > 0.05) in selected lower limb biomechanical variables between participants with and without patellofemoral pain syndrome.</p><p>In conclusion there was no significant difference in static quadriceps angle, hamstring tightness and ankle pronation between participants with and without patellofemoral pain syndrome. It was recommended that PFPS development is probably multifactorial with other functional disorders of the lower extremity apart from the selected variables.</p>
Fanny Granger, Marion Etevenard, Jean-Pascal Kily and Martin Garet*
<h2>Abstract</h2><p><strong>Context:</strong> Shoulder pain is one of the most frequent reported complaints in intensive competitive swimming. The so-called ‘swimmers’ shoulder’ has been widely explored and has been reported sometimes without specific reference to contributing mechanisms or structures. Somatic dysfunction is defined as an impaired or altered function of related components of the somatic system and may appear in the early stage of pain feeling.</p><p><strong>Aim</strong>: To evaluate somatic dysfunctions in a group of young competitive swimmers with and without shoulder pain and its relationship with the shoulder’s mobility along with the efficacy of an osteopathic manipulative treatment (OMT) on shoulder’s mobility, pain, and comfort of swimming.</p><p><strong>Material and method</strong>: 20 competitive swimmers (14.6±1.3 ys; 11.6±2.4 hs.wk-1) were divided into two groups, with and without shoulder pain (SPG / CG). Before and after light touch/OMT, and 1 week later, somatic dysfunctions, shoulder’s range of mobility, pain, and swimming comfort were assessed by 2 independent osteopaths.</p><p><strong>Results</strong>: Somatic dysfunctions were observed in both groups without significant differences in the number or localization and were independent of severity of pain. In the SPG, pain decreased significantly after OMT (6.1±1.9 vs. 3.9± 1.8; P=0.001) and remained stable 1-week later (P=NS). Shoulder’s mobility was lower on the aching shoulder in the “shoulder pain” group when compared to the control group on flexion and abduction tests but not on extension or adduction tests. Following OMT, only abduction improved when compared to light touch. Comfort in swimming was reported as “better” in both OMT/light touch groups.</p><p><strong>Conclusion</strong>: There is no difference between light touch and OMT as both decreased pain and increased comfort in swimming but abduction range of motion only improved in the OMT group.</p>
Nanocontainers of the type CuO, ZnO and CeMo were developed in the present work and incorporated into commercial paints. The nanocontainers were filled with bromosphaerol (CuO and ZnO), SeaNineTM 211 (CuO and ZnO), and 8Hydroxyquinoline (CeMo). The new resulting paints were tested in the lab and in the sea via painting a fraction of two ships. The outcome of this work is encouraging demonstrating that the new nanotechnology-based paints yield to superior commercial paints that may present a major milestone in the new generation of marine paints.
The study proved that in gully systems with the largest catchment area ranging from 5.0 to 28.8 km2, the degree of dismemberment of gully systems is small, varies mainly from 1 to 3 km / km2, less often from 3 to 5 km / km2. As can be seen, the average annual growth of ravines is 0.34 ... 7.48 m in length, 0.20 ... 2.48 m in width, 0.10 ... 1.16 m in depth. The intensity of erosion development (ravine, planar, etc.) is mediated by their catchment area. Moreover, the degree of division of individual gully systems here is not dependent on their catchment area, moreover, the greatest dissection is observed in gully systems that have the smallest catchment area, which is associated with the conditions of their location.
Background: Paroxysmal nocturnal hemoglobinuria (PNH) is a rare acquired hematologic condition which could be revealed by deep venous thrombosis. It could be fatal unless correctly treated.
Case report: We report here the case of a 28 year-old male with no medical history who was admitted to the emergency room for severe abdominal pain. Computerized Tomography angiography (CT) scan revealed portal vein thrombosis. Laboratory findings showed pancytopenia with severe regenerative normocytic anemia resulting in PNH. Because of the lack of Eculizumab, treatment was first based on curative anticoagulation until bone marrow transplant, with no success.
Conclusion: PNH remains a severe disease with bad prognosis unless treated with Eculizumab.
For something that’s literally as old as the universe, dark matter doesn’t get much attention outside scientific circles. Maybe that’s because, other than a short-lived SyFy series and a late-period Randy Newman album, this nebulous star stuff has had a tough time breaking the pop-culture barrier. But the truth is that today, dark matter has never mattered more. Our own Milky Way is embedded in a massive cloud of it, we’re looking for its interactions deep inside the earth, and there are whole galaxies without it. So what is dark matter, anyway? Why can’t scientists get enough of the stuff, even though they can’t actually find it? What deep, dark secrets does it hold? And could it ultimately shape the future of life as we know it?
Nurses play a vital role in acute care hospitals and health care delivery. The purpose of this research study is to identify the nurse’s perception of the Clinical Ladder Program at their hospital and the correlation it has on the nurse’s job satisfaction and their professional development.A quantitative study will be conducted using two convenience samples from Alexian Brothers Hospital and Saint Anthony’s hospital with a total of 52 nurses who are currently participating in the clinical ladder program. The results of this research should be used as opportunities for improvement within the nursing profession at an acute care hospital. This project is beneficial in advancing nursing knowledge and practice because many nurses do not understand why participating in this advancement program can positively impact many aspects of their role at work aside from being a nurse, such as role and identity development at their workplace. Implementing clinical advancement programs in a facility can also increase quality of patient care delivery by retaining excellent nurses. These nurses can demonstrate their It is important in the field of nursing to actively seek improvement and education in practice to keep up with the new evidence-based research practices that are developed daily. The Clinical Ladder Program has become a widespread program in various acute care hospitals for nurses to increase their professional role development.
Mohamed Anouar Dendane, Achraf El Bakkaly*, Zakaria Alami Hassani and Abdelouahed Amrani
Subungual exostosis (SUE) is a benign phalangeal tumor of an osteocartilaginous nature [1]. SUE is most commonly diagnosed in children and young adults; most of these lesions are located in the big toe, although they can occur (albeit infrequently) in other toes. We report five observations of SUE described in young children under 10 years and discuss the particularities of this pathology in the pediatric population.
Pedro Agnel Dias Miranda Neto*, Hortência Biatriz de Melo Santana, Vanessa Maria das Neves, Hermerson Sousa Maia, Thayna Milena Nunes Franca and Rosana Karla Costa
Introduction: Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis (Bacillus of Koch), and presents chronic evolution affecting the lungs frequently.
Objectives: Analyse, in the state of Maranhão, the epidemiological prevalence of tuberculosis between 2014 and 2016.
Materials and Methods: Documentary and descriptive study of secondary data collected in the database of the dates, epidemiological information and morbidities, between 2014 and 2016.
Results: 3,897 cases of tuberculosis in the state of Maranhão were recorded. The most affected age range was 15 to 59 years, totaling 3,111 cases, for both gender; of 60 to 79 years, 577 cases were totaled.
Conclusion: Tuberculosis affects more adolescent males from adolescence to old age, and it is necessary to promote knowledge of the disease for the population in order to advance in the control of the same and obtain satisfactory clinical results.
Conclusion: Tuberculosis affects more adolescent males from adolescence to old age, and it is necessary to promote knowledge of the disease for the population in order to advance in the control of the same and obtain satisfactory clinical results.
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.
In this message, I will give an overview of the main recommendations in the European guidelines under two headings: diagnosis and treatment and I will conclude by comments.
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. In this message, I will give an overview of the main recommendations in the European guidelines under two headings: diagnosis and treatment and I will conclude by comments.
Abdelaziz Raji*, Houda Mounji, Youssef Rochdi, Hassan Nouri and Mehdi Elfakiri
Background: Cochlear implants (CI) are nowadays a widely accepted treatment for sensorineural hearing loss SNHL.
Aim: This study aimed to describe the epidemiological characteristics and the surgical approach and to evaluate the outcomes of our experience in cochlear implantation.
Setting: Department of Otolaryngology-Head and Neck Surgery of University Hospital Mohammed VI Marrakech Morocco.
Methods: A retrospective chart review was conducted on 113 patients with severe to profound hearing loss who underwent a cochlear implantation between 2007-2018.
Results: There were 65 females and 48 males with severe to profound bilateral deafness, of whom 103 had prelingual deafness. The mean age of pediatric cochlear implantation was 5.25 years. Implantation was unilateral in all patients. The procedure was followed by regular adjustments and speech therapy. The evaluation was carried out by the same team each month during the first 6 months, then every 6 months. The average duration of follow-up was 37.54 months. All patients benefited from their implants with inter individual variability.
The good results were correlated with early implantation, significant parental investment and a steady follow-up of speech therapy.
Conclusion: Cochlear implantation has revolutionized the management of severe to profound deafness. It is a safe and effective technique when it is aimed at correctly selected populations.
Alsacia Atanasio-Nhacumbe* and Carlos Francisco Sitoe
A survey was carried out to determine the prevalence and seasonal variations of eggs of gastrointestinal nematodes in goats in four provinces of Mozambique, from November 2016 to October 2017 in Tete and Cabo Delgado, and from November 2016 to October 2018 in Maputo and Gaza. In each province, flocks were selected from both lowlands, located within the valleys of the rivers, and uplands which are located outside the valleys. Faecal samples were collected at monthly intervals to monitor faecal egg counts fluctuations. The modified McMaster technique was used for quantitative analysis of nematode eggs and for detecting cestode eggs in faecal samples. The sedimentation technique for detecting trematode eggs in faecal samples was used. A total of 2 703 samples were examined for nematode eggs and 2 587 for trematode eggs. Faecal examination indicated that between 18% and 100% of goats sampled were infected with gastro-intestinal nematodes. The prevalence varied according to the season of the year and the ecological conditions. The highest prevalence and worm egg counts were recorded at about the peak of the rainy season. Strongyloides papillosus, Calicophoron spp., Fasciola spp. and Schistosoma mattheei eggs were also found. Moniezia expansa and Moniezia benedeni eggs were found in all the four study areas but its prevalence was low and irregular. Based on the results of this study, which showed a clear seasonal pattern, strategic anthelmintic medications to effectively control helminth infections in goats in the different ecological zones of Mozambique are suggested.
In 1901, ABO system of blood groups was determined by Karl Landsteiner. It is present in different organisms like rodents, primates that includes chimpanzees, bonobos etc. The blood groups type in this system depends on some genes that are specific ABO gene. Arachnophobia is the dread of creepy crawlies and different creature like spiders. Individuals suffering from arachnophobia generally feels uneasy in any place where they accept that they could harbour arachnids or their existence for example, webs. 100 samples of blood from volunteers were used for Blood group test. The Blood groups were tested and results were recorded after the test all the used kits were discarded. The results shows that there is no clear cut difference between the arachnophobic males and non-arachnophobic male’s percentages, so no relation found in males. Similarly, in females both phobic and non-phobic ladies have no differences in their result values so, no relation was found. Whereas, in case of arachnophobic males and females comparison no relation was found. So, there is no relationship between ABO blood group system and arachnophobia and there may be a relation between non-phobia and AB+, B+ blood group in males whereas, in females only B+ blood group have relation with non-phobia.
Solar lentigo is defined as an alteration in cutaneous pigment deposition on account of exposure to ultraviolet radiation. Solar lentigo is a benign, pigmented lesion with a characteristic increment in the quantification of pigmented keratinocytes. It can manifest as a dark brown spot on the skin.
Galia ZA Awean, Khalil Salameh*, Hala Elmohamed, Hoor Alshmayt and Mohamed Riad Bur Omer
Urinary tract infection (UTI) is one of the extremely popular causes of febrile illness in children, demanding antimicrobial therapy [1]. Overall, 8% of females and 2% of males, experience at least one incident of UTI by seven years of age, and recurrence takes place in up to 30% during a year [2].
Escherichia Coli has been known as the commonest causative organism of the majority of urinary tract infections in children with prevalence ranging from 80-90% [3]. Extended-spectrum beta-lactamases (ESBL) are enzymes produced by Gram-Negative Bacilli (GNB), accountable for fighting against penicillin, cephalosporin and aztreonam [4].
Transaldolase TALDO deficiency is a rare autosomal recessive disorder of the pentose phosphate pathway. It has variable presentations with poor outcome when present early in life. We present a young Saudi infant with a fatal early presentation of TALD deficiency.
Child abuse remains a complex issue affecting individuals, families, groups and society, and one which WHO prevalence figures show as a significant ongoing problem. The nature of the abuse, be it physical, sexual, psychological, or neglect, places the child at high risk of experiencing the multiple sequelae of the trauma. Depending on the child’s country, the disclosure of abuse by the child or a third party will either be moved into criminal justice system or directed to the medico-psycho-social sector.
In 1985, in Belgium, specialist teams were established to evaluate and support situations involving child abuse. More than thirty years later, we considered it opportune to update the parameters that our team has developed based on four reflexive themes. The first discusses the transformation of our society, families and individuals, exploring how each influences the others. The second theme describes the diagnostic process, holding in mind the complexity of any situation. The third theme describes the reasoning behind these teams, considering this as a de-judicialisation of such situations. Finally, we describe the different treatments available. This paper describes the evolution of clinical practice including developments in several aspects that have arisen through handling situations of abuse.
Sanjeewani Fonseka*, B Subhani, V Alahakoon, CN Wijeyaratne, IB Gawarammana, NS Kalupahana, N Ratnatunga, S Rosairo and PVR Kumarasiri
<p><strong>Background: </strong>Polycystic ovary disease (PCOD) is an endocrine disorder. It leads to menstrual disturbances, infertility, obesity and dermatological manifestations such as hirsutism and acne which leads to impaired health-related quality of life (QOL).</p><p><strong>Aims: </strong>To evaluate the perceived health related QOL in patients with PCOD treated with ethinyl oestradiol (35µg)/cyproterone acetate (2 mg) (EE/CPA) and ethinyl oestradiol (20 µg)/ desogestrel (0.15mg) (EE/DES) alone and in combination with low-dose metformin.</p><p><strong>Methods: </strong>A total of 117 patients with PCOD diagnosed according to Rotterdam Consensus Criteria 2003 with a hirsutism score of 8 or more according to modified Ferriman-Gallway Score (mFGS) were randomised to receive one of four drug combinations (arm A – EE/CPA, arm B- EE/DES, arm C- EE/CPA plus metformin, arm D- EE/DES plus metformin). The outcomes assessed were body mass index (BMI), hirsutism (using mFGS) and health-related QOL (Polycystic Ovary Syndrome Health- Related quality of life Questionnaire (PCOSQ) and a Visual Analog Scale (VAS) score) at baseline and 12 months after treatment.</p><p><strong>Results: </strong>PCOSQ score in relation to the hirsutism, emotions, menstruation, obesity, infertility and VAS score in relation to hirsutism and obesity had improved at the end of 12 months (p< 0.001) in all treatment arms. There was no difference between treatment arms in all measured outcomes at baseline and at the end of 12 months.</p><p><strong>Conclusion:</strong> Treatment with EE/CPA and EE/DES is associated with an improvement in perceived QOL in patients with PCOD. The addition of low-dose metformin did not have a significant benefit.</p>
Vehbi Gunes*, Gultekin Atalan, Latife Cakir Bayram, Kemal Varol, Hanifi Erol, Ihsan Keles and Ali C Onmaz
A male, 4 days old and 20 kg Simmental calf was evaluated for regurgitation and hyper salivation since birth. The mother became pregnant by artificial insemination and the pregnancy was the second of the mother. A membrane closed the pharynx and a diverticulum on dorsal of this membrane was seen during oropharyngeal examination through inspection. Membrane was also viewed by endoscopy under general anaesthesia. Larynx and oesophagus were imaged by bronchoscopy through the back side of the membrane. After these applications, it was decided that soft palate adhered firmly to the root of tongue causing congenital atresia. Surgical treatment of oropharyngeal membrane was carried out under general anaesthesia. Firstly, tracheotomy was performed for to ease breathing and membrane removed by electrocautery application. Intensive fluid accumulation and oedema formation at the incision area were detected by endoscopic examination following operation and the calf had severe dyspnoea two days after operation and died due to respiratory insufficiency. At necropsy, severe inflammatory reaction, laryngeal oedema and intensive salivation at the surgical side was determined. Direct imaging techniques should be used to determine in the closed oropharyngeal lumen. Moreover, nasopharyngoscopy should be considered to image larynx and oesophageal way. Present case is the first report with concern to pharyngeal membrane formation together with direct imaging and surgical procedures. Therefore, it was considered that this case report could be useful for colleagues and literatures.
Left ventricular outflow tract obstruction is a well-recognized feature in hypertrophic cardiomyopathy but can occur in other clinical scenarios when anatomically susceptible heart is subjected to permissive physiological conditions that provoke systolic anterior motion of the mitral valve (SAM): ie, reduced preload, increased inotropic state, and decreased afterload.
This report describes a case of hemodynamically significant latent LVOTO that was associated with hypotension, syncope, acute myocardial ischemic ECG changes, and an increase in cardiac enzymes. (Type II myocardial infarction) in a non HCM patient with excessive anterior mitral valve tissue.
Standardized method of seed treatment is of prime importance in the production of groundnut. The study was to carry out control trial using bark extract (aqueous and ethanol) and oil (seed) of mahogany (Khaya senegalensis) on seven (7) isolated fungi from two groundnut varieties (peruvian and valencia).The result shows that both mahogany bark and seed extracts are capable of inhibiting mycelial growth of all the isolates. There was no significant variation between the aqueous and ethanol bark extracts in-vitro, however the in-vivo test shows a significant difference between the aqueous and the ethanol bark extract in which the ethanol extract reduced growth of the pathogens more than the aqueous. For all the pathogens except Rhizopus stolonifer there was no growth between 50% to 100% concentration of the Khaya senegalensis oil in-vitro, however in-vivo control at 50% produced scanty to moderate growth for all the pathogens except Rhizopus stolonifer on peruvian, while there was full coverage on the seeds of valencia variety with Aspergillus niger and Rhizopus stolonifer having total coverage though Pseudaiiescheria boydii and Cylindrocarpon lichenicola were effectively inhibited and showed no growth at the 50% and 100%. Further research to focus on the quantifying the chemical constituents and formulation are suggested.
D Martinez-Lopez, D Jover-Rios, P Esteve-Atienzar, J Mendez-Mora, A Mendez-Jover, F Caparros-Hernandez, V Jorda-Climent, C Segui-Perez, M Segui-Perez, C García-Cervera, JM Nunez-Cruz, J Guzman-Martinez, I Hernandez-Isasi, D Bonet-Tur, S Banon-Escandell, J Peris-García, P Roig-Rico, A Perez-Fullana and JM Seguí-Ripoll*
Chronic kidney disease (CKD) is a highly prevalent disease, imposing high mortality rates worldwide, and it is closely related to cardiovascular events. Vitamin D deficiency is very prevalent in patients with CKD from the earliest stages of the disease, and it has been associated with higher mortality. In order to assess the prognostic implications of vitamin D deficiency in CKD, we undertook a literature review, searching different databases in October 2018 for publications related to vitamin D in patients with CKD and hypovitaminosis D, and not on dialysis. The main cause of death in these patients is cardiovascular disease. Vitamin D is one of the first parameters that CKD changes and has an important prognostic role in this entity. Deficient levels in blood are associated with increased cardiovascular risk and survival impacts, independently of cardiovascular disease. Treatment with paricalcitol appears to reduce this risk. However, the evidence analyzed is insufficient to establish an association between vitamin D levels and the progression of kidney disease.
Juliana Amaro Borborema Bezerra, Carlos Teixeira Brandt*, Daniel Mozart Bezerra Borborema, Arthur Quirino Ramos, Matheus Rodrigues de Souza and Fernanda Andrea Menezes Florencio Maciel
Introduction: Obesity may cause progressive chronic kidney disease. Weight loss in the postoperative follow-up of bariatric surgery may improve renal function in these patients. Thus, the purpose of this study was to give insight on the subject using a sensible biomarker.
Methods: This cross sectional study was performed in the Obesity Department from Campina Grande – Paraiba, Brazil. It was randomly enrolled 23 postoperative patients (7 bypass and 16 sleeve), with at least two years of follow-up, from the outpatient Department and 29 (18 bypass and 11 sleeve) in the preoperative period for bariatric surgery. They were homogeneously from both genders with ages ranging from 25 to 57 years. Serum levels of creatinine and cystatin C were measured, and the glomerular filtration rate (GFR) was estimated using the CKD Epi (chronic kidney disease epidemiology collaboration) cystatin-creatinine equation. The investigation was approved by the Ethics Committee.
Results: The mean body mass index (BMI) of the preoperative group was significantly greater than the postoperative group (p ≤ 0.0001). The mean serum levels of C cystatin was significantly greater in the postoperative group as compared to preoperative (p= 0.0197). However, there was no mean difference between creatinine serum concentrations comparing the two groups (p = 0.3252). The mean glomerular renal function rates of the groups were similar (p = 0.1240).
Conclusion: There is no definitive evidence for supporting the hypothesis that there is improvement in the kidney renal function after bariatric surgery in obese patients. Prospective cohorts are necessary to enlighten the answer for this important question.
Background: Drosophila models of amyotrophic lateral sclerosis (ALS) have been widely used in understanding molecular mechanisms of ALS pathogenesis as well as discovering potential targets for therapeutic drugs. Mutations in the copper/zinc superoxide dismutase (SOD1) cause ALS by gain of toxic functions and induce toxicity in fly motor neurons.
Results: In this study, we have determined that human carbonic anhydrase I (CA1) can alleviate mutant SOD1-induced motor neuron toxicity in the transgenic fly model of ALS. Interestingly, we found that motor neuron expression of CA1 could independently induce locomotion defect as well as decreasing the survival rate. In addition, CA1-induced toxicity in motor neurons is anhydrase activity-dependent. Mechanistically, we identified that both SOD1- and CA1-induced toxicity involve the activation of eIF2α in the ER stress response pathway. Downstream activation of the JNK pathway has also been implicated in the induced toxicity.
Conclusion: Our results have confirmed that SOD1-induced toxicity in fly motor neuron also involves endoplasmic reticulum (ER) stress pathway. More importantly, we have discovered a new cellular role that CA1 plays by antagonizing mutant SOD1-induced toxicity in motor neurons involving the ER stress pathway. Such information can be potentially useful for further understanding disease mechanisms and developing therapeutic targets for ALS.
Mauro Luisetto*, Behzad Nili Ahmadabadi, Ahmed Yesvi Rafa, Ram Kumar Sahu, Luca Cabianca, Ghulam Rasool Mashori and Farhan Ahmad Khan
Aim of this work is to produce a general theory related an new depurative strategy to be devalued for reduce or delay some spinal cord and brain degenerative and inflammatory chronic disease or acute traumatic condition. It is used and informatics approach in order to set correct the problem and the process. Scope of this project is to submit to the researcher a new therapeutic strategy (under a depurative- toxicological-pharmacological) in this complex kind of disease. A Turing machine theory say us a method to TRASLATE the need of a strategy in a practical hypotesys of work. A global conceptual map can help in this field.
Аnna P Bogachuk*, Zinaida I Storozheva, Andrey Т Proshin, Vyacheslav V Sherstnev, Irina V Smirnova, Tatyana M Shuvaeva and Valery M Lipkin
Aim: The work was to perform a comparative study of the neuroprotective and nootropic activities of two pharmaceutical substances, the HLDF-6 peptide and its amide form (HLDF-6-NH2).
Materials and Methods: We used in the study healthy adult male Wistar rats aged 180–200 days weighing 280–300 g. We modelled ischemic stroke in rats by chronical occlusion of carotid arteries. Solutions of the HLDF-6-NH2 and HLDF-6 peptides were administered intranasally. Cognitive functions we assessed with Novel object recognition test and Morris maze.
Results: The amide form of HLDF-6 peptide is more efficient: the neuroprotective activity of HLDF-6-NH2, evaluated by improvement of cognitive functions in animals, surpassed that of the native HLDF-6 peptide. A dose of 250 µg/kg of HLDF-6-NH2 peptide resulted in practically complete restoration of the disturbed functions. In the model of ischemic stroke, the amide form of the peptide significantly excelled the reference substance mexidol both in the effective dose and biological activity.
Conclusion: The results of study of the agent allow hoping for its success in further clinical investigation. In view of high demand for the agent and in case of successful clinical trials, it will surely become widely used in clinical practice in treatment of IS.
Sunitha V, Jeyastri Kurushev, Felicia Chitra and Manjubala Dash*
Sleep influences each intellectual and physical health. It’s essential for a person’s well-being. The reality is when we see at well-rested people, they’re working at an exclusive degree than people making an attempt to get by way of on 1 or 2 hours much less nightly sleep. Loss of sleep impairs your higher tiers of reasoning, problem-solving and interest to detail. Sleep deficit will additionally make people much less productive and put them at higher danger for creating depression. Sleep affects almost each tissue in our bodies. It influences growth and stress hormones, our immune system, appetite, breathing, blood pressure and cardiovascular health. Nurses play a foremost function in teaching and guiding the sleep deprived patients on the importance of sleep and its physiological and psychological effects.
Seyda Yavuzkir, Suna Aydin*, Melike Baspinar, Sevda Korkmaz, Murad Atmaca, Rulin Deniz, Yakup Baykus and Mustafa Yavuzkir
Background: Growing evidence has revealed that fear and anxiety related situations could affect cardiac parameters. P wave dispersion (Pd) is an important index. In the present study, we aimed to evaluate Pd values in patients with premenstrual dysphoric disorder.
Methods: The study was composed of twenty-five female patients with premenstrual dysphoric disorder and same number of healthy controls. Pd, Pmin and Pmax values were determined by electrocardiogram (ECG) in the subjects.
Results: It was found that patients with premenstrual dysphoric disorder had considerably higher Pmax and Pmin values compared to those of healthy subjects. Pd was also significantly higher in patients with premenstrual dysphoric disorders than that of healthy subjects.
Conclusion: Study suggests that patients with premenstrual dysphoric disorder seems to have increased Pd, as can be seen in anxiety and fear related clinical conditions, considering that this group of patients have an increased trend to cardiac abnormalities, particularly cardiac arrythmias. To access strong conclusion, it is required novel studies with larger samples.
Charles Fauvel, Michael Bubenheim, Olivier Raitiere, Charlotte Vallet, Nassima Si Belkacem and Fabrice Bauer*
Background: The prognostic signifi cance of impaired left ventricular (LV) relaxation and increased LV stiffness as precursor of heart failure with preserved ejection fraction and death is still largely unknown in apparently healthy subjects.
Methods: We constituted a cohort of 353 patients with normal ejection fraction (>45%) and no significant heart disease, based on a total of 3,575 consecutive left-sided heart catheterizations performed. We measured peak negative first derivative of LV pressure (-dP/dt) and operating chamber stiffness (Κ) using a validated equation. Patients were categorized as having: 1) normal diastolic function, 2) isolated relaxation abnormalities (-dP/dt > 1860mm Hg/sec and K <0.025mm Hg/ml), or 3) predominant stiff heart (K ≥0.025mm Hg/ml).
Results: During a follow-up of at least 5 years, the incidence of the primary composite endpoint (death, major arterial event, heart failure, and arrhythmia) was 23.2% (82 patients). Compared to isolated relaxation abnormalities, predominant stiff heart showed stronger prognostic significance for all events (p=0.002), namely heart failure (HR, 2.9; p=0.0499), cardiac death (HR, 5.8; p=0.03), and heart failure and cardiac death combined (HR, 3.7; p=0.003).
Conclusion: In this apparently healthy population referred to our center for cardiac catheterization, the prevalence of diastolic dysfunction was very high. Moreover, predominant stiff heart was a better predictor of cardiovascular outcomes than isolated relaxation abnormalities.
Lousararian Marina, Troglia Ana, Cabrera Maria J and Alday Luis E*
We report a challenging patient with Williams syndrome and severe coarctation of the aorta. As in a few similar cases reported, several surgical and catheter interventions for recoarctation, intrastent intimal proliferation and stenosis of the left sub-clavian artery were required. Aortic patch angioplasty is planned for the future in a grower child.
The shapes and sizes of human cardiomyocytes are accessible to systematic observation under most circumstances only at autopsy. This constraint has seriously curbed the study of these topics, thereby leaving a crippling gap in our understanding of heart failure. In recent years the only published ongoing findings have come from this laboratory. This article is a condensation of these reports, using those sources to develop fresh analyses designed to construct a set of organizing principles. The data are entirely retrospective thereby forbidding hypothesis testing and permitting only hypothesis formation. The hypotheses generated in this way are novel and surprising. In spite of the severe limitations in this methodology is seems possible that some useful new directions of inquiry might evolve from pursuing these original observations.
Yew-Keong Choong*, Nor Syaidatul Akmal Mohd Yousof, Jamia Azdina Jamal and Mohd Isa Wasiman
The calyces of Hibiscus sabdariffa have been used by many communities as herbal tea. Their anthocyanin contents have been reported as the key component in anti-obesity studies. This present work reported results of anthocyanin content of calyces in two varieties of H. sabdariffa collected from Sabak Bernam, Selangor, Malaysia.The samples have been authenticated in the Herbarium, Institute of Bioscience, University Putra Malaysia prior to the study. The samples were processed and the ground dry raw material and its aqueous extract were analyzed using Fourier Transform Infrared (FTIR) and Two-Dimensional Infrared (2DIR). The short hybrid calyces (FT11-15A) raw material spectrum showed more than 80% similarity with long wild variety calyces (FT11-15B) when using “Compare” in analysis. The differences of both samples were obviously shown in their aqueous extract spectra. The peak at 1672 cm-1 and 841 cm-1 showed that tri-substituted double bond in FT11-15B aqueous extract was not present in FT11-15A aqueous extract spectra, whereby a double peak was assigned at 1221 cm-1 referred to anti symmetry stretching of aromatic and vinyl =C-O-C- with other =C-O- and 1192 cm-1 is assigned In-plane δ C-H in FT11-15A aqueous extract. The peak at 1071 cm-1 assigned as bonding C-H in plane bending of phenyl of both samples was the only peak comparable with standard delphinidin and cyanidin which are used for qualification and quantification of sample content. Aqueous extract spectra of both samples showed higher number of peaks detected compared with raw material spectra, which was attributed to the higher solubility of anthocyanins in water. The 2DIR correlation spectroscopy is advantageous in enhancing the qualitative analysis of herbal products. The anthocyanin content in both varieties of H. sabdariffa in descending amount is delphinidin-3-O-sambubioside (DS), cyanidin-3-O-sambubioside (CS), delphenidin-3-O-glucoside (DG) and lastly cyanidin-3-O-glucoside (CG). FT11-15A has more content of DS and DG of raw material and CG of water extract plus TFA than FT11-15B, whereby, FT11-15B has more content of CS, CG of raw material and DS, DG, CS of water extract plus TFA than FT11-15A.
<h2>Abstract</h2><p>Through cultural consciousness, the characteristics of traditional Chinese sports culture in the new period are analyzed and studied, and the traditional Chinese sports culture in the new period has the following six characteristics: 1. Sports social model of “etiquette” 2. Sports personality model of the gentleman’s way; 3. The sports behavior mode of the golden mean; 4. The social nature of sports of socialism with Chinese characteristics; 5. Sports cultural nature of emotional culture; 6 limited competitive sports competition.</p>
<h2>Abstract</h2><p>Sea swim (2.4 mile), bike ride (112 mile) and Marathon (26 mile), all in one day!<br />There are lessons that the 7.8 million UK Chronic Pain patients can learn from the world of endurance sports, and vice versa [1]. The training, psychological tools and strategies used by athletes to complete an endurance event, are equally relevant for those with chronic pain, who wish to regain some form of “normal” life if treatment therapies have failed [2,3].</p><p>This is my reflection of how, using some of the techniques involved in Pain Management Programs, I trained for an Ironman Triathlon in just over one year.</p>
Alcohol abuse is a global health problem. Alcohol withdrawal syndrome (AWS) ranges from mild to severe symptoms that can lead to fatal delirium tremens requiring ICU admission and incurring high health care cost as high as $20,000 a month. The latest published reports suggest that phenobarbital is a promising therapeutic option for management of AWS as evidenced by less ICU admissions, length of stay in hospital, use of adjunctive agents, health care costs and attention from the nursing staff than that of patients treated with commonly used benzodiazepines such as lorazepam, diazepam, and chlordiazepoxide. Phenobarbital is beneficial for the treatment of AWS, both in the emergency and inpatient settings and both as monotherapy or in conjunction with benzodiazepines. It is safe for patients without severe hepatic impairment, has a better mechanism of action and longer half-life than benzodiazepines, and leads to less delirium and agitation. Powered randomized controlled trials with large populations are required, yet phenobarbital can be used to safely to treat AWS.
Pumpkins (Cucurbita pepo) are grown all around the world for a variety of reasons ranging from agricultural purposes to commercial and ornamental sales. The pathogens causing the rot of pumpkin in the world include fungi, bacteria, and viruses. The study was aim to identify fungal pathogens of pumpkin rot during storage, as well as control measures of the diseases using wood ash, mango leaf and rice chaff.Three hundred and sixty-six (366) fruits of pumpkins were studied in Pela, Gaya and Kulinyi districts of Hong Local Government Area of Adamawa State. The diseased samples (fruits) were randomly purchased. Of all the districts visited, Kulinyi has the highest percentage of disease samples (43.82%) while the least is Gaya district with 21.35%. Potato Dextrose Agar (PDA) was used for the isolation of pathogens and these gave Fusarium solani, Aspergillus niger, Aspergillus flavus, and Phytophthora capsici. All the fungal isolates exhibited different degree of pathogenic effect on the pumpkin fruits. The pathogens are susceptible to treatment both In-vitro and In-vivo control trials with wood ash and mango leaf at p ≤ 0.05. Inhibition improved with increased in concentration of the wood ash and mango leaf. Rice chaff treatment equally proved worthwhile with significant inhibition compared to the control at p ≤ 0.05.
Khalid Ahmed Al-Anazi*, Al-Anazi WK and Al-Jasser AM
Varicella zoster virus behaves differently from other herpes viruses as it differs from them in many aspects. Recently, there has been growing evidence on the beneficial effects of the virus in immune compromised hosts and these effects are translated into prolongation of survival. The reported beneficial effects of the virus include: (1) stimulation of bone marrow activity in patients with hematologic malignancies and bone marrow failure syndromes, (2) antitumor effects in various hematologic malignancies and solid tumors, and (3) association with graft versus host disease which has anticancer effects. Additionally, there are several reports on the safety of the live-attenuated even in severely immune suppressed individuals and on the emerging role of the virus in cancer immunotherapy. In this review, the following aspects of the virus will be thoroughly discussed: (1) new data on the genetic background, pathogenesis, vaccination, and new therapeutic modalities; (2) bone marrow microenvironment and hematopoiesis; (3) cells involved in the pathogenesis of the virus such as: mesenchymal stem cells, dendritic cells, natural killer cells, T-cells and mononuclear cells; (4) cellular proteins such as open reading frames, glycoproteins, promyelocytic leukemia protein, chaperons, and SUMOs; (5) extracellular vesicles, exosomes, and micro-RNAs; and (6) signaling pathways, cytokines, and interferons.
Objective: The main aim of the study was to compare outcomes based on diabetic control for patients undergoing formation of a new upper limb arteriovenous fistula (AVF). Research design and methods: A prospective cohort study was performed where we obtained baseline HbA1c in 65 patients before undergoing AV fistula formation. Patients were followed up at our clinic 6 weeks after creation to assess fistula maturity.
Results: Multiple logistic regression was used to analyze the association between HbA1c status and maturity of AVF at 6 weeks after controlling for possible confounding factors such as age, sex, presence of hypertension and dyslipidaemia. Those with HbA1c less than 6.5 were 22 times likely to have maturity of AVF at 6 weeks as compared to those with HbA1c 6.5 or more (AOR = 22.65, p < 0.005).
Conclusion: Good diabetes control, reflected by an HbA1c of less than 6.5, is associated with a very high possibility of AVF maturity at 6 weeks post creation.
What is called “idiopathic biliary duct system dilatation” or better to name it “un-explained biliary dilatation” is mostly following surgical procedures related to upper gastrointestinal and hepato-bilio-pancreatic systems. Having such situation, adaptive physiology of the biliary duct system has to be considered and rational has to be explained. The vast multimodal progress in techniques of investigations that has been applied on studying the hepato-bilio-pancreatic system has been utilized to clear the clinical ambiguity of biliary duct system dilatation for no logic reason but missing the correlation between both fields; the technical and the clinical ones. This clinical review is trying to fill this gap and introduce a comprehensive discussion of the subject. Mechanical, biochemical and immune causes constitute a wide diversity of etiology related to biliary system dilatation that in some situations is really difficult to verify clinically. On the least, even we could not verify the etiology we need to identify that reaching a closed road is different than postulating suspicions that never exist. This review is a trial collecting all subject-related data that might be related to etiology mechanisms and utilize to find a correlation rationale. At some point verification of such correlation is really a far target that might be even impossible clinically with availing technical tools and hope in the future could be achieved.
Anasarca is generalized swelling of the body following accumulation of fluid in the extracellular compartments. It may result from multiple aetiology mainly of renal, hepatic or cardiovascular origin.
The aim of this case report is to highlight the challenges encountered in making diagnosis in a patient with anarsaca.
We report a case of a 34 year old transporter who presented with anasarca. He had clinical features and risk factors suggestive of renal, hepatic and cardiovascular disease. However investigations ruled out renal, hepatic or cardiovascular diseases as the aetiology of the anarsaca. The anarsarca was also noted to be unresponsive to diuretics. The diagnosis of the disease causing the anarsaca was therefore a dilemma.
Madeeha Malik*, Muhammad Usama Khan, Azhar Hussain and Ayisha Hashmi
<p><strong>Background:</strong> Antidepressant therapy is the most adopted treatment option for depression. The evaluation of cognitive effects related to antidepressant drug use is important for better selection of antidepressant drugs that leads to improved cognitive performance and patient health related quality of life. Aim: The aim of the present study was to evaluate the effects of antidepressant drugs on cognition and memory among patients of depression in Pakistan. </p><p><strong>Method:</strong> A descriptive cross-sectional study design was used. A pre-validated data collection tool Mini Mental State Examination was used. The sample size was calculated to be 382 with 95% confidence interval and 5% level of error. The data was cleaned, coded and analyzed statistically using spss 21. Chi-Square test (p ≥ 0.05) was used to find association among different variables.</p><p><strong>Results:</strong> The results showed that out of 382 respondents, 7.3% (n=28) were being prescribed amytryptyline and among them 46% (n=13) had questionably significant cognitive impairment and 53% (n=15) had mild cognitive impairment. On the other hand out of 23% (n=89) patients on escitalopram monotherapy, 85% (n=76) had impairment of questionably significant impairment and only 13.4% (n=12) had mild impairment. Area of residence and medication therapy were significant variables (p<0.05) that can affect cognition and memory among patients of depression. </p><p><strong>Conclusion:</strong> The results of present study concluded cognitive impairment of questionably significant nature among patients of depression in Pakistan. For the better management of depression, it is recommended that anti-depressant drug therapy should be tailored according to individual patient requirements.</p>
Ahmad M Tabash, Wesam M Afana, Abdrabbou M Elregeb, Sameer Abu Eid and Ayman M Abu Mustafa*
Background: There is an important shortage of blood in the greatest blood banks worldwide to meet up with requirements for numerous medical interventions. Limited studies have associated regular blood donation to the lowering of lipid function parameters. Assessing the lipid function is a classical method of evaluating an individual’s risk for coronary heart disease.
Objective: The general goal of the study is to determine lipid and hematological profile among blood donors in European Gaza Hospital, Palestine.
Materials and Methods: This study was a case-control study that involved 120 male, 40 of whom were regular blood donors (study group), 40 first time donors and 40 non- donors (control group) aged between 18-60 years. A volume of 5ml venous blood was drawn from each fasting participant into a dry biochemistry screw-capped tube. This was allowed to clot and the serum was used to determine total cholesterol (TC), triglycerides, High-density lipoprotein cholesterol (HDL-C), Low-density lipoprotein cholesterol (HDL-C), while HDL-C/LDL-C and TC/LDL ratio were calculated by using the following formula. Anthropometric parameters (weight, height) of donors were measured using standard protocol. The height (in meter), weight (in kilogram) were used to calculate the body mass index (BMI) using the following formula. BMI= weight (kg)/ (height in meter)² and blood was collected from each participant in EDTA (for hematocrit, ESR). Three groups were matched for age and BMI. Data were analyzed using SPSS version 23. Chi-square (χ²) was used to compare the relationship between categorical variables, ANOVA was used to measure the difference between means. Data were summarized using tables, pie charts, histograms. A P-value < 0.05 was considered to be statistically significant for all tests conducted.
Results: The mean total cholesterol (169±10.85 mg/dl), triglycerides (116±9.73 mg/dl), HDL (54±2.5 mg/dl ), LDL (92±11.4mg/dl), LDL/HDL ratio (1.73±0.25) and TC/HDL ratio (3.16±0.26) were lower in the regular blood donors than the first time donors(198±10.13, 179±5.82, 42.33±1.6, 120±11.2, 2.85±0.36, 4.7±0.40) and non- donors (202±10.19, 180±12.68, 41.75±1.4, 125±11.7, 2.99±0.33, 4.86±0.32) respectively and statistically significant (P < 0.05).The mean ESR (6.63±0.87mm/hr) was lower statistically significant in the regular blood donors than the first time donors (7.40±1.17) and non- donors (7.60±1.48) respectively (P < 0.05). The mean HCT (42.98±0.86%) was lower statistically significant in the regular blood donors than the first time donors (44.63±0.90) and non- donors (44.75±0.74, P < 0.05).
Conclusion: Regular donors have reduced risk of developing coronary heart disease as reflected by the low total cholesterol, triglycerides, LDL-c, LDL-c/HDL-c ratio, TC/HDL-c ratio and HCT and high HDL. BMI in regular donor was less than the donor for the first time and did not donate, but did not reach the statistical significance. Also in our study regular donors have reduced risk of developing inflammation as reflected by low ESR.
Julien Adjedj*, Mathias Kirsch, Anna Nowacka and Olivier Muller
Background: Persistent left atrial thrombus remains a contra indication to transeptal valves in valves procedure. We aimed to perform a double valves in valves replacement through transapical access with cerebral angiography control during the procedure just after implantation. Our case shows the feasibility of this strategy and the management of right ventricle laceration successfully treated after extra corporeal membrane oxygenation implantation and local hemostasis. We reported a feasibility case report of successful double valves in valves implantation through transapical access with 6 months of clinical and computed tomography follow up.
Background: Azithromycin (AZM) is a macrolide antibiotic with distinct pharmacokinetic properties and is increasingly used as maintenance treatment in patients with bronchiectasis in order to reduce infectious exacerbations and improve pulmonary symptoms. The exact mechanism of action is not known and the relation between azithromycin dose level, local and systemic drug levels and clinical effect however, has not been extensively studied yet.
Objectives: To explore the relation between AZM serum and sputum concentrations, clinical effect parameters and side effects.
Methods: Azithromycin concentrations were measured in serum and sputum samples of bronchiectasis patients receiving one year of AZM treatment (250mg OD) enrolled in the Bronchiectasis and Azithromycin Treatment (BAT) trial, a double blind, randomised placebo-controlled trial. Results were correlated with data on AZM dose level, exacerbation frequency, lung function (forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC), quality of life and symptoms collected within the same year.
Results: 83 sputum samples from 31 patients and 151 serum samples from 43 patients were available for analysis. Mean AZM dose-level ranged from 18.8 to 39.8 mg/kg body weight/ week, generating mean AZM concentrations of 7.57 mg/L (SD 9.49) in sputum and 0.11 mg/L (SD 0.085) in serum. No correlation was found between side effects and AZM dose level, sputum- or serum concentrations. Significant correlation was found between AZM sputum concentration and CRP-level (r= -0.6).
Conclusion: High and stable AZM sputum levels were reached during long term treatment, as opposed to low AZM levels in serum. Apart from CRP-levels to AZM sputum concentration, no other outcome parameter showed significant correlation to AZM serum- or sputum levels. AZM dose- or exposure levels were not predictive for the occurrence of side effects.
The circadian clock is an endogenous molecular oscillator with a period of about 24 hours, which regulates the physiology and developmental processes of almost all higher plants. Pseudo-response regulators (PRRs) are an important part of the central clock oscillator, together with other clock genes, constituting interlinked transcriptional feedback loops, which partly influence plant growth and development.In this study, a circadian clock-related gene MsPRR7 was cloned from Medicago sativa (alfalfa) by homologous cloning. The full length MsPRR7 gene was 2648 bp in length, with an open reading frame of 2385 bp encoding a protein of 795amino acids. Phylogenetic analysis showed that the MsPRR7 was closely related to PRR7 from the PRR family of Arabidopsis thaliana. Subcellular localization analysis found that MsPRR7 was located in the nucleus. Quantitative reverse-transcription polymerase chain reactions (qRT-PCR) demonstrated that expression of MsPRR7 gene transcripts in leaves was affected by circadian rhythms, and that its expression level increased with an extension of illumination time, reaching a peak around 8–10 hours. These results will provide the experimental basis for further study of the regulation of PRR family genes in alfalfa.
Objective Study: Whether the narrow-band CE-Chirp ASSR test in the sound field is an objective evaluation method for the hearing aid compensation effect, and whether there is a difference in children with different hearing loss levels.
Methods: 39 children (67 ears) wearing full digital hearing aids with good rehabilitation effect and ability to cooperate with behavioral audiometry were selected. The narrow-band CE-Chirp ASSR test group in the sound field was set as the experimental group, and the sound field behavioral audiometry after hearing aid was set as the control group. According to the degree of hearing loss, it was divided into moderate hearing loss group, severe hearing loss group and extremely severe hearing loss group. The difference between test results of experimental group and control group was compared.
Results: There were no significant differences between the experimental group and the control group in the moderate hearing loss group and the extremely severe hearing loss group at 0.5, 1, 2, and 4kHz (P > 0.05). The results of the experimental group and the control group in the severe hearing loss group, There was no significant difference at 0.5, 1, 2kHz (P > 0.05), there was a significant difference at 4kHz (P < 0.05), and the mean difference was - 6.4dB HL. When the degree of hearing loss was not grouped, there was no significant difference between the experimental group and the control group at 0.5, 1, 2kHz (P > 0.05), 4kHz was significantly different (P < 0.05), and the mean difference was -3.2dB HL.
Conclusion: It is clinically feasible to evaluate the hearing aid compensation effect of the narrow-band CE-Chirp ASSR in the hearing-impaired children. The grouping according to the degree of hearing loss can be more accurate in evaluating the hearing aid compensation effect. The narrow-band CE-Chirp in the sound field of children with moderate and very severe hearing loss ASSR results can be directly used to assess the hearing aid compensation effect, while children with severe hearing loss need to apply correction values at 4kHz.
Atif BE Fazari*, Maria Eugenia Ramirez Aristondo, Faiqa Azim, Basma Abdo AlMaamari and Rasha Eltayeb
<h2>Abstract</h2><p>Morbidly adherent placenta (MAP) includes the spectrum of placenta accreta, increta, and percreta. It is a major cause of obstetric hemorrhage. Caesarean section is main risk factor for MAP. Ultrasound scan is highly sensitive method for MAP diagnosis and sometime Magnetic resonance image is of choice. Early diagnosis timed elective planned intervention after preparation under skillful multidisciplinary team improve the outcome and minimize the morbidity. Caesarean hysterectomy, major arteries ligation, arteries embolization and leave the placenta in-situ all are choices of management. Use of Methotrexate for the placenta in-situ in MAP is still debatable. We present a case of MAP in which placenta left in- situ followed by multiple Methotrexate injection during postpartum with good outcome and acceptability.</p>
<h2>Abstract</h2><p>The aim of our study is to try to give a predictive vision on governance in the field of sports in Algeria.</p><p>This predictive approach looks at the overall quality of governance in order to be at the continental level or even across the Arab world.</p><p>To identify this and answer our questions, we conducted a survey of some leaders of the different sports institutions, namely the presidents of clubs (football, handball, athletics and judo), managers also have a sports experience and occupy currently responsible positions as managers of sports facilities.</p><p>The results of the survey we reveal significant figures on the component related to sports development prospects.</p><p>However, there are other aspects that are ambiguities in the management and organization that have an impact on good governance in sports.</p><p>To identify this and answer our questions, we conducted a survey of some leaders of the different sports institutions, namely the presidents of clubs (football, handball, athletics and judo), managers also have a sports experience and occupy currently responsible positions as managers of sports facilities.</p>
<p>“It isn’t the mountains ahead to climb that wear you out; it’s the pebble in your shoe.” Muhammad Ali</p><p>What mind strategies can an endurance athlete use to get their body that bit further or faster, to be a inisher? At "top-level" sport, some say it's all in the mind!! When we push ourselves to the limit, we experience adversity. How and if we overcome that, will deine us, and our achievements.</p><p>“Adversity causes some men to break; others to break records.” William A. Ward (Inspirational Writer).</p><p>Pain is not only a physical experience, it is an emotional one as well. This is encapsulated in the very definition of pain by the International Association for the Study of Pain [1].</p>
Zhijian Lin, John C Lieske*, Yue Li and Muthuvel Jayachandran
Background: Hyperuricosuria, persistently low urinary pH, and low urinary volume are the main risk factors of uric acid nephrolithiasis. Epidemiologic studies suggest that high water intake is protective against the occurrence of symptomatic kidney stone events of all types. The objective of this systematic review and meta-analysis were to evaluate the effectiveness of increased water intake to prevent symptomatic uric acid kidney stone events.
Methods: Seventeen studies were identified for the meta-analysis. Analysis of Q and I2% statistics revealed that a high heterogeneity in 16 studies, thus, random effects model was used. Protective associations were identified for high water intake individuals (SMD=0.52 L; 95% CI: 0.19, 0.84; p=0.002); a significantly decreased relative super saturation of uric acid versus controls (SMD=-1.15; 95% CI: -2.00, -0.30; p=0.008). Risk factors including urinary uric acid excretion and pH were not significantly related to high water intake (SMD=7.32mg/d, 95% CI: -52.27, 66.91; p=0.81), (SMD=0.14; 95% CI: -0.02, 0.31; p=0.09), respectively. Further subgroup analyses revealed that urinary uric acid excretion was significantly decreased in healthy individuals (SMD=-36.23 mg/d, 95% CI: -65.14, -7.31; p=0.001) compared to stone formers (SMD=27.41 mg/d, 95% CI: -33.18, 88.01; p=0.38); urinary uric acid excretion was significantly decreased in routine water intake groups (SMD=-61.49 mg/d, 95% CI: -120.74, 12.24; p=0.04) compared to mineral water intake groups (SMD=44.50 mg/d, 95% CI: -18.30, 107.29; p=0.16); urinary pH was significantly higher in mineral water groups (SMD=0.13, 95% CI: 0.01, 0.46; p=0.04) compared to regular water groups (SMD=-0.00, 95% CI: -0.13, 0.13; p=0.98).
Results: A total of 129 patients had 150 internal jugular catheter insertions. The mean age was 51.4±15.2 years with male to female ratio of 1.5:1. All the patients had chronic kidney disease; about 80% had tunneled IJC and 96.9% of the catheters were inserted in the right internal jugular vein. Immediate complications were recorded in 10% and late complications in 34.9% of the procedures. The immediate complications were kinking of guide wire (2%), arterial puncture (1.3%) and difficulty in locating the internal jugular vein (1.3%) or tunneling (1.3%). The late complications were infection (12.8%), poor blood flow (9.2%), bleeding (5.5%) and spontaneous removal of the catheter (5.5%). There was no statistical significant difference in both immediate and late complication with age and sex.
Conclusion: This meta-analysis identified evidence that urinary uric acid excretion, volume, pH and relative supersaturation of uric acid can be altered with high water intake intervention, reducing the risk of uric acid kidney stones.
Okafor Umezurike Hughes*, Alade Stella and Edeh Samuel
Internal jugular vein catheters (IJC) is recommended as the central venous access of choice in haemodialysis patients. However it is associated with complications of variable severity.
Objectives: To study the complications associated with internal jugular vein catheters in haemodialysis patients in southern part of Nigeria.
Methodology: The clinical details of patients who had IJC insertion at the kidney house, Hilton clinics Port Harcourt from 1st October 2011 to 30th September 2016 were documented. Complications from the IJC developed by the patients during the study period were also documented. The data obtained was analyzed using SPSS version 22. P value less than 0.05 was considered significant.
Results: A total of 129 patients had 150 internal jugular catheter insertions. The mean age was 51.4±15.2 years with male to female ratio of 1.5:1. All the patients had chronic kidney disease; about 80% had tunneled IJC and 96.9% of the catheters were inserted in the right internal jugular vein. Immediate complications were recorded in 10% and late complications in 34.9% of the procedures. The immediate complications were kinking of guide wire (2%), arterial puncture (1.3%) and difficulty in locating the internal jugular vein (1.3%) or tunneling (1.3%). The late complications were infection (12.8%), poor blood flow (9.2%), bleeding (5.5%) and spontaneous removal of the catheter (5.5%). There was no statistical significant difference in both immediate and late complication with age and sex.
The ultrasound examination at discharge had a sensitivity of 31% and specificity of 87% to detect future symptomatic lymphoceles. The positive predictive value was only 10%. The second ultrasound test had the best test variables to detect symptomatic lymphoceles with a sensitivity of 93% and a specificity of 87% and a predictive value of 28%.
Conclusion: Internal jugular catheter is froth with immediate and late complications in haemodialysis patients.
A man I knew had an extreme allergy to poison ivy when he was a child. When he was about four-teen, he was hanging out with a group of his friends who dared him to eat some poison ivy. He did, and never got poison ivy again. Presumably, the ingestion of the allergen led to the development of immunity.
Josef Hyanek* František Pehal, Kseniya Dryahina, Ladislava Dubska, Blanka Míkova, Lada Gombíkova, Miroslav Prucha, Stanislav Kubu, Petra Halackova and Jaroslav Feyreisl
<h2>Abstract</h2><p><strong>Introduction:</strong> In this retrospective study, we comment on the cause and diagnostic potential of the elevated serum total cholesterol and some non-cholesterol sterols in a population of healthy pregnant women from Prague, Czech Republic.</p><p><strong>Methods: </strong>Based on a total of 21,000 clinical biochemistry tests of healthy pregnant women with hypercholesterolemia observed during pregnancy, a testing group of 84 women with a total cholesterol (TC) above 7.0 mmol/l was established to analyze their non-cholesterol sterols (NCS) by Gas Chromatography–Mass Spectrometry. Lathosterol (Lat) and desmosterol (Des) were evaluated as markers of endogenous cholesterol synthesis, whereas campesterol (Cam) and sitosterol (Sit) were analysed as markers of intestinal absorption.</p><p><strong>Results:</strong> In the basic population, the frequency of gestational hypercholesterolemia with the serum TC levels > 7.0mmol/l was 1 to 136.The mean values were: TC 6.8 mmol/l, LDL-C 4.6 mmol/l, and HDL-C 2.2 mmol/l. In the selected testing group of 84, the mean values were: Lat 7.8+/-1.7 μmol/l, Des 4.7+/-0.9 μmol/l, Cam 9.8+/-2.6 μmol/l, and Sit 9.6+/-3.8 μmol/l. Lat correlated with TC (r = 0.53), LDL-C (r = 0.36), and non-HDL-C (r = 0.35). No such correlations were observed for Cam or Sit.</p><p><strong>Conclusion: </strong>Our findings prove that gestational hypercholesterolemia is caused by increased endogenous cholesterol synthesis via lathosterol. Subsequently, we demonstrate how a single cholesterol test taken in the fifth to sixth month gestation can efficiently help detect familial hypercholesterolemia, and prevent related late pregnancy circulatory complications.</p>
Hesham El-Sayed, Sohair Mehanna, Adel Hassan, Mahmoud Sheded, Maha Abdel-Fattah, Samar Elfiky, Nermine Elmaraghy*, Nehal Lotfy and Zeinab Khadr
Background: Egypt has the highest prevalence of HCV in the world as more than 10% of population suffers from HCV infection. High prevalence of HCV in Egypt represents a great risk to the whole population that requires aggressive mass awareness regarding routes of infection and means of prevention.
Aim: To determine the knowledge and practices of university students in 5 different faculties in Suez Canal University regarding HCV infection and means of prevention.
Materials and method: A cross sectional study was conducted in five university faculties in Suez Canal University.
Results: The study included 698 students from the faculties of Medicine, Pharmacy, Dentistry, Nursing and Education in Suez Canal University in Ismailia city in Egypt. There was a statistically significant difference regarding the knowledge about the diagnosis, complications and routes of transmission total knowledge score for HCV among the different faculties.
Conclusion and Recommendations: Knowledge and practices of university students in Suez Canal University is partial to weak especially in students of non-biological sciences who have less close contact with patients.
Nermine Elmaraghy*, Said Abbadi, Gehan Elhadidi, Asmaa Hashem and Asmaa Yousef
Background: Pseudomonas aeruginosa is one of the top five pathogens causing healthcare-associated infections. Biofilm formation is nowadays a major problem. Aim: The aim of this study was to examine the prevalence of virulence genes in clinical isolates of Pseudomonas aeruginosa at Suez Canal University Hospitals with respect to the site of infection and microbial resistance of the strains.
Materials and methods: A cross-sectional descriptive study was carried out on 47 Pseudomonas aeruginosa strains collected from hospitalized patients from December 2015 to August 2017. To detect biofilm formation, we used Tissue Culture Plate Method. The virulence genes (toxA, algD, nan1, pslA and pelA) were amplified using PCR technique.
Results: The highest sensitivity was to Imipenem and Ciprofloxacin (85.1% and 68.1% respectively).With respect to the virulence genes, toxA gene was detected in 45 isolates (95.7%), algD gene in 42 isolates (89.4%), pslA in 42 isolates (89.4%) %), pelA cted in 41 isolates (87.2%) and nan1gene was detected in 19 isolates (40.45%).
Conclusions and Recommendations: We conclude that there is relationship between virulence genes and biofilm formation in Pseudomonas aeruginosa. We recommend the expansion of work on a larger sample size in a longer period of time.
Tadao Tsuji*, G Sun, A Sugiyama, Y Amano, S Mano, T Shinobi, H Tanaka, M Kubochi, K Ohishi, Y Moriya, M Ono, T Masuda, H Shinozaki, H Kaneda, H Katsura, T Mizutani, K Miura, M Katoh, K Yamafuji, K Takeshima, N Okamoto, Y Hoshino, N Tsurumi, S Hisada, J Won, T Kogiso, K Yatsuji, M Iimura, T Kakimoto and S Nyuhzuki
Treatments via the minor papilla is effective where the deep cannulation via the major papilla is impossible in such cases as [1] the Wirsung’s duct is inflammatory narrowed, bent or obstructed by impacted stones [2] pancreatic duct divisum (complete or incomplete) [3], maljunction of pancreatico-biliary union with stones [4], pancreatic stones in the Santorini’s duct. In [1,2] cases, the pancreatic juice flow via the major papilla decreases, while that of the minor papilla increases. Then the size of minor papilla and its orifice shows corresponding enlargement. This substitutional mechanism is an advantage when undertaking our new method. Since the pancreatic juice flow is maintained via the minor papilla in these cases, accurate and careful endoscopic skills are necessary to prevent pancreatitis due to the occlusion of the Santorini’s duct after this procedure. We have experienced 135 cases treated via minor papilla in these 27 years, so we would like to report about its safety and efficacy.
Background: We have developed a femoral supporting pad with an integrated ultrasound probe holder and examined its practical usability on patients with lower limb surgery.
Objectives: To evaluate the function of this novel femoral supporting pad with respect to its practicability during the performance of a distal sciatic nerve blockade, the time needed to perform this blockade including the catheter insertion and the quality of postoperative analgesia within the first 24 hours.
Methods: 50 patients which had been scheduled for elective lower leg, ankle or foot surgery had received a continuous blockade of the distal sciatic nerve. Sciatic nerve blockade was performed sonographically controlled with the patients in supine position by using our novel femoral supporting pad with an integrated ultrasound probe holder.
Primary endpoint: duration of the intervention. Secondary endpoints: pain intensity (visual analogue scale VAS 0-10) at the first postoperative day; cumulative opioid (piritramide) requirement during their stay on the post Anaesthesia care unit (PACU) with vs. without distal sciatic nerve blockade.
Results: 49/50 patients received a distal sciatic catheter, which had been sonographically placed within a mean time (mean ± sd) of 11:30 ± 3:13 minutes. VAS at the first postoperative day was (mean ± sd) 1 ± 2 at rest and 2 ± 2 as maximum. The piritramide requirement during PACU stay (mean ± sd) was 11 ± 8 mg without vs. 3 ± 6 mg with distal sciatic nerve blockade (p< 0.05).
Conclusion: Continuous distal sciatic nerve blockade using a novel femoral supporting pad with an integrated ultrasound probe holder was feasible in 49 of 50 patients within 11 minutes and 30 seconds.
Maja Joosten, Paul P Poyck, Frank C d’Ancona and Wilbert A van der Meijden*
Introduction: Ultrasound examination is frequently used to evaluate the graft after renal transplantation and to detect possible lymphoceles. The first ultrasound scan in our hospital is normally performed on the day of discharge. We questioned whether perirenal fluid collections detected by ultrasound examination at discharge are predictive for future symptomatic lymphoceles.
Methods: All ultrasound reports of all renal transplant recipients treated in our hospital between January 2010 and December 2017 were collected and screened for abnormalities such as fluid collections. Patients that developed a symptomatic lymphocele were compared with a control group from the same cohort. Sensitivity and specificity of ultrasound examination to detect symptomatic lymphoceles were calculated for the primary and consecutive ultrasounds tests.
Results: There were no significant differences at baseline characteristics between the Symptomatic lymphocele group and control group, with the exception of mean age at kidney transplantation (47 ± 17 years in the control group vs. 56 ± 13 years in the symptomatic lymphocele group, p=0.02).
The ultrasound examination at discharge had a sensitivity of 31% and specificity of 87% to detect future symptomatic lymphoceles. The positive predictive value was only 10%. The second ultrasound test had the best test variables to detect symptomatic lymphoceles with a sensitivity of 93% and a specificity of 87% and a predictive value of 28%.
Conclusion: Routinely use of ultrasound testing on the day of discharge does detect perirenal fluid collections, but is not predictive for development of symptomatic lymphoceles in the future.
Introduction: The phimosis condition is characterized by the inability to retract the foreskin on the glans, making it impossible to expose them. Surgical treatment, although effective, has been questioned by the risk to which the patient is exposed. Therefore, we have opted for the use of topical corticosteroids to resolve this pathology.
Goals: To compare the effectiveness of Dexamethasone and Hyaluronidase + Betamethasone Valerate associated with preputial massage in the treatment of infantile phimosis, the degree of regression of phimosis, the time needed to achieve complete efficacy, possible adverse reactions, long-term outcome and parental adherence to treatment in children attending a specialized service in Blumenau, Santa Catarina.
Materials and methods: Controlled clinical trial, quantitative, non-blind, prospective and randomized sample analysis through the analysis of 523 patients.
Results: After 1 month of treatment, 435 patients presented some degree of regression and 63 children were referred to surgery. The success rate in this period was 45.8% in boys who were taking Hyaluronidase + Betamethasone Valerate and 49.8% in those who used Dexamethasone. In the late evaluation, 398 children reached grade 0, and 213 used Hyaluronidase + Betamethasone Valerate and 185, Dexamethasone; 39 patients were referred to the postectomy. Adherence to treatment was similar in both groups. The average time for degree 0 to be reached similar in both.
Conclusion: Both topical corticosteroids were effective in the resolution of phimosis. However, in the evaluation after the first month and in the regression, Dexamethasone proved to be more effective. The time to resolution of the condition was similar for both. The surgical procedure was taken when there was no clinical improvement. No adverse effects were reported in both groups.
Long Ching*, Ming Him Yuen, Tak Lap Poon, Fung Ching Cheung, Shun Hin Ting and Wing Chi Fong
Lesions that spontaneously come and go in central nervous system without any treatment at different time points and at different locations (CNS) usually lead ones to think of the possibilities of multiple sclerosis. However, sometimes there are exceptions. Surgical biopsy remains an important tool for defi nitive diagnosis in difficult cases. We report a case of intracranial diffuse large B cell lymphoma that spontaneously disappeared without any treatment and then reappeared at different time points and different locations.
<p><strong>Introduction:</strong> The problem of protecting and strengthening the mental health of the population is the most important task of ensuring the socio-economic well-being of the Komi Republic (RK) as an integral part of the Russian Federation (RF), since it is a key resource for the development of a subarctic region.</p><p><strong>The aim of the work:</strong> was to characterize diseases of the mental sphere revealed by the psychiatrist at contingent of patients of the consultative outpatient admission at the 1State Autonomous Health Agency of the Republic of Komi “Consultative and Diagnostic Center of the Republic of Komi” (SAHA RK “CDC”) of the subarctic territory.</p><p><strong>Materials and methods: </strong>The analysis of a continuous sample of 6255 patients of the psychiatrist of the consultative department in 2015-2017 was carried out. on the basis of medical records. Analysis methods included: analytical and statistical. The control group consisted of a continuous sample of 5,356 psychiatric patients in 2010–2012. The depth of the study was 8 years.</p><p><strong>Discussion:</strong> Trends in changes in demographic indicators, including gender and age, in the structure of patients of a psychiatrist in an outpatient consultative procedure are considered. Indicators of the identified pathology of the mental sphere, including the first identified and pathology in patients suffering from epilepsy in comparison with the control group are given. Attention is paid to the organizational and methodological work of an outpatient counseling psychiatrist on the targeted identification by internists of signs of mental pathology in patients referred to a diagnostic center with somatic diseases. Priorities for the improvement of specialized advisory (including psychiatric) assistance to the population of the RK and ensuring its quality were identified.</p><p><strong>Conclusions:</strong></p><p>1. The psychiatrist of the advisory department in 2015-2017. 6255 people were accepted (889 more than in the control group of 2010-2012). The increase was 16.78%. Primary patients account for 64.38% of the total number of people who applied to a psychiatrist (4027 people)</p><p>2. In the structure of the psychiatric pathology of the outpatient psychiatric appointment, the proportion of organic, including symptomatic, mental disorders (F00-F09) is 47.9±0.6%; neurotic, stress-related and somatoform disorders (F40-F49) - 39.6±0.6%; mental and behavioral disorders associated with the use of psychoactive substances (F10-F19) - 3.5±0.2%; mood disorders (affective disorders) (F30-F39) - 2.8±0.2%.</p><p>3. The most frequently detected pathologies in patients with epilepsy are: 1) Mild cognitive impairment; 2) Personality disorders; 3) Organic emotionally labile (asthenic) disorders. Their share annually accounts for 71.5%-75.8% of all types of nosological forms. The fourth and fifth ranking places are taken by: 4) Organic anxiety disorders; 5) Non-psychotic depressive disorders. Rarely diagnoses are established: “Organic Amnesia Syndrome” and “Dementia”.</p><p>4. Organic, including symptomatic, mental disorders prevail in the structure of newly discovered mental disorders; neurotic, stress-related and somatoform disorders (up to 87.7%). Mental and behavioral disorders associated with the use of psychoactive substances and mood disorders (affective disorders) do not exceed 8.4%.</p>
Climate change and the increasing global population pose a severe threat to the availability of freshwater in the world. Over consumption of water and deteriorating water quality are problems that should be addressed in order to ensure water availability for the coming decades. In this context, the increasing presence of micropollutants in water has shown to cause detrimental impact on water quality, given the negative disturbances that they can cause on human health and on the environment. Thus, it is important to study and quantify the presence of micropollutants in water bodies and also in regenerated wastewater based irrigation systems.
Domingos Dias Cicarelli*, Fernando Chuluck Silva, Carolina Martins Ricardo, Ana Carolina Makinoo Antunes, Murilo Alexandre Carmona and Maria Jose Carvalho Carmona
Provide a safety anesthesia to patient is only possible with the knowledge of material surrounding the operation room. Benzine is highly flammable substance and can produce several injures without the necessary care. This case describes a small fire caused by the presence of benzine in the surgical field concomitant with the use of electrocautery, which caused slight burns to the patient, but which could have been catastrophic, and proposes the use of protocols to prevent such accidents.
‘Patients were left in soiled sheets or sitting on commodes for hours. Some patients needing pain relief got it late or not at all.’ These were a sample of the findings in the Francis Report which revealed severe failings in patient care in the Mid Staffordshire NHS Foundation Trust in the UK. Recommendations in the Francis Report included the need to recruit compassionate staff and having compassion training for clinicians [1].Whether telling a young man that he has cancer or comforting an elderly woman who is feeling anxious, the health professional needs to be skilled in understanding what the other person is going through and respond appropriately.. The crisis of compassion in medicine is multifaceted in origin and some factors identified in the Francis Report were compassion fatigue, overwork, excess demand, lack of continuity and the failure to see the patient as a fellow human being [1]. Unfortunately modern medical practice prioritises technical progress, evidence-based medicine, meeting targets set by bureaucrats and efficiency at the expense of the ‘soul of medicine and medical practice’. Meeting key performance indicators (KPIs) has become the priority rather than the patient. Couple of other factors include increasing commercialisation of healthcare and the overemphasis of the biomedical model in medicine.
Platelet vesiculation is common factor contributing in coagulation and thromboembolism in patients with atrial fibrillation (AF). Platelet-derived vesicles are involved in the coagulation, thromboembolism, microvascular inflammation, arterial stiffness, vascular calcification, atherosclerotic plaque shaping and rupture, endothelial dysfunction, cardiac remodelling, and kidney dysfunction. Recent clinical studies have revealed elevated concentrations of platelet-derived vesicles in peripheral blood of patients with current AF and history of AF. The aim of the mini review is to discuss the role of platelet-derived micro vesicles as predictive biomarker in AF. Serial measures of circulating levels of platelet-derived vesicules are discussed to be useful in stratification of AF patients at risk of thromboembolic complications, but there is limiting evidence regarding their predictive value that requires further investigations in large clinical trials.
Varicella zoster virus (VZV), a double-stranded DNA virus, is a highly contagious human neurotropic virus that belongs to the alpha group of herpes viruses [1-4]. Primary VZV infection (chickenpox) occurs in childhood then the virus becomes latent in the nerve ganglia [1,5-7]. Reactivation of the virus may occur decades later and cause herpes zoster (HZ) which is manifested by a typical painful skin eruption that has characteristic dermatomal distribution [1,5]. Reactivation of VZV is usually predisposed to: old age; comorbid medical conditions such as diabetes mellitus, chronic obstructive airway disease, and end-stage renal disease; and immunosuppression due to malignancy, autoimmune disorders, immunosuppressive therapies, trauma, cytotoxic chemotherapy, hematopoietic stem cell transplantation (HSCT), and solid organ transplantation (SOT) [1,5-7].
VZV infections can cause not only transient pancytopenia but also aplastic anemia that may require allogeneic HSCT [8-12]. Additionally, VZV infections have been reported to be associated with increased risk of developing lymphoid malignancies and solid tumors [13-17]. On the contrary, there is growing evidence showing certain beneficial effects of the virus in immunocompromised individuals and these effects may be translated into prolongation of overall survival (OS) [18,19]. In a single center, case-controlled, retrospective study that included 16 episodes of VZV infections occurring in 14 patients with various types of hematologic malignancies (HMs) and bone marrow (BM) failure syndromes, Al-Anazi KA et al., reported an increase in white blood cell count, hemoglobin (Hb) level, and platelet count starting approximately 6 weeks following VZV infections and this stimulation of the 3 hematopoietic cell lines in the BM that followed VZV infections was maintained for periods longer than 3 years following the infection [18]. In another single center retrospective study that included a large number of patients with multiple myeloma subjected to high-dose melphalan followed by autologous HSCT after control of their primary disease, Kamber C et al., reported that approximately one third of these patients developed VZV infections either before or after HSCT [19]. Despite encountering VZV infections in patients with worse expected prognosis, the OS in patients who developed VZV infection was superior to that in patients who never developed the infection [19]. Recently, Al-Anazi KA et al., reported BM biopsy-proven reversal of pure red cell aplasia manifested by a gradual increase in Hb level starting 6 weeks following a localized HZ infection till the Hb level plateaued above 14g/dL fourteen months following the viral infection [4]. Additionally, several studies have demonstrated that VZV infection may trigger chronic graft versus host disease (GVHD) following allogeneic HSCT [20-22]. GVHD is associated with graft versus cancer effects and, provided GVHD is of low-grade, it can be associated with improvement in OS in patients with acute leukemia or lymphoma [23-25].
Background: The patient in this study experienced a childhood marked by conflicts within the family, physical abuse, frequent changes of school settings, truancy, and unspecified learning disabilities. After leaving school at age 17, she was chronically depressed, had anger attacks, lacked motivation, refused psychological assistance, and had problems finding work. At age 30, this culminated in an aggravated assault of a female in an urban public space, after which she was referred to the criminal courts. She was granted probation and hospitalized for psychiatric evaluation with follow-up, outpatient psychiatric treatment.
Aim: To present outcomes of longitudinal monitoring of methylphenidate effects on cognition and self-regulation during treatment of attention-deficit disorder with hyperactivity and substance use.
Methods: During more than a year of treatment, psychiatric interviews and norm-referenced assessments of processing-speed and cognitive overhead monitored changes in cognition and substance use.
Results: At baseline, processing-speed measures of reactive and active attention were within the average-normal range, whereas cognitive overhead/shift cost was in the atypically high range, suggestive of ADHD symptomatology. The patient engaged in daily excessive use of cannabis, amphetamines, and other illegal substances. At the end of treatment, cognitive speed was increased and cognitive overhead normalized. With reductions in ADHD symptomatology, the patient used small amounts of cannabis during weekends and showed improved self-regulation, and legal restrictions were discontinued.
<h2>Abstract</h2><p>This observational study assessed the knowledge of pregnant women attending antenatal clinics at two selected hospitals in Abeokuta South, Nigeria on the causes and risk factors of maternal mortality, identified barriers to knowledge acquisition, and examined the influence of parity of respondents on their knowledge of factors causing maternal mortality. Maternal mortality is extremely high in Nigeria, it is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. Descriptive research design was used in this study and qualitative data from 136 respondents selected randomly, were obtained through a self-designed questionnaire that comprised three sections. Data were analyzed and indicated that parity of the pregnant women do not have an influence on their knowledge of factors responsible for maternal mortality. Findings revealed that majority (67.6%) of the respondents had high knowledge on the causes of maternal mortality – haemorrhage, sepsis, prolonged/obstructed labour, anaemia, unsafe abortion, infection, hypertensive disorders, care rendered by unskilled medical practitioners and its risk factors - parity, poverty, place of last delivery and low attendance at antenatal clinic. Educational background, marital status, irregular antenatal visits, socio-cultural practices and occupational status were identified as barriers to knowledge acquisition. This paper concluded that pregnant women may have a high knowledge about the factors responsible for maternal mortality. This is probably due to the fact that all respondents had formal education and because they were interviewed on antenatal clinic days, which suggests that they might have heard about the causes and risk factors for maternal mortality during their visits. Authors recommended that government should employ qualified health professionals and provide medical subsidy, it is hoped that this will ensure that pregnant women get quality care throughout the period of pregnancy and delivery.</p>
Maryam Asgharnia*, Tayebeh Rahbar and Seyedeh Fatemeh Dalil Heirati
<h2>Abstract</h2><p>Mesenteric cysts are rare benign intra-abdominal tumors with an incidence of 1 case per 250,000 hospital admission. This lesion occurs most frequently in women in the reproductive period.The etiology of such cysts remains unknown but several theories regarding their development exist. Most of these lesions present with vague abdominal pain and nausea. Less commonly they will present with bowel obstruction due to external compression. The diagnosis of these tumors is by abdominal ultrasound or computed tomography. We report a case of Mesenteric cyst in 51-year-old female patient.</p>
<h2>Abstract</h2><p><strong>Background:</strong> Accessibility to healthcare is a major component of primary health care campaign for maintaining population health. Owing to this, the government of Ghana has instituted the free maternal care and focused antenatal care policies into the maternal health care policies to woefully control maternal mortality, morbidity and to ensure improved access, quality and continuous ANC use among pregnant women. Despite these interventions, pregnant women in the Kwabre East Municipality do not fully use ANC services as recommended by the World Health Organization.</p><p><strong>Methods:</strong> Using an in-depth interview and two focus groups conducted with women of reproductive age (15-49) in the Kwabre East Municipality. The study investigated women’s opinions, perceptions and experiences on their ANC visits.</p><p><strong>Results:</strong> The study revealed that physical accessibility and the social context of pregnant women continue to influence their ANC use even after the introduction of the free maternal care and focused antenatal care policies.</p><p><strong>Conclusion:</strong> The study suggests that in order to fully utilize ANC visits as recommended by the WHO in the Kwabre East Municipality, the Municipal Health Directorate should liaise with collaborating stakeholders if not eliminating to limit the influence of restrictive factors to women’s quest of using ANC. It is further recommended that management do away with hindrances that delay women who seek for ANC services in health facilities and adopt strategies and procedures that aim at increasing ANC uptake.</p>
<h2>Abstract</h2><p>Despite evidence on major interventions on the uptake and scale up of interventions meant to promote maternal health care services, little is known about adequate use of such program in urban Ghana among reproductive aged women. This study examined the determinants of women’s Satisfaction on antenatal care use in selected health facilities in the Kwabre East Municipality of Ghana. Using facility-based cross-sectional survey design, a three-stage sampling technique was conducted to sample 220 women attending postnatal care at selected public health facilities. Open-ended questionnaires were used to obtain data from respondents. Descriptive statistics and inferential statistics including binary logit regression model were used to analyze the data with the help of SPSS and STATA software. Logit analytical framework was computed to determine equations of variance. The association between antenatal care use and women’s satisfaction was determined and assessed using Pearson’s χ2 (2) test indicating 1% was run. Most women (92.7%) had at least four ANC visits during their entire pregnancy. The results indicate standard deviation of 7 with 81% regular ANC visits and 19% irregular. Most women (55%) received care by one caregiver, followed by women (35%) who received care by two caregivers and women (10%) who were cared for by three caregivers. The regression results showed varying utilization levels of 10%, 5% & 1% ANC satisfaction. System induced factors aimed at promoting maternal care use satisfaction are suggested. </p>
Ricardo Bassil Lasmar* and Bernardo Portugal Lasmar
<h2>Abstract</h2><p>The Office hysteroscopy (OH) is a important procedure to make diagnosis and sometimes, treatment, of intrauterine pathology, without getting the patient to Operating Room. Its advantages are very well known: less costs, fast diagnosis, see and treat and several others. It's mainly difficulty is the discomfort during the procedure. To stimule to grow the number of gynecologist to leave OR and to go to office hysteroscopy, we propose thirteen steps for office hysteroscopy with minimal discomfort.</p>
Abebe Muche*, Bekalu Bewket, Eferem Ayalew and Endale Demeke
<h2>Abstract</h2><p><strong>Background: </strong>Post abortion family planning (PAFP) is the initiation and use of family planning methods immediately after, and within 48 hours of an abortion, before fertility returns. In most women fertility returns on average about two weeks after an abortion; however, ovulation can occur as early as 11 days post-abortion.</p><p><strong>Objective:</strong> To assess utilization of post abortal contraceptive use and associated factors among women who came for abortion service at Debre Berhan Referral Hospital, Debre Berhan, Ethiopia March 2019.</p><p><strong>Methodology:</strong> Institutional based cross sectional study design was conducted using hospital data obtained from Gynecology ward in Debre Berhan Referral Hospital, Debre Berhan, Ethiopia, from March 1 -10, 2019. A systematic random sampling technique was used from the abortion register log book. Data was cleaned manually, coded and entered into Epi-data version 3.1 then exported to and analyzed by SPSS version 21 software. Multivariate analysis with AOR, 95% CI and p-value< 0.05 were used to identify variables which have significant association.</p><p><strong>Result:</strong> The finding of the current study showed that among 371 study subjects 170(45.8%) utilized post abortal family planning. There was a significant association between utility of post abortal family planning and post abortion family planning counseling [AOR: 19.245, 95% CI: (10.199, 36.313), p-value= 0.001] and women who were primiparous had 5 times more likely to utilize post abortal family planning as compared to the women who were nullyparous [AOR: 5.314, 95%CI (1.089, 24.210), p value=0.001].</p><p><strong>Conclusion and Recommendation:</strong> From a total of 371 study subjects 45.8% have utilize contraceptive after abortion service received. This study also showed that parity and counseling’s of family planning were statistically significant associated with utilization of post abortal family planning. We recommend Debre Berhan hospital to scale up activities on post abortal care to increase the number of clients who post abortal family planning.</p>
Peaches, Prunus persica were planted as grafted saplings in an avocado orchard previously infested with Armillaria mellea (Vahl) P.Kumm. Trees were planted in large or small holes with or without fresh yardwaste chips added as an amendment and with or without a Trichoderma biocontrol product sprayed into the hole. Trees were monitored for six years -- growth and mortality was tabulated.Six years later 40% of the trees had died from the disease. Trees planted in a large hole were more likely to survive than in a smaller hole (P=0.07) and trees in large holes with fresh organic matter added were the most likely to survive (P=0.04). Trichoderma sprays in the planting hole did not increase survival rates. While growth was initially retarded by adding fresh yardwaste to the hole, in later years none of the treatments affected growth rates.
Glomus tumors are rare, usually benign, lesions that arise most often in the extremities. They are derived from the glomus body and have a propensity to be found in the fingers and toes, and often in the subungual area [1]. They typically demonstrate pinprick sensitivity, cold hypersensitivity and paroxysmal pain [2]. Only two glomus tumors of the scrotum have been reported and we report a third case of this rare tumor.
The ovarian serous Cystadenocarcinoma shared large number of deaths in gynecologic carcinoma. It has various numbers of molecular events from initiation to progression and at advance stage, surgery is the end product of such molecular signaling. We assess in this study the whole mechanistic view of TNFSF10 network which has the ideal apoptotic causing identity. We used fresh insilico strategy to uncover the secrets and inter-links from its protein-protein interaction complex. We retrieved the TNFSF10 signaling network from STRING database (www.string-db.org). The network contains 25 nodes and 152 edges with clustering presentation. After retrieval, we performed gene enrichment and characterization analysis of network from WebGestalt toolkit (www.webgestalt.com). Finally, we examined the participation of whole network in ovarian cancer progression from cBioPortal, a cancer genomic data portal (www.cbioportal.org). Our results showed that majority of cases have loss of function of death receptors (DR4 and DR5) that are the main unit of initiation of apoptotic signaling. Most of downstream signaling members showed amplification that regulates cell proliferative pathways including NFkB pathway. TNFSF10 cluster has loss of function and in future it gain attention for further research studies to discover its interactome level view for valuable therapy. FAS cluster has large number of members and majority showed amplification rendering them as co-targets for combinational drug designing.
Felicitas Escher*, Uwe Kuhl, Dirk Lassner and Heinz-Peter Schultheiss
Cardiomyopathy is a heart muscle disease with structural and functional myocardial abnormalities in the absence of coronary artery disease, hypertension, valvular disease, and congenital heart disease. However, it has become clear that diverse etiologies and clinical manifestations (e.g. arrhythmogenic right-ventricular cardiomyopathy/dysplasia (ARVC/D), ARVD/C, left-ventricular non-compaction cardiomyopathy (LVNC)) are responsible for the clinical picture of dilated cardiomyopathy (DCM).
Ylber Jani*, Atila Rexhepi, Bekim Pocesta, Ahmet Kamberi, Fatmir Ferati, Sotiraq Xhunga, Artur Serani, Dali Lala, Agim Zeqiri and Arben Mirto
Background: An increasing body of evidence indicates that inflammatory activation profoundly impacts the electrophysiological properties of cardiomyocytes. A marker of systemic inflammation such as C-reactive protein(CRP), is associated with all parameters of the Mtabolic syndrome(MetS) and that may result in adverse cardiac events via multiple effects, ultimately resulting in a prolongation of Action Potential duration (APD), and thereby of the QTC (QT corrected) interval on ECG.
Objective: We sought to investigate the influence of CRP levels on the prevalence of prolonged QT-dispersion and prolonged Tpeak-Tend –dispersion in the patients with MetS.
Methods: We conducted a multicenter observational cross-sectional study. The study population consisted of 200 patients with MetS, stratified in two groups:103 participants (50 females and 53 males) with level of CRP>3mg/l, and 97 participants (47 females and 50 males) with level of CRP<3mg/l), who attended outpatient visits at general cardiology Health Care Clinics during 1 calendar year. For the analysis of the ECG, we performed a manual measurement of the values using a digital caliper with measuring range of 0-150 mm, 0.01 mm resolution, and 0-100 ± 0.02 mm accuracy. QT interval dispersion was obtained by the difference between the maximum and the minimum QT intervals found in the 12-lead electrocardiogram. The Tpeak-Tend interval was obtained from the difference between QT interval and QTpeak interval.
Results: Prolonged QTC. dispersion, was found in 51.4% of participants with level of CRP>3mg/l and in 32.9% of with level of CRP<3mg/l, the differences were statistically significant. (p=0.004). The results showed that 51.4% participants with level of CRP>3mg/l had a prolonged Tpeak-Tend interval, and 32.9% of participants with level of CRP<3mg/l had prolonged Tpeak-Tend interval. Difference were statistically significant.( p=0.04). There were significant association of increased levels of CRP and QTC-dispersion (OR = 2.486, 95% CI 1.389-4.446).There were significant association of increased levels of CRP with Tpeak-Tend Dispersion (OR=2.239,95%CI 1.262-3.976). Prolonged QTC max. Interval OR=2.236,%CI 1.246-4.014),Prolonged Tp-Te-interval. (OR=2.367, 95%CI 1.327-4.222), also there were significant association of increased levels of CRP with BMI. (OR=1.154, 95%CI 1.095-1.227) and significant association of increased levels of CRP with presence of uncontrolled glicemia.(OR=1.779, 95%CI 1.014-3.12).
Conclusion: We think we proved the hypothesis that patients with MetS and high level of CRP have higher prevalence of QT- dispersion and Tpeak-Tend dispersion than patients with MetS and lower level of CRP. These findings have both epidemiological and clinical relevance, also these findings might lend further insight into potential mechanisms by which MetS is associated with adverse cardiac events.
Carlos Jesus Rodriguez-Zuñiga, Leonel Martínez-Ramírez, Carlos Alberto Guizar-Sanchez, Mauricio Quetzal Trejo-Mondragon and Nilda Espinola-Zavaleta*
A 16-year-old man with history of two weeks-flu like symptoms with intermittent fever. He came to the emergency department with 2 hours-chest pain that radiates to the back and upper extremities. At the admission he was hemodynamically stable with normal blood pressure The ECG showed sinus rhythm and ST segment elevation of 0.5 mV in all leads (Figure 1A).The cardiac enzymes were elevated (Troponin 12.19 ng/mLland creatine kinase-MB fraction 63.25 U/L). He was admitted to the Intensive Care Unit and later transferred to our medical unit to continue with study protocol. The transthoracic echocardiogram (Figure 1B) reported normal left ventricular systolic function with left ventricular ejection fraction (LVEF) 68%, global longitudinal strain -18%, TAPSE 30 mm, and normal systolic pulmonary artery pressure (30 mmHg).
Jan Jacques Michiels, Yonggoo Kim, Myungshin Kim, Francisca Valster, Vincent Potters, Zwi Berneman, Alain Gadisseur, Wilfried Schroyens and Hendrik De Raeve
The clinical phenotypes in 268 JAK2V617F mutated MPN patients in the Seoul study were PV in 101, ET in 95 and MF in 78 and 56 CALR mutated MPN consisted of PV in none, ET in 40 and MF in 16 cases. CALR mutated MPN patients were younger than JAK2V617F mutated MPN patients (mean ages 57.5 and 66 years), had lower values for values for leukocytes (8.6 vs 11.9x109/L) and higher values for platelets (898 vs 643x109/L respectively). Bone marrow histopathology in 268 JAK2V617F mutated MPN patients in the Seoul study was featured by an increased erythropoiesis and megakaryopoiesis (EM) in 13.5%, an increased erythropoiesis, megakaryopoiesis and granulopoiesis (EMG) in 31.3%, a normocellular megakaryocytic (M) proliferation in 29,1%, a megakaryocytic and granulocytic (MG) proliferation with a relative reduction of erythropoiesis in post-ET and Post-PV myelofibrosis in 26.2%. The bone marrow histology in 56 cases of CALR mutated MPN show a predominantly increased megakaryopoiesis (M) in two thirds and an increased megakaryopoiesis and granulopoiesis (MG) with a decreased erythropoiesis in one third.
Thirteen consecutive CALR MPN patients in the Belgian & Dutch cross sectional study presented with thrombocythemia associated with a typical PMGM bone marrow histology in 11 and myelofibrosis in 2 cases. All 11 thrombocythemia and 2 myelofibrosis CALR mutated MPN patients did not have constitutional symptoms and did not suffer from microvascular erythromelalgic disturbances, major thrombosis at platelet counts between 400 and 1000x109/L. There was an occurrence of hemorrhages at platelet counts above 1000x109/L in two CALR thrombocythemia cases.
Bone marrow histology of CALR mutated thrombocythemia in the Seoul and Belgian/Dutch study showed loose clusters of large megakaryocytes (M) with bulky, cloud-like nuclei with a normal or a minor reduction of erythropoiesis and no increase in reticulin fibers grade 0 or 1 (RF 0 or 1). CALR thrombocythemia patients show various degrees of increased bone marrow cellularity due to dual megakaryocytic and granulocytic (MG) proliferation featured by large megakaryocytes with roundish bulky nuclear forms and cloud-like clumsy nuclei, which are almost never seen in JAK2V617F ET and PV. Assessment of allele burden is an independent and most important factor for all molecular variants MPN disease burden. Overt myelofibrosis with advanced post PV and or ET myelofibrosis at the bone marrow level occurred in one third (30%) of 208 evaluable JAK2 MPN patients and in 8 (14%) of 56 CALR MPN patients in the Seoul study.
Antarctica is known for its extreme environmental conditions. It is the best model to study multiple stress factors at a time on human physiological responses. Although the coastal Antarctica is on Sea level but the Antarctic plateau or pole at high altitude. Since Antarctica is also becoming tourist site it is pertinent to have a proper understanding of altitude induced illnesses. In this review we have described the human acclimatization process at high altitude of Antarctic polar plateu and South Pole. The review also highlighted the symptoms, clinical features and prevention of altitude induced diseases.
The rise in all-cause and cardiovascular mortality and hospitalization rates among the hemodialysis (HD) patients after the long weekly inter-dialysis interval is very impressive. In fact, there is an additional long-term morbidity risk besides this acute rise in mortality and hospitalizations that can be expected from the weakly exaggerated pre-dialysis peaks of the less risky hemodynamic and biochemical parameters. An approach for eliminating these long weekend inter-dialysis intervals is through the provision of the hemodialysis sessions on every other day (EOD) basis, regardless of the week days. This is likely to be both practical and cost-effective. Such EOD schedule can be introduced easily beside the ongoing thrice weekly HD schedule without disturbance of the HD unit work. The availability of EOD schedule would provide a healthier and cost-effective alternative schedule for those patients who can’t tolerate the weekend intervals and for those looking for maintaining their long-term health on the option of hemodialysis. In fact, with available data, medical staff is expected to encourage all patients to shift their HD to the EOD schedule.
Salman Imtiaz*, Ruqaya Qureshi, Amna Hamid, Beena Salman, Murtaza F Drohlia and Aasim Ahmad
Background: Patients with chronic kidney disease (CKD) are at the risk of increase hospital admission as compared to the general population, due to various reasons. They have increased vulnerability to cardiovascular diseases (CVD) as well as infections, therefore they usually got admit in health care units due to various reasons. The causes of hospitalization in CKD patients in this part of the world are not studied well.
Methods: This cross sectional study was conducted in The Kidney Centre Post Graduate Training Institute (TKC-PGTI) of Karachi. Variables included in the study were age, gender, are of residence, ethnicity, smoking status and level of education. Comorbid conditions like causes of CKD and causes of hospitalization. Data analysis performed by using software IBM SPSS 21.
Results: Total of 269 patients were enrolled in our study. The male 148(55%), mean age was 55 years. The most common cause of hospitalization in our population was infection148 (55%) and urinary tract infection (UTI) was the most common site of infection 55 (20%) followed by sepsis of unknown origin 29(10.8%). Cardiovascular events like volume overload 32 (11.4%) and acute coronary syndrome 20(7.4%) were the second most important cause of hospitalization.
Conclusion: Hospitalization of CKD patients is high, and in our population infection is found to be the leading cause of hospital admission. Infection originating from urinary tract is more common in all stages of CKD patients, while blood born infection originating from double lumen (DL) dialysis catheter or arteriovenous fistula (AVF) cannulation is more common in dialysis population. Cardiovascular events, both acute coronary syndrome and pulmonary edema due to volume overload followed the infections.
During the last three decades, there has been an interesting debate on the intake of A1 ‘like” milk and incidence of type 1 diabetes (T1D) in genetically predisposed individuals. The epidemiological, ecological and case-control studies have concrete pieces of evidences in favor of the hypothesis that is further supported by animal trials in mice and rat and in vitro trials on cell lines. But on the other hand, European Food Safety Authority reported that there isn’t sufficient data to draw a final recommendation at this stage in terms of contradictory results, lack of cause-effect relationship and being a mere suggestive evidence [1]. However, the report itself states that these studies are strong enough to formulate a concrete hypothesis and further research is needed to confirm the same. Keeping in view the published data in favor of the hypothesis and the counter-arguments, it is suggested that further research with well-designed animal and in vitro trials with intact proteins and peptides is needed to fully confirm the hypothesis. Until the issue is fully resolved, it’s the personal choice of the individuals at risk to T1D (genetically predisposed) to either remove A1 “like” or increase the A2 “like” milk from their diet.
Nanotechnology is a smart technology in the field of biomedical engineering used for the diagnosis and treatment of diseases. Nanodrugs provide better encapsulation of drug and efficiency at low dosage to kill the targeted tissue/cells. However, the chances of chronic toxicity and high cost of treatment limits its applicability [1]. To overcome these problems still, the experts of the scientific community have been working on it, to design the best one and cost-effective treatment for the human welfare.
Healthcare is realizing the importance of health information technology - its applications and devices in play today. Advancing healthcare best practices will rely on up to date data and analysis to provide the most effective forms of therapy. Healthcare is becoming more reliant on patients who are engaging in their own healthcare. With this we are seeing an increase in available health related apps for these devices. This summary reviews various connected health strategies using proven apps and devices to improving the quality of care, promoting patient engagement, and improving outcomes. Here we discuss several trends and the healthcare delivery implications.
The Federal and State governments have declared the presence of an opioid addiction pandemic in the United States claiming the lives of more than 55,000 in 2015 (Rudd RA, Seth P, David F and Scholl L. 2016). The pharmaceutical manufacturers of the numerous FDA-approved opioid drugs are raking in more than $5 billion per year with about 2 million chronic pain sufferers addicted. The irony of this narcotic use and abuse conundrum is the existence of evidence-based technology for drug-free pain management which is not covered for reimbursement among public and private third-party payers. Therefore, this paper is presented to propose a pilot study to demonstrate the efficacy of resolving the chronic inflammation, edema and ischemia that causes non-malignant chronic pain with PEMF therapy, a non-invasive, non-thermal radio transmission of electrical impulses, thereby invalidating the legitimacy of prescribing opioid analgesics in such cases.
The considerable improvements in cardiac support systems technologies have not solved until now the problem of connecting the cardiac assistance devices (CAD) to external energy sources, which makes these Patients at risk of lethal infections and dependent on external batteries with few hours of autonomy. Authors illustrate and discuss the hemodynamic concepts and clinical that underlie the mechanics of the first not-motorized implantable cardiac assistance device (NICA).
<h2>Summary</h2><p>Changes in contemporary obstetric and gynaecological practice in relation to ultrasound cervical screening during pregnancy, the treatment of intra-epithelial cervical neoplasia and laparoscopic surgery have resulted in an increased utilization of trans-abdominal cervico-isthmic cerclage in an attempt to reduce the incidence of mid-trimester and early preterm birth in women with repeated pregnancy loss.</p>
Benzene (B), toluene (T), ethylbenzene (E) and xylene (X), collectively named as BTEX are mono-aromatic ring compounds with a 6-carbon benzene ring. Due to the presence of the aromatic ring, these compounds, especially benzene, are generally considered to be non-reactive species [1]. However, they are known to undergo hydrogenation and certain substitution reaction depending on the prevailing environmental conditions. Their solubility in water is usually low (i.e. relatively hydrophobic in nature) due to the low octanol-water partition coefficient (Kow) values which favour hydrophilic dissolution [2]. BTEX compounds are relatively insoluble in water and in some situations, their levels have been recorded at up to 1000 mg/L, which is much higher than the allowed maximum contaminant level of 0.005 mg/L for B, 1 mg/L for T, 0.7 mg/L for E, and a total of 10 mg/L for all three forms of X [3]. They are released into the natural environment (air, water, soil and sediments) due to landfill leaching, underground storage tanks, accidents during oil transportation and pipeline leakage from petroleum and chemical industries [4].
Anna M Michałowska-Kaczmarczyk and Tadeusz Michałowski*
This article refers to calculations involved with determination of ethanol, analyzed according to redox back titration principle. A quantitative reasoning, based on logical sequence of statements, is presented for derivation of the formulas required to calculate the results of chemical analyses according to stoichiometric principles. The titrations are considered as two-step analytical procedures. This way, one can gain an insight into a classical redox titration and get a knowledge on the advantages of back titrations.
Biomarkers have been used in the diagnosis of disease and other conditions for many decades. There are diverse ranges of analytical targets, including metabolites, nucleic acids and proteins were used as a biomarker. Clinical diagnoses already rely heavily on these for patient disease classification, management, and informing treatment and care pathways. For that there is always a need of rapid and point of care test. However, until fairly recently, studies of biomarker efficacy in a clinical setting were mainly limited to single or dual use, and the landscape was complex, confused, and often inconsistent. Few candidates emerged from this somewhat clouded picture: C-reactive protein, procalcitonin (PCT) for sepsis, ADA for mycobacterium tuberculosis and a Circulating miRNAs serve as molecular markers for diverse physiological and pathological conditions.
Kalach Mussali Alberto J* Gonzalez-Magana Fernando and Malagon Hidalgo Hector O
Several articles have discussed mandibular condyle position after bilateral sagittal split osteotomies (BSSO). However, previous studies have sought to establish a relationship between orthognathic surgery and the improvement of temporomandibular joint (TMJ) signs and symptoms.Also, they have been limited to two-dimensional evaluation of condylar position considering only the condylar “sag” or improper inferior seating of the condyle. The purpose of this study was to investigate a relationship between changes in condylar position using three-dimensional computed tomography and the negative clinical impact of BSSO on the temporomandibular joint.
Ali Mohammed Abu Zeid, Doaa Youssef Mohammed*, Amal Saeed AbdAlazeem, Anas Saad Elsayed mohammed Seddeeq and Ashraf Mohamed Elnaany
Background and objectives: New AKI biomarkers (on the top of it NGAL biomarker) have demonstrated better performance for prediction of AKI in critically ill patients with heterogeneous illness. Renal angina index was recently reported to enhance prediction of severe AKI at the time of intensive care unit admission. This study tested the hypothesis that incorporation of uNGAL in patients with renal angina improves the prediction of severe AKI.
Design, setting, participants & measurements: In our study 53critically ill children admitted to the pediatric intensive care unit in Zagazig university hospital, Measurement of urine neutrophil gelatinase– associated lipocalin (uNGAL) was determined individually by ELISA kit and in combination with the RAI which is calculated in each critically ill child for severe AKI. Statistical analysis was done for these data.
Results: Individual uNGAL demonstrated marginal discrimination for severe AKI (area under curve [AUC]: NGAL, 0.877), little higher than prediction by RAI (AUC=0.847). Incorporation of uNGAL significantly added to the renal angina index AKI prediction (AUC=0.847, increased to 0.893).
Conclusion: This study shows that incorporation of uNGAL into the RAI improves detection ability of severe AKI in critically ill children.
Background: Transcatheter arterial embolization can be used for patients with recurrent bleeding from the upper gastrointestinal tract after failed endoscopic treatment. Our aim to identify the clinical and technical factors that influenced the outcome of transcatheter embolization for therapy of upper gastrointestinal bleeding after failed surgery or after failed endoscopic treatment in high risk surgical patients.
Methods: We performed a prospective study to analysis of the 15 patients who underwent Transcatheter arterial embolization for nonvariceal upper gastrointestinal bleeding at Alshifa hospital from January 2015 to March 2019.
The following variables were recorded: demographic data, time from bleeding start to TAE, units of packed red cells before TAE and units of packed plasma before Transcatheter arterial embolization and we analysis 30 days rebleeding rates and mortality
Results: Patients treated with Transcatheter arterial embolization (median age: 62 years, range: 14–79 years).The technical success rate of the embolization procedure was 100%. Time from bleeding start to TAE was 2.1 (1-4) days , units of packed red cells before Transcatheter arterial embolization was 12.8 (4-22) packed and units of packed plasma was 3.2 (2-5) packed. Following 30 days after embolization, 2 (13%) patients had repeated bleeding and 3 (20.0%) patients died.
Conclusion: In our experience, arterial embolization is a safe and effective treatment method for upper gastrointestinal bleeding and a possible alternative to surgery for high-risk patients.
This article reflects the opinion on a few of my clinical experiences involving symptoms and signs which are not mentioned in standard textbooks on medicine or clinical methods. These are clinical and a few radiological signs which I think worth discussing by clinical community, includes Muslim prayer’s feet, hyponatraemic bullae, early signs of oedema, PCV sign, hemi-semi-Hoffman’s sign and a few more.
<h2>Abstract</h2><p>NMDA receptor encephalitis is a rare disease first described in 2007. Anti-NMDA receptor encephalitis affects mostly young women as neoplasms, mostly ovarian teratomas, are the underlying cause. The disease is caused by antibodies binding to extracellular epitopes of neuronal cell-surface, which leads to an internalization of NMDA-receptors. The characteristic syndrome of patients with anti-NMDAR as well as its recovery follows a certain pattern. Treatment includes immunotherapy and removal of the immunologic trigger. This case report describes a young woman with anti-NMDA receptor encephalitis caused by an ovarian teratoma.</p>
Paulo Kauffman*, Alfredo S Helito, Mairy JA Poltronieri, Marcos R Garcia and Publio CC Viana
Introduction: Peripherally inserted central venous catheters (PICCs) have been increasingly used as an alternative to conventional central venous catheters for long-term administration of chemotherapy, antibiotics, parenteral nutrition, and hydration in patients with difficult venous access. Traumatic complications to arteries and nerves adjacent to veins selected for PICC placement have been rarely described.
Case presentation: We report the case of a PICC placement in the brachial vein of the right upper limb of a 78-year-old woman that resulted in brachial artery pseudoaneurysm and median nerve lesion.
Discussion: The pseudoaneurysm was successfully repaired with thrombin injection, but neurological deficits to the hand resulting from nerve injury persisted even four months after the procedure.
Doaa Mohammed Youssef*, Mohammed Hassan Mohammed, Eman Mohammed EL-Behaidy and Asmaa EL-Sayed Abo-warda
Introduction and aim: Idiopathic nephrotic syndrome (INS) is the most common type of this disease during childhood. Minimal change nephrotic syndrome (MCNS) is the most common histopathological lesion (80 – 90%) of INS in children and about 90% of patients are steroid responsive, while congenital nephrotic syndrome is disorder that may be caused by several diseases. Intrauterine infections, especially CMV infection, have frequently been incriminated as etiological factors of secondary CNS. The aim of this research was to evaluate the frequency of CMV infection children with active nephrotic syndrome in our pediatric nephrology unit
Patients and methods: This descriptive (cross sectional) study was conducted in pediatric nephrology unit, Zagazig University Hospitals and included 60 patients WITH NS in activity; Participants were subjected to, Full history taking, Clinical examination; general & local, Routine laboratory investigations and Serum samples were tested for HCMV specific immunoglobulin G (IgG) and immunoglobulin M (IgM) using ELISA Kit.
Results: We found 100% of cases were IgG positive and 7/60 cases were IgM positive, There were no statistically significant differences between IgM positive-patients vs IgM-negative patients according to age, sex and first attack or relapsed NS, There were statistically significant differences between IgM positive-patients vs IgM-negative patients in blood laboratory data in decreases in HB (P=0.024) and serum urea nitrogen (P=0.04)
Conclusion: We concluded that serofrequency of cytomegalovirus infection in pediatric nephrology unit, Zagazig university hospitals during follow-up was 12% for cmv IgM and 100% for cmv IgG at ns children patients.
Background: Congenital Vascular malformation relatively rare and extremely varied clinical presentations. The purpose of our study was to present our initial experience of embolization in a series of 26 patients with congenital vascular malformation to assess retrospectively the results and the complications of ethanol and coils embolization treatment of these patients.
Methods: Retrospective trial, the study group consisted of 26 patients with congenital vascular malformations. Transcatheter arterial embolization by ethanol or coils were performed, Therapeutic outcomes were established by evaluating the clinical outcome of symptoms and signs, as well as the degree of devascularization at follow-up angiography.
Results: Between November 2014 and March 2018, 26 consecutive patients (3 male, 23 female) at Alshifa Hospital - Cardiac Catheterization Center with congenital vascular malformations in the body and extremities underwent staged ethanol or coils embolization. The mean age of the patients was 25 years (age range, 6– 59 years). Ethanol embolization was administrated in 16 patients, coil embolization in 9 patients and graft stent in one patient. The side effect such as pain, pulsation, and bruit in most of the patients were obtained. The reduction of redness, swelling, and warmth was achieved in all of the patients, According to the angiographic findings, congenital vascular malformation were devascularized 100% in 12 patients, 50% to 99% in 11 patients, less than 50% in 3 patients. The most common complications were reversible skin necrosis.
Conclusion: Transcatheter embolization by ethanol or coils has proved efficacious and safe in the treatment of congenital vascular malformation of the body and extremities but with acceptable risk of complications.
Marieke T Drijver-Messelink*, Mariette Wagenaar, Jacqueline van der Meij and Anneke ten Brinke
Asthma is a highly prevalent airway disease with multiple phenotypes [1,2]. Adult-onset eosinophilic asthma is a severe asthma subtype associated with more frequent and severe exacerbations, the development of persistent airflow limitation and a poorer quality of life. This type of asthma is much more difficult to control than other asthma subtypes, requiring high doses of inhaled or even oral corticosteroids (OCS) [3,4]. Recently, several new monoclonal antibody therapies have been approved for eosinophilic severe asthma, including anti-IL-5 treatment. IL-5 is essential for eosinophilic maturation and survival [5] and anti-IL5 treatment has markedly reduced asthma exacerbations with sparing of OCS use in patients with eosinophilic asthma [6]. Eosinophilic asthma is frequently associated with chronic rhinosinusitis and/or nasal polyposis [7], suggesting that a similar eosinophilic inflammatory process might drive both conditions. Eosinophilic otitis media (EOM) also might fit in this concept, showing remarkable similarities with asthma and nasal polyposis. The disease was first reported in 1994, but only since 2011 diagnostic criteria for EOM were identified. If a patient shows otitis media with effusion or chronic otitis media with eosinophil-dominant effusion (major criterion) and is being positive for ≥2 items of the 4 minor criteria (highly viscous middle ear effusion, resistance to conventional treatment, association with asthma, association with nasal polyposis) he is diagnosed as having EOM. Eosinophilic granulomatosis with polyangiitis and hypereosinophilic syndrome must be excluded [8].
Although laurel wilt disease was first reported in the United States in 2002 from redbay trees (Persea borbonia) around Savannah, Georgia it has rapidly spread throughout the southeastern coastal plain including Georgia and Florida. In the current study, transects were used to assess the spread and impact of the disease on two native bay trees redbay (P. borbonia) and swampbay (P. palustris) from north Florida in a semi-naturalized ecological preserve. Although tree size and mortality rates have been reported previously, this study provides the first size-based static life tables for both species. While a significantly higher percent (76%) of swampbay trees exhibited signs of laurel wilt disease compared to redbay trees (62%); redbay had more of its canopy damaged by the disease (41% vs. 32% for redbay vs. swampbay respectively); this resulted in a significantly smaller stem diameter for P. borbonia compared to swampbay, both species are experiencing significant declines due to the disease. Both species exhibited a Type III survivorship curve in which the vast majority of individuals were in the smallest size class (average stem diameter was only 2.5 and 3.6 cm for redbay and swampbay respectively). Although traditionally, population age (or size) structure that is heavily biased toward younger or smaller size classes suggests that the population is likely to expand in the future, for these bay trees high mortality rate due to beetle/fungal infestation of larger size classes is responsible for this trend; the smallest size classes are largely free from beetle infestation and laurel wilt disease because the stem diameter is likely insufficient to support beetle development. Results from this study suggest that swampbay is also highly susceptible to laurel wilt disease and its populations are likely to exhibit a similar (albeit slower) decline in Florida’s wetland and mesic ecosystems.
Assuming that the road infrastructure has been implemented in accordance with specifications and standards, poor adhesion between the two layers of asphalt mix can be a significant cause of pavement problems. The general problem observed with the weak adhesion between the layers is the slip failure. Slipping disruption in areas where transport acceleration increases, in areas where acceleration decreases or may occur in bumps. One of the criteria and a test method for measuring adhesion resistance between the hot mix asphalt layers is needed to improve the surface finish. The main objective of this study is to determine the effect of reducing the coefficient of friction between asphalt layers in the displacement of asphaltic layers. Because performing experimental experiments in the country is a deterrent to this goal, the use of analytical and numerical methods has been shown to play an important role in conducting studies. Therefore, in this paper, using vehicle simulation in ABAQUS software and analyzes, it has been found that decreasing the coefficient of friction (adhesion reduction) increases the interlayer deformation, which causes the surface of the pavement to fail. Three different thicknesses for asphalt cladding, including 4, 6, and 7 centimeters, and three different thicknesses for roller concrete layers of 18, 20 and 22 centimeters are used. Modeling and analysis of pavements with finite element method has been performed and the depth of the asphalt and tensile strain slope is calculated at the maximum level. The results show that the type of asphalt mix has a high impact on the amount of sloping and tensile strain at the maximum level. So that under different conditions it is estimated to be about 2-3 times in the amount of rotation at the surface. Also, the amount of groove and strain in the middle of the procedure is increased by a thickness of 11% the thickness of the roller concrete thickness has not changed, but the surface strain has been reduced by 9%.
For 51 days, Gaza was pummeled down by the Israeli military in a war known as Operation Protective Edge. During the 50 days (7-7-204 to 28-8-2014) of the Israeli campaign, 2104 Palestinians were killed, including 253 women (12%) and 495 children (24%). According to the UN, at least 69% of Palestinians killed were civilians. It is estimated that 10,224 Palestinians, including 3,106 children (30%) and 1,970 women (19%) were injured.
Thirunavukarasu S, Zaman M, Hayat A, Aghamohammadzadeh R and Malik N
Background: Vascular closure devices are routinely used following femoral artery access to perform percutaneous coronary interventions (PCI). A number of devices are available on the market. We have reported previously on our experience of the Mynx device following diagnostic coronary angiography.
Aims: To assess the success and complication rates of the Mynx device used in all-comers in the context of PCI within a single cardiac centre.
Methods: Retrospective analysis of data available for patients who underwent PCI via the femoral route and received a Mynx device at a single tertiary centre.
Results: The device was used to achieve haemostasis in 113 patients following PCI. In all cases weight-adjusted Heparin as well as dual antiplatelet therapy (Aspirin and Clopidogrel/ Ticagrelor) was administered as per PCI protocol. The device was successfully deployed in 111 cases (98.2%). The were 2 cases of device failure, one due to operator error and the other due to Mynx grip balloon bursting during device deployment. In 15 cases (13.2%; 9 male and 6 female) there were reports of small haematomas (<2cm) or oozing resulting in application of manual pressure or Femstop (St. Jude). A further patient required ultrasound-guided compression of the artery due to a large retroperitoneal bleed resulting from access complications. A larger proportion of the cases with complications were done as PPCI (44% vs 33%). The group with complications had higher systolic BP (140mmHg vs 128mmHg; P<0.05) and MABP (97mmHg vs 75mmHg; P<0.05) as compared with the group without any complications.
Conclusion: The Mynx closure device is safe and easy to use in the context of PCI, in both the elective and emergency (PPCI) settings. Complication rates, predominately minor, can be minimised in experienced hands.
Gastrointestinal (GI) bleeding is a very common medical problem encountered in the acute care setting, and is a major cause of admission to hospitals with about 300,000 patients admitted annually. Obscure GI bleeding, defined as persistent or recurrent bleeding following initial negative upper and lower endoscopy, represents approximately 5% of all GI hemorrhages. The small bowel is the most common source for obscure GI bleeding. Variable lesions of the small bowel can cause obscure GI bleeding, with tumors, Crohn’s disease and Meckel’s diverticulum being more common in young age group. Meckel’s diverticulum, the most common GI congenital malformation, is usually asymptomatic and incidentally found. It can present with GI bleeding, seen more in pediatric patients, and rarely in adult patients. Herein, we present a 45 years old female patient, presenting with massive obscure GI bleeding due to Meckel’s diveticulum.
Background: Today’s older adults are often well informed and want to participate in decision-making processes. The coordinated individual planning process offers them active involvement in deciding and owning how their care will be managed.
Aim: The aim of the study was to explore active older adult's knowledge and views regarding coordinated individual planning
Methods: The study has an exploratory inductive approach. Five focus-group discussions were conducted with 40 participants from different organizations and associations. A qualitative interpretive description framework was used, and the analysis resulted in four unique themes.
Results: The four themes resulting from the analysis are collaboration and continuity, participation and involvement in decision, individual need for support, and access to information and service. Collaboration between different levels of the healthcare system and between professionals is crucial. Older adults wanted to be participating actors in their healthcare. They worried about the lack of continuity and thought that services were not responsive or did not meet individual's needs.
Conclusion: Older adults want their views and preferences to be taken into consideration, and they want to be actively engaged in the decision-making process regarding their care.
Soma Mondal*, Ashutosh Srivastava, Geeta Joshi and HC Yashavantha Rao
Tropical forests have long been of interest to biologists because of their high species diversity and their complicated patterns of community organization. The recent ecological studies which have demonstrated that tropical trees are diverse in their reproductive biology and dynamic population structure.Asynchronous flowering among the clones in a clonal seed orchard is an inherent problem resulting in poor seed and fruit set in them. These results in the complete defeat of the prime objective of establishment of clonal seed orchards (CSOs) i.e. abundant quality seed production poor flowering and asynchronous flowering between the clones are a major bottleneck in higher seed set in these clonal seed orchards across the country. Asynchrony found between clones may be attributed to the origin of clones, which are collected from different zonal populations as revealed by isoenzyme and DNA markers studies. This article reviews the work done in CSOs across the world and suggests an alternate strategy in designing the clonal seed orchards of the future.
Maurizio Falso*, Matilde Grillo, Anna Righetti, Franco Lopa, Lisa Rocco and Emanuela Facchi
Background: The use of a custom-made orthotic plantar device is referenced as a true sensor-motor facilitation tool for the control of the postural orthostatic and orthodynamic position in patients with Parkinson’s disease.
Aim: To outline the postural and kinematic effect of a pro-ergonomic multilayer foot insole versus a custom-made carbon-kevlar dynamic foot insole in a cohort of patients affected by extrapyramidal disease.
Setting: A rehabilitation institute for the treatment of neurological and orthopaedic gait disorders.
Methods: A sample of 8 patients (mean age of 82.6), of whom 4 affected by Parkinson’s disease (P) and 4 by Parkinsonism (PS) were recruited for the aim of this study. In line with our inclusion criteria (clinical-functional diagnosis of Parkinson’s disease or Parkinsonism, Webster scale ≤ 20, Mini-mental State Examination (MMSE) ≥ 18), the study design developed in 2 times:
a. time T1 (or evaluation time), in which recruited patients affected by Parkinson’s disease or Parkinsonism were evaluated at the Hospital and Noble Resting House Paolo Richiedei through an accurate functional (Conley scale, Barthel Index scale, Tinetti scale and the Berg Balance Scale), postural evaluation (VPA) and walking examination (VGA, baropodometric evaluation, kinematic gait evaluation through WIVA system); to each group of patients of our study were therefore entrusted 4 foot-insoles, of which 2 synthetic and 2 carbon-kevlar custom-made foot-insoles called PRODYNAMIC; at the end of this step, patients started with our integrated rehabilitative treatment course.
b. time T2 (or experimental time; 90 days from T1), a new clinical-instrumental evaluation of each patient was performed, repeating the clinical-functional and instrumental evaluation performed at the time T1 in a specular way; this assessment was performed in FW condition, with personal footwear and previously acquired foot-insoles used during the evaluation at the T1 time.
Results: Most of our patients have been able to find benefit from the use of the plantar orthosis and integrated rehabilitation treatment so as to bring some modifications within personal postural attitude, recording an improvement but not uniform change within the sample. The results obtained by comparing the VPA at time T1 and at time T2 explain how patients affected by both clinical forms tend to establish incorrect postural attitudes due to stiffness and appearance of hypertonic plasticity, which become then structured and only partially modifiable. There was a general performance improvement in line with the VGA: within the P.B group, we observed with the use of the Prodynamic insole a partial or even complete normalization of the dynamic heel-contact phase, a better alignment of the COP in its excursion from the 1st to the 2nd rocker phase of the step, a notable facilitation to the inertial thrust in progress in the 3rd and 4th rocker phase, an improvement in the eccentric control of the patellofemoral alignment in the acceptance phase of the so-called load-response in stance and, finally, the acquisition of a more physiological propulsion structure of the trunk basin unit with an improvement of the clearance and fixation skills in the sequential phases of the step. This trend was evident but not uniform in the other groups considered. Analysis of the evolution of the degree of functionality in the daily life activities expressed by the Barthel index, passing from time T1 to the time T2, showed an improvement and consistent change in all groups considered within our study that we can find in a more or less way for the other clinical outcome data. An objective time-related and intra-group comparison of the raw static and dynamic baropodometric data acquired in our 4 study conditions showed different time-related trends for the two groups taken into consideration. A specific WIVA profile was found for each pathology group, highlighting different trends passing from time T1 to time T2 in particular of the gait cadence and gait speed. In particular, in the “Prodynamic” study condition the gait cadence shows in the Parkinson group a significant increase from time T1 to time T2, passing respectively from an average value of 41.9 ± 11.7 to 54.9 ± 1.1; patients of the Parkinsonism group showed a value of the average gait cadence at time T1 higher than the other study conditions at the same evaluation time, with an increase of this data from T1 to T2, passing from 43.1 ± 11.8 to 47.4 ± 4.4. If we consider the gait speed time-related trend, in the “Prodynamic” study condition at T1 the gait speed in Parkinson patients is similar to that recorded in the “shoe” study condition; in Parkinsonism the gait speed recorded at time T1 is higher than that recorded in the other study conditions; at time T2 there is a less evident increase in speed compared to that observed in patients with Parkinson’s.
Conclusion: In today’s management of the profile of complexity of extrapyramidal pathology, the association of several health figures is of fundamental importance, with professional profiles and diversified skills, in such a way as to be able to guarantee a comprehensive management of the patient. From this point of view, the figure of the orthopedic technician will be able to play a new role within the rehabilitation team, which will be responsible for the best possible functional response (deriving from an optimal integration between orthotic and rehabilitation treatment) of patients with Parkinson’s disease.
Sorin P*, Ramirez FJ, Joly A, Patino O and Terrasa S
Study Design: Prospective Observational Study
Background: Physical therapy is one of the primary treatment options for these patients, however, we were unable to identify previously published research that objectively assesses the impact of taping on joint range of motion or on pain levels in patients with SAIS. This gap in the literature motivated the present study.
Objectives: To describe the results of the application of neuromuscular taping in patients with subacromial impingement syndrome (SAIS), with respect to their pain levels, joint range of motion, and acromiohumeral distance, assessed via ultrasound.
Methods: A prospective series of cases was evaluated at the Hospital Italiano de Buenos Aires between April and September of 2018. Twenty-four patients from age 25 to 65 were invited to participate (9 men and 15 women), all of whom had been diagnosed with rotator cuff tendinopathy, impingement syndrome, or bursitis with positive signs of impingement in the affected shoulder and anterior shoulder pain in flexion.
Result: Significant changes in AHD (Figure 2), pain, and anterior flexion were registered after taping. Superficial dermatitis was detected in only two patients, but this did not affect the assessment.
Conclusion: In the results obtained by this study, it has been observed that the application of neuromuscular taping using the method described above significantly increases AHD, leading to short-term improvements in pain and joint range of motion.
Objective: To investigate the effect of kinesio tape and therapeutic ultrasound on pain and hand grip strength associated with tennis elbow.
Material and Methods: Twenty male and female patients with age from 20-50 years suffering from lateral epicondylitis were participated in this study. All patients were randomly selected from orthopaedic surgeon. They were dividing into two groups. Group (A) (ultrasound and exercises group). Group (B) (kinesio tape and exercises group). The hand-held dynamometer was used to provide a detailed and objective measurement of wrist joint strength throughout its range of motion, the pressure being registered in kilogram (Kg) and Visual Analogue Scale (VAS) was used to record the degree of pain intensity.
Result: The result shows no significant difference between group A and B in their ages, weights, heights, and BMI where their t and P-values were (0.8, 0.43), (0.03, 0.97), (0.98, 0.33), and (0.9, 0.37) respectively. In Group A the significant differences in hand grip strength between pre and post-test which shows 31.59), compared to the pre-test (27.35), while in group B (33.17) compared to the pre-test (23.88). According the pain scale for group A and group B there are significant differences where the results were (2.50), compared to the pre-test (5.90) and (2.00), compared to the pre-test (7.30), retrospectively.
Conclusions: The treatment was improvement between both groups. However, the kinesio tape is better than therapeutic ultrasound.
The research concerning a preventive treatment of an osteoporitic femoral neck fracture started in 1990 because the surgical procedure of unstable femoral neck fractures is difficult. After effects are frequent and their number will increase in the next decade. The goal is to reinforce the femur with a biomaterial acting as a bone graft.
Natural coral is bioresorbable and biocompatible. It acts as an autofocus bone graft for reconstruction of either cortex or cancellous bone and increases their mechanical resistance.
This work shows evidence of new bone formation in an osteoporotic unbroken femoral neck femur. Consequently, the preventive surgical treatment of osteoporosis should be taken in consideration [1]. The purpose of this work is to show the results on the mineralization of the cancellous bone of an upper femoral metaphyses when a natural biomaterial is set in an unbroken osteoporotic femoral neck.
Summary: Mrs. L is an 84 years old lady. Her osteoporotic unbroken right hip was grafted preventively with a biomaterial in order to prevent the high risk of break in case of fall. The biomaterial used is beads of natural coral. The reasons of this preventive treatment is discussed, as well as the choice of the biomaterial. The results are shown including a two years follow up.
Brief History: Before going further, few words of history. Three centuries BC, an Aristote’s follower, Théophraste thinks that Natural coral is a petrified plant.
The present article extends the PVSG-WHO criteria into a simplified set of Rotterdam and European Clinical, Molecular and Pathological (RCP/ECMP) criteria to diagnose and classify the myeloproliferative neoplasms (MPNs). The crude WHO criteria still miss the masked and early stages of ET and PV. Bone marrow histology has a near to 100% sensitivity and specificity to distinguish thrombocythemia in BCR/ABL positive CML and ET, and the myelodysplastic syndromes in RARS-T and 5q-minus syndrome from BCR/ABL negative thrombocythemias in myeloproliferative disorders (MPD). The presence of JAK2V617F mutation with increased erythrocytes above 6x1012/L and hematocrit (>0.51 males and >0.48 females) is diagnostic for PV obviating the need of red cell mass measurement. About half of WHO defined ET and PMF and 95% of PV patients are JAK2V617F positive. The combination of molecular marker screening JAK2V617F, JAK2 exon 12, MPL515 and CALR mutations and bone marrow pathology is 100% sensitive and specific for the diagnosis of latent, early and classical ECMP defined MPNs. The translation of WHO defined ET, PV and PMF into ECMP criteria have include the platelet count above 350 x109/l, mutation screening and bone marrow histology as inclusion criteria for thrombocythemia in various MPNs. According to ECMP criteria, ET comprises three distinct phenotypes of true ET, ET with features of early (“forme fruste” PV), and ET with a hypercellular erythrocythemic, megakaryocytic granulocytic myeloproliferation (EMGM or masked PV). The ECMP criteria clearly differentiate early erythrocythemic, prodromal and classical PV from congenital polycythemia and idiopathic or secondary erythrocytosis. The burden of JAK2V617F mutation in heterozygous ET and in homozygous PV is of major clinical and prognostic significance. JAK2 wild type MPL515 mutated normocellular ET and MF lack PV features in blood and bone marrow. JAK2/MPL wild type hypercellular ET associated with primary megakaryocytic granulocytic myeloproliferation (PMGM) is the third distinct CALR mutated MPN. The translation of WHO into ECMP criteria for the classification of MPNs have a major impact on prognosis assessment and best choice for first line non-leukemogenic approach to postpone potential leukemogenic myelopsuppressive agents as long as possible in ET, PV and PMGM patients..
Primary myelofibrosis (PMF) is a distinct clinicopathological myeloproliferatve disease (MPD) not preceded by any other MPD ET, PV, CML,... Combined use of bone marrow histology and increased erythrocyte counts above 5.8x1012/L can replace increased red cell mass at time of presentation as the pathognomonic clue for the correct diagnosis of hetero/homozygous or homozygous mutated PV. Erythrocyte counts are in the normal range below 5.8x1012/L in heterozygous JAK2V617F mutated ET and prodromal PV but above 5.8x1012/L in heterozygous-homozygous or homozygous mutated PV. The bone marrow cellularity and morphology in pre-fibrotic ET, prodromal PV and PV carrying the JAK2V617F mutation are overlapping showing clustered increase of large mature pleomorphic megakaryocytes (M) with no increase of cellularity (<60%) in ET. The bone marrow is hypercellular (60%-80%) due to increased erythropoiesis megakaryopoiesis (EM) in prodromal and classical PV and trilinear hypercellular (80%-100% due increased megakaryopoiesis, erythropoiesis and granulopoiesis (EMG) in advanced PV and masked PV. Bone marrow cellularity ranging from normal (<60%) in ET to increased erythropoiesis (EM) in prodromal PV to hypercellular (80-100%) in advanced PV and masked PV largely depends on increasing JAK2V617F mutation load from low to high on top of other biological MPN variables like constitutional symptoms during long-term follow-up. MPL515 mutated ET is featured by an increase of clustered small and giant megakaryocytes with hyper-lobulated staghorn-like nuclei in a normal cellular bone marrow. The third entity of pronounced JAK2/MPL wild type ET associated with primary megakaryocytic granulocytic myeloproliferation (PMGM) without PV features proved to be caused by calreticulin (CALR) mutation. CALR mutated thrombocythemia is characterized by dual proliferation of megakaryocytic and granulocytic bone marrow proliferation of dense clustered large to giant immature dysmorphic megakaryocytes with bulky (bulbous) hyperchromatic nuclei, which are not seen in MPL515-mutated Thrombocythemia and JAK2V617F-Thrombocythemia, prodromal PV and classical PV.
In 2010, a study identified that only about 40 percent of doctors and other health care providers comply with proper hand hygiene techniques in hospitals and other healthcare facilities. These statistics are alarming as healthcare professionals are the ones who set the gold standard for hygiene and sterility, but they continue to find it difficult to demonstrate this standard in every practice [1]. Even with The Joint Commission supporting that hand hygiene as the most critical intervention for preventing healthcare-associated infections (HCAIs), the compliance rate for hand hygiene has not drastically improved [2]. The goal of this article brief is to answer the question why hasn’t handwashing improved even with the evidence to support that proper hand hygiene decreases HCAIs?
Pseudomyxoma peritonei or Gelatinous Peritoneal Disease is a rare disease. We report a case treated in the department of Hepato-Gastroenterology at Ibn Sina Hospital in Rabat, of a 64-year-old male who presented with an abdominal pain and an increased volume of the abdomen corresponding to ascites. Imaging and anatomopathological study made it possible to diagnose the disease. However, given the general state of the patient, he is under palliative care.
Introduction: Abdominal hernia is a pathological condition resulting from abnormal protrusion of abdominal viscera. In particular, internal hernias (IH) represents about 0.2-0.9% of all cases with para- duodenal hernias while obturator hernias accounting for only 0.07% of all hernias.
Methods: We reported the case report of 79 year old women who was admitted to Internal Medicine Department of our Hospital for lung failure and after few days transferred to our Surgery Department for abdominal pain.
Conclusion: Obturator hernia is rare type of hernia and it is more frequent in older women with history of multiple pregnancy, chronic cough, and habitual constipation. In our patients, detailed physical examination and MRI preoperative imaging studies, have induce to the successful diagnosis.
Outbreaks of Ebola virus can cause substantial mortality in affected countries. The largest outbreak of Ebola to date is currently underway in West Africa, with 3944 cases reported as of September 5, 2014. For the sake of deriving a better understanding of the Ebola transmission dynamics, we have undertaken to revisit data from the initial spark of origin of the Ebola virus, which occurred in 1976 in Zaire (now Democratic Republic of Congo). By fi tting a mathematical process to time series stratifi ed by disease onset, outcome and source of infection, we have managed to estimate several epidemiological quantities, previously admitted to be too challenging to measure, including hospital and infected community contribution infection to the widespread transmission.
Background: The measures are being put in place for the management of Hepatitis B virus (HBV) infection in Hargeisa, Somaliland among pregnant women remain the most vulnerable to develop chronic hepatitis. Routine screening in pregnant women is therefore necessary for effective control. However, the performance of the commonly used the HBsAg sero test strips has been available. Also, identifying the risk factors of transmission in pregnant women is importance for the implementation of preventive measures. Hence, the goal of this study was to determining seroprevalence and associated risk factors with HBV infection among pregnant women.
Material & Methods: The study area was carried out at Hargeisa group hospital in Somaliland from May 2018 up to December 2018. The researcher was collected research pregnancy woman data through questionnaire & used diagnostics methods such as Hepatitis B surface antigen (HBsAg) test, antibodies test (HBsAb) by used anti-card test and ELIZA system. In order to find specific full information’s about patients & relationship the associated risk factors with hepatitis B in pregnancy. Data processed and analyzed by used both words and SPSS package. The sample size investigated was 80 patients. Of these, 28 were excluded; among the reasons for exclusion were prior HBV vaccination and known HBsAg sero-positive status.
Aims of Study: The study was designed & aimed to determine seroprevalence and associated factors of HBV infection among pregnant women. To assess and establish if there is significant relationship between blood transfusion and hepatitis B virus at Hargeisa group hospital (HGH).
Results and Discussion: The results in the current study shown that the pregnancy with hepatitis BV and it relation with appeared some symptoms in our study was 24(46.15%) of patients appeared they have cirrhosis symptom, 12(23.08%) of patients answered they have liver failure, while 9(17.31%) of patients appeared yellowish of eyes & skin and 5(9.62%) showed hepatic cancer.
Overall, HBV prevalence: HBsAg was detected in fifteen 15(31.3%) of the participants while all fifteen (100%) had total HBcAb (both IgM and IgG). Of the HBsAg sero-positive women, 26(42.7%) were positive for HBeAg; eight (13.3%) were positive for HBeAb and four 4(9%) were negative for both HBeAg and HBeAb which was close similar with other previous studies. On the other hand, We found identify statistically significant p-values < 0.05 and high relationship between HBV and some demographic and clinical risk factors such as blood transfusions, levels of knowledge about HBV infection in addition to age and marital status.
Conclusion: The results of this study showed that the seroprevalence of HBV infections in pregnant women and it relationship with blood transfusion in Hargeisa Group Hospital, Hargeisa, Somaliland is high. However, further studies are needed to assess the role of other demographic and clinical risk. Urgent action is required to improve hepatitis B infection control measures to reduce dependence on blood transfusions and make new policies for treatment of anemia in HGH.
“Pharmacodynamics of cannabinoids “(i.e. a set of biological effects elicited in the living organism by interaction with its biochemical and biophysical functions up to the cellular level) is studied for a long time during both, physiological and pathological conditions.
Sufia Athar*, Joohi Ramawat, Mohammad Abdel Aziz and Vincent Boama
<h2>Summary</h2><p>Hyperglyceridemia induced pancreatitis in pregnancy accounts for 4% of all cases of acute pancreatitis. Though rare, hypertriglyceridemia induced pancreatitis may lead to fatal maternal and fetal complications, even maternal death. Its management during pregnancy remains a challenge for many physicians. Management options are limited in pregnancy. In the refractory cases, management options and timing of delivery is debatable. Here we report a case of hyperglyceridemia induced pancreatitis and the challenges faced in the management.</p>
Cellular Angiofibroma is a rare benign mesenchymal tumor without gender preference. It is usually a small (<3cm), well-circumscribed, mostly asymptomatic and typically slow growing. Surgical removal of the mass with its capsule is the preferred treatment, not only helps guarantee complete excision and prevent its recurrence but also minimize blood loss. We present the case of a 76-year-old woman with a giant vulvar mass.
Ajite AB*, Ogundare EO, Oluwayemi IO, Olatunya OS, Babatola A, Taiwo A, Komolafe A and Fatunla O
Background: Tetanus continues to threaten the survival of children in spite of it being a vaccine preventable disease. The objective of this study was to determine the prevalence of post-neonatal tetanus, review the vaccination of affected children, complications encountered and the outcome among affected children in a tertiary health institution in southwestern Nigeria.
Methods: The study was a retrospective study. Case notes of children outside neonatal life admitted to the Paediatric ward with clinical diagnosis of tetanus between January 2012 and October 2018 were retrieved and evaluated to identify socio-demographic and clinical characteristics. A review of the immunization history and cards was done where the immunization cards were available.
Results: 21children with post-neonatal tetanus were admitted over a period of six years (November 2012 to October 2018) with a prevalence of 0.3%. The M:F was 3.2:1. The mean age in years was 10.14 ±3.44 while the age range of the subjects was 4 to 16years. None of the patients had booster doses of tetanus toxoid (TT) outside the infancy period. Nine (42.9%) subjects had no previous TT vaccination, 2 (9.5%) had 3 doses of TT vaccine in infancy but developed tetanus at age ≥9 years, 1(4.8%) subject had a dose of TT while the remaining 9subjects had no proof of previous TT vaccination. The percentage mortality was 19% (4 out of 21). All the patients that died had no prior record of TT vaccination. Complications identified included laryngeal spasm and autonomic dysfunction.
Conclusion: Post-neonatal tetanus is still common in our locality because booster doses of Tetanus Toxoid are not part of the national immunization schedule. Complete dose of tetanus toxoid vaccination during infancy and booster doses at school entry is necessary and should be part of school health programme to forestall post-neonatal tetanus
Before discussing the crux of the matter, it is important to understand what “wild” signifies and the characteristics that define a wild animal.
As contrasted to domesticated animals, a wild animal can be defined as an animal living freely in his natural habitat, independently of Man. These animals are only exposed to variations in the biological equilibrium, to the imperatives of their genetic program and live in a habitat that gives them the possibility of expressing it themselves.
However, this definition is very narrow as there exist a number of species of wild animals that don’t live freely in their natural habitat. These animals are constrained by Man, who by creating a relationship of dependence, controls them and in turn becomes responsible for their sustenance. In such a situation, their habitat is no more their natural habitat but than which has been imposed on them by Man; such animals are said to be “held in captivity” or even “tamed”.
In short, when talking about law and ethics related to wild animals, there are two things to be taken into account: wild animals that live in the wild and wild animals that live held in captivity by Man.
However, this definition is very narrow as there exist a number of species of wild animals that don’t live freely in their natural habitat. These animals are constrained by Man, who by creating a relationship of dependence, controls them and in turn becomes responsible for their sustenance. In such a situation, their habitat is no more their natural habitat but than which has been imposed on them by Man; such animals are said to be “held in captivity” or even “tamed”.
In short, when talking about law and ethics related to wild animals, there are two things to be taken into account: wild animals that live in the wild and wild animals that live held in captivity by Man.
Abdoul Rahamane Cisse, Jean Marie Vianney Hope* and Abdoulaye Ba
Purpose: Medical coverage of the 29th “Tour du Faso” primarily aimed to report the experience of the medical coverage of the 2016 International Cycling Tour of Burkina Faso. Methods: This is a prospective study of the medical coverage of the 2016 International Cycling Tour of Burkina Faso. Results: During the 12 days of medical coverage, 216 consultations were recorded. The complaints were diversified. From simple asthenia to severe malaria. There were cases of indigestion, gastroenteritis and food allergies. Conclusion: The medical coverage of a cycling competition requires knowledge of the discipline, expertise in sport and emergency medicine.
King DA*, Hume PA, Cummins C, Clark T, Gissane C and Hecimovich M
Background: Epidemiological studies report that females experience greater rates of concussion when compared with males. Biomechanical factors may result in greater post-impact head velocities and accelerations for a given force for females when compared with males.
Purpose: To quantify the magnitude, frequency, duration and distribution of impacts to the head and body in rugby league match activities for females versus males.
Methods: 21 female and 35 male amateur rugby league players wore wireless impact measuring devices (X2Biosystems; xPatch) behind their right ear over the mastoid process during match participation across a single season. All impact data were collected and downloaded for further analysis.
Results: Male amateur rugby league players experienced more head impacts than female amateur rugby league players (470 ±208 vs. 184 ±18; t(12)=-3.7; p=0.0028; d=1.94) per-match over the duration of the study. Male amateur rugby league players recorded a higher median resultant Peak Linear Acceleration (PLA(g)) (15.4 vs. 14.6 g; F(824,834)=51.6; p<0.0001; t(1658)=-3.3; p=0.0012; d=0.10) but a lower median resultant Peak Rotational Acceleration (PRA(rad/s2) (2,802.3 vs. 2,886.3 rad/s2; F(831,827)=3.1; p<0.0001; t(1658)=5.7; p<0.0001; d=0.13) when compared with female amateur rugby league players
Conclusion: Females recorded lower median values for PLA(g) and Head Impact Telemetry severity profile (HITSP) for all positional groups but had a higher PRA(rad/s2) for Hit-up Forwards (HUF) and Outside Backs (OSB’s) when compared with male HUF and OSB’s. Females also recorded more impacts to the side of the head (48% vs. 42%) and had a higher 95th percentile resultant PRA(rad/s2) (12,015 vs. 9,523 rad/s2) to the top of the head when compared with male rugby league players.
Introduction: Implementation of prevention strategies for patients with coronary artery disease (CAD) is essential, but many fall short of reaching their goals. Patients often perceive themselves as healthy and are less motivated to change lifestyle. To obtain better results patients need repeated information, preferably with motivational and person-centered approaches.
Aims: To investigate whether health care providers inform CAD patients about risk factors and lifestyle changes at a percutaneous coronary intervention unit. Also to investigate whether the information given at discharge included secondary prevention management and if motivational and person-centered approaches were used.
Methods: This is a descriptive, observational study that includes both a qualitative and quantitative design. Physicians and nurses working at a percutaneous coronary intervention (PCI) unit and physicians at a coronary care unit (CCU) participated. A staff nurse observed and noted what information the patients received at the PCI unit. At the CCU, observations regarding secondary prevention strategies during the discharge counselling were performed.
Results: There were 50 observations made at the PCI unit. The information mainly consisted of tobacco consumption, physical activity and diet.
During the 31 discharge counselling sessions the diagnosis, interventional procedure and medical treatment were frequently included. Most patients received little or no person-centered or motivational counselling.
Conclusion: Nearly all patients at the PCI unit received information about the consequence of tobacco consumption, and more than half about the beneficial effects of physical activity. In contrast, the counselling at discharge need to focus more on behavioral changes and a motivational and person-centered approach.
The analytical models are mainly combined with numerical equations for the problems of the pavement under the wheel load. Different assumptions can be considered, such as elastic asphalt and viscoelastic as well as static or dynamic load. Mainly on deformation at the bottom of asphalt and tension layers focus on subgrid. The pavement structure was considered as layers with uniform characteristics. Therefore, this analytical model calculates the three-dimensional contact tension between the wheel and the pavement and the shape of the contact area. Basis and subgrid are considered linear and the asphalt layers can be linear or viscoelastic. This model is based on the results of direct shear stress tests at an axial load constant. The curves obtained from this experiment can be defined by three parameters: the maximum shear stress (shear stress curve versus shear displacement), the interaction modulus between the layers (the same curve slope) and the friction coefficient after the failure. Due to the ability of ABACOUS software, this project is done with this software. One of the methods widely used to predict viscoelastic responses of asphalt mixtures is the finite element method. ABAQUS software is one of the tools that can simulate mixed asphalt behavior based on a finite element method, taking into account all the determinant parameters. The use of the Prony series is one of the common techniques for describing the viscoelastic behavior of asphalt mixtures in ABAQUS software. For this purpose, it is necessary to determine the parameters required for this field, including proven constants, moment elastic modulus, and asphalt mixture poison ratio. On the other hand, the determination of these parameters through testing in addition to spending time and costs requires laboratory equipment. Therefore, in this thesis, a three-dimensional finite element model with ABAQUS software was constructed to analyze the persistent pavement using theoretical relations without conducting the experiment. Also, viscoelastic behavior of common asphalt mixtures and time dependence of its responses at different temperatures can be modeled in ABAQUS software. After performing the shear stress test for different axial loads, different temperatures, with or without a single coil, they found that all parameters are temperature dependent and the coefficient of friction does not depend on the applied axial load. This new model improves the accuracy of the finite element model and its important role can be an analytic expression that includes all the variables that are effective in the problem.
The carried work has based on transient vibration response of multiple degrees of freedom (MDOF) system. By this work study of Time–history analysis and prediction of the displacement for excitation has done. For the MDOF system, we have taken the four-storey building to done transient vibration. We establish the equivalent spring-mass system. Transient analysis has done for both Undamped and Damped of the forced system of multiple degrees of freedom (MDOF) system. In the case of the Damped system, we have done three stages of damping, i.e., (1) Underdamped system, (2) Critically damped system, (3) Overdamped system. The time-history graph obtained for two different time stages i.e. 0.001 sec & 0.01 sec with initial time 0.000001 sec. The natural frequency has determined by both theoretical calculation and ANSYS. The whole study of transient vibration makes it possible to predict the damping values that oppose any kind of sudden impact or force vibration, such as blasts, earthquakes and tsunamis. The ANSYS is the modelling and simulation software is used to perform the transient vibration response. The Mode Superposition method is used by ANSYS to calculate the structure response.
Background: Premarital sexual practice significantly attributes for increase adolescent’s risk of unintended pregnancy, early marriage, abortion and STIs. In Ethiopia adolescents were intended to engage at early initiation to sexual intercourse without having proper protection has been one of the concerns. Study aimed to assess the prevalence of premarital sexual practice and associated factors among high school students.
Method: A facilities based study design was employed. Data were collected from 291 randomly selected Negade and Finca Bamo high school students using structured questionnaire from June 1-30, 2018. Bi-variate logistic regression used to identify variables that crudely associated and variables with p-values<=0.05 fitted to multiple logistic regression. Odds ratio with 95% confidence interval was estimated using multivariable logistic regression to identify independent predictors of premarital sex.
Result: Among high school students, 31.2% reported had experienced premarital sexual practices. This shows that premarital sexual practices among high school adolescent’s students were high. Drinking alcohol [AOR=4.06, 95%CI, (2.06-7.99)].Watching pornographic video [AOR: 2.78, 95% CI, (1.45-5.3)] and educational status of mothers [AOR: 0.33; 95% CI (0.13, -0.84)] were significantly associated factors.
Conclusion: Drinking alcohol, watching pornography and mother education were predominantly significantly associated. Therefore, an integrated effort needs to be highlighted to deter the health behavioral problems of school adolescents at the early stages.
Al-Anazi KA*, Kanfar S, Aldayel A, Abduljalil O and Sayyed AH
Background: Pure red cell aplasia is characterized by anemia, reticulocytopenia and diminished bone marrow erythroid precursors. It has multifactorial etiology and consequently several therapeutic interventions.
Case: In August 2017, a young patient was diagnosed to have pure red cell aplasia. She was given immunosuppressive therapy for approximately two months but this treatment was stopped due to intolerance. Later on she developed herpes zoster infection that was treated with valacyclovir. Subsequently, it was noted that the patient became blood transfusion independent due to normalization of her hemoglobin and regeneration of the erythroid precursors in the bone marrow.
Discussion: Varicella zoster virus behaves differently from other members of the herpes group of viruses such as cytomegalovirus and Epstein-Barr virus. Two retrospective studies, performed in patients with malignant hematological disorders and bone marrow failure, have shown that infection with the virus may cause stimulation of the three cell lines in the bone marrow and superior overall survival.
Conclusion: The outcome of the patient presented confirms the findings of the two studies showing long-term beneficial effects of varicella zoster virus infections in immunocompromised individuals.
Discussion: Varicella zoster virus behaves differently from other members of the herpes group of viruses such as cytomegalovirus and Epstein-Barr virus. Two retrospective studies, performed in patients with malignant hematological disorders and bone marrow failure, have shown that infection with the virus may cause stimulation of the three cell lines in the bone marrow and superior overall survival.
Conclusion: The outcome of the patient presented confirms the findings of the two studies showing long-term beneficial effects of varicella zoster virus infections in immunocompromised individuals.
Chronic rhinosinusitis (CRS) is an inflammatory condition involving nasal passages and the paranasal sinuses for 12 weeks or longer [1]. It can be subdivided into three types: CRS with nasal polyposis (CRS with NP), CRS without nasal polyposis (CRS without NP), and Allergic fungal rhinosinusitis (AFRS).
Rui Wang, Hu Du, Qingmin Jin, Yu’e Lin, Yujuan Zhong, Chunpeng Yao, Xiaomei Xu and Tingquan Wu*
Stable reference genes are indispensable for ensuring the fidelity of determined gene expression levels. However, the expression levels of reference genes are unable to remain constant under all possible experimental conditions. Therefore, the stability determination of reference genes is necessary in an experimental system set.In the preset study, the stability of nine cucumber candidate reference genes (CsACT, CsUBQ, CsEF1α, CsCYP, CsαTU, CsCACS, CsTIP41, CsYSL8 and CsHEL) subjected to stresses from Phytophthora melonis(P. melonis) were determined using four different analysis methods, including Delta Ct, BestKeeper, NormFinder and GeNorm. The study results revealed that CsUBQ and CsCYP were the most stable genes suitable as internal control in cucumber plants under attack by P. melonis condition.
The question raised in the title of this letter is a natural consequence of the findings and conclusions that have been growing steadily in recent years regarding the results of treatment for acute pneumonia (АР). If you look at the publications of recent years in this field of medicine, it turns out that one of the main obstacles to progress in improving the results of treatment of this disease is the lack of appropriate methods for determining the pathogen. Thus, the lack of timely diagnostic information about the etiology of the disease excludes the possibility of targeted antibiotic therapy. In recent years, such regrets have become more and more relevant, playing the role of the main explanation for treatment failures .Continuing to narrow the unidirectional view of the problem and to pay attention only to the microbial factor as the main cause of the disease, such views are in fact another illusion, which, even in the case of its hypothetical implementation, will not make significant changes in the overall trend. This statement is easy to verify if you rely on well-known facts, and not use as arguments assumptions and guesses.
Background: In sickle cell anemia (SCA), compromise of the renal vasculature due to sickled red cells has been recognized.
Objectives: To assess the renal function and blood pressure pattern in children with sickle cell anaemia (SCA) presenting in a tertiary institution.
Method: A cross-sectional study of patients with sickle cell anaemia (SCA) over six months involving the use of questionnaires, general physical examination, blood pressure, investigations for haemoglobin genotype, urinalysis, serum creatinine, screening for hepatitis B and HIV.
Results: 51 children with SCA were seen. The prevalence of impaired renal function as defined by reduced eGFR <90mL/min/1.73m2 in this study was 27.5%, previous hospital admission and blood transfusion were associated with reduction in eGFR but blood pressure did not have significant correlation with the eGFR. The overall mean age at diagnosis of SCA was 4.09 ± 3.33 (years).
Conclusion: Impaired renal function is a major comorbid condition in children with SCA. In countries/locations where there is no newborn screening for sickle cell disease, diagnosis is delayed, thus detecting impaired renal function may be delayed, therefore the need for early detection and management is imperative.
The blood and drainage cultures are suggested for early diagnosis of bloodstream infection (BSI), which are time consuming and laborious. Nasal colonization of bacteria is one of the modalities, occasionally can predict BSI. We hypothesized that nasal culture, as an accessible fluid may be helpful to predict future BSI in hemodialysis patients. The present prospective study evaluated 63 patients undergoing maintenance hemodialysis at the Pars hospital dialysis center, Tehran, Iran, from November 2015 until February 2016. Nasal fluid of patients were collected from the 1–cm internal anterior part of both nostrils of patients by a sterile swab and cultured in Trypticase soy agar. All patients were followed for three months for BSI. The results of first nasal fluid sample revealed that 33.3% in first sampling and 27.0% in sampling had positive nasal fluid culture. The type of bacteria in all positive cases was Staphylococcus aureus. The rate of BSI infection in the patients with positive and negative first nasal fluid culture was 9.5% and 2.4% respectively with no significant difference. We found also no significant association between BSI positivity and nasal culture results so that positive BSI was revealed in 5.9% of patients with positive nasal fluid culture and 4.3% in those with negative nasal fluid culture with no meaningful difference. None of the baseline variables including age and gender, underlying risk factor, access, or duration of dialysis was associated with BSI positivity. In hemodialysis patients, BSI may not be predicted by nasal fluid culture positivity.
The concept of space-matter motion in the new Cartesian physics, based on the identity of space and matter, creates the basis for the study of consciousness as the action of the brain in space inside and outside itself and offers a way of materialistic explanation of life on Earth. She claims that consciousness in living matter arises when the brain begins to create the surrounding space the image of themselves and the world. And since space according to Descartes is identical to matter, the images created by the brain of itself and the external world in the surrounding space have a material basis and therefore the displayed organs interact with each other and the external world.
Background: In health care systems nursing care documentation is a vital and powerful tool that ensures continuity of care and communication between health personnel for better patient outcomes. Knowledge, attitude and practice of nurses’ towards nursing care documentation affect the quality and coordination of patients’ care. Hence, this study aimed to assess knowledge, attitude, practice and associated factors towards nursing care documentation among nurses in West Gojjam Zone public hospitals, Amhara Ethiopia.
Method: Institutional based cross sectional study was conducted among 246 nurses in West Gojjam Zone public hospitals from February to March 8, 2018. The study participants were selected by simple random sampling technique. Data were collected by using pre-tested and validated self-administered structured questionnaire with internal reliability of Cronbach’s Alpha values 0.912, 0.784 and 0.713 for knowledge, attitude and practice questions respectively. Epi data version 3.1 and SPSS version 20 was used for data entry and analysis respectively. Descriptive statistics and binary logistic regression model were used.
Result: The overall response rate was 97.56%. Among 240 respondents 54.6% of them had good knowledge, 50% of study participants had favorable attitude and 47.5% of study participants had good nursing care documentation practice. Sex and monthly salary were found to be statistically significant with knowledge of nurses. Work setting, work experiences and knowledge of nurses had significant association with nurses’ attitude towards nursing care documentation. Availability of operational standards, knowledge and attitude of nurses had significant association with nursing care documentation practice.
Conclusions and Recommendation: Results of this study showed that knowledge, attitude and practice of West Gojjam zone public hospital nurses on nursing care documentation were poor. Therefore; in order to solve this problem each hospital should recruit nurses until hospitals are saturated enough. It is recommended to avail nursing care documentation standards/guidelines in each hospital and to give training about it and also it is recommended to conduct multisite studies especially qualitative type to increase its quality.
Luis Alcocer, Humberto Alvarez-Lopez, Gabriela Borrayo-Sanchez, Ernesto German Cardona-Munoz, Adolfo Chavez-Mendozaa, Enrique Diaz y Diaz, Jose Manuel Enciso-Munoz, Hector Galvan-Osegueraα, Enrique Gomez-Alvarez, Pedro Gutierrez-Fajardo, Hector Hernandez y Hernandez, Francisco Javier Leon-Hernandez, Jose Antonio Magana-Serrano, Jose Zacarias Parra-Carrillo and Martin Rosas-Peralta*
Today, Mexico has more than 130 million inhabitants; 85 millions of them are adults of 20 or more years old. The population pyramid is still one of base wider and this base corresponds to adults younger than 54 years old. Despite predictions made 20 years ago, about a transformation of the population pyramid shape to a mushroom shape as a consequence of more life expected and adult population growth; this change has not been occurred. Hypertension has become the biggest challenge of noncommunicable chronic diseases to public health in Mexico. Around 30% of adult Mexican population has hypertension; 75% of them have less than 54 years old (in productive age); 40% of them are unaware but only 50% of aware hypertensive population takes drugs and, 50% of them are controlled (< 140/90 mmHg). Cardiovascular risk factors including hypertension, dyslipidemia, obesity, and diabetes often cohabit in the same person and are magnified one to another in terms of common pathophysiological pathways. Atherosclerosis, arrhythmias, stroke and heart failure are common and are the final pathologic end-points and explains why cardiovascular diseases occupy first place in mortality in Mexico and worldwide. The costs of care for these diseases are billionaires and if we do not generate appropriate strategies, their global impact can become a high threat to social development of the country. The life style like nutrition, sports habits of the Mexicans must be emphasized; there is poor education about this crucial topic. This position paper is focused on the principal controversies and strategies to be developed by all, government, society, physicians, nurses, patients and all people related with healthcare of hypertension, in order to confront this huge public health problem in Mexico.
Mauro Luisetto*, Naseer Almukhtar, Ahmed Yesvi Rafa, Behzad Nili Ahmadabadi, Ghulam Rasool Mashori, Farhan Ahmad Khan, Ram Kumar Sahu, Gamal Abdul Hamid and Khaled Edbey
Aim of this work is to verify the effect of some neurotoxins, physical factors and geography in presentation of some Relevant Neurological disorder like some form of ASL, PD, AD.
The geographic diffusion of the ASL/PD in west pacific (GUAM foci), and mutation of SOD 1 and other mutations are interesting facts to verify the recent literature about the neurotoxic process.
Related to the references presented a global conclusion about the pathogenetic progression of some neurological disease will be produced as instrument for new hypothesis and for the introduction of new innovative therapeutic strategies.
The geographic diffusion of the ASL/PD in west pacific (GUAM foci), and mutation of SOD 1 and other mutations are interesting facts to verify the recent literature about the neurotoxic process.
Related to the references presented a global conclusion about the pathogenetic progression of some neurological disease will be produced as instrument for new hypothesis and for the introduction of new innovative therapeutic strategies.
We report a case involving infection with Strongyloides stercoralis found in the sputum of a 66-year-old male patient who had a medical history of nephrotic syndrome and was treated with methylprednisolone and monthly intravenous cyclophosphamide therapy 3 months previously. This patient presented with stubborn pulmonary symptoms and signs, which was the mechanical destruction caused by larval migration. We found strongyloides in his sputum that provided diagnostic proof.
Peritonitis is the main complication of peritoneal dialysis caused the withdrawal of treatment like peritoneal dialysis which was used as primary treatment modality few years back in Pakistan. With this motto to know the exact cause of peritonitis this retrospective study was done and 35 out of 42 pervious peritoneal dialysis patients who had peritonitis were analyzed using old data. A total of 57 bags of all these peritonitis patients were analyzed in department of microbiology during the year 2007-2011. Out of these bags positive culture was obtained from 42 bags (74%). Most of patients with positive culture were undergoing acute peritoneal dialysis 66.67% and rest were on chronic ambulatory peritoneal dialysis. Main concern was the yield of organisms causing culture positive peritonitis. It was found that bacterial peritonitis was positive in 80%, fungal peritonitis was 11% and mycobacterium tuberculosis peritonitis was 09%. Various culture techniques along with Gram Stain, Zeihl Nielsen Stain and Auramine stain were used for knowing the yield.
Limitations: Old and only small available data of peritonitis patients and stop of further peritoneal dialysis.
Natalia Silva*, Luis Oliveira, Monica Frutuoso and Teresa Morgado
Anti-glomerular basement membrane (anti-GBM) disease is an uncommon autoimmune disease that classically presents as an aggressive necrotizing and crescentic glomerulonephritis (CG), with or without pulmonary hemorrhage, and typically does not relapse. The pathologic hallmark is linear staining of GBM for Immunoglobulin G (IgG) which binds to the alpha-3 chain of type IV collagen. Recent reports have noted the occurrence of anti-GBM disease with atypical clinical presentations. We describe a case of a 22-year-old female presenting an anti-GBM disease with typical histological features with a singular clinical presentation with lower limb edema, elevated serum creatinine and nephrotic range proteinuria. Renal biopsy showed signs of chronicity and direct immunofluorescence microscopy demonstrated diffuse, intense linear positivity for IgG. All serologic tests were negative, including anti-GBM antibodies. Hence, a diagnosis of atypical anti-GBM disease was made. The patient was treated initially with mycophenolate mofetil and corticosteroids. After 3 months she began to aggravate renal function so mycophenolate of mofetil was discontinued and a low dose cyclophosphamide was initiated.
<h2>Opinion</h2><p>Epilepsy is commonly seen in women of reproductive age and it is affecting their reproductive and pregnancy outcomes in an adverse manner [1]. It has seen that there are increased numbers of maternal deaths of pregnant women with epilepsy than those who have no any epilepsy symptoms or episodes.</p>
Mahdi Graiouid, Walid Bai*, Messian Gallouo, Dakir Mohammed, Adil Debbagh and Rachid Aboutaieb
Local isolated recurrence of kidney cancer in the renal lodge after radical nephrectomy is rare and has a poor prognosis. Surgical excision, sometimes even extended to neighboring organs, is currently the only effective treatment for local recurrence of kidney cancer. The interest of new medical therapies remains to be defined. We report a case of local recurrence in a patient with radical nephrectomy.
Acute dizziness/vertigo is among the most common causes for visiting the emergency department or primary care physician. Although the majority of these presentations represent an acute peripheral vestibulopathy (APV), lateral medullary, lateral pontine, and inferior cerebellar infarctions can mimic APV very closely. We present an atypical presentation of an aggressive APV and outline how a well-constructed bedside neurotologic evaluation can distinguish central from peripheral vertigo in the acute setting.
The use of novel PGPR as bio inoculant is an alternative sustainable agricultural practice to improve soil health, grain quality, increase crop productivity, and conserve biodiversity. The aim of this study is to isolate, and characterized PGP bacteria colonizing tef rhizosphere during the seedling stage. For this concern, 426 samples of tef (Eragrostis tef) rhizosphere soils and roots were collected from East Shewa zone, Oromia regional state. 200 morphologically different bacterial pure colonies were isolated and screened for their PGP traits and biocontrol properties. Among these 40.5% isolates were positive for phosphate solubilization. 36% were positive for IAA production, 4.5% were positive for ammonia production, 19 % were positive for (EXPS), 15.5% were positive for protease production, 12.5% were positive for HCN productions, 9.5 % were positive for cellulase production, 4% were positive for amylase production, 3.5% were positive for chitinase production. For abiotic stress tolerance test, all of the isolates were grown well at 20oc and 30oc and neutral pH, 27% isolates were grown well at 4oc, 25.5% grew at 40oc, 25.5% were grown well on pH-9 and pH-11, 23.5% were tolerated pH-5, 3.5% grew at 50oc and 60oc, 13.5% were grown well on 5% NaCl (w/v), 3.5% were grown well on 10 and 15% NaCl (w/v), which indicated these isolates can survive in some extreme conditions. Totally 15 bacterial species having PGP traits, biocontrol properties, and abiotic stress tolerance ability were identified using the Biolog bacterial identification system. Among these, the majority of the identified PGPR have utilized carbohydrate, carboxylic acid, and amino acid, which are the main components of plant root exudates. The above results indicated that thus PGPR can be used as biofertilizers as well as biocontrol agents to replace agrochemicals to improve crop productivity. Hence, these species can be further formulated and used for greenhouse and field applications.
Sandonaid Andrei Geisler, Carina Francisca Arguelles and Cristian Antonio Rojas*
Ilex paraguariensis, also known as ‘Yerba mate’, occurs naturally in Argentina, Brazil and Paraguay and is also grown in these countries with different intensities. Leaves and branches of this plant are used in the preparation of a stimulant beverage that beside social importance has notorious health impact.However, the cultivated herbs present low productivity, due to deficiencies in cultivation and harvesting techniques, as well as due to the abiotic stresses that this species is subject to. The discovery and characterization of cold response mechanisms in plants such as Arabidopsis thaliana, began research in order to unravel the physiological and molecular mechanisms in response to cold in other plant species. In this work, we studied the physiological response observed in Ilex paraguariensis plants submitted to low temperatures (0°C), with or without a pre-moderate acclimatization treatment period of (8°C).
Our results suggest the existence of an acclimation response in Ilex paraguariensis, similar to that described in other species of the same temperature.
Jan Jacques Michiels*, Zwi Berneman, Wilfried Schroyens, Fibo W J ten Kate, King Lam and Hendrik De Raeve
The broad spectrum of heterozygous versus homozygous JAK2V617F mutated MPN consists ET, ET with early features of PV (prodromal PV), classical PV, masked PV, advanced PV and post-PV myelofibrosis. Combined use of bone marrow histology and increased erythrocyte counts above 5.8x1012/L can replace increased red cell mass at time of presentation as the pathognomonic clue for the correct diagnosis of hetero/homozygous or homozygous mutated PV. Erythrocyte counts are in the normal range below 5.8x1012/L in heterozygous JAK2V617F mutated ET and prodromal PV but above 5.8x1012/L in heterozygous-homozygous or homozygous mutated PV. The bone marrow cellularity and morphology in pre-fibrotic ET, prodromal PV and PV carrying the JAK2V617F mutation are overlapping showing clustered increase of large mature pleomorphic megakaryocytes (M) with no increase of cellularity (<60%) in ET. The bone marrow is hypercellular (60%-80%) due to increased erythropoiesis megakaryopoiesis (EM) in prodromal and classical PV and trilinear hypercellular (80%-100% due increased megakaryopoiesis, erythropoiesis and granulopoiesis (EMG) in advanced PV and masked PV. Bone marrow cellularity ranging from normal (<60%) in ET to increased erythropoiesis (EM) in prodromal PV to hypercellular (80-100%) in advanced PV and masked PV largely depends on increasing JAK2V617F mutation load from low to high on top of other biological MPN variables like constitutional symptoms during long-term follow-up. MPL515 mutated ET is featured by an increase of clustered small and giant megakaryocytes with hyper-lobulated staghorn-like nuclei in a normal cellular bone marrow. The third entity of pronounced JAK2/MPL wild type ET associated with primary megakaryocytic granulocytic myeloproliferation (PMGM) without PV features proved to be caused by calreticulin (CALR) mutation. CALR mutated thrombocythemia is characterized by dual proliferation of megakaryocytic and granulocytic bone marrow proliferation of dense clustered large to giant immature dysmorphic megakaryocytes with bulky (bulbous) hyperchromatic nuclei, which are not seen in MPL515-mutated Thrombocythemia and JAK2V617F-Thrombocythemia, prodromal PV and classical PV.
Worldwide, Canine Distemper Virus (CDV) infection is a highly prevalent disease with high morbidity and mortality. CDV causes a multisystemic disease in a wide range of hosts including 9 families of mammals among them some primates, cetaceans and numerous carnivores. It presents a high tropism for lymphoid, neurological and epithelial tissue, leading to an infection of almost all systems, so the clinical signs observed are very varied. The diagnosis is made based on the clinical presentation of the disease, which considers a variety of signs and must be confirmed by a laboratory diagnostic method. The molecular technique called Reverse Transcription Polymerase Chain Reaction (RT-PCR) has been used to characterize viral strains based on the basis of genetic differences on the hemagglutinin (H) gene of CDV has allowed the identification of 14 circulating lineages in the world. Two lineages, namely the America-1 and the Europe-1/South America-1 have been described in Chile. The goal of this work was to implement a multiplex RT-PCR protocol, which was built on the in silico design of primers based on the H gene nucleotide sequences stored in the Genbank® database. This method was capable of detecting the previously described two circulating genetic lineages of CDV in a differential way providing a supporting diagnostic tool for epidemiological studies in the country. These results suggest that the primers described here are extremely selective for the above-mentioned lineages. In addition, our initial screening indicated that most analyzed clinical samples corresponded to the America-1 lineage, stressing the need for a continuous surveillance in order to properly address the prevalence of both lineages in Chile.
Ding Dai*#, Qi Cai#, Nasreen A. Vohra, Jan Wong, Zsuzsanna P. Therien, Karlene Hewan-Lowe and Ann Sutton
Rosai-Dorfman disease (RDD) is an idiopathic, benign proliferation of histiocytes that can be present in multiple organs such as lymph node, skin, soft tissue, orbit, central nerve system and bone; however, it rarely occurs in the breast. In general, RDD is a painless, firm and poorly defined lesion, which can radiologically mimic a breast cancer and is therefore an important differential consideration. The diagnosis of breast RDD is challenging, especially on a small biopsy specimen. We report a unique case of breast RDD with a literature review including common presentation, differential diagnosis, and recommended management. A high index of suspicion for this rare entity is essential to render a correct diagnosis, thereby avoiding unnecessary diagnostic tests and treatment.
Purpose: Monolayer passage of chondrocytes results in dramatic phenotypic changes. This “de-differentiation” is expected to restore the chondrogenic properties such as “re-differentiation” in autologous chondrocyte implantation (ACI). The purpose of this study was to compare the chondrogenic re-differentiation potential of chondrocytes, from osteoarthritis (OA) patients and young adult patients, after monolayer culture.
Methods: Chondrocytes from five old patients with knee OA (OAC) and five young patients with recurrent shoulder dislocation (non-OAC) were used. The chondrocytes from passages 1 to 3 were analyzed for the expression of cell surface markers (CD73, CD90, CD105, and CD44) by flow cytometric analysis. Chondrocytes of passage 4 were cultured as pellets for re-differentiation and evaluated histologically. Real-time PCR were performed to measure the chondrogenic related genes transcriptional levels.
Results: OAC and non-OAC had comparable positive ratios for CD44, CD73, CD90, and CD105. The expression of CD105 was upregulated from passage 1 to passage 3 in OAC, and it increased at the same level as in non-OAC during passage 2 and 3. The expression of COL2 decreased from passage 1 to passage 3 in both the groups. There were no statistical differences in the Bern Scores between OAC and non-OAC.
Conclusion: The chondrocytes from OA patients and young adult patients had chondrogenic re-differentiation potential. The changes in cell surface markers and chondrogenic related genes showed similarity for both the groups. Our findings suggest that OAC can become the cell source for ACI.
Samuel Ayokunle Dada*, Adebukola Bidemi Ajite, Funmilayo Abimbola Ibitoba, Awolowo Anthony Thomas, Oluwamayowa Esther Dada and Olabisi Olamide Deji-Dada
Background: Haemodialysis is the commonest method of Renal Replacement Therapy in Nigeria. Despite an advancement in the technicality and better understanding of haemodialysis, a number of complications are known to be associated with this procedure..
Objective: We aimed to highlight our experiences and share some of the uncommon complications encountered during haemodialysis and present the outcome of our patients.
Subjects and methods: A retrospective review of 101 patients during the last two years was done. Data extracted include: sociodemographic characteristic, aetiology of kidney disease, type of vascular access, intradialytic complication and outcome of treatment.
Results: The total number of dialysis session during the period was 823. Males constituted a higher proportion (64.4%) and were found to be older than female patients 49.8 vs 42.8 years (P=0.001).
Majority (89.1%) had chronic kidney disease while chronic glomerulonephritis was the main cause of CKD as seen in about 45% of the patient.
Due to the cost implication, only 2(1.98%) were able to undergo 3 sessions of dialysis per week for up to 1 month.
Vascular access was femoral (66.3%), internal jugular vein (25.7%), while only 2% used Artero-venous-fistula and one patient had femoral vessel pseudoaneurysm from frequent cannulation.
The commonest complication was hypotension which was present in 15.8%. Twenty-eight deaths were recorded, 44(43%) were either lost to follow up or absconded while 5% were transplanted at a referral centre.
Conclusion: Challenges of renal replacement therapy is overwhelming in our country due to poor human and financial resources. Early diagnosis and adequate government support are advocated.
Introduction: Chronic kidney disease is a costly and burdensome public health concern. Delayed recognition and treatment of CKD may predispose patients to unfavorable future outcomes and burden the healthcare services. The early detection of disease via screening programs is widely recommended. The present study is a hospital camp-based screening for detecting patients with chronic kidney disease in Varanasi from 2014-18.
Methods: The study subjects constituted 436 apparently healthy adults (age ≥18 years) of Varanasi. Information on socio-demographic profile, personal characteristics and clinical investigations were recorded. Stepwise binary logistic regression analysis was applied to find the significant predictors of chronic kidney disease.
Results: Median age of the study subjects was 40.5 years. There were 39.7% males and 60.3% females. Chronic kidney disease was found in 23.9% subjects. Underweight, diabetes mellitus, hypertension, smoking status and higher creatinine levels came out as significant predictors of chronic kidney disease.
Conclusion: We screened apparently healthy individuals and found very high percentages of chronic kidney disease and its predictors. Henceforth, understanding the preventable and modifiable risk factors of chronic kidney disease becomes a prerequisite to intervene before risk populations reaches to irreversible stages of adverse future outcomes.
Moran Sciamama Saghiv*, David Ben-Sira, Ehud Goldhammer and Michael Sagiv
The purpose of the present study was to define the period of time in which aerobic training does not increase further serum S-Klotho levels in untrained young adult males, and to examine the relation between plasma S-Klotho concentration and maximal oxygen uptake (VO2max).
Methods: Sixty (60) untrained subjects (27.05±1.1 years) were divided into 2 groups, both exercised six months 4×wk-1 for the duration of 45 min×session. One group (LTI) exercised below the anaerobic threshold at 40-50% of VO2max, while the second group (HTI) worked above the anaerobic threshold at 65-70% of VO2max. Testing sessions were performed at 0, 2, 4, and 6 months. Blood samples were drawn after overnight fasting; S-Klotho was analyzed using an ELISA kit.
Results: Following 2 and 4 months, significant (p≤0.05) increases were noted in the HTI group, at the fourth testing session, S-Klotho leveled off. In the LTI group, S-Klotho remained almost unchanged. Findings of the present study, support emerging evidence suggesting that a relation between plasma S-Klotho concentration and VO2max exists.
Conclusion: Data suggest that increases in S-Klotho is tidally associated with VO2max levels. In addition, the S-Klotho increase levels-off following 4 months of aerobic training. Exercising below the anaerobic threshold does not increase VO2max and thus, does not increase S-Klotho.
Köbberling-Dunnigan syndrome, also known as partial familial lipodystrophy, is a rare genetic disorder characterized by abnormal distribution of adipose tissues. Many people with Köbberling-Dunnigan syndrome develop insulin resistance, a condition in which body tissues cannot adequately respond to insulin hormone. Insulin is a hormone that helps regulate the level of your blood glucose. Köbberling-Dunnigan syndrome can be due to mutations in several different genes. However, type 2 Köbberling-Dunnigan syndrome is caused by the mutation of the LMNA gene, which is located on the long arm of chromosome 1 as 1q22.
Alyssa Penning, M.D, Claire Kassakian, M.D, Donald C Houghton, M.D and Nicole K Andeen, M.D*
Prednisone-sensitive hypocomplementemia, renal insufficiency, and kidney biopsy demonstrating severe tubulointerstitial nephritis (TIN), storiform fibrosis, and tubulointerstitial immune deposits are typical of IgG4-related tubulointerstitial nephritis and hypocomplementemic interstitial nephritis. A diagnosis of hypocomplementemic interstitial nephritis requires clinical and pathologic exclusion of IgG4-related tubulointerstitial nephritis. We describe a patient with hypocomplementemic interstitial nephritis who did not develop diagnostic features of IgG4 related disease (RD) over 2-year follow-up. We conclude that hypocomplementemic interstitial nephritis could be on a biologic spectrum with IgG4-related disease, but not all cases will develop the abundance of IgG4-positive plasma cells, systemic manifestations, or elevated immunoglobulin levels characteristic of IgG4-RD.
Syed Haseeb Raza Naqvi, Tariq Abbas, Han Naung Tun*, Ali Ahmad Naqvi, Zubair Zaffar, Badar ul Ahad Gill and Nisar Ahmad
Background: Acute Coronary Syndrome describes a spectrum of disease ranging from unstable angina through non-ST-Elevation Myocardial Infarction (NSTEMI) to ST-Elevation Myocardial Infarction (STEMI). Early death in NSTEMI is usually due to an arrhythmia. Patients should be admitted immediately to hospital, preferably to a cardiac care unit because there is a signifi cant risk of death.
Objective: To compare the diagnostic accuracy of TIMI versus GRACE for prediction of death in patients presenting with Acute Non-ST elevation Myocardial Infarction.
Material & Methods: This present cross sectional study was conducted at Department of Cardiology, CPEIC, Multan. All patients assessed according to given scores in the two scoring system i.e. TIMI risk score and GRACE score. Then patients were labeled as high or low risk for death. Data was collected by using pre-designed proforma. 2x2 tables were generated to measure the sensitivity, specificity, positive predictive value, negative Predictive value and diagnostic accuracy of TMI Risk score and GRACE Score for prediction of death in NSTEMI patients.
Results: In our study the mean age of the patients was 55.73±9.78 years. The male to female ratio of the patients was 1.6:1. The diabetes as risk factor was found in 145(39%) patients, smoking as risk factor was found in 53(14.2%) patients and hypertension as risk factor was found in 174(46.8%) patients. the sensitivity of TIMI risk was 97.7% with specificity of 92.93% and the diagnostic accuracy was 95.16%, similarly the sensitivity of GRACE risk was 100% with specificity of 95.96% and the diagnostic accuracy was 97.85%.
Conclusion: Our study results concluded that both the TIMI risk and GRACE risk are good predictor of death in patients presenting with Acute Non-ST elevation Myocardial Infarction with higher sensitivity and diagnostic accuracy. However the GRACE risk showed more accurate results as compared to TIMI risk.
Ryosuke Kohno*, Wenhua Cao, Pablo Yepes, Xuemin Bai, Falk Poenisch, David R Grosshans, Tetsuo Akimoto and Radhe Mohan
Purpose: The purpose of this study was to evaluate biological dose in single-field optimization (SFO) and multi-field optimization (MFO) intensity-modulated proton therapy (IMPT) plans for brain tumor patients that used a fixed relative biological effectiveness (FRBE) and those that used a variable RBE (VRBE).
Materials and methods: SFO and MFO IMPT plans were planned by the Varian Eclipse treatment planning system for three brain tumor patients. Dose and linear energy transfer (LET) distributions for each plan were recomputed using an in-house fast Monte Carlo dose calculator system, and then biological dose distributions were calculated with a FRBE of 1.1 or with a previously published VRBE model. We then compared biological dose distributions obtained by the VRBE with those obtained by the FRBE.
Results: Doses obtained by the VRBE for the gross tumor volume and clinical target volume in all plans were 1%-2% larger than those obtained by the FRBE. The minimum dose obtained by the VRBE for the brainstem in the SFO IMPT of one patient was 140% larger than that obtained by the FRBE, but the difference was only 5.3 cGy (RBE). The difference in maximum dose for the optic chiasm in the MFO IMPT of another patient was less than 3.2%, but the dose difference was 149.2 cGy (RBE). We also found that no major differences were seen between the biological dose differences in the SFO IMPT plans and those in the MFO IMPT plans.
Conclusion: We could observe biological dose differences between the FRBE and the VRBE in the SFO and the MFO IMPT plans for brain tumor patients.
Mohamed Lasheen, Mohamed Mahfouz, Tamer Salama* and Hossam El-Deen M Salem
Background: Minigastric bypass is gaining popularity worldwide as an effective bariatric surgery which has fewer complications than RYGB. There is raising concerns about biliary reflux and its effect on gastric mucosa. In this study we tried to find the link between the presence of bile in the stomach and the incidence of gastritis after MGB.
Methods: This prospective study was conducted in Ain Shams university hospitals from January 2017 to May 2018 including 40 patients. All patients underwent MGB with a 12-month follow-up, UGI endoscopy was performed 9 months after MGB for all patients, where multiple biopsies and gastric aspirate were obtained for bilirubin level.
Results: Mean age at operation was 32 years (18–60) and preoperative BMI 44.31 kg/m2. The mean operative time was 95 (± 18 min), Mean % EWL was 81.2% at 12 months. Complete resolution occurred of hypertension in 8 patients (80%) and of Diabetes type 2 in 11 patients (84.2%). Level of bilirubin in gastric aspirate was elevated in 8 patients (20%) all of them had different levels pouch gastritis confirmed by histopathological examination.
Conclusion: Biliary reflux reached about 20% after MGB, the severity of biliary gastritis is related to the elevation of bilirubin level in the gastric aspirates, this results need to be confirmed by further studies on the MGB.
One of the factors of assisted reproduction technology (ART) success is an adequate growth and development of endometrium. At the end of follicular phase of menstrual cycle endometrium reaches its greatest thickness. It is believed that there is a critical limit of endometrial thickness beyond which the implantation of embryo is unlikely or impossible [1-5]. In practice of ART programs ultrasound measurement of endometrial thickness is used to evaluate uterine lining growth. Scientific literature is debatable as to what thickness of endometrium should be considered optimal, some researchers emphasize the negative impact of “thin endometrium” on the success of ART programs [1-12], while others do not agree [6,7,9]. Nevertheless, when endometrial thickness in ART program does not exceed 6 mm the chance of pregnancy occurring is very low (Kumbak B, et al. 2009). Endometrium is a unique tissue that has thousands of cycles of growth, differentiation and detachment during woman’s life [13-15]. Various organs and tissues are believed to contain stem cells populations that ensure the recovery of these tissues. Cells with multipotent properties were also found in endometrium [16,17]. A group of scientists from Australia detected and identified population of mesenchymal stem cells (MSCs) and epithelial progenitor cells in human endometrium [13,18-20]. It may be assumed that the absence, lack and defects of MSCs or the absence of signals needed to push their proliferation and differentiation lead to the fact that endometrium is not renewed, thin and unable to provide the implantation of embryo. Endometrial MSCs are adult stem cells similar to those found in other tissues. Therefore, in case of their lack or absence it is logical to assume that endometrial niche can be colonized by autologous stem cells derived from other tissues. In some areas of medicine, autologous stem cells are already used in clinical practice for the repair of damaged tissues and organs, although these methods are still experimental [21,22]. There were several publications about the use of stem cells for improving the endometrium growth and structure in experimental (animal) models (Zhao Jing et al. 2014) and in clinical practice in patients with Asherman syndrome and endometrial athrophy refractory to other types of therapy [23,24], (Singh N, et al. 2014; Santamariya X, et al. 2016). The main source of autologous stem cells is bone marrow. However, lately adipose tissue becomes popular because the procedure of its extraction - liposuction is less traumatic and better tolerated by patients compared to spongy bone puncture for bone marrow obtaining [25]. First MSCs were derived from adipose tissue during its cosmetic extraction in 2001 [26]. These adipose-derived mesenchymal stem cells (ASCs) have rather high capacity for differentiation (multipotency) and proliferation.
The aim of this work was to study the possibility of autologous ASCs use for the treatment of “thin endometrium” in patients with unsuccessful ART programs.
The protocol of treatment was approved by local ethical committee and patient’s informed consent was obtained for it.
Venous Thromboembolism (VTE) is a multifactorial disease that is influenced by individual genetic background and various environmental factors, high altitude (HA) being the one. HA exposure may cause release of several damage associated molecular patterns (DAMPs), which act as ligand for various immune receptors. Previous studies on western population involving SNPs analysis of TLRs demonstrated that TLRs are involved in development and progression of several cardiovascular diseases. But, no such study has been done in Indian population in context of HA exposure. TLRs, being receptors play a significant role in manifestation and elimination of diseases by recognition of specific ligands and downstream signal transduction therefore; the genetic variation in TLRs could be implicated for imparting varying response of individuals to discrete diseases.
Therefore, in accordance with it, in present study changes in protein structures of TLR2 and TLR4 due to presence of SNP were accessed by in-silico tools to observe whether the mutation has effect on protein structure and integrity which further influencing its function. The results showed that SNP harbouring protein has decreased functional pockets, thus may be protective for disease. Taking this lead further to genotypic level, first time association between Toll-like receptor genes polymorphism and risk of high altitude induced venous thrombosis is analyzed in Indian population by PCR RFLP method. Though the result showed initial trend that TLR2 and TLR9 SNP are monomrphic in distribution and for TLR4 there was no significant difference in distribution of SNP between healthy and HA-DVT group, these SNPs have potential to be used as susceptibility markers if studied in large population size.
Flexible magnifying endoscopy with narrow band imaging (ME-NBI) has outstanding diagnostic correctness for gastrointestinal metaplsia and is hope for to be highly useful for imaging stage cervixcal metaplsia beginning by imaging the first stage of metaplasia by imaging single layer of subcolmnar reserve cells reserve cells hyperplasia, the reserve cells are round to cuboid with large oval or round nuclei, seen below the surface columnar cells and the columnar within the endocervical gland figure page (1).
Second stage reserve cells proliferate the cells gain more cytoplasm, and the nuclei decrease in size figure page (3)
Third stage, the surface columnar cells degenerate and sloughed, figure page (1)
The fourth stage stratified cells develop squmous characteristics and acquire glycogen figure page (4)
Third stage, the surface columnar cells degenerate and sloughed, figure page (1)
The fourth stage stratified cells develop squmous characteristics and acquire glycogen figure page (4)
Abdelhamid MS, Nabil TM, Nafady HA, Garib AZ, Soliman SS
Nothing without risk. As cholecystectomy is one of the most common procedures, any minor risk will be a mass volume. This study was to define the magnitude of that risk. In the study were 1486 patients between Feb. 2009 and April. 2018. Open in 292 (19.6%), 1194 (80.4%) laparoscopically, 1086 [91%] completed so and 108 (9%) converted. There were 18 (1.2%) with bile duct injury. 1 (0.3%) in the open group and 17 (1.4%) in the laparoscopic group. 9 diagnosed during surgery, 4 with jaundice, 2 early and 2 late, 5 with leak. Statistically the operative injury is insignificance in the 2 groups (P<0.3). The jaundice was significantly high in the laparoscopic group of patients (P<0.045). Also the bile leak (P<0.028). The same for morbidity (P<0.01. The revers was for mortality (P<0.04). Conclusion: The incidence of CBD injury in the literature is less than the actual rate. Laparoscopic interventions have a higher rate of injury and the proximal ducts are at higher risk.
Chronic venous leg ulcers (VLU), especially long-lasting non-healing ulcers, are among the risk factors for squamous cell carcinoma (SCC) with particularly aggressive behaviour. We present a case of a 71-year-old female patient with a relevant personal history of multiple SCC and basal cell carcinoma (BCC) excision and chronic venous insufficiency showing for about three years a ulcerated lesion located on the anteromedial distal third of the left leg non-responsive to specific treatment, which subsequently increased their size and merged. Biopsy sample was taken. Histopathology revealed a G2 SCC in all biopsy samples. After the staging, a left inguino-femoral lymphadenectomy and the excision were done. The treatment of bone exposure with a soleus muscle flap in the upper half of the defect and skin graft for all the defect and a specific oncologic treatment were proposed as possible curative solutions. Patients with chronic venous leg ulcers and clinically suspicious lesions should be evaluated for malignant transformation of the venous lesion. When diagnosed, malignancy complicating a chronic venous leg ulcer requires a resolute treatment as it may be fatal.
State Department had evacuated a number of Americans from the U.S. consulate in Guangzhou, China after they experienced unexplained health issues. A group of U.S. diplomats stationed in China have been brought back to the states after being inflicted by a mystery illness that reportedly resembles the brain injuries previously suffered by staff in Cuba. At the end of the December 2018 we have found a medicine fully treating the damages caused the Frey Effect of Microwave and other types of Sonic Weapons in Human’s internal, endogenous organs. I am proposing to use Naphasoline nitrate, (former) nasal decongestant, to treat Carcinogenesis of the Human’s internal, endogenous organs caused by Sonic Weapons through the release and cleaning of the Lymphatic ways in patients with colorectal, colon, pancreatic, breast, etc., cancer. I have proved this healing effect of the Naphazoline nitrate on myself during treatment in last months of the year 2018.
This review paper analyzes the response of renal function during two types of exercise: 1) exercise of increasing intensity and 2) exercise of submaximal intensity and prolonged duration. During an effort of increasing intensity there is a decrease in renal blood flow that, theoretically, could compromise renal function.However, several studies seem to show that the kidney has self-regulatory mechanisms that allow maintaining the filtration fraction. On the other hand, ultra resistance exercises, such as ironman, are becoming more frequent. Knowing the renal response to this type of exercise is essential to apply knowledge to emergency situations such as dehydration or hyponatremia.
Asthma is one of the most common chronic diseases in the world and affects people of all ages. But having an asthma patient with a good overall fi tness level helps reduce the chances of getting a seizure. Aqua-aerobic exercises is appropriate programs for the treatment of asthma.The aim of this study was to propose a rehabilitation program using aqua-aerobic exercises and to determine its effect on some functional parameters (forced Expiratory Volume in first Second Fev1, Peak Expiratory Flow PEF, and the Forced Vital Capacity FVC), and improve the respiratory functions to reduce the intensity and severity of asthma attacks for asthmatic children. This program was applied to a sample of 09 children with light to severe asthma and who are involved in the Asthma Association in Mostaganem- Algeria. The application period lasted 20 weeks, with three training units per week. We relied on the experimental approach and used one group as a sample. Moreover, we adopted pre and post measurements in addition to interstitial measurements at the end of each month using a Spirolab device. The results showed statistically significant differences between the pre and post measurement in the values of respiratory indicators, in favor of the latter. This proves that aqua-aerobic exercises improve the function and efficiency of the respiratory system, and thus reduce the severity of asthma attacks for asthmatic children.
Giardia is the most common pathogenic intestinal flagellate protozoan in the world. The most studied species is Giardia lamblia (syn. Giardia intestinalis, Giardia duodenalis) that infects mammals, including humans.About the other seven species the scientific literature is very scarce and little is known about its characteristics and epidemiological importance. The exception is Giardia muris species that is frequently used in experimental infection to attempt to understand the parasite-host interaction in G. lamblia infection [1].
The classification of G. lamblia has been made based on the host of origin and morphomolecular characteristics [2,3]. The first divisions in G. lamblia assemblages were performed according to the host specificity from which the isolate originated [4]. This subdivision was corroborated in analyzes of intrinsic characteristics of the parasite, such as antigenic factors, isoenzymes, but mainly through DNA analysis that allows to reaffirm the heterogeneity of G. lamblia [4,5]. Eight assemblages are known, distributed with denominations A to H. Assemblages A and B are potentially zoonotic, as they infect humans and other mammalian hosts, including non-human primates, canids, felines, rabbits, beavers, muskrats, mustelids, rodents, marsupials, wild ruminants and livestock animals. Assemblages C to H are still considered host-specific. Assemblages C and D have already been described in canids; assemblage E was isolated from hoofed animals, as horses, swine, cattle; assemblage F, specific for felines; Assemblage G is found exclusively in mice and rats; Assemblage H was described from pinnipeds feces [1,5].
Fatemeh Kazemi-Lomedasht*, Delavar Shahbazzadeh and Mahdi Behdani
Hemiscorpius lepturusis a dangerous scorpion and referred to health concern issue in Khuzestan, Iran. The venom of H.lepturus is cytotoxic and its effect is similar to spider Loxosceles reclusa. Metalloproteinases are the important class of enzymes in the venom that has hemorrhagic activity. The early finding suggests the existence of metalloproteases in the transcriptome of venom gland of H.lepturus. Phylogenetic analysis was accomplished to reveal the evolutionary relationship of identified metalloproteases. The phylogenetic tree was constructed by Molecular Evolutionary Genetics Analysis software and neighbor-joining method. Results showed among three sequences, two metalloproteinases named HLMP1 and HLMP3 of H.lepturus were most close to spider P. tepidariorum. The third sequence named HLMP2 was different and formed an independent clade in the phylogenetic tree. The results suggest that the sequence of metalloproteases in the venom component of H.lepturus is similar to the spider than the scorpion.
The article presents the results of x-ray anatomical studies of 56 whole lung preparations, which were carried out immediately after the autopsy of children who died from АP. In 47 cases it was carried out the contrast of the vessels and in 9 cases the bronchial tree. The results allowed to clarify some details of the pathogenesis of АP and were additional arguments in support of the new doctrine of the disease.
Modern AP concepts are focused exclusively on the infectious nature of the disease and the presence of certain pathogens. This belief determines the principles of treatment, the lack of effectiveness of which remains a concern of health professionals. The article presents a fragment of the study devoted to the etiology of АP. 994 children aged 4 months to 14 years with various forms of so-called community-acquired pneumonia were examined and treated. Bacteriological examination of the material from the inflammation zone was carried out in 542 patients. Experiments on modeling АP and its pleural complications were performed on 44 animals. The obtained results and critical analysis of the literature data and scientific facts allow us to consider bacteria only as one of the etiological elements of АP, which is not mandatory in all cases of the disease. Scientifically based revision of existing ideas about the causes and mechanisms of AP development leads to the need for a radical change in the principles of treatment and is a strategic direction in solving the problem.
The age-old battle between plants and viruses has many twists and turns. Plants acquired the RNAi factors to checkmate the viruses and the viruses encode VSRs to defeat RNAi for their own survival. Plants designed mechanisms to neutralize the toxic effects of VSRs and the viruses, in their turn, use host microRNAs to strengthen their infection processes.The infightings between these two entities will take different shapes with prolonged evolution and accordingly the researchers will dig these novel forms of duels not only to throw lights in the involved mechanisms but also to manipulate various antiviral strategies. Some of the research courses that might come up in the immediate future are discussed.
Inflammatory myofibroblastic tumor is rarely seen in the prostate. Most of prostatic tumors are benign. However, local aggressively invading the adjacent organs and recurrence are frequent. Rarely, the malignant transformation and metastasis occurs, especially in elderly patient. The definitive diagnosis in a small biopsy is challenging. The correct diagnosis preoperatively will help to avoid unnecessary radical prostatectomy. Interval follow up is recommended. Here we reported two cases of prostatic inflammatory myofibroblastic tumor with literature review.
Olaf Jensen*, Fereshteh Baygi, George Charalambous, Agnes Flores, Lise Hedegaard Laursen, David Lucas and Debbie Andrioti
Five key sectors of transport have been selected as the target groups: seafarers, truck drivers, dockworkers, rail workers and airline workers. Transport workers often operate under stressful working conditions, long-work hours, lack of good sleep, healthy diet and physical exercises that contribute to fatigue, impaired well-being, mental ill-health, stress and chronic diseases. The hypothesis is that good mental health workplace culture depends on good education, staffing and management.
Objectives: To create, implement and evaluate a research based mental health culture promotion program
Determinate existing researches and training programs,
To study the knowledge, skills and needs for specific training in diferent age-groups
Create and implement effective and relevant training,
Produce training materials and scientific evidence available for ship owners, students and workers and to develop proposals for new mental health policies, legislations and regulations
Methods: Multidisciplinary training and research methodology with quantitative and qualitative research methods will be used. Validated mental health culture promotion methods with new programs for the specific sectors.
Expected impact
• Significant less sickness absence and suicides
• Benefit for the workers’ health including benefit for the company economy.
• Policies developed for improved mental health culture based on the research.
• Policies developed for improved mental health culture based on the research.
Expected impact
• Significant less sickness absence and suicides
• Benefit for the workers’ health including benefit for the company economy.
• Policies developed for improved mental health culture based on the research.
• The training programs are ready to be continued at the end of the project.
Lizette Arizmendi-Ocampo, Martin Rosas Peralta*, Daniela Salinas Morales, Alejandro Chanona Espinosa, Alicia Contreras Rodriguez, Erick Ramirez Arias, Carlos Riera kinkel, Guadalupe Castro Martínez and Jose Antonio Magana-Serrano
Background: Several epidemiologic studies indicate that up to 50% of patients with heart failure have a preserved ejection fraction, and this proportion has increased over time. The knowledge of its severity and associated comorbidity is determining factor to develop adequate strategies for its treatment and prevention. This study was focus on the creation of a cohort and follow-up of Mexican population and to analyze its severity as well as its interaction with the comorbidity of other cardiovascular risk factors.
Methods: We included patients from different sites of Mexico City than were sent to the Cardiology hospital of the National Medical Center in Mexico City for the realization of an echocardiogram as part of their assessment by the presence of dyspnea, edema, or suspicion of hypertensive heart disease. Complete medical history, physical examination and laboratory studies including Brain Natriuretic Peptide (BNP) serum levels were performed. Diagnosis of diastolic dysfunction was based on symptoms and echocardiographic data including time of deceleration, size of left atrium, e´ septal and e´ lateral, as well as E wave, A wave and its ratio E/A. All patients had left ventricle ejection fraction > 45%.
Results: We included 168 patients with HFpEF. The most common risk factor was hypertension (89.2%), followed by overweight and obesity (> 78.5%), dyslipidemia (82.1%) and diabetes (42.8%). Women were dominant, 108 (64.3%); the mean age was 63 years old. When we classify by severity of diastolic dysfunction, we found that 41.1% were grade I, 57.1% were grade II and only 1.8% were grade III. The risk factors most strongly associated with the severity of diastolic dysfunction were hypertension, obesity and dyslipidemia. We found BNP levels highly variables, but the levels were higher detected as the ejection fraction was approaching to 45%. At one year of follow up mortality was not reported.
Conclusion: HFpEF is a frequent entity in patients with cardiovascular risk factors in Mexico. The most common risk factor was hypertension. The combination of hypertension, overweight and dyslipidemia predicted the severity of diastolic dysfunction. We recommend that all Mexican patient with hypertension and overweight or obesity should be submitted as a part of its medical evaluation to an echocardiogram study in order to detect diastolic dysfunction even though the signs or symptoms are or not evident.
Mast cells play a central role in the genesis and modulation of allergic and inflammatory responses. The general aim of the present work was to study the interaction between mast cells and the most common additives approved for use in foods. Dose-response studies about the effect of the main food additives (tartrazine, sodium bisulphite and sodium benzoate) on mast cell degranulation were carried out. Rat peritoneal mast cells were incubated with: 1) buffer solution or 2) stimulus. The stimuli were tartrazine, sodium benzoate, sodium bisulphite and the calcium ionophore A23187. A23187 was used as a reference mast cell secretagogue. Different doses and combinations of food additives were used. The viability of the mast cells was evaluated with trypan blue. In the incubation solutions, the release of β-hexosaminidase was quantified by colorimetric reaction and ELISA plate reader. The remaining β-hexosaminidase concentration (not released) was studied in the cells after the incubations, and morphology of the mast cells was analyzed by light microscopy with toluidine blue stain. The food additives tartrazine, sodium benzoate and sodium bisulphite did not stimulate the release of β-hexosaminidase from mast cells at any of the concentrations used. In contrast, tartrazine at concentrations of 0.1 μM and 1 μM, and sodium benzoate and sodium bisulphite at concentrations of 0.1 μM, 1 μM, 10 μM and 100 μM, significantly inhibited the basal release of β-hexosaminidase from mast cells. Considering these findings, we decided to determine the effect of these additives on the degranulation of mast cells induced by the calcium ionophore A23187. Sodium bisulphite inhibited mast cell activation induced by the calcium ionophore A23187 in this experimental model. The present study demonstrates that food additives of usual permitted use do not stimulate basal degranulation of mast cells in an in vitro model of peritoneal mast cells and that the additive sodium bisulphite inhibit mast cell activation induced by intracellular calcium increase. This food additive could represent an interesting alternative in the prevention of pathologies mediated by mast cells, as well as in the field of nutritional biochemistry.
There is evidence that complement components induce cell migration in mesenchymal stem cells and regulate cytokine production in osteoblastic cells thus playing a regulatory role in normal bone formation. The aim of the present study was to investigate the involvement of complement system in the differentiation of bone marrow cells in complement-depleted model of rheumatoid arthritis (RA). Arthritis was induced by intraarticular injection of zymosan in cobra venom factor (CVF)-treated mice depleted of functional complement. The expression of different markers by bone marrow [1], on fibroblasts (CD29), mesenchymal cells (CD105), dendritic cells (CD14, CD86), osteoclasts (CD265), cells expressing Dectin1 (CD369) and megakaryocytes (CD62P) was determined by flowcytometry. The lack of functional complement activity at the point of arthritis initiation (day 3) lead to an increase of fibroblast and megakaryocyte populations, to a decrease of mature and dectin1 positive populations, while the number of mesenchymal cells was not changed, all compared to arthritic mice. Immunohistochemical staining showed that low complement activity diminished arthritis-induced generation of megakaryocytes and platelets in BM. Chronic inflammation during erosive conditions such as rheumatoid arthritis, leads to dysregulated differentiation and prolifеration of bone cells, inflammation of synovial membrane and bone marrow, and degradation of cartilage and bone. Present results point that the lack of functional complement changed the ratio between different cell populations that can be used for determining the development and stage of rheumatoid arthritis and can help finding of new therapeutic approaches.
Aim: Study the monitoring method of separation of Salvianolate through macroporous resin chromatographic column using UV spectral data.
Method: HPLC was used to determine the concentration of Salviol B in the eluent liquid of macroporous resin chromatographic column. The UV spectrum of the eluent liquid was measured using portable UV spectrometer. Stepwise regression was used to develop the model to predict the concentration of Salviol B in the eluent liquid of macroporous resin chromatographic column using the UV spectral data.
Result: Stepwise regression model was developed to predict the concentration of Salviol B in the eluent liquid of macroporous resin chromatographic column. RMSE was 0.3263, MAP was 0.2323 and CV was 0.1796.
Conclusion: Stepwise regression model could be used to predict the concentration of Salviol B in the eluent liquid of macroporous resin chromatographic column using UV spectral data.
Amelia Carr, Saso Ivanovski, Randy Bindra and Cedryck Vaquette*
This opinion paper provides a summary of the current reconstructive surgical techniques for the scapholunate interosseous ligament (SLIL) and critically highlights their benefits and shortcomings. Due to limited success with direct repair of the ligament, current practice focuses on achieving biomechanical stabilization and does not allow for tissue regeneration to occur. In addition, the biomechanical behaviour of the ligament is still poorly described and understood, resulting in a very large variation in published mechanical parameters. Therefore, a thorough understanding of the biomechanics of the joint, via both experimental testing and numerical modelling is necessary for enabling the design of the next generation of implants in order to address mechanical stabilisation and regeneration.
With the invention of the stethoscope, in the early 1800s, a better diagnosis of heart and lung disorders was opened up. Through the stethoscope's 200-year history, there has been a significant development of the stethoscopy from the use of the simple monaural earpiece to the binaural stethoscope, followed by the electronic stethoscope, which, together with other studies, has enabled a thorough diagnosis of these disorders. Here is a glimpse of this story.
The cross-border investigation
Far back in time, it has been clear that the function of the heart and lungs played an important role in maintaining life. By tapping with the finger (percussion) and putting the ear to the patient's chest (auscultation), it could hear sound from the body telling about the patient's condition, especially about the presence of fluid or air-filled organs. Auscultation is already described in the Corpus Hippocraticum, in the Diseases II section [1]. The doctor puts the ear to the chest of a patient with water sores, to hear the pain as a wine vinegar from the lungs - or the doctor grabs the patient about the shoulders, shakes him and places his ear to his chest to hear in which side his pleuritis is sitting. Since then, auscultation seems to have been partially forgotten, although it has probably been known by Ambroise Paré and William Harvey [2]. It was not until the late 1700s that it became an important diagnostic aid, just like the pulse clock and the medical thermometer [3 p. 277]. Here, Joseph Leopold Auenbrugger (1722-1809) is considered to be the father of the modern physical examination, which is based on percussion. Percussion he performed by knocking direcly on the thorax with the finger or cupped hands. His discovery of the percussion sounds from the chest during inhaling and exhaling originates from his work in 1760 at the Vienna Military Hospital [4]. In 1761, His little book on thoracic percussion revealing thoracic diseases appeared in 1761 [3p.271], which in 1808 was translated into French by the Parisian physician Jean Nicolas Corvisart des Marets (1755-1821). This contributed to the French doctors starting to use percussion and ausculation more routinely [5].
The limitation of simple auscultation was the fact that the sound was weak and incomplete and therefore there was a need for improved sound quality. In addition, the direct contact with the patient's body could seem insulting.
Kirill N Novikov*, Vladimir L Voeikov, Ekaterina V Buravleva and Nadezhda G Berdnikova
Blood plays an important role in oxygen absorption and its transfer to organs and tissues in vertebrates, as well as in a number of invertebrate species. Numerous interactions between cellular and non-cellular blood components constantly occur. A special role in these interactions belongs to erythrocytes and leukocytes, between which oxygen is constantly exchanged and activated, which we showed directly in whole blood. Blood is a liquid tissue, which is a complex cooperative system and has many inherent functions and the most important one is the ability to maintain the homeostasis of the body. Our experience has shown that despite its high optical density, undiluted blood of humans and animals can be a source of radiation due to the transformation of the energy of electron-excited (EEE) states and secondary processes occurring in the whole blood system. Parameters of this radiation - ultra-weak photons emission (UWPE) from blood - depend upon its physiological properties and reflect the physiological state of a donor. Analysis of UWPE from non-diluted blood is a simple and sensitive method that allows to monitor the course of treatment of a patient. In spite of high opacity of non-diluted blood it may be a strong source of UWPE both in the presence and absence of UWPE enhancers. Analysis of patterns of UWPE from blood reveals its highly non-linear, stable non-equilibrium and cooperative properties. Characteristic of a living system.
The study aimed to identify possible environmental risk factors for breast cancer among women in Gaza Strip and conducted in 2010. A case- control study design was used with face to face interviews by structured questionnaire with breast cancer patient women as well as healthy women. Statistical Package of Social Science (SPSS) was used to analyze the collected data. The study population was 288 women, 144 were women with breast cancer (cases) and 144 were healthy women (controls) with response rate 100% for cases as well as controls. The study was carried out in the two main hospitals in Gaza Strip (El-Shifa and European Gaza) and on cases who had a regular follow up in each hospital, while controls have been chosen from women who had no history of breast cancer by mammogram or by self-examination. In this study the main statistically significant risk factors were; marital status, educational status, physical trauma on breast, medication for infertility treatment, eating red meat 500g or more weekly, eating canned food, eating chicken skin, eating raw and cooked vegetables, using oils with saturated fats in cooking, living in or beside a farm, dealing with crops with naked hands, working in a farm during pesticides application or during 24 hours of pesticides application, cleaning pesticides’ equipment, living with people working in a farm or a agricultural field, and application of pesticides personally. In contrary, no statistically significant differences were found between cases and controls in relation to area of residency, exposure to X-ray in the past, having radiation therapy, getting contraceptive pills, using hair dyes, using anti-deodorant underarm, using facial cosmetics, using hair removal ointment, washing vegetables and fruits, buying and transporting pesticides, and wearing protective tools during pesticides mixing and application.
The consumption of dietary herbs and supplements may be associated with several physiological consequences including, but not limited to disturbances of acid-base homeostasis, minerals and electrolytes wasting, gastrointestinal disturbances as well as hemodynamic changes. Plants food based nutritional studies are important for assessing the effect of plants on human health and wellbeing. The aim of this study was to assess the changes in acid-base status and electrolyte homeostasis following the consumption of lemongrass tea. The acute and sub-chronic effects of infusions prepared from 2, 4, and 8g lemongrass leaf powder on serum and urinary pH, and electrolytes levels were assessed in 105 subjects using an interventional study design. The results post-treatment were compared with baseline values.
Plasma pH decreased from baseline value of 7.37 ± 0.02 to 7.20 ± 0.03, and 7.30 ± 0.02 at days 10 and 30 respectively for participants treated with infusion prepared from 2g of lemongrass leaf powder. For those treated with infusion prepared from 4g of lemongrass leaf powder, plasma pH decreased from baseline value of 7.35 ± 0.02 to 7.22 ± 0.02 and 7.29 ± 0.02 at days 10 and 30 respectively.
Treatment with infusion prepared from 8g of lemongrass leaf powder caused a decrease in plasma pH from baseline value of 7.38 ± 0.02 to 7.15 ± 0.02 and 7.18 ± 0.02 at days 10 and 30 respectively. Corresponding changes in urinary pH were also observed. Furthermore, at days 10 and 30, plasma protein concentrations increased significantly (p < 0.05) in subjects treated with infusion prepared from 8g lemongrass leaf extract. There were also significant increases (p < 0.05) in urinary volume, urination frequency, and urinary electrolytes levels within the same period.
The consumption of lemongrass tea may be associated with changes in acid-base balance and electrolyte homeostasis due to its varied biological constituents and their activities.
MS Abdelhamid*, TM Nabil, HA Nafady, AM Bekeet, AZ Garib, MA Negida and SS Soliman
Purpose: To compare the outcomes of Abdelhamid technique in treatment of inguinal hernia to conventional TAPP with mesh stapling, Prolene hernia system (PHS) and Lichtenstein repair.
Background: the mesh is applied and fixed externally aiding in decreasing port size and cost. There is controversy concerning the necessity of securing the mesh during laparoscopic TAPP repair.
Patients: The study was carried out at the faculty of medicine – Beni Suef University, Egypt from September 2008 to April 2018. 672 patients with unilateral inguinal hernia participated in the study. 432 were treated using Abdelhamid Technique, 382 of which were unilateral primary inguinal hernia and 50 were unilateral recurrent. 50 patients were treated using Prolene Hernia System (PHS). 50 patients with recurrent hernias were treated using Lichtenstein repair and 140 patients went TAPP with mesh stapling.
Results: Abdelhamid technique showed more cost effectiveness than stapling (1800$ vs 3000$) , pronounced less recurrence rate in comparison with Liechtenstein and PHS (2% vs 4%) , same LOS compared to other techniques and mean operative time of 76 minutes which is longer than stapling (60 mins), Liechtenstein (65 mins) and PHS (55 mins).
Conclusion: Abdelhamid technique was a more lengthy operation costing more than open surgery but less than mesh stapling. The recurrence rate is considerably reduced with shorter recovery period. The technique is done with smaller port size that leads to cost reduction.
Mohamed Abdelhamid*, AM Bekeet, MA Negida, AZ Garib and SS Soliman
Primary closure of the common bile duct following exploration has been safely and effectively performed, as advocated by Halsted, provided no evidence of pancreatitis, cholangitis, or ampullary obstruction exists. This study was to gain back confidence to primary closure in selected cases. This study was conducted at Beniswaif University Hospital. Between July 2008 to May. 2014. Using this precedent, the operative management and post-operative course of 19 patients undergoing common bile duct (CBD) exploration for choledocholithiasis were studied, twelve had primary closure of the common bile duct following choledochotomy and exploration, and seven had T-tube placement.
Patients were selected for T-tube if there were pancreatitis, cholangitis, undue trauma, ampullary obstruction. Two patients in that study had bile leak, one in each group. Intravenous fluids were less in primary suture (P<0.001). The long of stay were significantly less in primary suture (P<0.001). The outcome of this study greatly support the safety of primary common bile duct closure in selected cases.
Purpose: To compare the outcomes of Abdelhamid technique in treatment of inguinal hernia to conventional TAPP with mesh stapling, Prolene hernia system (PHS) and Lichtenstein repair. Background: the mesh is applied and fixed externally aiding in decreasing port size and cost. There is controversy concerning the necessity of securing the mesh during laparoscopic TAPP repair.
Patients: The study was carried out at the faculty of medicine – Beni Suef University, Egypt from September 2008 to April 2018. 672 patients with unilateral inguinal hernia participated in the study. 432 were treated using Abdelhamid Technique, 382 of which were unilateral primary inguinal hernia and 50 were unilateral recurrent. 50 patients were treated using Prolene Hernia System (PHS). 50 patients with recurrent hernias were treated using Lichtenstein repair and 140 patients went TAPP with mesh stapling.
Results: Abdelhamid technique showed more cost effectiveness than stapling (1800$ vs 3000$) , pronounced less recurrence rate in comparison with Liechtenstein and PHS (2% vs 4%) , same LOS compared to other techniques and mean operative time of 76 minutes which is longer than stapling (60 mins), Liechtenstein (65 mins) and PHS (55 mins).
Conclusion: Abdelhamid technique was a more lengthy operation costing more than open surgery but less than mesh stapling. The recurrence rate is considerably reduced with shorter recovery period. The technique is done with smaller port size that leads to cost reduction.
We present below a mechanistic molecular approach for development of Anti-Inflammatory biomarkers of Probiotic Bacteria in Fermented Foods. Probiotics are live microorganisms that promote human health by counteracting the noxious toxic gut microflora in human intestine, by modulating of the tight junctions, and by increasing mucin production, enforcing intestinal epithelial cell barrier function, modifying microbial community within the gut intestinal disorders, and improving immune responses associated with chronic inflammation in experimental animal models, collectively enhancing human health. Cytokine secretion by intestinal epithelial cells and macrophages are regulated by probiotics through key signaling pathways such as nuclear factor-κB and mitogen-activated kinases, resulting in alleviation of several disorders such as allergies, diabetes, obesity, heart diseases and cancer. MicroRNAs are small non-coding RNA molecules involved in transcriptional and post-translational regulation of gene expression by inhibiting gene translation. Using in vitro and in vivo approaches in cell lines and mice models to study effects of probiotic conditional media and heat-killed bacterial strains with anti-inflammatory effect to elucidate the mechanisms by which probiotics affect signaling pathways, and by using global cytokine and microRNA gene expression analyses arrroaches to develop biomarkers for studying different pro- and anti-inflammatory activities, and using statistical approaches to analyse the data, we show that cytokines and miRNAs have an essential role in regulation of cancerous and inflammatory bathways. This mechanistic approach will result in developing specific disease biomarkers for the early diagnosis of certain pathogenic states, as well as evaluating the effect of different dietary componenents on developed biomarkers in health states that will promote and enhance human health. Comparing the concordance of the in vitro to the in vivo research findings will confirm the correspondence of both approaches to each other. Moreover, this study will have a major public health relevance in elucidating the role of miRNAs and their targets in inflammation, paving the way to diagnosing and treating of pathogenic human disease stages.
Background: Chronic Kidney Disease is no longer considered just a health burden today but a major health priority owing to its high treatment costs and poor outcome. World Kidney Day and International Women’s Day in 2018 coincided, thus offering an opportunity to reflect on the importance of women’s health, and specifically their kidney health. The current study aims to identify chronic kidney disease in women through a cross sectional screening in hospital based camp in Varanasi on World Kidney Day.
Methods: 138 females attending a health camp were screened for clinical parameters like serum creatinine, random blood sugar, and pregnancy complications. Demographic and anthropometric parameters were noted. Ordinal logistic regression analysis was used to find the predictors of chronic kidney disease stages.
Results: The median age of the participants was 36 years. The prevalence of chronic kidney disease was 6.4% with 1.4% of Stage 1, 2.1% of Stage 2, 1.4% of Stage 3 and 1.4% of Stage 4. Women with diabetes were nearly 4 times at a greater risk of developing higher stages of chronic kidney disease compared to women without it. With a unit increase in serum creatinine levels, women were nearly 13 times more likely to develop higher stages of chronic kidney disease.
Conclusion: Serum creatinine levels and diabetes were the significant predictors for the development of higher stages of chronic kidney disease. Early screening for kidney diseases in women could reduce the load of health care delivery system that is involved in renal replacement therapies.
Shahrzad Ossareh*, Bahareh Marghoob and Robabeh Bayat
Purpose: Deficiency of Fetuin A, as a calcification inhibitor, is assumed to be involved in vascular calcification in patients on maintenance hemodialysis (MHD). This study examined the relationship between serum Fetuin-A and vascular and valvular calcification in a cohort of MHD patients.
Methods: The study was conducted on 122 MHD patients. Serum levels of calcium, phosphorus, parathormone, and Fetuin-A were tested. Intima-media thickness (IMT) ≥0.8 mm and the presence of stenosis>50% or plaques in carotid doppler sonography were considered as vascular calcification. Calcification of cardiac valves or mitral annular calcification in two-dimensional echocardiography, were considered as cardiac valvular calcification. The presence of any or both of the two conditions was defined as cardiovascular calcification (CVC).
Results: Fetuin-A was lower than normal in 37% of 122. Totally 106 patients (87%) had CVC, who were older (61±14 vs. 38±14 years, P<0.001), more affected by diabetes (54% vs. 13%, P=0.007), had a longer dialysis vintage (median 5 vs. 2 years, P=0.006), lower levels of creatinine (8.9±2.8 vs. 11.9±3.1 mg/dL, P<0.001) and higher levels of calcium (8.7±0.7 vs. 8.4±0.5 mg/dL, P=0.026). There was no significant difference in mean Fetuin-A level between the two groups (P=0.101). In logistic regression increased age (OR=1.1, CI 95%=1.1 - 1.2) and serum calcium (OR=2.8, CI 95%=1.1- 7.6), and diabetes mellitus (OR=7.4, CI 95%=1.1 - 47.4) were risk factors.
Conclusion: This study showed that 87% of our patients had vascular and/or valvular calcification. Increased age and calcium level and diabetes were the predictors of CVC, whereas Fetuin-A was not.
Luisetto M*, Naseer Almukhtar, Behzad Nili Ahmadabadi, Gamal Abdul Hamid, Ghulam Rasool Mashori, Kausar Rehman Khan, Farhan Ahmad Khan and Luca Cabianca
Many pathologic disease can be considered as related to an Endogenous toxicological moves and in time dependent way (kinetics and dynamic of the process). In this work starting from the analysis of relevant literature involved with different disease and related to the endogenous local micro- environment some global conclusion useful as new tools for innovative pharmacological strategies will be submitted to the researcher. Physiology, pathology concept linked to the endogenous toxicological local micro-environment status as new research instruments. The same carcinogenesis process can be related also to endogenous agents that may have a major contribution in spontaneously process. (Reactive oxygen species (ROS), which are involved in multiple cellular processes by physiologically transporting signal as a second messenger or pathologically oxidizing DNA, lipids, and proteins).
Functional appliances used in correction of class II malocclusions are shown to modify the neuromuscular environment of dentition & associated bones. There are many studies related to the skeletal, dental and neuromuscular changes which are evaluated cephalometrically, clinically as well as with the recent diagnostic aids like MRI. The aim of this short communication was to highlight and discuss the different aspects of condylar modifications and its role in its growth.
The Twin Block has higher effectiveness & comfort as compared to other removable functional appliances [1.2]. The action of Twin Block & Bionator is for 24 hours so effects are more with these appliances. Over the years, several theories have emerged attempting to shed light on condylar growth. One of the earliest theories, the genetic theory, suggests the condyle is under strong genetic control like an epiphysis that causes the entire mandible to grow downward and forward. Although this may be related more to development of the prenatal than postnatal condyle, the theory does indirectly question the effectiveness of orthopedic appliances in condylar growth as proposed by Brodie [3,4]. Several long-term investigations actually showed clinically insignificant condylar growth modification after continuous mandibular advancement with a reasonable retention period in human beings although the initial treatment results appeared encouraging. This leads to the conclusion that the general growth of the condyle appears relatively unalterable in long-term studies.
A second hypothesis based on the earliest available acute and blind EMG monitoring technique, suggests that hyperactivity of the lateral pterygoid muscles (LPM) promotes condylar growth. Rees reported that other muscles and tendons, including those of the deep masseter and temporalis, also attach to the articular disk region. Attachments of the LPM to the condylar head or articular disk may be expected to cause condylar growth, but anatomic research has not found evidence that significant attachments actually exist [5,6]. The LPM tendon is observed attaching, however, to the anterior border of the fibrous capsule that in turn attaches to the fibrocartilage of the condylar head and neck anteriorly. At the same time, it is doubtful that initial hyperactivity could occur where the LPM muscle has been shortened by continuous mandibular displacement therapy. By using LPM myectomy in rats, which may have disrupted condylar blood supply, Whetten and Johnston found little evidence that LPM traction had any pronounced effect on condylar growth. More recently, permanently implanted longitudinal muscle monitoring techniques have found that the condylar growth is actually related to decrease postural and functional LPM activity. This notion was also supported in human studies by Auf der Maur, Pancherz and Anehus- Pancherz, and Ingervall and Bitsanis that reported decreased muscle activity. The LPM hyperactivity theory brought forward by Charlier et al. Petrovic, and later espoused by McNamara however, was important in prompting further investigations in muscle-bone interactions [7,8].
A third hypothesis, the functional matrix theory, postulates the principal control of bone growth is not the bone itself, but rather the growth of soft tissues directly associated with it. Although this was supported in part by investigations testing the different growth and developmental responses between the condyle and epiphysis, there has been no explanation as to exactly how condylar growth would be stimulated. Thus, this theory’s validity has been questioned. One of the reasons was that there was little explanation of the specific mechanism by which the condyle was stimulated to grow. Endow and Hans presented an excellent overall perspective suggesting that mandibular growth is a composite of regional forces and functional agents of growth control that interact in response to specific extra-condylar activating signals [9,10].
Aiman Nazhmetdinova*, Albina Izmailova, Altinay Chalginbayeva and Adlet Kassymbayev
Annually the list of pesticides is replenished by new ones. One of the main criteria for their registration is toxicological and hygienic assessment and its impact on the environment.
In order to register the new soy herbicide Damu - Safen, EC (fomesafen, 250 g/l) it was necessary to assess its toxicological and hygienic impact on the environment and humans. Therefore, for the first time we conducted studies of the environmental objects under the influence of Damu-Safen, EC (fomesafen, 250 g/l) and the risk assessment of the active substance fomesafen and pesticide Damu - Safen, EC on the workers. According to the results of the assessment of working conditions for the workers of the tanker and the tractor operator, an acceptable risk was obtained that meets regulatory and hygienic requirements. Residual amounts of fomesafen not exceeding the normative levels were found during conducted studies on environmental objects.
Consequently, the results of the risk assessment in the application of pesticide Damu-Safen, EC (fomesafen, 250 g/l) and its impact on the working people and environmental objects indicate the possibility of its application in compliance with optimal environmental conditions and compliance with regulations for appliances and personal protective equipment.
Asthma is a complicated chronic disease of airway and airway inflammation, bronchoconstriction, cough, dyspnea and wheezing that are main symptoms of the asthma. Genetic, epigenetic and environmental agents are main factors in pathophysiology of the asthma.
Howaida Mahmoud Hagag, Yosra Hussein Alam-Eldin, Mahmoud Khalifa Mahmoud, Khadiga Ahmed Ismail*, Amany Mamdouh Abdulaziz, Ahmed Mahmoud Khalifa and Osama Mahmoud Khalifa
Trichomonas vaginalis could be seen in Pap smears where it is reported, but because main concerned is placed on malignant cells in Pap smears, not much effort is done to search for this parasite in smears. In this study, 100 cervical and vaginal specimens were examined microscopically by the conventional Papanicolaou method and liquid base cytology (LBC) for the presence of Trichomonas vaginalis (T.vaginalis). 16% were infected with T.vaginalis while 10% of diagnosis based on both perinuclear halo and T. vaginalis presence although the association between perinuclear halo and T, vaginalis is statistically insignificant it is recommended to increase the number of the cases to prove or disprove the association.
Maurizio Falso*, Silvia Zani, Eleonora Cattaneo, Marco Zucchini and Franco Zucchini
Background: A structured multidisciplinary team is very important during every phase of the amputation process and a good communicative team guarantees a greater tranquility for the patient, thanks to more homogenous information, that is already discussed between the clinicians.
Aim: The aim of this study was to define the efficacy and outcome value of an innovative procedure tool (TRIA-MF protocol) in the treatment of lower limb amputees before and after prosthesis use with the purpose to quantify the quality of the procedure and its economic impact on the clinical patients’ recovery.
Setting: A rehabilitation institute for the treatment of neurological and orthopaedic gait disorders.
Methods: 12 patients (4 women and 8 males) subjected to lower limb amputation and admitted according to the principles of inclusion criteria of the TRIA-MF protocol at the Rehabilitation Department of the Clinical Institute Città di Brescia were recruited in this study. All patients were included in an integrated and task-specific management protocol of the amputee, which allowed to follow the rehabilitation process from amputation to the final restoration, for a period of 6 months for each patient. Patients were evaluated 5 times during the study, collecting their degree of pain (VAS), their independence profile (Barthel Index) and the cirtometry of their amputation stump. Data on the duration of their admission to the rehabilitation unit, the inter-time between the amputation and acquisition of the temporary prosthesis, and between temporary prosthesis acquisition and the final prosthesis acquisition were also reported.
Results: Patients of our sample, at the end of their hospitalization, highlight a significant modification of the temporal data at 1 month and 6 months from their hospital discharge. A statistical significant increase of the Barthel Index value was observed in all patients recruited in this study proceeding from time T0 to time T4; in the same way, a statistical significant decrease of the VAS scale was observed in all patients recruited proceeding from time T0 to time T4; the cirtometry of the amputation stump (expressed in cm) showed a statistical significant decrease in all patients recruited proceeding from time T0 to time T4. We haven’t observed a statistical significant correlation between the duration of the rehabilitative hospitalization and our clinical data; no statistical significant correlation was observed between the amputation stump cirtometry time-related modification and our intertime data.
Conclusions: The protocol was found to be a clear and relevant tool with the definition of the operational profile for each single professional figure involved; it could also be considered as an optimal tool for coding the management and evaluation of the effectiveness of amputee treatment, with a related high reproducibility, sensitivity and specificity profile. In line with the literature, the TRIA-MF protocol has allowed us not to exceed a period of hospitalization in rehabilitation units of more than 23 days, thus showing that it is an excellent tool for optimizing the management costs of the amputee over time.
Synthetic biology is an interdisciplinary branch of biology and engineering. The subject combines various disciplines from within these domains, such as biotechnology, evolutionary biology, molecular biology, systems biology, biophysics, computer engineering, and genetic engineering. Synthetic biology aims to understand whole biological systems working as a unit, rather than investigating their individual components and design new genome. Significant advances have been made using systems biology and synthetic biology approaches, especially in the field of bacterial and eukaryotic cells. Similarly, progress is being made with ‘synthetic approaches’ in genetics and animal sciences, providing exciting opportunities to modulate, genome design and finally synthesis animal for favorite traits.
Research is the process of searching for knowledge. It is systematic search pertinent information on specific topic of interest. It is a careful investigation or inquiry especially through search for new facts in any branch of knowledge [1].It is a scientific way of getting answers for research questions and testing hypothesis. The research question is based on uncertainty about something in the population. This can be formulated by searching different literatures from index and non index journals, books, internet, and different unpublished research work etc. A good research question should follow the FINER criteria i.e. Feasible, Interesting, Novel, Ethical and Relevant [2].
The complete research is the whole design which arises from defining research problems to the report writing (Figure 1). The research problems are determined on the basis of well known concept and theories or previous research findings. The assumptions in term of hypothesis are made. The process of inquiry is done by interviewing or observing or recording data and the collected data are analyzed with interpretation. Basically there are two approaches of data collection, quantitative and qualitative. The quantitative approach views human phenomena as being focused to study objective i.e. able to be measured. It has its roots in positivism. Quantitative approach to research involves data collection methods such as structured questionnaire, interviews and observations together with other tools. This approach helps investigators to quantify the information.
Saeed Oraee-Yazdani*, Maryam Golmohammadi, Mohammadhosein Akhlaghpasand and Maryam Oraee-Yazdani
A 35-year-old female, known case of complete spinal cord injury, presented with cervical pain and neck deformity that interfere with her physiotherapy and occupational therapy. Two years before admission, she had a car accident which result in a complete quadriplegia. That time at another center, she underwent surgery to anterior cervical fixation of C6-C7 through insertion of cage and plate without corpectomy. Based on current radiologic images, spondyloptosis was detected at the C6-C7 with bilateral locked facet, due to hardware failure. A three approaches in one stage was performed to maintain cervical alignment that includes posterior, anterior and again posterior approach. With this manner, anterior fusion through corpectomy and insertion of expandable cage and plate as same as instrumental posterolateral fusion were done. After surgery, she was pain free and the alignment of cervical spine was maintained so she could come back to ordinary rehabilitation programs.
Calheiros-Cruz T, Caamaño-Vara MP, Villar-Fernandez B, Ruibal-Azevedo J, Cameselle-Cortizo L1, Cameselle-Arias M, Charro Gamallo ME, Turienzo-Pacho F, Yera Acosta A and Cameselle-Teijeiro JF*
McArdle’s Disease, or Glycogen Storage Disease Type V, is the result of a deficiency in one of the enzymes responsible for the metabolism of glycogen in the body. Individuals with this disease, lack or produce very small concentrations of the myophosphorylase or glycogen phosphorylase enzyme.
McArdle’s disease is a metabolic and recessive genetic disease caused by a mutation on the PYGM gene located on chromosome 11q13. This gene is responsible for the synthesis of the myophosphorylase (or glycogen phosphorylase) enzyme. It is the most common form of muscular glycogenesis. We present here the clinical case of a 35 years old woman diagnosed with McArdle’s disease at the age of 21 after a visit to a Neurologist. It was confirmed that the patient had shown symptoms of this disease at least 10 years before definitive diagnosis: intolerance to exercise, asthenia and muscular weakness. In this report we describe the different signs and symptoms of the disease, as well as the tests performed to confirm the diagnosis by muscle biopsy and genetic analysis. McArdle’s disease is classified as a rare disease and often its diagnosis is delayed due to a lack of knowledge about its symptoms and signs. Our intention is to make, with the description of our clinical case, the information about this disease more available to physicians to prevent future misinterpretations and delayed diagnosis. A medical documentary we have created on “McArdle’s Disease” can be seen in YouTube using the following links: https://youtu.be/HAhoZ7jxz7Q (English version) and https://youtu.be/uZopzSHOl20 (Spanish version).
Objective: To assess the knowledge, attitudes, and skills in pre-hospital care and emergency medicine of doctors, nurses and Emergency Medical Technicians (EMT), who accompanied emergency patients in ambulances?
Methods: A descriptive cross-sectional study was conducted among the doctors, nurses, and EMT who accompanied emergency patients in ambulances to the National Hospital. All ambulances arriving from August to October 2008 (n=409) were screened. A self-administered questionnaire with 30 items was used to assess knowledge, attitudes, and skills. The knowledge was categorized into three levels, EMT-basic level, EMT-intermediate level, and EMT-paramedic level and the scores were converted into the percentages.
Results: The overall knowledge score on basic, intermediate and paramedic level were 57.5%, 42.9%, and 33.9% respectively. The knowledge on airway management (84.3%), bleeding control (82.9%), patient transport (71%) and first aids (61%) at the EMT-basic level were higher, however oxygen administration (37.1%) and basic life support (38.6%), spinal immobilization (45.7%), traction splinting (47%) and triage (48.6%) were lower. For the EMT-intermediate level, knowledge on endotracheal intubation (41.4%) and initial cardiac drug therapy (44.3%) were low. For the EMT-paramedic level, the knowledge on the advanced respiratory support (53%), ECG interpretation (37%), pharmacology (13%) and paediatric life support (20%) were lower.
Most staff showed positive attitudes towards the need of basic knowledge in pre-hospital care (97.1%, n=34), need for proper training (97.1%, n=34) and cost for pre-hospital care (77.1%, n=27), while they showed relatively negative attitudes towards the outcome of pre-hospital care (74.3%, n=26).
For the required skills for advanced life support, most of the staff showed skills in IV cannulation (71.4%, n=25) and IV drug administration (71.4%, n=25) however less skills were shown cricothyroidotomy (22.9%, n=8), pleural drainage (25.7%, n=9) and laryngoscopy and intubation (31.4%, n=11).
Conclusion: The knowledge at the EMT-basic level was average and intermediate and paramedic levels were lower than average. The attitudes were generally positive. However they lacked some specific skills.
Aim: With the continuing trend in the incidence of diabetic ulcer, the current researches on wound care and healing will bring best and effective practices on wound care and healing among patients suffering from diabetes mellitus.
Methods: This study utilized a systematic review of literatures in light of wound care through Pub Med database with the key words “Diabetes Mellitus,” “wound practices,” “wound healing,” and “systematic review.” The searched literatures were of case reports, interventional studies, and review papers whose main texts were in English.
Results: There were 7,988 published articles yielded from the keywords used and 16 were included in this study. The practiced management and techniques in these literatures focused on comfortable and cost efficient means of wound care and healing with the involvement of group participation than individual plan of care.
Conclusions: There are meager evidences of feasible wound and healing options that needs further studies in resolving wound issues among patients with Diabetes Mellitus. This systematic review establishes the insufficiency of high level of evidence based studies on wound healing in DM patients and brings a track for continuity of rigid studies concerning this topic.
Luisetto M*, Naseer Almukhtar, Ghulam Rasool Mashori, Ahmed Yesvi Rafa, Farhan Ahmad Khan, Gamal Abdul Hamid, Luca Cabianca and Behzad Nili-Ahmadabadi
In this work is analyzed scientific literature involved in human evolution to be used as an archeological Pathway to link different sciences in an overall new discipline.
A rational classification of single evidence make possible to better understand under new light some Physiological process.
The archeological instrument to be applied in other field like biology or other sciences.
ational classification of single evidence make possible to better understand under new light some Physiological process.
The archeological instrument to be applied in other field like biology or other sciences.
Muhammad Bukhari1*, Azharuddin Mohammed, Abdullah Al-Guraibi, Ahmed Shahata and Mansour Al-Ghamdi
Brucellosis is a zoonotic infection that is endemic in some Mediterranean countries, North Africa and the Middle East. Brucella is a rare cause of peritonitis in Peritoneal Dialysis (PD) population and in non-dialysis patients alike. We report here a challenging case of PD-related Brucella peritonitis in a 45-year-old Saudi male with late peritonitis that delivered some key learning throughout its course from presentation, diagnosis and treatment to catheter salvage attempts so as to circumvent PD failure. We provide an in-depth review of limited published literature on PD-related Brucella peritonitis (seven cases, and present case) and summarized the data on key clinical characteristics, management and PD technique outcome to benefit nephrologists when encountered with this rare presentation.
Georgery H*, Migali G, Pochet JM, Tintillier M, Van Ende C and Cuvelier C
Liver cyst infection in patients with autosomal dominant polycystic kidney disease (ADPKD) is a rare but life-threatening complication. Diagnosis and treatment remain challenging. We report the case of a 64-year-old kidney transplant patient presenting with fever and abdominal pain. The diagnosis of liver cyst infection was made by positron emission tomography scan (PET/CT). Moreover, the course of our patient illustrates the interest of subsequent PET/CT during follow-up as our patient failed on antibiotherapy and required liver cyst drainage.
Cystoid macular edema is a common cause for unexplained painless vision loss after cataract surgery. Even the pathogenesis of pseudophakic cystoid macular edema (PCME) still remains undefined, it can most frequently occur in eyes with high vasoactive profile, had complicated cataract surgery such as posterior capsule rupture and risk of inflammation. Increased inflammation, ultimately leading to the breakdown of the blood-retinal barrier and cystic accumulation of extracellular intraretinal fluid. The natural history of PCME is spontaneous resolution without any treatment in most of patient, but it may take weeks or months, in addition permanent visual morbidity may occur in some cases. Therefore there is lack of consensus regarding treatment approach for this common ocular condition.
In this review treatment alternatives of PCME and its relation with underlying patho-physiologic mechanism are evaluated.
Aim: To evaluate the outcome of Trabeculectomy in advanced glaucoma in a hospital in Rivers State, Nigeria.
Methods: This was a non-randomized interventional study in which each patient served as its own control. Patients with advanced glaucoma and demonstrable field defects and Mean defect ≥-12 were included. The intervention employed was Trabeculectomy and IOP and visual acuity pre operative, as well as post op were collected and compared at pre- op, post -op day 1, one week, one month, 6 months. Data was analyzed using SPSS version 20.
Results: Thirteen (13) eyes from ten (10) patients with advanced glaucoma were involved in the study. Mean age of study population was 53±19.62 years. Mean of mean defect was -19.05±5.23dB while mean of vertical cup disc ratio (VCDR) was 0.88±0.04.
Mean of Pre- op Visual acuity (log MAR) was 0.46 and dropped to 0.72 first day post-op but improved over 6 months to 0.42. The mean of IOP pre-op was 24.15mmHg and dropped to 11.23mmHg (58.24%) over 6 months (p=0.001).
Conclusion: Trabeculectomy still remains the gold standard surgical treatment for glaucoma. In our study it resulted in a 58.24% drop in IOP over 6 months with mean visual acuity maintained at pre-op levels after 6 months follow up. It therefore is effective and safe surgical intervention in advanced glaucoma.
Motahar Heidari-Beni* and Seyedeh-Masomeh Derakhshandeh-Rishehri
Roux-en-Y Gastric Bypass surgery is superior to medical treatment for short- to medium-term remission of Type 2 diabetes (T2DM) [1]. Recent research indicates that the improvements in insulin sensitivity following bariatric surgery are associated with elevated circulating bile acid concentration and remodeling of gut microbiota [2].
Between 2013 and 2016 the main tasks for the German public health care departments were mainly related to medical support in terms of the management of outbreaks of infectious diseases, physical examinations of children and adults to exclude tuberculosis ore other infectious diseases, the administration of vaccinations and medical acute care.
Benish Khanzada*, Mala Jitendra Shahani and Areesha Kamran Khanzada
<h2>Abstract</h2><p><strong>Objective: </strong>To determine the complications (infection, perforation and expulsion rate) of immediate postplacental insertion of intrauterine contraceptive device (Multiload Copper375) in postnatal patients.</p><p><strong>Methods:</strong> A case series study was conducted between October 28, 2014 to April 30, 2018 in obstetrics and gynaecology department, Civil Hospital Karachi,-+ Informed consent was taken. Intrauterine contraceptive device (Multiload) was inserted immediately within 10 min after delivery of placenta. These women were observed to determine outcome (infection, perforation and expulsion) at the time of discharge and 6 weeks postpartum. Absence of all these were taken as satisfactory outcome.</p><p><strong>Results:</strong> A total of 435 women were included in this study. 165 (38%) were delivered through cesarean section and 270 (62%) were delivered through vaginally. There were 36 (8.3%) cases of infection. The cumulative rate of expulsion and perforation at the end of sixth week of post insertion was 39 (9%) and 0% respectively and 360 (82.8%) had satisfactory outcome. Post-placental placements during cesarean delivery are associated with lower expulsion rates than post-placental vaginal insertions without increasing rates of postoperative complications like perforation, slightly increase infection rate following vaginal delivery.</p><p><strong>Conclusions:</strong> Immediate postpartum insertion of IUCD is an effective, safe and easily reversible method of contraception. Rates of the complications (Infection, expulsion and perforation) are remarkably low.</p>
Hanife Saglam, Funda Atalay*, Ayse Filiz Avsar and Hüseyin Levent Keskin
<h2>Abstract</h2><p><strong>Aim:</strong> The aim of this study was to determine the sensitivity of the tumor markers and diagnostic methods used in the preoperative period for dermoid cysts, the most common benign neoplasm of the ovary.</p><p><strong>Material and Methods:</strong> 136 patients who were operated for any reason and reported as ovarian dermoid cyst in the Department of Obstetrics and Gynecology, Ankara Atatürk Training and Research Hospital between January 2004 and September 2005 were included in the study. The medical records of the cases were obtained retrospectively from Ankara-Atatürk Training and Research Hospital, HIS, archive files and patient numbers where necessary.</p><p><strong>Results:</strong> In the preoperative period, 119 patients underwent ultrasonographic examination, 33 underwent Computed Tomography, and 17 underwent Magnetic Resonance Imaging.10 of the cases only underwent CT, while 3 of the cases underwent only MRI 22 of them underwent both USG and CT, USG and MRI were performed on 13 cases and only 1 case underwent all three of the imaging methods. Tumor markers were CEA, CA 125, CA 19-9, CA 15-3 and AFP.</p><p><strong>Conclusions:</strong> The reviews of ultrasonography and / or computed tomography and / or magnetic resonance imaging (n = 132) revealed that 103 of the cases were put into operation and the sensitivity of the preoperative screening methods were calculated to be 75.5%. The sensitivity of the tumor marker CA 19-9 was calculated to be 31%.</p>
Delivering health care is a complex task that marginalized a portion of the population intentionally or unintentionally. Discrepancy in health care providing to the intended patients is sometimes accompanied by unintended collateral damage to the bystanders who desperately needing our help and assistance.
I was called to help in the management of a 75-year old Caucasian male with history of ischemic heart disease requiring percutaneous coronary intervention (PCI) for 2-vessel disease treated with stent placement, hyperlipidemia, chronic obstructive pulmonary disease, peripheral vascular disease, and diastolic heart failure with preserved ejection fraction of 50-55%. The patient was admitted this time with community acquired pneumonia resulting in hypoxemic respiratory failure demanding initiation of mechanical ventilation and tracheostomy placement.
Konstantinos Filis*, Constantinos Zarmakoupis, Fragiska Sigala and George Galyfos
According to recent guidelines, endovascular angioplasty is the standard treatment for TASC A and B primary aorto-iliac occlusive (AIOD) disease, and the first-line approach for TASC C lesions [1,2].Extended TASC D occlusive disease is usually treated by open surgery yielding excellent patency rates at a cost of a higher mortality (2%-4%) and a severe morbidity (up to 10%) [3]. However, several studies have reported promising results after endovascular treatment of extensive AIOD and full reconstruction of the aortic bifurcation [4,5]. In a recent meta-analysis, Jongkind et al., concluded that endovascular treatment of extensive AIOD can be performed successfully by experienced interventionists in selected patients [6]. Although primary patency rates seem to be lower than those reported for surgical revascularization, reinterventions can often be performed percutaneously yielding a secondary patency comparable to surgical repair.
Common causes of chronic infrarenal aortic occlusion (CIAO) include: i) atherosclerotic occlusive disease; ii) middle aortic syndrome; iii) Takayasu arteritis; iv) fibromuscular dysplasia; v) neurofibromatosis; and vi) coral reef aorta [3,7-9]. Although standardized infrarenal aorto-bifemoral bypass (AoBFB) remains the surgical procedure of choice for CIAO, operative decisions may proceed beyond AoBFB in complicated cases. Different therapeutic strategies include axillo-(bi)femoral bypass (AxBFB), aortoiliac endarterectomy (AIE) or hybrid procedures. AxBFB grafting usually refers to patients of high risk for aortic clamping or patients with many comorbidities that prohibit an extensive transperitoneal procedure [10]. However, its primary patency is usually inferior compared to classic aortofemoral bypass surgery and AxBFB is associated with an increased risk for infections. In a recent systematic review, anatomical open procedures such as AIE showed very low perioperative mortality, with 5-year primary patency rates of over 80% [11]. Finally, hybrid procedures show equivalent midterm primary patency rates with the open procedures even for TASC D lesions while reducing perioperative mortality rates [12]. Hybrid procedures for aortoiliac disease usually include iliac stenting plus femoral endarterectomy or femorofemoral bypass.
<h2>Abstract</h2><p>The aim of the paper is to determine the effects of physiotherapy and rehabilitation (PHTR) on a child with Pallister-Killian Syndrome (PKS). Gross Motor Function Measure (GMFM) and duration of grasping ping pong ball were the primary outcome measures which were conducted at the beginning, 12th, and 24th month.Neurodevelopmental Therapy and Sensory Integration Therapy were used as intervention methods. The most increase with around 50% was acquired in Section A of the GMFM. Duration of holding a ping pong ball gradually increased. As a result, this is the first paper presenting a PHTR shedule and its results in a child with PKS.</p>
<h2>Abstract</h2><p><strong>Purpose:</strong> The benefits of Physical Activity (PA) considered as a major supportive care in cancer patients, on survival, and recurrence risk is largely disseminated in public communication. However, these data must be taken with caution.The main objectives were to review the evidence and limits of studies reported regarding the post-diagnosis PA role on cancer survival and recurrence risk to secondly discuss of research perspectives on PA programs.</p><p><strong>Method</strong>: The narrative review included all published or ongoing studies in English during the last 20 years related to PA, survival and recurrence risk with a systematic search on main databases.</p><p><strong>Results and discussion</strong>: The current evidences regarding the PA role on survival and recurrence risk were only based on cohort studies, mainly in breast cancer. The major methodological limits identified as the lack of PA change assessment, PA level assessed largely by self-reported methods and the significant inter- but also intra- variability make the interpretation of data very. Beyond the use of rigorous RCT, the major issue is to develop adapted and personalized interventions to progressively increase PA level overtime in cancer survivors.</p><p><strong>Conclusion</strong>: Despite the lack of causal relationship between post-diagnosis PA, survival and recurrence risk, the review underlines several interesting research perspectives. The future PA interventions, using innovative tools and integrated to the “real-life” will argued for the potential antitumoral PA role growing in literature.</p>
Mauro Luisetto*, Naseer Almukhtar, Behzad Nili-Ahmadabadi, Ghulam Rasool Mashori, Kausar Rehman Khan, Ram Kumar Sahu, Farhan Ahmad Khan, Gamal Abdul Hamid and Luca Cabianca
In various patients conditions involved in lower urinary tract disease LUT (like overactive bladder, bladder neck sclerosis, dis –synergy (with our synenrgic contraction between bladder detrusor and bladder neck, BPH, recurrent cysytitis, interstitial cystitis, chronic prostatitis, uretral stenosys, loss of sfinteric coordination.
Prostatic cancer, anatomic abnormalities and other the receptor status play relevant role to reduce effect of vicious clycle that can be responsible in progression of the pathologic process.
In this work the complex receptorial status is analyzed to verify new therapeutic strategies.
Starting from the observation that various irritant substanties produce irritant stimulus in Prostatic Patients or in bladder neck condition is interesting to deep understand the etio-patogenesys and Functional results.
In Various prostatic, bladder neck or ureteral condition a reduced urinary fluss can produce infectious.
Conditions like acute or chronic prostatitis.
Irritants sustanties in diet (in example etilic alcohol drink, hot spices, crud meats, carbonate drinks, caffeine and other) can produce Painful stimulus in innervations of vecical trigonous, bladder neck and prostatic urethra.
The same recurrent cystitis and Bph contribute in a complex situation.
This stimulus produce ipertonus of bladder muscle involved in the expulsion of urine.
The event related inflamation and edema (bladder, prostatic uretra, trigonus) contribute to the global effect.
So conditions like bladder neck sclerosys IPB, recurrent prostatitis and cistitys in acts in a vicious circle. (Also immunomediated: Bph and cronic prostatitis with linfocite infiltration and tissue remodeling).
The ormonal status check the systems (see 5-ARI efficacy in Bph).
Simpatic, parasimpatic and other system are deeply involved.
Also behavioral habits or diet can influence in example urinary flux in a complex system like LUT. (Bladder and prostatic irritants that can produce edema and acute inflamation).
Other behavior habits are deeply involved as too much sedentary, water intake, coffee, pee modality and also psychological profile and stressing conditions.
Some disease like diabetes produce high consequences in all this systems due to
Bladder modification, oxidative stress, osmotic movens, and increase susceptibility of urinary infections.
This article are verified this kind of movens that contribute in physio -pathology of some low urinary tract conditions.
The anatomic abnormalities produces, obviously, physiological disfuntions.
Maurizio Falso*, Michela Delpero and Eleonora Cattaneo
Background: In line with the so-called “embodiment concept”, human bodily experience is characterized by the immediate feeling that our body is localized in a certain position in space and that the self is localized within these body limits.
Aim: To verify in a cohort of patients affected by unilateral spatial neglect (NSU) secondary to cerebrovascular damage the possible correlation between a comprehensive neuromotor/neuropsychological rehabilitative treatment and the modification of body representation.
Setting: A rehabilitation institute for the treatment of neurological gait disorders and neuropsychological failures.
Methods: 12 patients (7 males, 5 females; mean age 60 ± 2yy) affected by NSU secondary to cerebral stroke and recovered in the Neurological Rehabilitation Section of the Clinical Institute Città di Brescia were recruited for the aim of this study. In accordance with our inclusion criteria we recruited 4 patients affected by ischemic stroke and 8 patients affected by haemorragic stroke; 9 patients of our study group arrived from a coma state period. Recruited patients underwent at time T0 (hospitalization day) to a functional impairment evaluation (Motricity Index = MI; Trunk Control Test = TCT; Functional Ambulation Category = FAC) and to a neuropsychological evaluation (Behavioural Inattention Test = BIT; Representional drawing; Personal Neglect evaluation scale); each evaluation was repeated in the same way at time T1 (intertime between 2 and 4 months after hospitalization) and time T2 (inter time between 5 and 6 months after hospitalization). At time T0 each patient began an individualized integrated (motor and neuropsychological) rehabilitative treatment course.
Results: In all patients recruited a statistical significant modification was observed for the MI LL left, the TCT and the FAC; no significant statistical modification was observed for the MI UL left, the MI UL and the MI LL right. The t-test showed a significant statistical modification of the personal neglect evaluation scale while no significant statistical modification was defined for the spontaneous human figure drawing test proceeding from time T0 to time T1. The spontaneous drawing of the human figure showed an individual different trend and modification in all patients recruited. A correlation analysis was made comparing the mean value of all motor scales (G1) with the mean value of all neuropsychological scales (G2) and no statistical significant correlation was observed between G1 (T0) and G1 (T1), G1 (T0) and G2 (T0), G1 (T0) and G2 (T1), G2 (T0) and G1 (T1), G2 (T0) and G2 (T1), G1 (T1) and G2 (T1). A second correlation analysis was made comparing all single motor scales with the neuropsychological scales, for the group made by 12 patients and the group made by 5 patients. For the group made by 12 patients, we observed the subsequently significant correlations: MI UL left (T0) correlates with MI LL left (T0); MI LL left (T0) correlates with MI LL left (T1); MI UL left (T1) correlates with MI LL left (T1); MI LL left (T1) correlates with FAC (T1); TCT (T1) correlates with FAC (T1). For the group made by 5 patients, we observed the subsequently significant correlation: TCT (T2) correlates with FAC (T2). In the group made by 12 patients, the mean amelioration of the time related normalized (T0-T1) motor scales is equal to 49% while to 63% was observed for the neuropsychological scales. The mean amelioration of the neuropsychological scale proceeding from time T0 to T1 is equal to 26% with an increase equal to 57% proceeding from time T1 to T2. The neurocognitive amelioration can be observed especially between the 5th and 6th month from the ischemic cerebral damage with a mean increase from 26% to 57%.
Conclusions: It would certainly make sense to treat patients with NSU from the neuropsychological point of view in the long term and from the neuro-motor point of view in the first 3-4 months after stroke; in all this, we cannot exclude that an improvement of the visuo-spatial exploration, emphasized by the neuropsychological treatment, can positively influence also patient’s motor outcome.
Aim: To verify in a cohort of patients affected by unilateral spatial neglect (NSU) secondary to cerebrovascular damage the possible correlation between a comprehensive neuromotor/neuropsychological rehabilitative treatment and the modification of body representation.
Canine Distemper have become a major concern within the veterinary clinical work. Thus, the appearance of many cases of canine distemper in adult animals with their vaccination plan up to date has alarmed veterinarians. Many cases of canine distemper have become a major concern within the clinical veterinary task. The purpose of this work was to detect the gene of hemagglutinin of the virus canine distemper, by using the Polymerase Chain Reaction associated with Reverse transcription (RT-PCR), as confirmation of the clinical diagnosis of disease. For this, peripheral blood samples of animals were used clinically patients and were grouped according to their date of extraction and using vaccines commercial as control.
The results allow to demonstrate a high sensitivity of the technique, besides allowing the use of samples up to seven days of storage at 4°C, despite the fragility of RNA viral.
Detection of canine distemper virus haemagglutinin gene in field samples and its high sensitivity, suggests studying its use as a diagnostic tool complementary to the clinical diagnosis of canine distemper in our country.
Bronchial asthma, is a quite common disease characterized by the chronic inflammation of the airways. It is due to the interaction of genetic with environmental factors. Currently, bronchial asthma is regarded as a public health problem, since its prevalence is constantly increasing worldwide.
Mona Sadat Larijani, Seyed Mehdi Sadat and Amitis Ramezani*
It is estimated that there are 36.9 million individuals living with HIV-1 from who 21.7 million patients receiving antiretroviral therapy (ART) [1,2]. ART has had a significant effect on the patients’ quality of life recently, however, its global coverage declines to 16-35% in low or middle income parts of Africa [3].
In our past 200 years we have seen the advancing development of Dental Arts and Science though discoveries by its practitioners. Perhaps it will do some good to review the basis upon which fixed tooth replacement has evolved—that is the prosthetic crown.
Prior to 1871, before the first manufactured foot-treadle dental engine was introduced in America, the restoration of structurally compromised teeth was with hand cutting instruments and bands of metal or wires that were place about the tooth remanents. Although crude and only for the very wealthy, they seemed to be secure enough to last sometime—temporarily or permanently depending upon the time in service. Since life expectancy at this time was less than 35 years, even “temporary”—a year or more—would work well.
We show here in our graphic figure 1, a page from the Dental Cosmos. In it we see the art of “engrafting” a metal crown about a tooth with minimal reduction/preparation.
e show here in our graphic figure 1, a page from the Dental Cosmos. In it we see the art of “engrafting” a metal crown about a tooth with minimal reduction/preparation.
Marwan O Jalambo*, Basil Kanoa, Mohammed S Ellulu, Smaher Younis and Mueen El-Kariri
Background: The fundamental cause of obesity and overweight is an energy imbalance between calories consumed and calories expended. Aim: To clarify and figure out food habits and different lifestyle pattern among a sample of Palestinian women attending the nutrition center in the Gaza Strip.
Methods: A cross-sectional study involved 116 women were randomly chosen by purposive census sampling. They aged 25 to 60 years with a diagnosis of obesity. The data collected by interview questionnaire that included social factors, lifestyle habits, and health/disease history.
Results: Age group variable has distributed significantly (p=0.024), (31.0%) of morbid obese were ≥35 years group compared to (13.5%) of morbid obese amongst the younger group. The higher intakes of legumes (OR: 2.134, P=0.003), nuts (OR: 3.917, P=0.019), eggs (OR: 6.840, P=0.009), fast foods (OR: 4.461, P=0.005), and soda drinks (OR: 2.230, P=0.004) were the risk factors linked to the increased risk of morbid obesity. Moreover, the higher intakes of legumes (OR: 8.439, P=0.011), eggs (OR: 6.900, P=0.041), chips (OR: 5.049, P=0.012), sugar (OR: 2.068, P=0.011), and fast foods (OR: 3.029, P=0.025) are risk factors of chronic diseases.
Conclusion: The study identified several lifestyle factors and improper dietary habits associated with obesity among women in Gaza city. There is a great need to change these habits to avoid the increased risk of obesity. Gene-environment interaction can explain the high incidence of obesity. A national plan of action to overcome obesity is urgently needed to reduce its economic and health burden
Lenient MO Ibiyo*, Rowland MO Kayode, A Oresegun, Oluwaseyi Mogaji and Felicia O Joshua
Two experimental feeding trials were conducted concurrently to study the growth response of African catfish Clarias gariepinus fingerlings to graded levels (0, 5, 10, 15 or 20%) of clupeids in Danish fish meal (DFM) based diets. Chemical analysis of the DFM and clupeids fish meal (CFM) was carried out. Completely randomized design with triplicated groups of fingerlings were used for both trials in an indoor and out-door concrete tanks for six and twelve weeks respectively. The study aimed at achieving a cost effective fish meal from local aquatic resources (clupeids fish) highly prolific and abundant in Nigeria water bodies to replace foreign fish meal in West Africa Region. A project supported by West African Agricultural Productivity Project (WAAPP) in NIFFR, Nigeria.
The results of proximate, amino acid profile, mineral and fatty acid composition analysis of CFM indicated values which are very close to those of the DFM. The proximate analysis revealed CFM to contain 70.6% crude protein while DFM contains 72%. There were no significant difference between the treatments with respect to final weight, feed consumed, feed conversion ratio, digestibility and survival (P>0.05) although there was significant difference in specific growth rate (P<0.05) with the highest value obtained in the diets with both fish meal at ratio 1:1. There were no significant difference in haematological parameters (P>0.05). However the lymphocytes were high in all the groups which might not be particularly due to the treatments. The high proliferation of the body defence cells by the fish could be a mechanism of survival in the aqua-medium which is likely to be high in microbial load due to waste materials. Feed Cost/Kg for DFM was N260.16 while for CFM was N227.16. The results of chemical analysis and feeding trials indicated positive replacement of the DFM with CFM in fish feeds without negative effect on growth performance.
Two major challenges face the practicing physicians and medical community regarding the management of hypertension. First is accurate diagnosis and finding who is the truly hypertensive patient in need of life-long treatment. Second is to improve blood pressure control through addressing hypertension risk factors, adherence to treatment and frequent monitoring. - Current Challenges in Management
Siekmann H*, Becherer L, Neef R, Kunath T and Florian Radetzki
Introduction: Fractures of both the anterior and posterior pelvic ring are common injuries in polytrauma and the elderly that extend beyond those of simple low-impact trauma. While conventional X-rays predominantly show the ventral aspect of the injury, computed tomography often detect additional fractures of the sacrum. A large number of these fractures are B-injuries by AO, mainly compression fractures at an advanced age. In addition, the prevalence of pelvic insufficiency fractures caused by osteoporosis rather than subsequent to an obvious trauma is increasing, with such an injury often associated with pain that impairs mobilization. The standard sacroiliac screw fixation is often characterized by loosening and thus failure of the osteosynthesis especially in osteoporotic bone of elderly patients.
Method: A new alternative surgical minimal invasive technique, the “iliosacral bridging”, stabilizes the fractures of the sacrum with an internal fixation from S1 pedicle of the uninjured side to the ilium on the affected side. The combination of this internal fixation with the standard single sacroiliac screw on the injured side allows an immediate full weight bearing and pain free mobilization. We present a case series of 8 patients.
Results: The clinical and radiological analysis analogous to the pelvic-outcome-score brought forward that 2 patients showed an excellent and 2 patient a good result. The other 4 patients achieved sufficient results.
Conclusions: The “iliosacral bridging” we have introduced in the present study provides evidence of an expected increased stability of the pelvis after B-injuries.
Mohamed Abdelhamid*, AM Rashad, MA Negida, AZ Garib, SS Soliman and TM EL-Gaabary
Patients undergoing laparoscopic surgery had a lower incidence of major complications, such as anastomotic leak, intra-abdominal bleeding, abscess, and evisceration. Controversies about the operative management of left colonic emergencies are decreasing. Nowadays there is worldwide shifting towards primary resection, on table lavage and primary anastomosis. The aim of this study is to record the safety of laparoscopic primary anastomosis in left-sided colonic emergencies.
Patients: The study was carried out at Beni-Suef University Hospital, in the period between January 2016 and July 2017. Twenty-six patients were included in this study, twelve with left colon cancer, twelve with left colonic complicated diverticulitis and two cases with sigmoid volvulus. Patients presented clinically with either obstruction or perforation. All patients were subjected to laparoscopic resection, on table lavage and primary anastomosis.
Method: Decompression was done prior to starting the intervention, followed by resection and on table lavage then colorectal anastomosis using the circular stapler. The study was approved by the ethical committee in the faculty.
Results: Mean operative time: 185 min (160- 245).
LOS: 12 (10- 18).
Leak: one in obstruction group and two in perforation group.
Redo one in perforation group.
Conclusion: Emergency laparoscopic left-sided colonic resection and primary anastomosis can be performed with low morbidity, however with caution if there was free perforation with peritonitis.
<h2>Abstract</h2><p>Emerging evidence indicates that micronutrient deficiency could play a significant role in the pathogenesis and progression of many chronic diseases including diabetes mellitus, hypertension, obesity, dyslipidemia, hyperuricemia, kidney disease, cancer, anemia and other cardio-metabolic and neurodegenerative diseases through the induction of Insulin resistance (IR). However, there are still gaps in our scientific knowledge regarding the links between micronutrient deficiencies, IR, and cardio metabolic disorders. This review provides current information on recent advances and a global perspective regarding the relationship between micronutrient deficiency, IR, and cardio metabolic disorders. Empirical evidence indicates that deficiencies in either micronutrients associated with insulin activity (such as Chromium, manganese, magnesium, and iron) or antioxidant enzyme cofactors (such as vitamin A, copper, zinc, and manganese) could impact several physiological processes leading to a cascade of metabolic and biochemical derangements such as B-cell apoptosis, loss of islet cell mass, defective tyrosine kinase activity, oxidative stress, pancreatic β-cell dysfunction, reduction in lean body mass, defective insulin signaling mechanism, elevated protein kinase C activity, and excess intracellular calcium. Collaboratively, these states of metabolic malfunctioning are associated with IR, which triggers the onset of many cardio metabolic diseases. Undoubtedly, the prevention of micronutrient deficiency may indeed ameliorate the incidence of IR and cardio-metabolic disorders in those at risk and in the general population.</p>
<h2>Abstract</h2><p>Sustained isometric contractions of skeletal muscles produce intramuscular pressures that leads to blood flow restriction. In result an active muscle feels defi cit of oxygen what bring to muscle fatigue.In another side during exercise we have physiological contradiction between raising of oxygen demand by working muscle and restriction of blood flow due to vessel pressing. To clarify this issue many research has been performed based mainly on measurement of blood flow in muscle tissue. The purpose of this study was to assess real-time changes in muscle oxygenation during a sustained isometric contractions of dorsiflexor muscle of low (30%), moderate (60%) and submaximal (90%) intensity. Experiments were conducted using the subject’s dominant (right) leg. Volunteers was recruited from eight male students of USIPC (age: 19±2 years, weight: 75±6 kg). Tissue oxygenation index (StO2) were recorded from the tibialis anterior using NIRS device (NONIN). Saturation was higher at 30% compared with both 60% and 90% MVC at all time points after start exercise and higher at 60% than 90%. Oxygen consumption (VO2) permanently increased from slow (30%) to moderate (60%) and submaximal contractions. After cessation of the each contraction there was a large and immediate hyperemic response. Rate of StO2 increasing after effort cessation what reflects the resaturation of hemoglobin which depend on integrity and functionality of vascular system and reflects blood vessel vasodilation. StO2 restoration rate permanently increased from slow (30%) to moderate (60%) and submaximal contractions too. At last on final stage of experiment arterial occlusion test has been performed to determine the minimal oxygen saturation value in the dorsiflexors. Oxygen saturation reached a 24±1.77% what is significantly higher than StO2 after 60 and 90%MVC.</p><p>So, we can conclude that oxygen saturation at 60% and 90% MVC are similar and sharply decreased after start of exercise. It means that after 60% MVC take place occlusion of blood vessels due to intramuscular pressure. Oxygen consumption of active muscle increased depend on intensity of exertion according to increasing of oxygen demand. StO2 resaturation rate (Re) permanently increased from slow (30%) to moderate (60%) and to submaximal contractions. Re increasing after effort cessation reflects the resaturation of hemoglobin which depend on integrity and functionality of vascular system and reflects blood vessel vasodilation.</p>
Post cardiac surgery stroke is a devastating complication with an incidence as high as 50%1. The association between intra-operative mean arterial blood pressure (MAP- better called linear blood pressure) during cardiopulmonary bypass (CPB) and the development of postoperative stroke-as diagnosed by neuroimaging- and of cognitive dysfunction (POCD) is controversial. This is due to differences in the study populations, stroke assessment tools, operation and conduction of MAPs, variations in neurocognitive testing and duration of follow up. As a result there is a gap in the knowledge on an ideal MAP as a preventive measure of post CPB stroke and POCD.
Heftiness, a mind boggling interchange among ecological and hereditary factors and is related with critical horribleness and mortality. Utilization of herbs for the administration of heftiness in the ongoing occasions is pulling in consideration.A web and manual based writing overview was led to survey the measure of data accessible on the natural items for weight administration. Customary writing, PubMed, Scopus, Google researcher databases were screened up to February 2012. The pursuit words were “stoutness”, “home grown medication/items/separates”, “restorative plants”, “customary drug”, “Ayurvedic prescription” without narrowing/constraining looking words or components. Distributions just with edited compositions/full articles and books were inspected in the pursuit. In light of the accessible writing, for huge numbers of the natural and weight reduction items, there is minimal distributed data and there have been no clinical preliminaries or the level of proof is restricted. Our writing study additionally demonstrated that these home grown items fall under an adequate level of proof or with no scientific foundation by any stretch of the imagination, or they have a logical discerning however not to an acknowledgment level. Endeavors were made in the audit to characterize the highlights of conceivable natural weight reduction item. A perfect home grown enemy of stoutness item ought to diminish the weight by 10% over fake treatment of treatment by demonstrating a proof of change of bio markers like blood pres-beyond any doubt, lipids and glycemia with no reactions.
Mehmet Besir Surme*, Omer Batu Hergunsel, Bekir Akgun and Metin Kaplan
Cranioplasty is a reconstructive procedure for the repair of skull defects or deformities. Polymethylmethacrylate (PMMA) is a commonly used alloplastic material when autologous bone is unavailable.However, manual shaping of bone cement for frontal and orbital bone defects is challenging and may not lead to cosmetically satisfactory results. Advances in computer-aided 3-dimensional (3D) design and printing technology allow the production of patient-customized implants with improved cosmetic and functional results. A 39-year-old female patient presented with right-sided frontal swelling and headache. Computerized tomography (CT) demonstrated a right frontal calvarial mass extending to the orbital wall. The boundaries of the lesion were marked using a 3D design software. A polyethylene terephthalate glycol (PETG) mold was manufactured with help of a 3D printer. Artificial bone flap was formed by pouring PMMA into the mold. After surgical resection of the calvarial mass, customized PMMA implant was applied with titanium mini plate and screws. The defect was closed properly with good aesthetic results. Production of customized PMMA cranioplasty implants with 3D printed molds is a useful technique and can be preferred for calvarial defects due to skull tumors, bone resorption and traumatic bone loss.
The growth of Rehabilitation, in all of its field and mainly in neuro-rehabilitation applications and settings, is showing increasingly strong interaction with the growth of technology and its innovative applications.
Nevertheless, is should be stressed that the use of machinery has always been a fundamental mainstay of Rehabilitation practices facing the whole person’s aspects and involving the whole physical world around the disabled people as it is: as it was in the past with physical exercises, physical modalities, and in many other trainings and activities that employed physical and technological means as Aids, Prostheses and Orthotics.
Christopher Mallard, Brad Withers, Brooke Bauer, Paul A Sloan, Sean Dineen and Annette Rebel*
Objective: The objective of this study was to evaluate the effects of intraoperative epidural anesthesia combined with balanced general anesthesia on intraoperative hemodynamics and fluid requirement, and on postoperative patient outcome.
Design: The study design was a retrospective data analysis of patients undergoing open hepatectomy at a single tertiary care center from May, 2013 to June, 2016. Patients undergoing hepatectomies were separated into two groups: patients not receiving epidural local anesthetic intraoperatively (either no epidural or epidural catheter not used intraoperatively) were designated the control group and patients receiving epidural local anesthetic intraoperatively (bolus and/or continuously). Patients were excluded if they underwent laparoscopic or non-elective procedures.
Results: 103 patients were included in the data analysis: Control n=14, Epidural = 89 patients. There were no major differences in demographics between groups. Epidural patients did not have higher requirements in intraoperative intravenous fluid administration, blood loss, or vasopressor use compared to control patients. Patients who received epidurals required less intravenous opioids with better post-operative pain scores initially and also on post-operative day 2. There were no differences in length of time to ambulation, or post-operative acute kidney injury amongst groups.
Conclusions: This study shows that patients undergoing hepatectomies using combined epidural and general anesthesia: 1) have no increased requirement for intraoperative crystalloid, colloid, or blood component therapy, 2) require lower total intravenous opioid dose, and 3) subjectively report better pain control. Therefore, intraoperative epidural anesthesia combined with general anesthesia may be advantageous for ERAS protocol based oncological procedures.
To determine the proportion of participants with elevated intraocular pressure and abnormal vertical cup disc ratio in a glaucoma screening event in a rural community in Nigeria.
Methods: 242 eyes of 121 participants at a one-day screening programme were examined. Visual acuity was accessed using Snellen literate and illiterate charts, followed by a pen torch examination of the anterior segment. The posterior segment was accessed using a direct ophthalmoscope (Welch Allyn, USA). All participants had intraocular accessed using Keeler non contact tonometer and those with significant media opacity preventing view of the posterior pole had cycloplegic examination after dilatation with 1%Tropicamide drops. Data generated was expressed as percentages and means.
Results: 121 participants (242 eyes) were examined. There were 42 males and 79 females giving a M:F ratio of 1:1.86. Age range of participants was 0-90years with a peak in the 5th decade. Mean age was 32 years. 79.3% of participants had normal visual acuity of 6/4 -6/18, while 9.5% had visual acuity worse than 6/60.
83% of eyes had intraocular pressure within normal level, <21mmHg, 12.4% within 21-30mmHg and 4.6% >30mmHg.
73.1% of eyes had Vertical Cup disc ratio (VCDR) <0.5, 10.7% had 0.5-0.7 and 6.6%>0.7. 9.6% of eyes could not be accessed due to media opacities.
Conclusion: 6.6% of participants had suspicious discs and 4.6% participants had intraocular pressures above 30mmHg. Opportunistic screening for glaucoma remains one of the important modes of case detection for glaucoma in the developing climes and should be encouraged as a way to address the scourge of this blinding disease.
<h2>Abstract</h2><p>It is still not well known the prognostic cardiovascular value of 24h ambulatory blood pressure monitoring in the pregnant woman with hypertension.</p><p><strong>Objectives: </strong>Assess to the prognostic value of ABPM parameters in predicting maternofetal event.</p><p><strong>Methods:</strong> Retrospective and observational study which included 166 pregnant women.</p><p><strong>Results:</strong> The authors found that the night time DBP was the best predictor of adverse events. Non-dipper profile had worse survival at follow up until delivery compared to those with a dipper profile.</p><p><strong>Conclusions:</strong> ABPM is a tool for pregnant with HT because this is the unique method available that analyses the night blood pressure.</p>
Sadia Ali, Adeena Khan*, Kiran Sarfaraz, Saba Akram, Mariam Javaid and Asma Bano
Objective: To determine the diagnostic accuracy of Magnetic Resonance Imaging (MRI) to differentiate Benign and Malignant Parotid Gland Tumors taking histopathology as gold standard.
Place and duration of study: Department of Diagnostic Radiology, Lahore General Hospital, Lahore from January till July 2014.
Methodology: 200 patients of age between 5 to 80 years of either gender with parotid gland swelling, having radiological evidence and clinical suspicion of parotid tumour like fixation to underlying skin, pain, facial palsy and cervical lymphadenopathy were taken. T1 and T2 plain and contrast enhanced 1.5 Tesla MRI unit using standard imaging coil was then carried out. Imaging was further evaluated for the presence or absence of benign or malignant parotid gland tumours using histopathology as a Gold standard. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of MRI were taken against the gold standard.
Results: There were 170 males and 30 females having mean age of 40.27±15.04 and 40.12±12.15 years respectively. Sensitivity, specificity, positive predictive value and negative predictive value of MRI were 90.4%, 89.33%, 93.39% and 84.41% respectively. The diagnostic accuracy of MRI to differentiate benign and malignant parotid gland tumours was 90%. These results were taken against surgery histopathology as a gold standard.
Conclusion: MRI is highly accurate in differentiating malignant & benign tumours of parotid glands and can be used as an adjunct to histopathology for pre-operative evaluation of the parotid gland tumours.
Tony Daher*, Robert G Mokbel and Vahik P Meserkhani
Successful implant restoration is depending on an adequate surgical and prosthetic protocol. In the last few years an increase in Peri-Implantitis has been attributed, in part, to the excess cement left around the implant collar and threads, leading in many cases to bone loss and even the complete failure of the implant treatment [1-5].
This article will attempt: 1. To describe a proper cementation protocol for cement-retained implant restorations to reduce cement induced implant failures, and 2. To review the alternative implant restorative options to cement-retained crowns such as screw-retained restorations, screwless and cementless implant restorations, screw-retained-cemented implant crown, angulated screw channel restorations, the lingual locking screw-retained restorations and the multi-unit abutment restorations.
Potassium is an important ion capable to maintain intra-extracellular electric gradient. Variations in the intra-extracellular ionic flow may alter cells functions, skeletal and smooth muscle contractility and electric activity of myocardial cells.
In this study we demonstrated that high level of serum potassium may be associated with cardiac and neurological life-threatening diseases.
We describe two case reports in which one patient, chronic hemodialysed, presented with cardiogenic shock in setting of hyperkalemia; the other, with end-stage kidney disease, showed a flaccid paralysis associated to high level of serum potassium during potassium sparing diuretic therapy.
Emergency haemodialysis was performed with a complete remission of the clinical manifestations.
Indeed, the use of simply diagnostic instruments such as serum electrolyte assay and electrocardiographic study (ECG) are helpful in clinical practice solving in timely serious complications due to hyperkalemia.
We describe two case reports in which one patient, chronic hemodialysed, presented with cardiogenic shock in setting of hyperkalemia; the other, with end-stage kidney disease, showed a flaccid paralysis associated to high level of serum potassium during potassium sparing diuretic therapy.
Emergency haemodialysis was performed with a complete remission of the clinical manifestations.
Indeed, the use of simply diagnostic instruments such as serum electrolyte assay and electrocardiographic study (ECG) are helpful in clinical practice solving in timely serious complications due to hyperkalemia.
Victor Tsirkin*, Alexander Nozdrachev, Elena Sizova, Tatyana Polezhaeva, Svetlana Khlybova, Marina Morozova, Andrew Trukhin, Julia Korotaeva and Grigory Khodyrev
The results of the 20 years studies of the presence in blood serum and other body fluids of endogenous modulators of adrenergic and M-cholinergic impact as a component of humoral link of autonomic nervous system. The article is devoted to the endogenous sensitizer of beta-adrenergic receptor (ESBAR) - water-soluble low molecular weight substances, analogs of which are histidine, tryptophan, tyrosine, mildronat and preductal. It is shown, that separate dilutions of human serum and animal (as a source of ESBAR) and analogs of ESBAR ways to enhance the effectiveness of activation of beta-adrenoceptors (AR) of smooth muscle (uterus, coronary and renal arteries, trachea, stomach), myocardium, erythrocytes and platelets (respectively influenced of histidine and tryptophan). It is reported that content of ESBAR in human serum (according to the titers of its dilution) depends on the sex and the presence of somatic diseases, and at women are also on the stage of reproduction and obstetric complications It is discussed possible mechanisms of ESBAR action, its physiological role, including as a component of beta-adrenoceptor inhibitory mechanism for myometrium, as well as the prospect of the use of analogs of ESBAR, including for the prevention of preterm labor, and for the treatment of bronchial asthma, coronary heart disease, hypertension and heart failure.
Non-invasive electrical stimulation in the form of neuromuscular electrical stimulation (NMES) and functional electrical stimulation (FES) has been documented as an optional assessment and treatment technology for decades.In contrast, translation of the robust clinical evidence supporting the effectiveness of FES’ enhancement of muscle force generation and adding to the recovery of motor control following damage to the brain appears limited. Furthermore, enabling many patients to regain locomotion ability though utilization of FES as a standard care option in rehabilitation medicine remains unmet. This perspective evolved over years of collaborative experience in clinical research, teaching, and patient care having a common goal of advancing patients’ rehabilitation outcomes. The clinical successes are supported by repeated evidence of FES utilization across the life span, from toddlers to elders, from hospitals’ critical care units to the home environment. The utilization include managing multiple deficits associated with the musculo-skeletal, neurological, cardio-pulmonary, or peripheral vascular systems. These successes were achieved in no small part because of the technological advancement leading to today’s wearable wireless FES systems that are being used throughout the continuum of rehabilitation care. However, failures to benefit from FES utilization are likewise numerous, collectively depriving most patients from using the technology to maximize their rehabilitation gains. The most critical failures are both clinical and technological. Whereas numerous barriers to NMES and FES utilization have been published, the focus of this perspective is on barriers not considered to date.
Poultry industry is a domineering section of agriculture sector in the world as it provides meat, income and employment. Of the poultry industry, broiler chicken is dominating, as US export was more than 41 billion pounds of chicken (about 16.5 percent of production) in 2017 [1]. In Pakistan, the poultry industry contributes around 1.4 percent to the GDP and 31 percent to total meat production [2]. The global demand for this meat is rising in developing world including Pakistan. To meet the needs, rearing of poultry at both domestic and commercial levels is imperative [3]. However, the industry faces a lot of constraints, preventing it from reaching its maximal potential. Poor welfare, insufficient quality nutrition and devastating diseases are some of these problems. Amongst the myriad of diseases, Infectious Bursal Disease (also known as Gumboro disease, infectious avian nephrosis and infectious bursitis) is an acute, contagious viral disease of chicken [4-6]. It not only affects domesticated but also wild poultry throughout the world by targeting the immune system. [7-9].
Gumboro disease is caused by Infectious Bursal Disease Virus (IBDV), which is a member of genus Avibirnavirus of the Birnaviridae family. IBDV is a non-enveloped virus having a capsid that contains a double stranded RNA genome, split into two segments A and B [10]. Segment A of the genome encodes four proteins (VP2, VP3, VP4 and VP5) while segment B encodes VP1. Based on Pathogenicity the IBDV strains can be grouped into three pathotypes; classical virulent, antigenic variant and very virulent [11]. Though the first outbreak of very virulent IBD virus was reported in Europe in early 1990s [12], recent pandemics across Asia, Africa and South America [13] have heavily damaged commercial and wild poultry. Contamination of a rearing site with the IBDV leads to a horizontal transmission of disease across the flocks through contaminated feed and water. However, vertical transmission is not reported yet [14]. Classical virulent strains flaunt a mortality rate as high as 20-30%, mostly due to the widespread bursal damage in infected poultry [15]. Classical virulent strains are the source of commercially available vaccines against IBD viral infections. In early 1980s, new antigenic variants emerged, causing more than 50 percent mortality in birds by rapid bursal damage [16]. Current vaccines prepared from classical strains have failed to control the disease caused by these antigenically variant strains. In the late 1980s, very virulent IBD virus strains were reported that induced IBD with a more pronounced bursal lesion and higher mortality (up to 90 percent) when compared to other IBDV strains [17]. In addition, vaccination against the very virulent strains encounters many challenges as very virulent IBD virus can breakthrough protective antibodies, and therefore requires more efficient vaccination approaches.
Objective: To perform a review of brain biopsies in the canine species and determine if it is possible to compare the stereotactic and neuronavigation results.
Method: A search was performed in NCBI’s PubMed database for stereotactic or neuronavigational canine brain biopsy publications and articles which met at least one of the inclusion criteria and not any of the exclusion criteria were selected. The inclusion criteria were: 1) assessment of the specificity of the biopsy, 2) assessment of system accuracy, 3) assessment of the biopsy results, and 4) duration of the procedure.
Results: Only one article met all the inclusion criteria. Eleven articles that partially met the criteria were used for comparison. Authors used different stereotaxic methods and two used neuronavigation equipment. The authors of the stereotactic studies either adapted devices from human medicine or developed their own devices; the level of accuracy was variable (errors of 0.0 mm to 5.1 mm), and the two articles that used animals with spontaneous lesions had a diagnostic specificity rate higher than 90 percent. The accuracy of the neuronavigation studies was approximately 3.3 mm; however, no live animals were used.
Conclusions: It was not possible to properly compare stereotactic and neuronavigation techniques. To do so, the methodologies and the assessed parameters need to be standardized.
Background: Despite remarkable progress in surgical,cardiopulmonary bypass (CPB) and anesthetic tecniques, neurocognitive damage still remains an important cause of postoperative morbidity in cardiac surgery. The aetiology of neurocognitive damage is likely to be multifocal; including macro and microemboli, cerebral hypoperfusion, inflammation and nonpulsatile flow. N-methyl-D-asparticAcid (NMDA) receptors play an important role during neurocognitive damage. Ketamine is a non-competitive antagonist to the phencyclidine site of NMDA receptor for glutamate and directly suppresses proinflammatory cytokine production. The aim of the present study was to evaluate whether ketamine has neuroprotective effects during open-heart surgery through the use of neurocognitive tests.
Methods: We considered all patients aged between 58-76 years who were referred to a single cardiothoracic surgical team for elective, primary coronary revascularization. Patients were excluded from the study for the following reasons: a history of neurological, psychiatric, gastrointestinal, hepatic, renal, hematologic and clotting systems disorder and repeat procedures. Undergoing CPB were randomized 2 groups: Group1 (ketamine)(n=25) or Group2 (propofol)(n= Patients 25) In the propofol group, anesthesia was induced with 3mg/kg propofol, 1µg/kg remifentanyl, 0.1mg/kg vecuronium. Remifentanyl 0.5-1μg/kg/min was infused intravenously throughout the whole procedure. In the ketamine group, anesthesia was induced with 1-2mg/kg propofol, 1-2mg ketamin, 0.1mg/kg vecuronium. Ketamin 1mg/kg/hour was infused intravenously. Pressors, inotropic agents and antiarrhythmics were used as needed. The Mini-Mental State Examination(MMSE) was administered the day before surgery and three days later. The change in scores for MMSE was calculated for each patient and all the group. The results were compared statistically with paired simple t-test.
Results: The mean age, CBP duration, lowest temperature was not statistically significant (Table1). Peroperative and postoperative blood pressures and pulse rates showed differences between groups. There were no preoperative differences between the groups on any of the mean MMSE score (Table2). The ECG monitoring revealed that most patients remained in sinus rhythm, with no difference between groups.
Conclusions: We could not demonstrate that intraoperatively administered ketamine resulted in greater neuroprotective effects compared with propofol. Ketamine in combination with propofol during cardiac surgery is associated with a stable hemodynamic profile. Propofol may reduce the delivery of microemboli to the cerebral circulation by decreasing the cerebral blood flow. Propofol has a direct neuroprotective effect in vitro, although Roach et al. could not demonstrate a protective effect of propofol during open-heart surgery. Propofol enhances the antiinflammatory response to surgery by several mechanisms. This might have masked a neuroprotective effect of ketamine because propofol was administered in both groups in our study.
Care of kidney transplant recipient remains complex and long-term graft survival is not seen in every transplant recipient. Due to reduced supply and increased demand of human organs, more transplants are carried out using marginal grafts on emergency lists. Transplant recipients have altered physiology due to known end-stage renal disease, recent surgery and the use of potent analgesic and immunosuppressive medications. Amongst the known surgical complications, urine leak remains the most common. It can result from poor graft preparation due to excessive peri ureteric or lower pole dissection or damage to lower polar artery resulting in ischemic necrosis. In addition, poor surgical technique, bladder outflow obstruction, iatrogenic injury to bladder or renal pelvis may contribute to urine leak. Ongoing urine leak may manifest itself as swelling, pain, high drain output, sepsis, ileus and eventual graft loss. Early identification, localisation and quantification of leak remain essential in management of these patients. In addition, sepsis should be identified and treated promptly as these patients are highly susceptible to infections. Early recognition of this complication can significantly reduce hospital stay, improve quality of life and reduce graft loss and mortality. In this article, we aim to develop an evidence-based management approach to a patient with urine leak using a clinical scenario.
<h2>Abstract</h2><p>The choice of anesthesia for cesarean section should depend on the urgency of the procedure, in addition to the condition of the mother and fetus. It is widely accepted that regional anesthesia for cesarean section is preferable to general anesthesia. Regional techniques have several advantages. They lessen the risk of gastric aspiration, avoid the use of depressant anesthetic drugs and allow the mother to remain awake during delivery. The most common type of regional anesthesia for cesarean section is spinal anesthesia because of its simplicity, cost-effectiveness and speed of onset. It is suitable for cases of an emergent cesarean delivery. Hypotension during spinal anesthesia is a common that is associated with morbidity for both mother and fetus. Epidural anesthesia is preferred when physicians want to minimize the maternal hypotension or when intense motor blockage of the thoracoabdominal segments is not desired. General anesthesia still leads to a higher maternal mortality and should be reserved for absolute emergencies and cases where neuroaxial blockade is contraindicated.</p>
TajEldin M Abdallah*, Abdalazeem A Ibrahem, Ezeldein A Ali, Elbashir G Ahmed and AbdelAziem A Ali
Introduction: Hypertensive crisis (HC) is recognized consequence of inadequate blood pressure (BP) control. A hypertensive crisis is further divided into hypertensive emergency (HT-E) and hypertensive urgency (HT-U).
Method: Using a cross-sectional hospital-based study design, patients who had been diagnosed as having HC between January and October 2017 were consecutively recruited in the study. The criteria proposed by the Seventh Joint National Committee were used for the definition of HC.
Result: A total of 81 (.81%) patients newly diagnosed as having HC were enrolled in the study. Of these patients, 50 (61.7 %) patients met criteria for HT-E, while 31 (38.3%) patients had HT-U. Renal impairment (16%), stroke (30.8%), acute coronary syndrome (13.6%) and heart failure (22.2%) were predominant complications associated with HT-E. Out of 81 study subjects, 13 (16%) patients died. Although there was no significant difference in residence, history of smoking, Diabetes mellitus and history of alcohol consumption between groups, old age (P=.o22), male gender(.046), history of hypertension(.007), history of non-governmental employee(.003), poor compliance (p=.002) and high case fatality rate (p=.041) were significantly associated with hypertensive emergency (HT-E).
Conclusion: This study showed that HT-E has high case fatality rate among patients admitted with hypertensive crisis at kassala teaching Hospital. Therefore early detection of hypertension and appropriate management are the main stay for reducing morbidity and mortality among patients with hypertensive crisis.
The Ontario government has been battling with the issue of extensive wait times in hospitals for several years. Although there are many complex reasons that stem off of the issues of wait times, such as available in patient beds and bed blockers (patients who stay in the hospitals for long periods of time after sustaining a massive injury), the primary cause is concentrated as a system wide problem in access to care [1]. Through numerous reforming and restructuring plans, the Ontario government devised a Wait Time Strategy plan to monitor, manage and improve access to health care services including surgeries and time spent in the ER. The strategy was also devised to enhance the efficiency and effectiveness of healthcare provision. The information derived from the results of the Ontario Wait Time Strategy (OWTS) was to be made public to citizens and providers to ensure that everyone is well aware of the results. Yet, it is quite difficult to implement such a strategy if the leadership challenges within the hospital are not addressed [2].
Filariasis is one of the Neglected Tropical Diseases (NTDs) known to be of serious public health importance and pose devastating socio-economic burden especially among the poor people in tropical and subtropical countries of the world. The parasite is responsible for lymphatic filariasis affecting about 1.3 billion people in 72 countries worldwide. The major parasitic agents of the infection are three closely related nematodes of clade Onchocercidaei namely Wuchereria bancrofti, Brugia malayi and B. timori that are transmitted to human through bites by mosquitoes of genera: Aedes, Anopheles, Culex and Mansonia. The disease is targeted by the World Health Organization (WHO) for elimination by 2020 through the use of chemically synthesized drugs used as therapeutic agents to cure the disease but there are some setbacks. Phytochemical extracts are viewed as alternative therapy in the management of the disease. Additionally, the species have many ecological variants and are diversified in terms of their genetic fingerprint. This diversification in terms of genomic sequences as well as rapid infection rate warrant the lymphatic filarial parasites to respond differently to diagnostic and therapeutic interventions. Thus understanding the genomic diversity of the parasite will help in efficient therapeutic management of the disease, thereby eliminating it to prevent unnecessary suffering and contribute to the reduction of poverty. In this review, we have highlighted on the used for phytochemical extracts in the therapeutic management of the lymphatic and the molecular genetic diversity of the parasite was delineated.
A new principle of origin and the nature of the action of gravity forces are proposed. Forces of universal attraction have plane-symmetrical directions. On this basis, it becomes possible to reconsider certain regularities in natural science. The new principle of gravitation will allow to explain physical paradoxes, to improve methods of scientific research and some technological processes.
The analysis of dependence of the length projection of Li vectors of biparametrical inhibited and activated (La) enzymatic reactions from the length projection of vectors of monoparametrical inhibited and activated enzymatic reactions on the basic σ0 plane in three-dimensional coordinate system, allows to deduct the quadratic forms of equations for the correction of the constants of inhibition (ki) and activation (Ka) of enzymes. Examples of correction of constants are given.
Maria Teresa Corona-Ortega*, Arturo Valle-Mendiola, Leonor Aguilar-Santelises, Araceli Garcia del Valle, Rosalva Rangel-Corona and Benny Weiss-Steider
Human cervical cancer tumours expressing the IL-2 receptor (IL-2R) were induced in the peritoneal cavity of nude mice. The tumours were significantly reduced by the i.p. administration of either free IL-2 or liposomes containing this growth factor. No toxicity was observed in the mice even at the highest doses of IL-2 in liposomes. We did not detect any IL-2 in the blood plasma pointing to a strong retention of the liposomes on the cavity. We concluded that this preclinical study for the treatment of tumours expressing IL-2R in the peritoneal cavity is effective and safe. The liposomes were stable and their IL-2 active for up to one year when kept at -14oC in a cryopreservation media approved by the FDA for human use.
Many agriculturally important properties such as heterosis, inbreeding depression, phenotypic plasticity, and resistance for biotic and abiotic stresses are thought to be affected with epigenetic components.New discoveries related with epigenetics are likely to have a major impact on strategies for crop improvement in rice breeding. However, assessing the contribution of epigenetics to heritable variation in plant species still poses major challenges. Methylation of cytosine in DNA is one of the most important epigenetic mechanisms in plants. DNA methylation not only plays significant roles in the regulation of gene activity, but also it is related with genomic integrity. Although most of next generation sequencing (NGS) technologies do not require the use of target specific primer pairs to identify and study DNA cytosine methylation, validation studies of NGS uses selective primer pairs. Bisulfite sequencing technique is a gold method for DNA cytosine methylation studies. However, bisulfite sequencing requires the development of bisulfite primer pairs to selectively study DNA sequences of interest. In this study 9 bisulfite specific primer pairs were identified and validated. These primer pairs successfully amplified bisulfite converted and unconverted genomic DNA extracted from radicle and plumule of rice (Oryza sativa L.) seedlings. Results of the present study clearly revealed the occurrence of CG, CHG and CHH (H stands for C. T or A nucleotides) contents in studied DNA sequence targets were different indicating potential role of DNA cytosine methylation in these genes. Primer pairs reported in this study could be used to detect DNA methylation which is one of the most important epigenetic mechanisms affecting the development, differentiation or the response to biotic and abiotic stress in rice (Oryza sativa L.).
A 51-year-old women presented with asymptomatic multiple polypoidal nodules over scalp with simultaneous papularnodular skin eruptions involving nose, nasolabial folds and forehead for 40 years duration. Her daughter also noted to be having multiple papularnodular skin eruptions involving nose, nasolabial folds and forehead which raised curiosity of possible familial condition. The punch biopsy of polypoidal nodule indicating histological evidence of spiradenoma was favour in diagnosis of Brook Spienger Syndrome. We report this case as this is a rare clinical entity.
Luca Gallelli*, Erika Cione, Stefania Zampogna and Gino Scalone
Chronic obstructive pulmonary disease (COPD) is the third leading cause of death and its prevalence and incidence is also related to smoking behavior [1]. COPD is still a chronic inflammatory and progressive disease caused by multifactorial agents including environmental pollutants [2].Besides that, it is emerging that endogenous epigenetic factors induced by lifestyle and environment [3] could play a role in the etiopathogenesis of the disease [4].
In the last years, several authors suggested that low vitamin D levels seem to be related with the increase of COPD manifestations [5]. Moreover, a multicentre, double-blind, randomised controlled trial documented that vitamin D supplementation protects against moderate or severe exacerbation of the disease, but not by upper respiratory infections [6]. However, low levels of vitamin D can be extended to many other diseases, including multiple sclerosis, diabetes, colon rectal cancer, headache or drug use [7-11]. Moreover, it is also important to remember that Vitamin D deficiency is common in high latitude regions, such as northern Europe, New Zealand, northern USA, and Canada where weaker ultraviolet B rays is not able to produce enough vitamin D. Finally, methodological factors (using low sensitivity methods) could contribute to misleading evaluation of circulating vitamin D levels. In any case, here we shall remind that vitamin D has a fundamental role in immunity [12]. In particular, it has been reported that vitamin D is able to shift the pro-inflammatory T-helper cell 1 to anti-inflammatory T-helper cell 2 [13]. Therefore, benefits of vitamin D supplementation in chronic diseases which directly or indirectly affect immune system are obvious. Today, the burden of COPD in never smokers is higher than previously believed. Therefore, more research is needed to unravel the characteristics of non-smokers COPD [1]. Notably, vitamin D levels are reported to be significantly lower in smoker’ssubjects than in non-smokers ones [14]. Therefore, low plasma vitamin D levels in COPD seems to be more a causality than a correlation.
Lucas A Kuzmanic, Lauren E Zuidema, Jason A Misurelli, Kazuko Uno, Sherine F Elsawa*, Masao Takagaki* and Narayan S Hosmane*
Fluorescein was conjugated with 1-methyl-o-carborane and the resulting bioconjugate was biologically evaluated through microscopic and flow cytometric studies in pancreatic cancer and squamous cell carcinoma cell lines. The uniform distribution of this bioconjugate, as well as its moderate cytotoxicity and higher boron content relative to present boronated delivery agents sodium borocaptate (BSH) and boronophenylalanine (BPA), provide justification for its further evaluation as a potential delivery agent for BNCT.
This study purposed to study the Preservative agents that are required to ensure that manufactured foods remain safe and unspoiled; work was conducted to evaluate the efficacy of essential oils from two eucalyptus species, Eucalyptus grandis and Eucalyptus crebra in food preservatives; to run this experiment flesh eucalyptus leaves collected from Ruhande Arboretum forest were submitted to hydrodistillation and yields(amount) of 0.38 and 0.34 % for Eucalyptus grandis and Eucalyptus crebra were obtained, respectively. Phaseolus vulgaris, Sorghum condatum, cooked Ipomoea batatas (sweet potatoes) and bread were the sample foods used to assess their preservative efficacy. Acanthoscelides obtectus and Stophilus oryzae were used as pests for Phaseolus vulgaris and Sorghum condatum respectively. For bread and cooked Ipomoea batatas, Rhizopus nigricans are used to assess the efficacy of these two essential oils to inhibit their growth; the obtained results revealed that those essential oils could act as insecticide in the storage of Phaseolus vulgaris and Sorghum condatum. Essential oil from Eucalyptus grandis protected these two foods against pests in the periods of 4 and 9 days, respectively while essential oil from Eucalyptus crebra protected them for the periods of 6 and 11days, respectively.
Aflatoxins, produced by Aspergillus spp., are strongly toxic and carcinogenic fungal secondary metabolites. Aflatoxin biosynthesis is a complex process and involves at least 30 genes clustered within an approximately 75 kB gene cluster.In this paper, we reviewed current status of the researches on the characterized structural genes involved in aflatoxin biosynthesis and their roles in aflatoxin-producing fungi, especially in A. flavus and A. parasiticus, which will improve our understanding of the mechanism of aflatoxin biosynthesis and regulation and provide reference for further study.
Lucy Amanya Mutuli*, Peter Bukhala and Gordon Nguka
Background: Alcoholism is a widespread problem in Kenya and is associated with severe impacts on health and quality of life of the individual. Physical activity is an affordable and sustainable adjunct treatment option for recuperating alcoholics; however its’ rarely used in rehabilitation of alcoholics in Kenya.
Objective: This qualitative study sought to elicit facilitators and barriers that influence the practice of physical activity amongst recuperating alcoholics under rehabilitation.
Methods: A focus group guide was utilized to gather views and perceptions of 15 alcoholics and 5 health professionals through focus group discussions. Constant comparative approach was used to analyze verbatim transcripts obtained from in-depth interviews. This analysis entailed three stages including open, axial and selective coding.
Results: Recuperating alcoholics’ recognized various forms of physical activity to promote mental and physical health during their rehabilitation. Health professionals and significant others considerably supported the recuperating alcoholics to practice physical activity however physical activity facilities and facilitation was lacking in Asumbi rehabilitation center.
Conclusions: The rehabilitation centres should have physical activity experts and facilities that can offer individualized physical activity services and support needed by the recuperating alcoholics.
Neelam Agrawal, Rhoughton Clemmey and Shamma Al-Inizi*
<p>Septic arthritis of the shoulder joint is rare and might affect around 3% of the general population [1]. A delay in diagnosis may increase morbidity and lead to bone and cartilage destruction [2]. Septic arthritis is an unusual complication of pregnancy and can progress to permanent arthropathy and disability [3].</p><p>Septic arthropathy in pregnancy requires multidisciplinary team involvement for prompt recognition and treatment to improve both maternal and fetal outcomes. High index of suspicion is vital when clinical and laboratory findings suggest septic arthritis. There are multiple predisposing factors reported previously for septic arthritis of the shoulder in pregnancy such as medical conditions, pyelonephritis and trauma. We report a 37 year old lady who presented at 26 weeks gestation with acute left shoulder pain and high temperature following minor left palm trauma. She also had left mastectomy with axillary clearance ten years earlier. She underwent arthroscopic wash out of her left shoulder joint and was covered with antibiotics with rapid improvement and recovery. We reinforce the importance of early multidisciplinary involvement when septic arthritis of the shoulder in pregnancy is suspected especially in women who have had previous mastectomy and axillary clearance which could be a predisposing factor for such a rare and serious joint condition in pregnancy.</p>
Although the veterinary art has been practiced since antiquity, the modern era began in the 18th century with the establishment of the discipline of “Veterinary Science” at universities. In the 19th century, veterinary education began in Australia with Kendall’s private veterinary school in 1888 [1].In 1909, a Veterinary Faculty was established at the University of Melbourne and Kendall’s school was incorporated into it. In 1910, a second faculty was established at the University of Sydney and in 1936, a third was established at the University of Queensland [2-4]. A fourth school was established at Murdoch University in Western Australia (WA) in 1974 [5].
In the first decade of the 21st century, three new veterinary schools were established; one at Charles Sturt University (2005), a second at James Cook University (2006) and the third at the University of Adelaide (2008). Australia now has more veterinary schools per capita of any Western Nation [6-8]. In Australia, veterinary science graduates serve in private practice, government service, academia and industry. Those in practice serve the animal-owning public and charge a fee-for-services rendered, whilst the others serve the purpose of the institution employing them and receive a salary for doing so.
The paper analyses performance boundaries of systems converting the heat energy into the mechanical or separation work. Authors approach this problem from the view-point of the finite-time thermodynamics. Using thermodynamic balance equations, authors provide the algorithm for calculation of realizability domain for such systems. The paper shows that the performance of these systems is the upper bounded function of the heat flux, assuming that heat and mass transfer coefficients are given. Authors present sufficient conditions under which the efficiency (specific heat flux per unit of the useful flux) of the system does not depend on kinetic coefficients when operating in the maximum performance mode. The paper shows how to use these conditions to optimally choose the separation order for multicomponent distillationfor multicomponent distillation.
Lucas Wheatley*, Michael Lonne, James Bennnet and Bhavik Patel
A 40 year old woman presented to the emergency department with acute on chronic abdominal pain in her right iliac fossa. On history her pain had been present for over 6 months and had previously been investigated with ultrasound, CT and a diagnostic laparoscopy several months prior to presentation. Her pain had acutely worsened over the preceding two weeks. This was associated with two days of diarrhoea but nil other systemic symptoms. Her medical history was significant for immunosuppression with tacrolimus, azathioprine and prednisone post renal transplant for IgA nephropathy [1].
Sardar Rezaul Islam*, Shafiqur Rahman, Shahalam Sarkar and Debabrata Paul
A 35-year-old man presented with swelling in the lower abdomen for 2 months. He was found to have left undescended testis. An ultrasound scan showed a solid floating pelvic mass. His chest x-ray and tumour markers for testicular cancer were normal. Exploratory laparotomy revealed the left intra-abdominal testicular tumour. Intra-abdominal left orchiectomy was performed. The patient made an uneventful recovery. Histology showed immature seminoma. A mass in the lower abdomen with a cryptorchidic testis strongly points towards the diagnosis of malignancy in abdominal testis. To prevent this complication all undescended testis gets orchiopexy before 2nd year or orchiectomy in post-adolescent life. But some cases remain unnoticed, which leads to this kind of presentation. So, we decided to present this rare and interesting case of intra-abdominal testicular tumour.
Chagas disease is a public health problem in Latin America and its treatment is based on the use of benznidazole or nifurtimox compounds. Both present problems such as resistance, inefficiency in chronic infection and cytotoxic effects. New compounds such as posaconazole and amiodarone have been tested against T. cruzii and shown to be effective. In addition, new molecules have been synthesized and tested against T. cruzii. Because this protozoan is highly pathogenic, even with a number of cases of accidental laboratory infections, few laboratories located outside Latin America are authorized to work with its infective developmental stages. On the other hand, Trypanosoma dionisii is a non-pathogenic protozoan phylogenetically related to T. cruzii and that shares similar strategies to complete its life cycle in mammalian cells in vitro. Here, we describe a comparative analysis of the sensitivity of both parasites to benznidazole, posoconazole and amiodarone. We also analyzed the morphological effects of these compounds on both Trypanosoma species using electron microscopy. Our results show that T. dionisii is more sensitive to the compounds tested than T. cruzii. They also support a previous suggestion that it may constitute an excellent model for large scale screening of compounds against T. cruzii.
Mark Taubert, Lorenz Weidhase, Sirak Petros and Henrik Rueffert*
A 64-year-old woman was referred to our hospital due to progressive dypnoea for the past week, combined with fever and type 1 respiratory failure. White blood cell count and procalcitonin level were normal. The Chest X-ray showed bilateral disseminated pulmonary infiltrates. Within the next 24 hours the patient developed a severe ARDS. A first diagnostic work-up for typical and atypical pathogens as well as serological tests for CMV, RSV, HIV and HSV were negative. Analysis of a second bronchoalveolar lavage fluid revealed Pneumocystis jiroveci DNA. The patient was successfully treated with trimethoprim-sulfamethoxazole and off label use with caspofungin. The cause of the infection was a six week treatment with dexamethasone. The patient developed a toxic epidermal necrolysis during further course, but completely recovered.
Pneumonia with Pneumocystis jirovecii must also be taken into account in non-HIV patients, whenever there are any indications that cellular immunity may be depressed
There are variations in therapeutic regimens of different liver diseases. The accurate diagnosis ensNusinersen treatment is a novel therapy for spinal muscular atrophy (SMA) type 1; consequently, the adverse reactions of the therapy, have not been well known, yet. The present study is a case report that declares a hyponatremia development after the nursinersen therapy. Since the therapy is quite new one and has limited practice, we hope that this rare complication will contribute to the scientific literature.
<h2>Text</h2><p>The advancement of human researches and scientific activities in the field of diseases prevention and treatment, has not diminished the importance of sexually transmitted diseases (STDs). Despite the continuous efforts for prevention and control of them, many peoples suffers from STD with very considered wasted expenses for anybody and for community [1,2].</p>
A 34-year-old male patient presented with the complaint of chronic pain in the left groin following left side testicular vein ligation for varicocele. Ilio-inguinal neurectomy and cremaster muscle division was done in another hospital for the pain but with no relief of pain. Patient on examination showed point tenderness in the left groin at the pubic tubercle. Finger Invagination test in the left was painful with severe tenderness. Investigation showed fibrosed contracted left distal inguinal ligament. Percutaneous Ultrasonographic (USG) guided inguinal ligament release and Platelet-Rich Plasma (PRP) injection relieved the pain completely. Post-procedure patient showed significant improvement of pain.
Rothmund-Thomson syndrome is a rare autosomal recessive disorder characterized by poikiloderma (skin atrophy, telangiectasia, hyper- and hypopigmentation), congenital skeletal abnormalities, short stature, premature aging, and increased risk of malignant disease.
A study on growth and carcass performance was conducted to evaluate the effect of Balanites aegyptiaca seed cake meal (BASCM) as a substitute for groundnut cake in the diet of growing rabbit. Five experimental diets were formulated representing the following treatments: T1, T2, T3, T4 and T5 respectively. T1 (0% BASCM) was served as the control diet, while T2, T3, T4 and T5 contained 25%, 50% 75% and 100% BASCM respectively. A total of 100 weaner rabbits of mixed breeds were purchased from the National Animal Production Research Institute (NAPRI), Zaria, Nigeria. The rabbits were fed the control diet during the one week of adjustment period. They were given vitalyte as anti-stress and were dewormed using ivermectin, at the end of one week of adjustment; the rabbits were housed in different hutches and fed their respective experimental diet for one month. Each treatment contained 20 rabbits and these treatments’ (T1-T5) each were replicated in four portions and each portion had five rabbits each. Results showed that all the parameters were significantly different (P<0.05) among the treatment groups. Balanites aegyptiaca seed cake meal can replace groundnut cake at 25% level inclusion without adverse effect on the rabbit physiology.
Jason M Slater, William W Millard, Samuel M Randolph, Thomas J Kelly and David A Bush*
Background: Biopsy findings of percentage of positive biopsy cores, percentage of cancer volume, and maximum involvement of biopsy cores have been shown to have prognostic value and correlate with magnetic resonance imaging (MRI) findings of extracapsular extension and seminal vesicle invasion.he relationship of these prognostic biopsy factors to MRI findings of the presence of a dominant lesion, has not yet been investigated.
Methods: Sixty-five patients with intermediate risk prostate cancer were included in a retrospective cohort. MRI was acquired using either 1.5 Tesla (T) with endorectal coil or a 3 T MRI unit. Findings of extracapsular extension, seminal vesicle invasion, and presence and number of dominant lesions were noted. T-test and Cox regression statistical analyses were performed.
Results: Patients with one or more dominant lesions on MRI had a significantly higher mean percentage of positive biopsy cores (56.7% vs 39.8%, p=0.004), percentage of cancer volume (23.5% vs 14.5%, p=0.011) and maximum involvement of biopsy cores (62.9% vs 47.3%, p=0.027) than those without a dominant lesion on MRI. On multivariate analysis, only percentage of positive biopsy cores remained a statistically significant predictor for a dominant lesion on MRI (Hazard Ratio 1.06 [95% CI 1.01-1.12; p=0.02]), whereas prostate-specific antigen, clinical T-stage, Gleason score, percentage of cancer volume, and maximum involvement of biopsy cores were not significant predictors of a dominant lesion on MRI. Receiver-operator characteristic analysis was done and a cutoff value of >=50% was chosen for percentage of positive biopsy cores, >=15% for percentage of cancer volume, >=50% for maximum involvement of biopsy cores.
Conclusion: Percentage of positive biopsy cores was found to be a significant predictor for the presence of a dominant lesion on MRI. This finding is hypothesis-generating and should be confirmed with a prospective trial.
When I asked the students in my general Chemistry class whether grade is more important than knowledge, a majority of them opted for grades over knowledge and this answer did not surprise me a bit as the smart phones are available for them to think while their brains are corrupted or unused for most of the time. This brings one to the Einstein’s prediction that technology will develop to the point where there is no human interaction, which will be the day a new generation of idiots will emerge, and we are witnessing everywhere, including in the classrooms all over the world.
<h2>Abstract</h2><p><strong>Purpose</strong>: Here, we report the complications of endoprosthesis with threaded cups according to our application in cases of complicated acetabulum (hip revisions and femoroacetabular impingement (FAI)).</p><p><strong>Methods</strong>: A total of 504 patients was analyzed, including 189 men and 315 women. For re-implanted patients (n = 49), the mean time to re-implantation was 6.3 years and the average age at re-implantation was 54.7 years. For censored patients (n = 455), the mean time to censoring was 5.5 years and the average age of the implant was 55.7 years. Among the patients that were censored, 77 died and 378 patients did not experience an event necessitating re-implantation.</p><p><strong>Results</strong>: For the total study population, the Kaplan-Meier estimate of 5 year survival is 0.94 and of 10 year survival is 0.85. 90% of the implants survived 7 years, 80% of the implants survived almost 12 years and 70% of implants survived almost 15 years. Kaplan-Meier survival analysis suggests that men have higher survival than women. Age of the patient at the time of implant was not a statistically significant factor for re-implantation (p value = 0.21) but sex was (p value = 0.02). Women had 2.25 times more risk of being re-implanted than men.</p><p><strong>Conclusions</strong>: In our case series, the failure rate, as a result of aseptic loosening, was 7.4% (n = 51). More than half the failure cases (56%) required re-implantation. Over one-third (37%) of the primary arthrosis cases, were found to be FAI, lessening the frequency of diagnosis of the former. In our clinic, the threaded cup seems to be indispensable in hip revision surgery and in treating FAI.</p><p> </p>
Catrin Henriksson, Mona-Lisa Wernroth and Christina Christersson
Background: Patients with myocardial infarction (MI) often experience anxiety, depression and poor quality of life (QoL) compared with a normative population. Mood disturbances and QoL have been extensively investigated, but only a few studies have examined the long-term effects of MI on these complex phenomena.
Aims: To examine the levels and associated predictors of anxiety, depression, and QoL in patients 2 years after MI.
Methods: This was a single center, observational study of patients with MI (n=377, 22% women, median age 66 years). Two years after MI (2012-2014), the patients were asked to answer the Hospital Anxiety and Depression Scale (HADS) and EuroQol 5-dimension (EQ-5D-3L) questionnaires.
Results: Most patients experienced neither anxiety (87%, 95% confidence interval [CI]: 83-90%) nor depression (94%, 95% CI: 92-97%) 2 years post-MI. Elderly patients experienced more depression than younger patients (p=0.003) and women had higher anxiety levels than men (p=0.009).
Most patients had “no problems” with any of the EQ-5D-3L dimensions (72-98%), but 48% (95% CI: 43%-53%) self-reported at least “some problems” with pain/discomfort. In a multiple logistic regression model (EQ-5D-3L) higher age (p<0.001) and female sex (p<0.001) were associated with more pain/discomfort. Female sex (p=0.047) and prior MI (p=0.038) were associated with anxiety/depression. History of heart failure was associated with worse mobility (p=0.005) and problems with usual activities (p=0.006). The median total health status of the patients (EQ-VAS) was 78 (95% CI: 75-80).
Manan Vora*, Digpal Ranawat, Apoorva Tiwari and Manit Arora
<h2>Summary</h2><p>Badminton is a sport that requires a player to perform while being still, as well as in motion. Stability is the ability to maintain or control joint movement or joint position, in the static as well as dynamic state. Improvement in stability could help maintain body control and proper posture positions during play. Accordingly, the study was proposed to analyze stability in junior badminton players and understand its importance. A total of 106 players from South Asia between the ages of 8 and 15 years were analyzed. Prokin 252N and Balance trunk MF systems of Tecnobody Italy were used in the assessment and static, dynamic, and pelvic stability was recorded. The variables used were gender, age, body mass index, and experience in years, level at which they play, current pain, and clicks & catches in the past 1 year. Our study showed that there was significant difference in pelvic stability in terms of age and level at which players compete. There were a variety of other factors which do not affect stability. There needs to be a greater focus on stability training as part of the development of junior badminton players.</p>
Rationale: Blood Pressure measurement has transitioned to the oscillometric method in most hospitals in the United States, however out-patient offices mainly use the auscultatory technique.
Objective: To determine time taken to measure blood pressure by an automatic oscillometric device compared to an auscultatory measurement device and to determine what each measurement costs.
Methods: Blood Pressures were measured in a single primary care office by medical assistants (MA) for patients seen for office visits. Timed measurements were performed using an automated oscillometric Welch Allyn Connex Vital Signs Monitor (WA) and manually using a Tycos device. A minimum of 400 readings were taken with each method.
Results: The average time to manually measure BP was 58.6 seconds, whereas the WA average was 39.8 seconds, 18.8 seconds faster (p<0.05). There was an improvement in measurement time with MA experience with the WA device (p<0.05). The average MA cost to measure a single BP using the manual method was $0.35 vs. the WA method ($0.24) or a savings of $0.11 per measurement. The improvement with experience of WA method reduced cost to $0.17 per measurement.
Conclusion: The oscillometric method saved 17cents per measurement potentially saving $1,119 per year for our primary care practice.
Patients with chronic kidney disease are at increased risk of thromboembolic complications and are therefore often managed with anticoagulation therapy [1]. While these patients are traditionally treated with Vitamin K antagonists (VKAs), the Non-Vitamin K antagonist oral anticoagulants (NOACs), such as rivaroxaban and apixaban are being used with increasing frequency. Relatively new to the anticoagulant treatment arsenal, both compounds are direct Factor Xa inhibitors and represent an alternative to traditional VKA treatments, such as warfarin. However, because these compounds are at least partially renally eliminated, achieving safe and effective anticoagulation in this vulnerable population has proven to be a challenge [2,3].
A rare case of Diabetic Foot in male of middle age has been shown.
Diabetes mellitus is a chronic disease due to complete absence of its hormone, Insulin, or has the hormone which is ineffective. This disease affects individuals of all ages and both sexes. When the disease affects individuals below 40 years of age and there is complete absence of Insulin (autoimmune reaction), the disease is known as type 1 Diabetes mellitus. On the other hand the disease when it affects individual above the age of 40 years and there is partial deficiency of insulin, it is known as type 2 Diabetes mellitus. However, this age division is no longer used; instead it is called Mutuality Onset Diabetes mellitus in Adults (MODY). The accompanying picture shows a diabetic foot with a big blister full of blood. This type of presentation of Diabetic foot is relatively rare. Upon incision of the swelling, reddish pus came out. Draining of the pus and debridement of dead tissue was done under antibiotic coverage along with Insulin. The patient had a slow recovery. Strict control of diabetic status was done. Culture of the pus yielded staphylococcus aureus sensitive to amoxyclav, gentamycin and oflaxacin. Antibiotic treatment was continues for 10 days. Although this time the patient recovered, he was advised to take scrupulous care of the feet and control blood sugar
Sojourn to high altitude may affect various human systems if proper acclimatization not followed. If acclimatization failed, sojourners may suffer with high altitude sickness such as acute mountain sickness (AMS), high altitude pulmonary edema (HAPE) and high altitude cerebral edema (HACE).Although a sojourner’s tolerance to high altitude hypoxia varies according to differences in physiology and physical conditioning. Acute mountain sickness may cause headache, insomnia, dizziness, nausea, vomiting and fatigue. While HACE is more serious stage where brain swelling occurs and it is potentially fatal. A sojourner with HACE may experience confusion, amnesia, delusions, and loss of consciousness. Staying in high altitude (above 9000 feet) environment poses low oxygen supply (hypobaric hypoxia) to the different body organs including brain.
Brain is the organ that reacts sensitively to oxygen deprivation, which leads to inflammation, oxidative stress and cognitive function impairment. Our previous studies have reported that exposure to hypoxia leads to neurodegeneration and memory impairment also hypoxia exposure upregulated NALP3 mediated IL-1 beta and NF-kB expression [1-3]. Recently our laboratory has reported that suppression of scavenger receptor Mac-1 attenuates microglial phenotype switching and working memory impairment following hypoxia [4].
Brain is the organ that reacts sensitively to oxygen deprivation, which leads to inflammation, oxidative stress and cognitive function impairment. Our previous studies have reported that exposure to hypoxia leads to neurodegeneration and memory impairment also hypoxia exposure upregulated NALP3 mediated IL-1 beta and NF-kB expression [1-3]. Recently our laboratory has reported that suppression of scavenger receptor Mac-1 attenuates microglial phenotype switching and working memory impairment following hypoxia [4].
Mauro Luisetto*, Behzad Nili-Ahmadabadi, Nilesh M Meghani, Ghulam Rasool Mashori, Ram Kumar Sahu, Kausar Rehman Khan, Ahmed Yesvi Rafa, Luca Cabianca, Gamal Abdul Hamid and Farhan Ahmad Khan
In 1874 J.M. Charcot was the first to describe ALS amyotrophic lateral sclerosis, a disease with an high non response therapy rate also to the actual therapy.
ALS is not clearly associate to only single etio-patogenetic movens but many process seem involved.
Also the strange geographic diffusion of different forms contribute to a complex syndromic pathology.
Also the strange geographic diffusion of different forms contribute to a complex syndromic pathology.
In this work the different neuronal damage movens and new therapeutic strategies are analyzed to produce a Unic global response to the pathologic process useful in next clinical application.
Genetic factors must be considered also added to environmental movens but also to the endogenous microenvironment of motoneuron involved.
A toxicological-biochemical-imunological approach can be useful tool to find new therapeutic strategies.
Or to improve local availability of pharmacological molecules.
Ailment repairing regiments has turn out to be arduous, despite a plenty of understanding and knowledge acquired in the past relating to the molecular underpinnings of Alzheimer’s disease (AD. Umpteen clinical experiments targeting the fabrication and accumulation have been turned fruitless to fit potency standards.The tests aiming beta-amyloid hypothesis also turned futile making it exigent for further handling tactics. The new emanation of a comparably candid, economical, and punctilious system known as gene editing have showed light in path of cure for AD by CRISPR/Cas9 gene editing. Being a straight approach this procedure has already shown assurance in other neurological disorders too such as Huntington’s disease. This review standpoint the immanent service of CRISPR/Cas9 as a remedial option for AD by aiming on specific genes inclusive of those that induce early-onset AD, as well as those that are substantial risk components for late-onset AD such as the apolipoprotein E4 (APOE4) gene.
Sendanyoye Marcel*, Uwambajineza Tito, Ineza Ines and Nahimana Jean Pierre
The intention of the present work is to validate an easy, better and reasonable approach for estimation of amoxicillin trihydrate in tablet formulation by opposite segment(reverse phase) HPLC –UV with advanced conditions and parameters for habitual use in Rwanda well known board in pharmaceutical laboratory in order to check if no substandard or counterfeit amoxicillin has entered in our country that can result in antimicrobial resistance, treatment failure which can be a chief difficulty on public health. an easy, selective, precise, speedy, specific, and correct reverse phase HPLC UV-seen technique has been verified for the dedication of amoxicillin, in addition that is a cost-effective technique for the established method, monobasic potassium phosphate (KH2PO4) used as buffer and methanol and had been used as a mobile section in the ratio 95:5 respectively. The elution turned into finished in an isocratic mode at a go with the flow rate of 1.5ml/minute proposed method became demonstrated as according to ICH guiding principle refereeing additionally to USP necessities for amoxicillin capsule. linearity range of amoxicillin and was evaluated inside the variety of 20–160 g/ml. the correlation coefficient r2 changed into 0.9998 and the relative well known deviation between six replicates injection was always much less than 2%. The retention time was found 3.5±0.02. the high percentage of healing of amoxicillin is 100.6±4% indicates that the proposed method is exceptionally correct and precise trueness of with the trueness of 100.06±1.2% .the statistical evaluation proved that the demonstrated method is appropriate for analysis of amoxicillin as the majority drug and pharmaceutical formula with none interference from excipients .with the aid of considering the efficiency of the drug samples, all analyzed pattern were within the variety of 90-120 % of percentage of labeled amount, but the efficiency had been distinctive amongst samples. The have a look at located that no counterfeit, no substandard product turned into amongst all batches of amoxicillin samples throughout the c programming language of the look at.
Ruiz Alvarado Cristina, Jesus Borboa Flores, Victor Cardenas Salazar, Soto Ortiz Roberto, Lourdes Díaz Cervantes and Rueda Puente Edgar O*
The halophyte Distichlis palmeri (Vasey) is a plant resource with high potential to be harvested in the coastal areas of northwestern Mexico; enlarge the knowledge and domestication for its incursion into the agricultural sector, plays an important role for arid areas with saline intrusion problems. However, its productivity depends on the supplementary supply of nitrogen, as well as other essential macro and micronutrients. The microorganisms considered beneficial are an alternative to chemical fertilization, highlighting those Plant Growth Promoting Bacteria (PGPB). In the present study, the inoculation of the Bacillus amyloliquefaciens (B.a.) as a halobacterium PGPB was evaluated to know the response in seeds of Distichlis spicatai obtained from natural population from colorado river in Delta north of the Gulf of California. Wild seed was collected and germinated previously inoculated with B. a., and sowed in germinated beds. Later, seedlings were planted under field and salinity conditions in the coast of Hermosillo, Sonora. Three treatments were examined (T1: B.a., T2: Chemical fertilization, T3: Negative control), with four repetitions each treatment. Each repetition consisted of experimental plots of 5 x 5 m, with a separation of 1 m between them. The harvest was carried out 600 days after sowing. The results indicate that treatments inoculated with halobacteria B.a., showed significant results in crude protein, non-protein nitrogen, neutral detergent fiber and acid detergent fiber, as well as spike length and number of seeds. The results obtained suggests the feasibility of biofertilizers where biomass and seed production are significant compared to non-inoculated controls.
Trina Aguirre*, Leeza Struwe, Ann Koehler, Rebecca Kreman, Rebecca Bowman, Erica Schulte, Kayla Pierce, Molly Bloodgood and Jeffrey Holloway
Obesity is a major contributor to ill health and numerous comorbidities globally. Recent studies suggest that addictive-like tendencies toward foods, especially highly processed foods, contribute to this epidemic. Therefore, interventions used to treat substance-use disorders may be effective for treating overweight/obese patients with food addiction (based on the Yale Food Addiction Scale, version 2.0). This pilot study evaluated four interventions, selected because of their effectiveness in the treatment of substance-use disorders [motivational interviewing, pharmacotherapy (naltrexone-bupropion), pharmacotherapy with motivational interviewing, information control (diet and physical activity instruction)], in overweight/obese individuals with and without food addiction. The food addiction construct identified a distinctive subset of overweight/obese individuals. Through one month, response to interventions differed between food addiction phenotypes with those who were positive for food addiction showing similar or less response to the interventions than those who were negative for the trait. This suggests that individuals with addictive-like tendencies toward food may require longer and more intensive intervention to achieve their goals. The greatest changes in biometric measures occurred between baseline and 1 month during which time participants were attending weekly intervention sessions. Across all groups, those who attended more sessions (dose) was correlated with a reduction in body mass index.
Objective: To determine the impact of Adenotonsillectomy on Health-related quality of life (HRQoL) in children’s before and after surgery.
Study Design: Prospective, Observational, before and after the trial. 142 children who underwent Adenotonsillectomy were included in the study. Parents were made to fill pre and post-operative questionnaires which were customized from Tonsil and Adenoid health status instrument (TAHSI) and HR-QoL (Health-related quality of life) forms, one day prior to the surgery and 6 months after the surgery respectively, and the results were tabulated and analyzed.
Result: Out of the 142 children in the study, 80 were male and 62 were female. Male to Female ratio is 1.3:1. Age group 1-4 years had the highest number of patients while the age group 9-12 had the least. Preoperatively the Mean score of the domain for Sleep disturbances, Physical Symptoms, Emotional distress, Daytime functions, and Caregiver concern was 14.1, 15.83, 6.89, 7.54, and 13.78 respectively. After 6 months of the surgery, the score decreased to 4.65, 4.22, 4.32, 3.1 and 4.2 respectively. This shows a significant improvement in the symptom complex and the quality of the life.
Conclusion: Adenotonsillectomy definitely leads to an improvement in the HRQoL in children as the majority of parents were extremely satisfied with the surgical outcome. Almost all of the parents reported a decrease in Sleep disturbances, Physical Symptoms, Emotional distress, Daytime functions, and Caregiver concern.
Introduction and goal: From the perspective of Islam, spiritual health means having a Sound Heart (a calm, confident and optimistic soul, with hope for God’s mercy, satisfaction with destiny and vitality). The way to achieve spiritual health is strengthening the faith and taking good deeds based on religious spirituality. This study was conducted with the aim of determining the impact of spiritual health (Sound Heart) on the other aspects of health at different levels of prevention.
Methods: In nine phases of research in 16 years, after designing and validating the “Sound Heart Model”. The spiritual problems of patients and healthy clients were determined. Spiritual care guidelines and the spiritual counseling model in patients and healthy clients were designed. Then “Parent’s Spiritual Empowerment Program”, “inter-professional spiritual health care training program” was extracted. Based on the findings of the previous steps, the effect of spiritual health on other aspects of health at different levels of prevention was extracted.
Findings: Belief in God and divine love creates spiritual health (Sound heart) with wisdom, chastity, courage, justice, dignity, kindness, and sincerity in action. Faith prevents neglecting from the God’s remembrance and its consequences such as: unhealthy lifestyle, risky behaviors, destructive excitements, psychosocial diseases in clients and eliminates the fear, anxiety, sadness and disappointment in patients. Spiritual health causes living in the present time with patience and grace of God, creates hope, optimism for the future, courage to face life crises. By creating mental health, it improves the psycho-neuron-immunologic function and improves physical health.
Conclusion: Considering the great impact of spiritual health on the other aspects of health at all levels of prevention, it is imperative that students and health care staff, by referring to these concepts, carry out spiritual care/counseling.
The current situation of bioethics illustrates what has become known as “the anthropological halt”, described with great lucidity by C. S. Lewis in his book The Abolition of Man as the neglect of the “Tao”, a not very extensive body of basic axioms which enable the overall integrity of reason, both in theory and practice.
Gribkov VA, Bienkowska B, Jednorog S, Paduch M, Tomaszewski K
In the paper a methodology that is elaborated for characterization of big-sized chambers of modern and future nuclear fusion reactors is described. It gives an opportunity to define distortions introduced by surroundings, systems and elements of the chamber into the neutron field generated during the reactors’ operation. The procedure is based on two types of experimental techniques supported by MCNP numerical modelling. These two classes are: 1) the neutron activation methods for measuring changes in anisotropy of the “absolute” neutron yields, and 2) the time-of-flight process for determination of neutron spectra deformations. MCNP calculations afterwards give an opportunity to fix just those elements of the surroundings that introduce the main impact in the perturbed neutron field characteristics.
AlShammasi S, AlNujaidi D, Bakhit K, Algarni A and AlAnazi KA*
Background: Invasive fungal infections cause significant morbidity and mortality in patients with hematologic malignancies and in recipients of hematopoietic stem cell transplantation.
Case: We report a patient with relapsed acute myeloid leukemia who developed disseminated Fusarium infection during the neutropenic period following the salvage cycle of chemotherapy given at King Fahad specialist Hospital in Dammam, Saudi Arabia. The invasive fungal infection was successfully managed with a combination of voriconazole and liposomal amphotericin-B.
Discussion: Fusarium species can cause invasive infections that may become disseminated and life-threatening in patients with acute myeloid leukemia.
Conclusion: Combined antifungal therapy and recovery of neutrophil count are essential to control invasive Fusarium infections
Conclusion: Combined antifungal therapy and recovery of neutrophil count are essential to control invasive Fusarium infections
Conclusion: Combined antifungal therapy and recovery of neutrophil count are essential to control invasive Fusarium infections
Ibrahim A Ali*, Elia Adil Nabih and Ahmed MS Eltohami
Background: Asthma is the most common chronic respiratory disorder in childhood. Asthmatic attacks are described and classified according to the type of wheezing to Non –atopic and Atopic asthma (IgE mediated wheezing). The aim of this review is to determine the onset of clinical diagnosis in relation to clinical presentation of asthma in children and obstacles related to delay of Asthma diagnosis.
Methods: This review highlights the results of studies done regarding clinical diagnosis in relation to clinical presentation and of asthma in children. An extensive search has been conducted for researches about asthma in children. This search based on the publications posted on the National Center for Biotechnology Information PubMed or by Google Scholar. Key words used for the research: Asthma, clinical diagnosis, children.
Results and Conclusion: Diagnosing asthma in young children is difficult because children often cough and wheeze with colds and chest infections, but this is not necessarily asthma. Miss diagnosis of asthma in children occurs when physicians diagnose patients with asthma from the clinical diagnosis in the first attack without excluding other asthma mimickers which can be any other respiratory problem. There is over-diagnosis of asthma due to the symptoms which mimic other respiratory infections. First episodes of cough, runny nose and fever that happen in cold/flu season- fall/winter/early spring is likely not asthma. If the child has several more episodes of wheeze and cough, it is likely to be asthma. Since there is no diagnostic test available for children younger than 6 years of age, making a diagnosis in this age group is more difficult than in older children. Over the age of about 6 years it is possible for a child to have a spirometer test.
Aim: The aim of the present study is to assess the efficacy and safety of Hydroxychloroquine in comparison with Teneligliptin in type 2 diabetes patients whose blood glucose levels were inadequately controlled with metformin, Glimepiride and insulin therapy.
Yuanshui Zheng*, Hardev Singh, Suresh Rana, Gary Larson, Prabhu Kiran, Lucius Doh and James Wong
Purpose: Adaptive planning is often needed in lung cancer proton therapy to account for geometrical variations, such as tumor shrinkage and other anatomical changes.The purpose of this study is to present our findings in adaptive radiotherapy for lung cancer using uniform scanning proton beams, including clinical workflow, adaptation strategies and considerations, and toxicities.
Methods: We analyzed 165 lung patients treated using uniform scanning proton beams at our center. Quality assurance (QA) plans were generated after repeated computerized tomography (CT) scan to evaluate anatomic and dosimetric change during the course of treatment. Plan adaptation was determined mutually by physicists and physicians after QA plan evaluation, based on several clinical and practical considerations including potential clinical benefit and associated cost in plan adaption. Detailed analysis was performed for all patients with a plan adaptation, including the type of anatomy change, at which fraction the adaption was made, and the strategy for adaptation. Toxicities were compared between patients with and without plan adaptation.
Conclusion: Adaptive planning is necessary in proton therapy to account for anatomy change and its effect on proton penetration depth during the course of treatment. It is important to take practical considerations into account and fully understand the limitations of plan adaptation process and tools to make wise decision on adaptive planning. USPT is a safe treatment for lung cancer patients with no Grade 4 toxicity.
Results: In total, 32 adaptive plans were made for 31 patients out of 165 patients, with one patient undergoing adaptive planning twice. Anatomy changes leading to plan adaptation included tumor shrinkage (17), pleural effusion (3), patient weight loss (2), and tumor growth or other anatomy change (9). The plan adaptation occurred at the 15th fraction on average and ranged from the 1st to 31st fraction. Strategies of plan adaptation included range change only (18), re-planning with new patient-specific hardware (9), and others (5). Most toxicities were Grade 1 or 2, with dermatitis the highest toxicity rate.
Conclusion: Adaptive planning is necessary in proton therapy to account for anatomy change and its effect on proton penetration depth during the course of treatment. It is important to take practical considerations into account and fully understand the limitations of plan adaptation process and tools to make wise decision on adaptive planning. USPT is a safe treatment for lung cancer patients with no Grade 4 toxicity.
Primary sources document Dr. Saul Hertz (1905 - 1950) as conceiving and developing radioiodine (RAI) as a diagnostic tool and as a therapy for thyroid diseases. Dr. Hertz was the first and foremost person to develop the experimental data on RAI and apply it to the clinical setting.
Saul Hertz was born on April 20,1905 to Jewish parents who had immigrated to Cleveland, Ohio. He received his A.B. from the University of Michigan in 1925 with Phi Beta Kappa honors. After graduating from Harvard Medical School in 1929, at a time of quotas for outsiders, he fulfilled his internship and residency at Cleveland’s Mt. Sinai Hospital.
In 1931, he came back to Boston to join the newly formed Thyroid Unit at The Massachusetts General Hospital serving as the Chief from 1931 - 1943.
Ruptured abdominal aortic aneurysm (rAAA) carries high morbidity and mortality. Advances in endovascular techniques in the last two decades allow for minimally invasive approach for repair of these aneurysms. A succinct but comprehensive pre-operative is essential for delivery of a safe anesthetic for the patient with rAAA. Placement of proximal occlusion balloon in the descending aorta using the rapid control technique can be life-saving. Endovascular aortic repair (EVAR) can be performed under monitored anesthesia care using local anesthetic and IV sedation, and with fewer invasive lines. However, rapid conversion to general endotracheal anesthesia should be expected. Anesthesiologists should be familiar with the hemodynamic management of rAAA and be ready to provide resuscitation to correct for anemia, coagulopathy, and acidemia. In addition, the anesthesiologist should be aware of the common complications related to EVAR, including abdominal compartment syndrome, distal ischemia, and local vessel injury.
The effect of acute administration of ethanol extract of F. thoningii on anxiety and fear in Swiss white mice was studied. 30 adult Swiss white mice of both sexes were randomly divided in to three groups of 10 mice each. Group1 served as the control and was administered normal saline only. Group 2 (low dose group) was administered 10mg/kg ethanol extract of the F. thoningii, while group 3 (high dose group) was given 20mg/kg of the same extract. All animals were allowed food and water ad libitum. Neurobehavioral parameter was assessed using the light/dark transition box. The analysis of variance (ANOVA) was used to test for variability within and among groups. Results were expressed as Mean ±SEM (standard error of the mean) and probability level p<0.05 was accepted as significant. The result showed that the frequency of transition in the light/dark transition box was significantly increased in the test groups (p<0.05; p<0.01).Similarly, the Light Box Duration was also significantly increased (p<0.01) in the low and high dose groups respectively. However, the Dark box duration was significantly decreased (p<0.05; p<0.01) in the low and high dose groups compared to control. This index showed a decreased level of anxiety and fear in the test groups. This was followed by a corresponding trend of decreased frequency of stretch attend posture and duration of freezing in the light/dark transition box (p<0.01; p<0.001) compared to the control. Summarily, acute administration of ethanol extract of F. thonningii causes calmness and sedation in moderate and high doses. It is therefore likely that it reduces aggression. If the result from this finding is extrapolated to humans, F. thoningii could be used to reduce anxiety disorders.
Ibtasam Ahmad, Muhammad Haris, Amnah Javed and Muhammad Azhar*
Objectives: There are variations in therapeutic regimens of different liver diseases. The accurate diagnosis ensures prompt recovery from these diseases. The present study aimed to evaluate the underlying causes of unexplained signs and symptoms associated with liver diseases through biopsies.
Methods: A retrospective study was conducted in a public child care specialty of Lahore, Pakistan. The data was collected from medical records of the patients who were index hospitalized with unexplained clinical presentation of liver disease between 1st July, 2017 and 31st December, 2017. Data were analyzed by using Statistical Packages for Social Sciences (IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.), and Microsoft Excel (MS Office 2010).
Results: Overall, the records of 53 patients were selected for the study. Most of them were 11 to 15 years of age. The patients were presented with unexplained hepatomegaly (60.4%) and jaundice (40.7%) during index hospitalization which made them eligible for liver biopsy (LB). The findings of LB revealed that the underlying causes of liver diseases in most of the cases were metabolic (33.9%) and inflammatory disorders (22.6%). Majority of the patients were ≤4 years of age, however cryptogenic cirrhosis (39.1%) was commonly found in >10 years of age. Although most of the patients were suffering from metabolic disorders (p-value=0.07) and liver cirrhosis (p-value=0.08) but these were not statistically significant.
Conclusions: LB was beneficial in evaluating the etiologies of unexplained signs and symptoms of liver diseases. It was found that glycogen storage diseases and liver cirrhosis were the most common etiologies of liver diseases among pediatric patients. But etiologies like metabolic and inflammatory diseases were insignificantly associated with gender.
Ridhi Narang*, T Das, M Dagar, M Srivastava, S Bhalla and I Ganguli
<h2>Introduction</h2><p>A malignant tumor has the capacity to grow rapidly and to metastasize to the other parts of the body. Ovary has been a common organ for secondaries caused by hematological spread of the tumor and exhibits the same histopathology as that of the primary tumor.</p>
Sheep are not native to Australia and were originally imported; 44 sheep were among the animals transported from Great Britain to the penal colony established on the east coast of Terra Australis in January 1788 http://firstfleetfelowshp.org.au.
The Australian Merino…comprised one of the greatest creative expressions of domestic animal species by and for mankind…one of the greatest contributions to the world economy [1].
These original sheep were for human provisions and consisted of fat-tailed native sheep from the Cape of Good Hope, but the primary source of sheep for the first three or four decades of Australia’s history were from Bengal, the closest British colony to Australia.
The following brief account of the history of wool in Australia is taken from “The Australian Merino” which began;
Mental illness is associated with a significant burden of morbidity and disability. Lifetime prevalence rates for any kind of psychological disorder are higher than previously thought, are increasing in recent cohorts and affect nearly half of the population.
The strategy of price liberalisation and privatisation had been implemented in Sudan over the last decade, and has had a positive result on government deficit. The investment law approved recently has good statements and rules on the above strategy in particular to pharmacy regulations. Under the pressure of the new privatisation policy, the government introduced radical changes in the pharmacy regulations. To improve the effectiveness of the public pharmacy, resources should be switched towards areas of need, reducing inequalities and promoting better health conditions. Medicines are financed either through cost sharing or full private. The role of the private services is significant. A review of reform of financing medicines in Sudan is given in this study. Also, it highlights the current drug supply system in the public sector, which is currently responsibility of the Central Medical Supplies Public Corporation (CMS). In Sudan, the researchers did not identify any rigorous evaluations or quantitative studies about the impact of drug regulations on the quality of medicines and how to protect public health against counterfeit or low quality medicines, although it is practically possible. However, the regulations must be continually evaluated to ensure the public health is protected against by marketing high quality medicines rather than commercial interests, and the drug companies are held accountable for their conduct.
The industrial production and use of chromium have grown considerably during the past five decades. Abundances of the chromium isotopes in terrestrial samples are identical to 0.01%. Among the dominant species of chromium, the trivalent form widely occurs in nature in chromite ores which is extremely immobilized especially in water bodies. Samples were mixtures of separated chromium isotopes and the calibration was made with the same species as those used in the measurements. The method had simplified the conversion of the ores to chromyl fluoride since the element could be readily separated as lead chromate from the leaching of chromite-sodium peroxide fusions. Isotope assay of chromyl fluoride under certain conditions was measured and the measurements of chromium isotopic anomalies ratios and isotope abundance of the chromite ores have been assessed. These provided sufficient quantitative mass spectrometric data, which were analyzed to calculate the abundance and the mean atomic mass of the questioned isotopes. Based on the high mass spectroscopy stability and the correction factors, the results were of good precision (incl. negligible systematic errors normally associated to inter-laboratory discrepancies) and the Cr isotopes availability (52Cr > 53Cr > 50Cr > 54Cr) was in conjunction with other classical tools such as oxygen isotopes. This paper is important for paleoecological, environmental, archeological, forensic, and nuclear researchers.
Heavy metals and metalloids are dangerous because they have the tendency to bioaccumulate in biological organisms over a period of time. However, it is conceived that a number of phytochemical agents as well microorganism can act as heavy metal removing agent both from human beings and the environment surrounding. For instance, microbes are used for the removal of heavy metals from the water bodies including bacteria, fungi, algae and yeast. This review shows that bacteria can play an important role in understanding the uptake and potential removal behaviour of heavy metal ions. The bacteria are chosen based on their resistance to heavy metals (incl. their toxicities) and capacity of adsorbing them. Due to specific resistance transfer factors, cell impermeability is drastically inhibited by several ion (i.e. mercury, cadmium, cobalt, copper, arsenic) forms. Between these elements, free-ion cadmium and copper concentrations in the biological medium provide more accurate determination of metal concentrations that affect the bacteria, than with most of the other existing media. Metal toxicity is usually assessed by using appropriate metal ion chelators and adjusting pH factor. Bacteria and metals in the ecosystem can form synergistic or antagonistic relationships, supplying each other with nutrients or energy sources, or producing toxins to reduce growth and competition for limiting nutritional elements. Thus, this relation may present a more sustainable approach for the restoration of contaminated sources.
Amy M Hopkins, Angela M Gibbs, Ryan S Griffiths, Rupali S Avasare and Firas G Khoury*
We present a case of hypocomplementemic urticarial vasculitic syndrome (HUVS) who developed severe renal failure requiring ICU-level care. Our patient is a 66-year-old man who presented with abdominal pain, rash, confusion, oliguria, and shortness of breath. He was found to be in acute renal failure with leukocytosis and elevated lactate. Work-up for infectious, autoimmune, and hematologic malignant diseases was negative. The presence of chronic urticaria, abdominal pain, hypocomplementemia, and leukocytoclastic vasculitis on skin biopsy confirmed the diagnosis of HUVS. He required hemodialysis for renal failure as well as gastrostomy tube placement for nutritional support secondary to the development of mucosal ulcers, a rare finding in HUVS. He recovered with several months of high-dose steroids and hemodialysis. This case highlights the effectiveness of steroids for initial treatment of HUVS, and the relapsing and remitting nature of the disease. Providers should also be aware of the broad range of presenting symptoms such as mucosal lesions that may require nutritional support. Interestingly, unlike many previously reported cases of HUVS, our patient had not yet developed signs and symptoms of systemic lupus erythematosus, which often overlaps with HUVS.
Shree Patel*, Jamie Benken, Patricia West Thielke, Sanjeev Akkina, Enrico Benedetti and James Thielke
Desensitization allows successful transplantation of patients with a positive crossmatch (PXM) against their live donor. We evaluated outcomes following PXM renal transplant despite failure to convert to negative flow cytometric crossmatch (FCXM) after desensitization. Patients that underwent desensitization before PXM transplant between 1/1/00 and 11/1/11 were identified for analysis. Patients who received a transplant despite failure to convert to negative FCXM were identified as the not converted group. Patients who converted to negative FCXM after desensitization comprised the converted group control arm. 108 patients were desensitized before PXM transplant, (not converted group=42; converted group=66). Mean eGFR was comparable between groups at all time points, and 3-year eGFR was 57.8 mL/min vs. 57.1 mL/min, p=0.91. Patients with eGFR < 30mL/min at 3 years did not differ significantly (28% vs. 14%, p=0.15). Biopsy-proven rejection rates were numerically higher within the not converted group for each type of rejection and time point, but the values did not differ significantly. Opportunistic infections rates were comparable. Patient survival (95% vs. 91%) and death-censored allograft survival (84% vs. 95%, p=0.07) were similar between arms at 3 years post-transplant.
Benjamin Courchia*, Leventer Roberts Maya, Meyer John, Galvez Maida, Herrera Jaime and Rauch Daniel
This is the case of a full-term baby girl, born to a mother with a history of parenteral inorganic mercury administration. Thirteen years prior, this mother injected 1mL of inorganic mercury in her right forearm, was subsequently hospitalized, but never received chelation treatment. Her first trimester blood and urine mercury concentration were found to be elevated at 28μg/L (normal <10μg/L) and 162 μg/L (normal <20μg/L) respectively. Her chest x-ray also revealed multiple small punctate metallic densities within the lower lung fields. The remainder of the prenatal course was uneventful. The baby was born at 40 weeks of gestation via uncomplicated caesarian section, and on day of life 3, blood mercury concentrations were found to be 20μg/L (normal <20μg/L). The baby, however, remained asymptomatic throughout her hospital stay and on outpatient follow up. She is now two years old. Mercury poisoning in the pediatric population remains a concern, and knowledge of exposure and health effects continues to be relevant as newer uses and modes of exposure are discovered. This case report illustrates a rare perinatal exposure scenario, and, while the mother and child were essentially asymptomatic, the case serves to raise awareness of the many ways in which fetuses, infants, and children may still be exposed to the harmful effects of mercury. This case underscores the need for careful environmental history taking in pregnancy, after birth, and ideally in the pre-conception period as well.
Lewei Zhang*, Tarinee Lubpairee, Denise M Laronde, Martial Guillaud, Calum E MacAulay and Miriam P Rosin
Aims: Histological diagnostic criteria are used for the assessment of the degree of dysplasia and hence the risk of cancer progression for premalignant lesions. Clonal changes in the form of hyperorthokeratosis and hyperchromasia that are sharply demarcated from adjacent areas are not currently part of the criterion for dysplasia diagnosis. The objective of this study was to determine whether such clonal change should be regarded as a diagnostic feature for dysplasia. The following histological conditions were used to define such change: (1) hyperorthokeratosis; (2) hyperchromatism but no other features of dysplasia; (3) sharp margin demarcation from adjacent area by both the hyperorthokeratosis and hyperchromasia (clonal change), and (4) no prominent rete ridges, marked acanthosis or heavy inflammation. Lesions fitting these criteria were termed orthokeratotic lesions with no dysplasia.
Methods: Patients from a population-based longitudinal study with more than 10 years of follow up were analyzed. Of the 214 patients with primary oral premalignant lesions, 194 had mild or moderate dysplasia (dysplasia group) and 20 fit the criteria for orthokeratotic lesions without dysplasia (orthokeratotic with no dysplasia group). The two groups were compared for their cancer risks using clinical (site and toluidine blue), histological (nuclear phenotype score), and molecular criteria (loss of heterozygosity) and by outcome (progression).
Results and conclusions: The lesions from orthokeratotic with no dysplasia group showed a similar cancer risk (clinical, histological and molecular risk) and time to progression as the dysplastic lesions. We recommend that the clonal change should be included as a criterion for dysplasia diagnosis.
The armored scale Aulacaspis alisiana, is a serious invasive pest of the Japanese silver tree, Neolitsea sericea, causing serious damage to the tree in Japan. However there are currently no control approaches available for it, complicated by shortage of information on the pest.We studied life history strategies of A. alisiana on N. sericea in Fukuoka Prefecture with a view to providing a basis for formulating sustainable control based on an understanding of the behavior of the pest and potential role of its natural enemies. We established that A. alisiana had three overlapped generations in Fukuoka, with generation times ranging between 65 and 71 days. The adults were relatively fecund, with each female producing between 60 and 67 eggs, with high hatchability, >78%. The pest settled on the lower side of leaves, and although it generally preferred younger leaves, it did not attack newly emerged leaves. Natural enemy groups comprising ants, spiders and beetles (coccinelids) played an important role in regulation of the pest population, with natural mortality of about 30%. They could thus form a critical component of an integrated management approach for the pest in Fukuoka.
Background: Diabetes mellitus is a leading cause of illness and death. Pulmonary function test PFT has assumed a key role in epidemiological studies investigating the incidence, natural history and causality of lung disease.
Methods: A cross sectional study was conducted in The National Ribat Teaching Hospital and Jabir Abualiz Specialized Diabetes Center in Khartoum state to measure the respiratory muscle power in 31 diabetic patients (case group) and 30 non-diabetics patients (control groups). Pulmonary function tests were measured by using Digital Spirometer-Micro-Plus version.
Results: Lung function parameters between diabetic patients and their matched control group show no significant differences between the means of FVC, FEV1 and FEV1/FVC. However, diabetic patients showed significant reduction in PEFR.
Conclusions: Exercise and well control of diabetes helped in preserving normal respiratory muscle power. Continuous reasonable exercise with good control is highly recommended for all diabetics.
Background: Proteases are a group of enzymes that catalyze the cleavage of peptide bonds in proteins found in nature. Microbial protease constitutes one of the most important for industrial aplications. Proteases play a crucial role in numerous pathologic processes as well. KCl is an unnatural salt. The purpose of this study was to examine the effect of this salt on protease production under different agitation and heat conditions.
Methods: The effects of KCl (rpm/heat) on the production of a protease, of E. coli, P. aeruginosa and E. faecalis strain, were investigated. The decrease in protease production at 37 °C was also observed in this work that proved that heat plays a major role in enzyme production.
Results: The presence of KCl also caused a decrease in protease production in three bacterial species. The use of KCl appears to be a viable alternative when it is necessary to reduce protease activity outside of industrial applications (such as health care). This unique property makes it attractive and useful to be used in health industries. In the future we think that it will contribute to clarification of the matter in this way.
Cesar A Keller*, Thomas A Gonwa, Athena L Russell, David O Hodge, David B Erasmus and Abba C Zubair
Background: Mesenchymal stem cell (MSC) effects can shift immune responses toward anti-inflammatory and tolerogenic phenotypes, potentially helping patients with bronchiolitis obliterans syndrome (BOS).
Methods: We evaluated the effect of infusing allogeneic MSC intravenously in 9 patients with moderate BOS refractory to standard therapy who were not candidates for retransplant, dividing them into 3 dosing groups: Group 1, 1×106 MSC/kg (n=3); Group 2, 2×106 MSC/kg (n=3); and Group 3, 4×106 MSC/kg (n=3). We recorded pulmonary function tests, laboratory variables, and serum biomarkers pre- and post-MSC infusion.
Results: These patients had significant decline in forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) over 1 year pre-MSC infusion (mean ± SD) FVC, 3.11±0.98 L, and FEV1 1.99+0.64 L versus FVC 2.58±1.03 and FEV1 1.61±0.52 just before infusion (P<0.05); representing a mean loss of 530 mL in FVC and 374 mL in FEV1 over 12 months. One year post-MSC infusion, mean FVC and FEV1 increased to 2.66±1.01 L and 1.63±0.55 L, respectively (changes no longer significant compared to before MSC infusion). Patients in Group 1 showed elevation of tolerance-inducing T regulatory cells and increased levels of epidermal growth factor. Tolerance-inducing Th-2 cytokines increased in Groups 1 and 2. These changes were not significantly different in these small sub-groups.
Conclusion: MSC infusion appears to slow down or reverse the progressive decline in lung function in some patients with moderate BOS, possibly by inducing anti-inflammatory effects and promoting cell proliferation and angiogenesis.
Soo Mi Kim, Suhn Hee Kim, Kyung Woo Cho, Sun Young Kim and Sung Zoo Kim*
Background: C-type natriuretic peptide (CNP) was isolated from porcine brain and is a 22-amino acid peptide which belongs to the natriuretic peptide (NP) family. Even though this peptide shares structural similarity to other endogenous NPs including atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) its receptor selectivity is different from other NPs. The present study was undertaken to investigate the expression of C-type natriuretic peptide (CNP) and its specific guanylyl cyclase (GC)-coupled receptor in the granulosa cells of the pig ovarian follicle.
Results: Specific 125I-[Tyr0]-CNP(1-22) binding sites were localized in the granulosa cell layer of the ovarian follicle with an apparent dissociation constant (Kd>) and a maximal binding capacity (Bmax) of 1.41±0.39 nM and 2.75±0.65 fmol/mm2 respectively. Binding of 125I-[Tyr0]-CNP(1-22) to these sites was also prevented by atrial natriuretic peptide (ANP(1-28)), brain natriuretic peptide (BNP(1-26)) and des[Gln18,Ser19,Gly20, Leu21,Gly22] ANP(4-23) (C-ANP). Production of 3’,5’-cyclic guanosine monophosphate (cGMP) by particulate GC in the granulosa cell membranes was stimulated by natriuretic peptides (NPs) with a rank order of potency of CNP(1-22)>>BNP(1-26)>ANP(1-28). HS-142-1, a selective antagonist of the two recognized GC-coupled NPRs, inhibited CNP(1-22)-stimulated cGMP production in granulosa cell membranes in a dose-dependent manner. Also mRNAs for all three recognized NPRs were detected in granulosa cells using reverse transcriptase-polymerase chain reaction (RT-PCR). Serial dilution curves of granulosa cell extracts were parallel to the standard curve of synthetic CNP.
Conclusion: These results indicate that CNP and its specific receptor are expressed in the granulosa cells of the pig ovary, and suggest that CNP may be a local autocrine and/or paracrine regulator via activation of its specific GC-coupled receptor, NPR-B.
A literature search was conducted using PubMed and PsycINFO to locate cyberbullying research that was published during the last 4 years. In this narrative review, cyberbullying research is briefly summarized and critiqued. The review is focused on the varying definitions and characteristics of cyberbullies, victims and bystanders. Highly variable prevalence rates have been reported for cyberbullies, victims and bystanders as a function of age, gender, country, size of the social network and socioeconomic factors. In addition, the effects of cyberbullying are reviewed including the frequent suicide attempts along with risk factors/predictors of cyberbullying which include previous cyberbullying, excessive internet use and lack of empathy, anger, narcissism and authoritarian/permissive parenting. To reflect the recent literature, special attention is given to the studies on victims of bullying. Research on cyberbullies and on prevention/intervention programs for bullying is extremely limited despite the increasing prevalence of bullying and the rapidly accumulating literature. Methodological limitations include the primary focus on the prevalence of bullying and on the victims of bullying. Longitudinal, multivariate studies are needed to identify profiles on risk factors for bullying that can inform prevention programs.
This is an anatomy of a miscommunication, written by the patient, a medical school professor and his orthopaedic consultant, who was also a colleague leading to a series of misunderstandings. This raises the practical question of who is responsible for effective communication with the patient who is also a colleague. At the pre-operative assessment a combination of the diffidence of an inexperienced nurse and the patient’s wrong assumptions about his post-operative mobility and his keenness to maintain his independence and identity nearly led to a delayed discharge. The miscommunication was due to the patient’s assumptions about previous orthopaedic and recent cardiac surgery hospital experience. Neither he nor the nurse checked these assumptions and we speculate might this possibly account for why senior colleagues who become patients sometimes have unexpected complications. There are lessons to be learned from this frank exploration of the colleague patient’s experience of a miscommunication.
<h2>Abstract</h2><p>The effect of weekly physical activity on biological age (BA) parameters, we have conducted a study 215 females from 17 to 18 years old who were divided into the experimental (EG, n=105) and control (CG, n=110) groups. It was established that if at the end of the experiment the BA parameters of the females CG weren’t a significantly different from the average data (p>0.05), then there was a statistically significant decrease in the BA parameters of the females EG. This was confirmed by statistical probability (p<0.01), which suggests the dependence of biological age parameters on the extent of weekly physical activity.</p>
Tarik Kivrak*, Zeynep Ulutas, Sena Sert and Bulent Mutlu
Background: Macitentan signifi cantly improves pulmonary hemodynamics and survival in patients with primary pulmonary hypertension (PPH). Its beneficial effect, however, may be blunted due to the adverse impacts such as anemia and peripheral edema.Pulmonary arterial hypertension (PAH) is a significant consequence of congenital heart disease (CHD). Its presence and severity are associated with increased morbidity and mortality. We tried to evaluate that the effectiveness of the macitentan in patients with late-onset pulmonary hypertension after atrial septal defect operation in our center.
Methods: The effect of a single dose of macitentan (10 mg) on pulmonary hemodynamics, functional capacity was examined in four patients with late-onset pulmonary hypertension after atrial septal defect operation.
Results: The macitentan significantly improved mean pulmonary artery pressure (MPAP), cardiac output (CO), tricuspid annular plane systolic excursion (TAPSE), right ventricle systolic wave(RVS’), 6-minute walking test and NT-proBNP levels compared with before treatment.
Conclusions: Macitentan can be used in patients with late-onset pulmonary hypertension after shunt operation especially atrial septal defect.
Zhao Liu*, Abdullah Tolaymat and Sreenivas K Avula
Sleep disorders in human are common and detrimental to general health of all age groups. While the neurobiological mechanisms of sleep disorders are not yet fully understood, recent advances in research on the sleep-wake regulation mechanism, genetic and epigenetic factors, cognitive,emotional and physiological changes related to sleep have shed light on the mechanistic basis of sleep disorders. Over the past two decades, studies in Drosophila have yielded new insights into basic questions regarding sleep function and regulation. More recently, powerful genetic approaches in the fly have been applied toward studying primary human sleep disorders and other disorders associated with dysregulated sleep. In this review, we discussed recent advances in neurobiology of sleep-wave cycle and common sleep disorders. Understanding these mechanisms are important in the diagnosis, treatment and prevention of these common disorders.
A 60-year-old man presented with an unusual history of lower limb flushing. A CT scan suggested a pancreatic neuroendocrine tumor. After a robotic distal pancreatectomy, his symptoms completely resolved. The tumor was positive for synaptophysin and chromogranin. This case emphasizes the importance of recognizing atypical features in patients, especially with an unusual skin presentation that might indicate rare tumor types.
Syed Taseer Abbas Jaffar*, Sajjad Yousefi Oderji, Si-an Zhang and Long-zhu Chen
This study investigated the effect of Portland cement on stabilization of heavy metal contaminated clayey soils that may give range of geo environemntal benefits. The absolute concentration of heavy metals: Lead (Pb), Zinc (Zn), Chromium (Cr), Cadmium (Cd) and Copper (Cu) were measured using an inductively coupled plasma atomic emission spectroscopy (ICP-AES). A series of laboratory scale experiments such as unconfined compression test (UCT), pH test and synthetic precipitation leaching procedure (SPLP) were performed to study the effects of curing time and cement content on the unconfined compressive strength (UCS) and leaching characteristics of heavy metals. According to results, excessive concentration of heavy metals are present in the topsoil of Shanghai Jiao Tong University (SJTU) among which Pb, Zn and Cd were most prominent. Other test results showed that the dry density of both C4 and C8 soil samples increases with curing time. Similarly the compressive strength (qu)of C4 and C8 samples at 21 d of curing increases by 40% (113 kPa-288 kPa) and 15% (745kPa-864 kPa) respectively, as compared to the 7 d of curing. Besides, the test results showed a prominent decrease in the leached concentration of heavy metals with increasing curing time.
Krema ZA, Mokthar ES, El Magrahi HS, Eshwika A, Ellabib MS, Cogliati M
Background: Melanin production due to phenoloxidase activity is a distinctive property of Cryptococcus neoformans and Cryptococcus gattii species complex yeasts. Therefore, an agar medium containing a precursor of melanin pigment is potentially useful to identify and differentiate cryptococcal colonies from other yeasts.
Background: This study aimed to evaluate and compare the ability of Cryptococcus neoformans species complex isolates to produce brown-pigmented colonies when grown on media prepared from various plant leaves or seeds extracts.
Material and Methods: Forty-six C. neoformans species complex isolates which were obtained from various environmental and clinical samples were inoculated on different media containing coriander, cumin, soybean, lupine, flax, pumpkin, basil, peppermint, and marjoram, were observed for the rate of growth and pigment production during a five-day period.
Results: All isolates were pigmented on all media within 24-48 hours, and brown or dark brown colonies were observed in less than five days, while C. albicans grew but did not produce any pigment.
Conclusion: The differential media tested in the present study are simple and inexpensive, and represent alternative valid tools for presumptive identification of C. neoformans species complex from clinical and environmental samples.
Mohamed H, Krema Z, Mokthar E, Ellabib M, El Magrahi H, Eshwika A
Introduction: Candidiasis is more frequent in human immunodeficiency virus (HIV)-infected patients and knowledge about the distribution and antifungal susceptibility of oral Candida species is important for effective management of candidiasis.
Material and Methods: An oral rinses sample collected from hundred HIV-infected patients with and without clinical evidence of oral candidiasis in this study at the Infectious Department/Tripoli Medical Center, Libya. Species identified by standard phenotypic and conventional methods and in vitro susceptibility testing of the yeast isolates to antifungals were performed using the Disc diffusion method protocol as recommended by the Clinical Laboratory Scientific Institute.
Results: Oral Candida colonization is detected in all patients with and without clinical syndromes, and Candida albicans were accounted for (74%), C. dubliniensis (11%) and C. glabrata (6%). A high proportion of Candida species (42%) showed decreased susceptibility to fluconazole. Among C., albicans more than 30% of isolate were resistant to most new azole antifungal including fluconazole, itraconazole, posoconazole and voriconazole.
Conclusions: A significant number of oral Candida species particular Candida albicans exhibiting decreased susceptibility to fluconazole were isolated from colonized HIV-infected individual, given the high incidence and severity of fungal infections in HIV-infected individuals. The results of this study reinforce the importance of antifungal susceptibility testing, which contributes to the therapeutic strategies and highlights the need for continuous surveillance of Candida colonization in this population.
Objectives: The aim of this study is to compute the radiation attenuation parameters such as mass attenuation coeffi cient, linear attenuation coefficient, half value layer, mean free path, and effective atomic number for some selected chemotherapy drugs such as Lomustine, Cisplatin, Carmustine, and Chlorambucil in the energy range from 1 keV to 100 GeV.
Materials and Methods: The mass attenuation coefficients were calculated with the help of WinXCOM program. Using the obtained mass attenuation coefficients, other parameters such as linear attenuation coefficient, half value layer, mean free path, and effective atomic number were derived.
Results: It is observed that the variations of these parameters with respect to the photon energy show changes in different energy regions. According to the obtained results, Cisplatin has the highest mass attenuation coefficient, linear attenuation coefficient and effective atomic number results among the selected chemotherapy drugs. Moreover, Chlorambucil has the highest half value layer and mean free path results among the selected chemotherapy drugs.
Conclusion: The results of this study are useful for applied science fields such as radiation physics, pharmacology, and medical physics. These results may be useful when the selected chemotherapy drugs are used together with radiology.
The micro dialysis procedure is a technique that has been established for some years. Although free radical reaction is a part of normal metabolism, sustained elevation of noradrenaline (NA) in the extracellular fluid can be autoxidized, which in turn leads (possibly by an in direct mechanism) to the formation of cytotoxic free radicals. Reactive oxygen causes excessive Na+ entry through the fast Ca2+ channel, leading to intracellular Ca2+ overload through the Na+-Ca2+ exchange system. However, the interaction between intracellular Ca2+ overload and oxygen free radicals in myocardium is not clear. Angiotensin converting enzyme (ACE) inhibitor is associated with cardioprotective effect due to suppression of NA-induced hydroxyl radical (•OH) generation in the heart. Low-density lipoprotein (LDL) oxidation may be related to NA induced •OH generation. Although the neuroprotective effects of nitric oxide (NO) is discussed, NO contributes to the extracellular potassium concentration ([K+]o)-induced •OH generation via NO synthase (NOS) activation. Opening of ATP sensitive K+ channel (KATP) channel may cause •OH generation. These finding may be useful in elucidating the actual mechanism of free radical formation in the pathogenesis of heart disorders.
Kunal Chowdhary, Gurinder Kaur, Kapil Sindhu, Muzzafar Zaman*, Aliya Shah, Rohit Dang, Ashish Kumar, Jose John Maiakal and Ashutosh Bawa
Background: Laparoscopic cholecystectomy is gold standard and most widely performed surgery for gallstone disease all over the world. Surgeons entering into the field of laparoscopic surgery for the first time faces challenges that are different from those with experienced hands. We in this study tried to enumerate the various such challenges and also recommend few steps to counter them.
Aims & Objectives: To study the challenges faced by new surgeons in laparoscopic cholecystectomy and recommendations to reduce them.
Material & Methods: This study was carried out in a medical college in the department of General and Minimal Access surgery. In this retrospective study, ten general surgeons working as senior residents in in this medical college over a period of 3 years having never performed laparoscopic surgery in past were included.
Results: A total of 50 cases, five operated by each surgeon with minimal assistance by senior surgeon in few cases. Operative time varied from 90 to 120 minutes. The various technical challenges faced by the new surgeon were in the Creation of Pneumoperitoneum, Creation of second port (epigastric port 10mm), Gallbladder Retraction and Dissection at calot’s triangle, Dissection at gallbladder bed and Removal of the gallbladder from epigastric port.it has been observed that following various simple steps will abate these technical difficulties for these beginners while doing laparoscopic cholecystectomy.
Conclusion: Laparoscopic cholecystectomy is the most commonly performed minimal access surgical procedure nowadays and almost all the new surgeons enter the world of laparoscopic surgery via this surgery. Knowing and following the above recommendations will help them abate the technical challenges generally faced during the initial phase in the laparoscopic field.
A gossypiboma is a mass of cotton material from any source, left in a body cavity after a surgical procedure. This enhances the morbidity, cost of treatment and potential mortality to the patient with the addition of medicolegal issues. We report a case of a 32 year old lady who presented with complaints of central abdominal pain and vomiting for 1 month, fever for 20 days and non-passage of flatus and faeces for 5 days. She had undergone a total abdominal hysterectomy 4 months prior. On clinical examination, adhesive small intestinal obstruction was suspected. On CECT evaluation, a gossypiboma was suggested to have possibly migrated into the small bowel. Laparotomy revealed the presence of clumped bowel loops, which on dissection got torn and showed a gauze like material within the bowel lumen. A diagnosis of gossypiboma with intestinal migration of a retained surgical sponge was ascertained. The possibility of a gossypiboma, particularly in previously operated cases, must be kept in mind and measures must be taken to prevent such incidences.
Abdullah Dawar, Zahir Shah*, Saeed Islam, Muhammad Idress and Waris Khan
The main purpose of this investigation is to inspect the innovative conception of the magneto hydrodynamic (MHD) nanoparticles of single wall carbon nanotubes base on the fluids (water, engine oil, and ethylene, glycol and kerosene oil) between two rotating parallel plates. Carbon nanotubes (CNTs) parade sole assets due to their rare structure. Such structure has significant optical and electronics features, wonderful strength and elasticity, and high thermal and chemical permanence. The heat exchange phenomena is deliberated subject to thermal radiation. Kerosene oil is taken as based nano fluids because of its unique attention due to their advanced thermal conductivities, exclusive features, and applications. The fluid flow is presumed in steady state. With the help of suitable resemblance variables, the fundamental leading equations have been converted to a set of differential equations. To obtain the solution of the modeled problem, the homotopic approach has been used. The influence of imbedded physical variables upon the velocities and temperature profiles are defined and deliberated through graphs. Moreover, for the several values of relevant variables, the skin fraction coefficient and local Nusselt number are tabulated. Plots have been presented in order to examine how the velocities and temperature profile get affected by various flow parameters.
Non-chain HF (DF) lasers are the most suitable and ecologically safe source of powerful and energetic coherent radiation in the 2.6-3.1 cm (HF laser) and 3.5-4.1 cm (DF laser) spectral regions. Among the different methods of HF (DF) pulse and pulseperiodic laser creation suggested by our team under the guidance of Academician A.M. Prokhorov was self-sustained volume discharge (SSVD).It is well known that a SSVD can be established in a gas by creating a primary electron density that exceeds a certain minimum value nmin throughout the discharge gap. Various methods for the preionization of the gas in the discharge gap have been developed for this purpose. Using these methods, primary electrons can usually be created directly in the discharge gas, which sometimes causes difficulties in the establishment of the conditions necessary for the formation of SSVD. For example, high voltages are needed for the formation of an initial plasma when the preionization source and active medium are combined in the same volume, whereas preionization with ultraviolet radiation may be ineffective because of the strong absorption of such radiation in a medium. In the case where soft x-rays are used, it is necessary to ensure rigid synchronization of the x-ray and pump sources. In the mixtures of gases typical of CO2 lasers, electron losses due to the trapping process are relatively small at low values of E/p. The trapping coefficient is considerably smaller than the absorption coefficient of ultraviolet radiation for the same mixtures. In principle, it should be possible to create primary electrons at the density needed for the formation of a SSVD at a considerable distance from an ionization source, and then to transport the electrons to the gap by drift in an electric field. We have investigated and confirmed this physical matter experimentally [1]. A SSVD formation method that works by filling the discharge gap with a flux of electrons drifting in an electric field, without preliminary ionization of the whole discharge volume, was proposed and implemented by our team. The electron source was a plasma formed in an auxiliary discharge initiated under a grid cathode. This method also made it possible to establish a SSVD in a system with a strongly inhomogeneous electric field in the discharge gap [1].
Background: There is a huge gap in the U.S. health care system when it comes to the prevention of substance abuse and addiction, specifically involving adolescents. It has been determined through literature review that parents in Utah are not informed about/knowledgeable of/aware of the current usage of alcohol/drugs in the adolescent population in this area or the inherent risks involved with consumption/use/misuse/abuse/addiction.
Aim: The overarching aim of the doctoral project was to prevent Utah County middle school students from harmful alcohol and drug consumption by involving parents in prevention efforts. The prevention goals of this project included: increased parental knowledge of the brain disease of addiction, warning signs of adolescent drug use, what to do if their child is already using, and increased parental self-efficacy on communicating with teens on this subject.
Design: For parents to be productively involved, barriers were broken down through education. The DNP student completed a 15-minute presentation at five separate parent meetings that took place annually during middle school registration at Lehi Jr High.
Population: The education was for parents, foster parents, guardians, etc. of first-year middle school students only; an estimated 420 participants were in attendance.
Data collection and analysis: A pre-and post- combined self-efficacy and knowledge test was given to the attendees. Data was gathered from 117 appropriately completed tests and analyzed using a paired t-test. The results were studied to evaluate effectiveness of the program relating to parental self-efficacy and knowledge.
Findings: The presentation ultimately increased parental self-efficacy and knowledge (p-value <0.01) which in turn increases protective factors and decreases risk factors associated with adolescent substance abuse.
Conclusions: The DNP project was successful, and the results assisted in the refinement of the presentation for sharing on a mass level to all Jr. High schools in Utah County, Utah.
Somia Osman, Gehan Farid* Reem Mohamed Kamal , Sarah Rabie Ali and Mohamed AH Swaraldahab
<h2>Abstract</h2><p><strong>Objectives: </strong>To highlight and determine the maternal and neonatal outcome and associated risks for patients who have undergone their 6th and more caesarean sections. </p><p><strong>Design: </strong>Case control study.</p><p><strong>Setting:</strong> Tertiary Centre (Security Forces Hospital – Riyadh – Saudi Arabia).</p><p><strong>Patients:</strong> 80 patients selected to study group who have undergone their sixth and more caesarean sections in Security Forces Hospital. Between June 2006 and May 2010. This group was compared to 80 patients who have undergone their third to fifth caesarean sections during the same time period and immediately following the studied case.</p><p><strong>Main outcome measured: </strong>Age and parity of women in study and the control group were correlated with the number of previous caesarean sections. Intra operative and post-operative maternal complications including presence and grade of adhesions, intra partum and postpartum hemorrhage, use of measurement and methods (both medical and surgical) to control bleeding such as Bakry balloon, Internal iliac artery ligation, etc., were highlighted. Bowel injury, blood transfusion, admission to surgical intensive care, incidence of placenta previa and accreta, post-operative complications like paralytic ileus, wound infection were also noted. Further, neonatal outcome including birth weight, Apgar score, and need for neonatal intensive care unit admission were reviewed.</p><p><strong>Results:</strong> Patients in the study group had higher incidence of extensive adhesions (41.25%) compared to (12.25%) in the control group. Bowel injury was (2.5%) in study group with none in the control group. The incidence of placenta previa was (8.75%) in the study group as compared to (2.5%) in the control group, with placenta accreta complicating (28.57%) of placenta previa seen only in the study group. Blood transfusion was higher in the study group (20%) as compared to (5%) in the control group.</p><p>Neonatal admission to NICU was higher in the study group (27.5%) in comparison to the control group (12.5%). Also birth weight was lower in the study group.</p><p><strong>Conclusion:</strong> The more the number of caesarean sections, the more the maternal and neonatal morbidity.</p><p>Patients should have proper counselling during antenatal follow up about the risks of repeated caesarean sections, and offered bilateral tubal ligation after the third or fourth caesarean sections.</p>
Susanne Buechner*, Gabriele J Sixt and Igor Florio
Herpes simplex virus (HSV)-1 encephalitis is the most common infectious cause of sporadic encephalitis. Despite treatment with acyclovir, HSV encephalitis is still associated with severe morbidity characterized by persistent neurological deficits. HSV encephalitis usually follows a monophasic course, however, some patients might develop relapsing symptoms caused by the formation of auto-antibodies directed against the N-methyl-D-aspartate receptor (NMDAR). Here we present an 82-year-old male patient with HSV encephalitis who developed shortly after his hospital discharge a Post-HSV NMDAR encephalitis, characterized by recurrent epileptic seizures and deterioration of his residual aphasia. First-line immunotherapy with intravenous immunoglobulins (IgIV) was administered and the patient returned almost to his baseline residual deficits of HSV encephalitis. Subsequently, he presented with recurrent relapses of NMDAR encephalitis. Since periodic treatment with IgIV has been started the patient is seizure-free and his neuropsychiatric condition is stable. In conclusion, the recognition of Post-HSV NMDAR encephalitis is very important because neurological manifestations can markedly improve with immunotherapy. Interestingly, in some patients cerebral HSV infection seems to trigger a chronic inflammatory disorder with persistent autoimmune activation which requires chronic treatment.
Hultin Sebastian*, Nguyen Tam and Murali Karumathil
Background: AngioJetTM rheolytic thrombectomy has been used in the treatment of deep vein thrombosis (DVT) to prevent post-thrombotic syndrome. Though not widely appreciated, it has the potential to cause intravascular haemolysis.
Report: A 37 year old man with no previous medical history presented to his GP with a three week history of progressive right upper limb swelling. Doppler imaging confirmed right upper limb DVT and CT scan demonstrated thoracic outlet syndrome. The patient underwent AngioJetTM thrombectomy followed by IV heparin infusion. Successful revascularisation of the occluded vein was achieved. Overnight he developed haematuria, which was initially attributed to IV heparin. Urinalysis however revealed no red cells or casts. Apart from an Hb drop from 134 to 117 his blood profile and blood film showed no abnormality. He subsequently developed progressive oliguria with marked oedema and acute kidney injury (AKI). His creatinine peaked at 1070umol/l at 96 hours post procedure and he was started on intermittent dialysis. He remained dialysis dependent for 6 days. Ultrasound imaging excluded urinary obstruction. Autoimmune and vasculitic serology were negative. Intravascular haemolysis and haemoglobinuria was confirmed by raised LDH (1714u/L) and low haptoglobin (<0.1units). Direct Coomb’s test, Cold agglutinin test and paroxysmal nocturnal haemoglobinuria screen were negative. The patient’s renal function normalised over 3 months.
Conclusions: The likely cause of this man’s AKI is heme pigment nephropathy from intra-vascular haemolysis. Increased awareness of this condition may allow early identification and intervention to reduce the risk of renal injury from AngioJetTM associated haemolysis.
The discipline of Hassidic Philosophy, which emanates from a particular movement in Orthodox Judaism called Hassidism, begins with the premise that all of creation is a dichotomous world of opposites with both sides in a perpetual conflict with one another. The human construct is therefore a dichotomous spiritual entity manifested in the physical world through a mind-body. One side of this soul is the Godly intellect giving rise to the human identity or self-awareness and the other side is the animal soul whose purpose is to galvanize the body. Having learned that this discipline provides its followers with tools for behavioral transformation through inner conflict resolution, I find that it offers a clearer understanding of the spiritual component of holistic health and nursing theory as well as a tool for behavioral transformation that has practical application in nursing practice. Therefore, the purpose of this paper is to present the basic constructs of Hassidism as it pertains to human behavior, demonstrate its compatibility with existing nursing theory and offer a new methodology for advanced practice nurses (APN’s) to assist their clients in achieving behavioral transformation through inner conflict resolution.
Hassan Ahmed Hashem*, Yasser Hamed Mustafa, Abdelazim M Reda, Sameh Azab and Ahmed M Solaiman
Background: The use of brain magnetic resonance imaging (MRI) for evaluation of neurological disorders has increased in the past two decades. This has led to an increased detection of incidental findings on brain MRI.The most common of these asymptomatic abnormalities are white matter lesions that are interpreted as demyelinating based on radiological criteria. However, in the absence of associated clinical symptoms suggestive of multiple sclerosis (MS), a definite diagnosis of MS can’t be made in patients with these incidental white matter lesions. These patients are diagnosed as CIS (clinically isolated syndrome) and RIS (radiologically isolated syndrome).Using the revised McDonald criteria now allows some patients who would have been diagnosed with CIS to be diagnosed as having MS before a second episode.
Method: Sixty one patients, 40 females and 21 males, age ranged between 15 years and 58 years, were included in our study. In addition to a detailed medical and neurological history and examination, CSF and blood analysis for oligoclonal bands and IgG index were performed for all patients.
Result: 41 patients had positive oligoclonal bands and IgG index. After clinical, MRI results and laboratory results 44 (72.1%) were diagnosed CIS and 17 (27.9%) were RIS.
Conclusion: Diagnosis of MS not depend only on MRI finding but need clinical and laboratory work up including CSF and blood analysis for oligoclonal bands and IgG index to confirm diagnosis.
Giuseppe De Vincentis, Mariano Pontico, Maria Ricci, Viviana Frantellizzi* and Mauro Liberatore
The presence of an incidental finding, defined as an abnormality which is unrelated to the initial scanning indication, is widely increases due to the access to new devices and imaging modalities. This growing number of incidental findings can lead to additional medical care including unnecessary tests nevertheless, in a minority of patients, can lead to diagnosis of an important and unexpected condition that could be crucial for the patient. We reported three cases in which nuclear medicine imaging, performed for different reasons and showed a relevant and unexpected pathology. In the case 1, a bone scan, performed in a 66 aged woman for breast cancer staging, allowed the diagnosis of a uterine fibroma. In the case 2, a HMPAO labeled-WBC scintigraphy performed because of a suspect of osteomyelitis, showed a remarkable heart-shaped photopenic area, highly suggestive of cardiac global dilatation. In the case 3, a 62 aged man referred to bone scintigraphy for the staging of recent diagnosed lung cancer. The bone scan allowed the diagnosis of a meningioma. Therefore, the occurrence of incidental findings could lead to reveal relevant abnormalities for the diagnostic pathway.
Obesity is a chronic and metabolic disease with a high increasing prevalence worldwide. It has multifactorial pathogenesis including genetic and behavioral factors [1-5]. Overweight and obesity have been defined and classified by the World Health Organization (WHO) and the National Institutes of Health (NIH) [2,3].A person with a normal weight has Body Mass Index (BMI) of 18.5-24.9. A person with a BMI under 18.5 is called underweight. An adult having a BMI of 25-29.9 is overweight and pre-obese. Class 1 obesity is defined as a BMI between 30.00-34.99. Class 2 (Severe) Obesity is to have a BMI between 35.00-39.99. Morbid (Extreme, Class 3) obesity is to have a BMI over 40 [1-5]. Obesity is significantly associated with enhanced morbidity and mortality rates. It has also various economic, medical and psychological effects and causes health problems including many systemic diseases, economic costs and burdens, social and occupational stigmatization and discrimination and productivity loss [4-6]. Obesity carries the increased risk of development of many systemic and chronic diseases, including sleep apnea, depression, insulin resistance, Type 2 (adult-onset) diabetes, Gout and related arthritis, degenerative arthritis, hypertension, dyslipidemia, heart disease such as myocardial infarction, congestive heart failure, or coronary artery disease, polycystic ovary syndrome and reproductive disorders, Pickwickian syndrome (obesity, red face and hypoventilation), metabolic syndrome, non-alcoholic fatty liver disease, cholecystitis, cerebrovascular accident, colonic and renal cancer, rectal and prostatic cancer in males, and gallbladder, uterus and breast cancer in females [6-12].
To repair articular cartilage (AC) defects in osteoarthritic patients, one approach is to engineer threedimensional grafts with physicochemical properties similar to endogenous AC. Such grafts can be grown in bioreactors that provide environmental conditions favoring chondrogenesis.Studies show mechanical stimulation during the culturing process greatly enhances development of functional engineered grafts. A review of literature on bioreactor options reveals a lack of capacity to simultaneously stimulate cells with a combination of shear stress and oscillating hydrostatic pressure, both of which are important parts of the in vivo AC environment. It is hypothesized that combining both forces in a new bioreactor design will contribute to better AC tissue growth. In this paper, we provide a brief review of bioreactors and describe a new computer-controlled perfusion and pressurized bioreactor system, and the novelty of its control programming features for service in a host of applications. We briefly summarize results on synergistic effects in employing perfusion, oscillating hydrostatic pressure in a scaffold free environment and with the addition of encapsulation for inducing chondrogenesis. We further describe efforts to modify the newly developed system to include a continuous flow and pressurized centrifugal mode to enhance further the capabilities for inclusion of very high shear stresses. Applications for several other cell and tissue engineering approaches are discussed.
Veronica Atterhem, Magnus Hultin and Tomi Myrberg*
Context: Perioperative management of morbidly obese patients undergoing bariatric surgery is challenging. Lacking standardized perioperative protocols, complication rates may be high. This retrospective study aims to quantify the incidence of significant blood pressure decreases on induction of anesthesia and intraoperative hypoxemia, before implementation of a standardized protocol designed for bariatric surgery.
Design: Retrospective, observational study.
Setting: A 250-bed county hospital in northern Sweden.
Subjects: 219 morbidly obese patients (body mass index > 35 kg/m2) who underwent bariatric surgery between 2003 and 2008.
Main outcome measures: Incidence of systolic blood pressure (SAP) falls to less than 70% of the preoperative baseline during induction of anesthesia and incidence of perioperative hypoxemia.
Results: The incidence of confirmed SAP falls to below 70% of baseline at induction of anesthesia was 56.2% (n = 123/219). This incidence rose with increasing age (p < 0.001) but not with body mass index (BMI). 3.7% (n = 8/219) of cases were marked as difficult intubations. A transient period of hypoxemia was observed in 6.8% (n = 15/219) and was more common with increasing BMI (p = 0.005). Fourteen different drug combinations were used in the study population. Of those administered an induction anesthetic drug, 72.6% (n = 159/193) were given an overdose when calculated by lean body weight, but this did not correlate significantly to SAP falls (p = 0.468).
Conclusion: The incidence of a significant blood pressure fall upon induction of anesthesia was common. The incidence of airway and ventilation problems were low. Overdosing of anesthetics and excessive variation in applied anesthesia methods were found.
Olivier Duc, Emilie Betrisey, Enrico Di Bella, Ivo Krejci and Stefano Ardu*
Objectives: To evaluate the colour stability of 3 recently developed resin based materials continuously exposed to various staining agents.
Methods: 144 disc-shaped specimens were made of each of the 3 tested composites (Essentia, Brillant, Inspiro). Half of them were of 1mm thickness, the other half 1.2mm thickness. The thicker group was than polished up to 4000 grit and reduced to 1mm thickness, too. All specimens after 24 h dry storage in an incubator (INP-500, Memmert), received an initial colour measurement by means of a calibrated reflectance spectrophotometer (SpectroShade, MHT, Niederhasli, Switzerland). Specimens were then divided into 6 groups (n=6) and immersed in 5 staining solutions or artificial saliva (control). All specimens were kept in an incubator at 37°C for 28 days. Staining solutions (red wine, curry mixed water, curry mixed oil, tea and coffee) were changed every 7th day to avoid bacteria or yeast contamination. After 28 days of storage spectrophotometric measurements were repeated and L*a*b* scores once more recorded to determine the colour (ΔE00) changes.
Results: All tested materials showed significant color changes after 28 days staining immersion.
When considered over a black background ΔE00 of polished samples varied from 1.7 (Brillant/distilled water) to 24.1 (Brillant/wine).
When considered over a white background ΔE00 of polished samples varied from 1.1 (Essentia/distilled water) to 32.5 (Inspiro/wine).
When considered over a black background ΔE00 of unpolished samples varied from 1.1 (Essentia, Inspiro/distilled water) to 25.8 (Essentia/wine).
When considered over a white background ΔE00 of unpolished samples varied from 1.4(Inspiro/distilled water) to 33.1 (Inspiro/wine).
Conclusions: Staining of restorative materials seems to be dependent on the composition of the product itself. Unpolished samples demonstrated to be more prone to staining than the polished ones
Climate change brings extreme events like drought, landslide, flood and anticipated more constraint to profitable livestock production causing huge economical loss in the livestock sector of the country. Deaths of livestock and damage to farms and farm infrastructure is causing a huge loss, small livestock holders are highly venerable to such climatic hazards. So to cope with these uncertain climatic hazards livestock insurance is the one of the best strategies. This study reveals that different climatic hazards is been experienced by the livestock holders of Kaski, Dolakha and Jhapa district of Nepal, 62% of the respondent has observed the change in climate. Of the total respondents perceived around 47% farmer have insured their livestock in Kaski district, 33% in Jhapa and 20 % in Dolakha district. Beside the proper vaccination, deworming, management and feeding of animals people are insuring their livestock assets due to uncertain in the climatic pattern and its consequences, this shows that livestock insurance is the one of the tool to mitigate with changing climate and climate relate hazard in livestock sector of Nepal.
Heba A Alqurashi, Ghada Al-Salmi, Mohammad A Al-Muhaizea and Sulaiman M Al-Mayouf*
Demyelinating peripheral neuropathy has been described in association with tumor necrosis factor (TNF) inhibitors. It is rarely developed after treatment discontinuation. We present the case of a child with juvenile idiopathic arthritis who developed peripheral neuropathy few months after TNF inhibitor withdrawal with clinical worsening of the neurological sequelae while undergoing treatment with abatacept.
Seriki A Samuel*, Adebayo O Francis and Odetola O Anthony
Hypertension is one of the most common chronic diseases of human, affecting more than one billion people worldwide. When it becomes chronic, hypertension leaves behind cardiac hypertrophy, heart failure, stroke, and kidney disease, resulting in substantial morbidity and mortality. Treatments that effectively reduce blood pressure can prevent these complications. Abnormalities in the production of urine by the kidneys have been implicated in increased vascular resistance, leading to high blood pressure and increased cardiac mass. By matching urinary excretion of salt and water with dietary intake, balance is usually attained, thereby maintaining a constant extracellular fluid volume and blood pressure. Based on the capacity for the kidney to excrete sodium, this blood pressure-altering mechanism should have sufficient advantage to limit intravascular volume and consequently lower blood pressure in response to a range of stimuli from elevated heart rate to increase peripheral vascular resistance. A major determinant of the level of intra- and extra- renal blood pressure is therefore sodium handling, and it is controlled by complex physiological mechanism by hormones, inflammatory mediators, and the sympathetic nervous system. Homoeostasis and favourable influence sodium balance are a basic mechanism of efficacy for diuretics and dietary sodium restriction in hypertension. Renin Angiotensin System (RAS) inhibitors, vasodilators, and β-blockers work to facilitate pressure-natriuresis. Also, WNK signaling pathways, soluble inflammatory mediators, and pathways regulating extra-renal sodium disposition may be the focus towards elimination of sodium and reducing blood pressure in hypertension.
<h2>Annotation</h2><p>We are able to test with statistic method Based Evidence Medicine the new Medicaments on common World Market or the new Medical Devices - Orthopaedic implants. Of course, with usage the same principles we could Tests similar ways the explicit efficiency, legalities and Technical Requirements Laws by Medical processing for implanting by standard Health care in Orthopaedic Clinics in network OECD.</p>
Yaméogo NV*, Tougouma SJ-B, Zabsonré J, Kologo KJ, Tiemtoré WS, Kagambega LJ, Bagbila WPAH, Traore A, Samadoulougou AK and Zabsonre P
Introduction: Systemic lupus is a disseminated inflammation of the conjunctive tissue. Cardiovascular lesions are the first cause of morbidity and mortality in the course of that disease. These lesions are prevalent in 30 to 62% of cases, depending on whether the diagnostic tool is clinical, echocardiographic, or autopsic. Any part of the heart can be affected, yielding manifestations of pericarditis, endocarditis, coronary heart disease, conduction disorders, and rarely myocarditis.
Objective: Describe cardiac manifestations during the follow up of patients diagnosed with systemic lupus.
Patients and Methods: We conducted a transversal descriptive study over a period of 27 months, in the departments of Internal Medicine, Dermatology, and Cardiology of Yalgado Ouedraogo University Hospital of Ouagadougou. All patients diagnosed with systemic lupus according to the American College of Rheumatology criteria, and having done an EKG, a Holter EKG, or a transthoracic echocardiography, were included in the study. Data were collected from inpatient medical records, outpatient follow up registry and booklets.
Results: Cardiovascular lesions were prevalent in 7 cases (43.75%) out of 16 patients diagnosed with systemic lupus. Mean age of patients was 36 years, with extremes of 23 and 51 years. Only female patients were affected in our study. Cardiac manifestations were mainly benign pericarditis, heart failure, and conduction disorders.
Conclusions: Cardiovascular manifestations are frequent during the course of systemic lupus, and occur after few years of disease progression. Transthoracic echocardiography and EKG remain useful non-invasive explorations for the assessment of cardiovascular lesions, despite minor shortcomings.
Sah BP*, Chettri ST, Karki S, Shah SP, Manandhar S and Jaiswal RK
Leiomyosarcoma is a malignant smooth-muscle tumor that has a predilection for the gastrointestinal and female genital tract and is a rare entity in the paranasal sinuses. It is locally fast-spreading and highly aggressive, and the prognosis is poor. We report a rare case of leiomyosarcoma of the maxilla in a patient who sought treatment for maxillary swelling, nasal obstruction with no epistaxis, orbital involvement or cervical lymph node metastasis. The patient underwent total maxillectomy followed by radiotherapy. At present after 5 years of follow up, he is symptom free with no recurrence.
Luisetto M*, Ghulam Rasool Mashori, Behzad Nili-Ahmadabadi, Farhan Ahmad Khan and Kausar Rehman Khan
Depression: According Pubmed Health: Depression is a state of low mood and aversion to activity that can affect a person’s thoughts, behavior, feelings and sense of well-being (moderate or severe).
Can we consider some depression status due to high amount of some stressant stimulus? Or continuous stress in a limited (or long) period? How can react mindset and brain in management an high amount of negative stressing thinking? Observing some relevant literature also mindset kinetics must be considered to better classify this kind of disorder under a specific endogenous –exogenous biochemical-toxicological aspect.
Concept like Kinetics, reaction velocity limits, saturation of the systems, residual buffer properties are currently used in biochemistry and related discipline.
This concepts can be applied also in some depression condition to better explain some phenomena?
Medical postgraduate trainees are given increasing levels of responsibility during training in the apprenticeship-model of training [1-3]. Responsibility is said to be a key driver of deep learning and understanding [4-7]. Trainees with greater levels of responsibility for decision making have higher levels of motivation to learn compared with trainees who self-assess as having less autonomy [5].
Martin Rosas-Peralta, Gabriela Borrayo-Sanchez*, Erick Ramirez-Arias, Gladys M Jimenez-Genchi, Martha Alicia Hernandez-Gonzalez, Rafael Barraza-Felix, Lidia Evangelina Betacourt-Hernandez, Rocio Camacho-Casillas, Rodolfo Parra-Michel, Hector David Martinez Chap and Jose de Jesus Arriaga-Davila
Atherosclerotic cardiovascular disease (ASCVD) is globally defined as coronary heart disease, cerebrovascular disease, or peripheral arterial disease presumed to be of atherosclerotic origin and it is the leading cause of morbidity and mortality for individuals with or without diabetes and is the largest contributor to the direct and indirect catastrophic costs of cardiovascular disorder. Very common conditions coexisting into the cardiovascular risk (e.g., obesity, hypertension, diabetes and dyslipidemia) are clear risk factors for ASCVD, and diabetes itself confers independent risk. Numerous studies have shown the efficacy of controlling individual cardiovascular risk factors in preventing or slowing ASCVD in people with these disorders. In other words it is not enough control one risk factor. We need to develop novel strategies to detect and control all of them at the same time. Thus, large benefits are seen when multiple cardiovascular risk factors are addressed simultaneously. Under the current paradigm of aggressive risk factor modification in patients with cardiovascular risk, there is evidence that measures of 10-year coronary heart disease (CHD) risk among U.S. adults with cardiovascular risk have improved significantly over the past decade and that ASCVD morbidity and mortality have decreased. In Mexico the Mexican Institute of Social Security is implementing new strategies of primary and secondary prevention in order to confront this pandemic.
In this review, we analyze the state of the art to approach at the same time the different cardiovascular risk factors, in an integral form because of this is the real worldwide challenge of health.
Like many tropical countries, Sudan has ample biomass resources that can be efficiently exploited in a manner that is both profitable and sustainable. Fuel-wood farming offers cost-effective and environmentally friendly energy solutions for Sudan, with the added benefit of providing sustainable livelihoods in rural areas. This article provides an overview of biomass energy activities and highlights future plans concerning optimum technical and economical utilization of biomass energy available in Sudan. Results suggest that biomass energy technologies must be encouraged, promoted, implemented, and fully demonstrated in Sudan.
Sunitha Ramachandra*, Lakshmi Rao and Masoud Al Kindi
43-year-old lady presented with incidentally discovered liver lesions while she was being managed for her complaints of menorrhagia. CT and MRI showed hepatomegaly with multiple lesions in both lobes of the liver with vascular element in the background of diffuse fatty infiltration. Patient underwent laparoscopic core biopsy. Histopathology showed extensive steatosis, intracytoplasmic giant mitochondria and absence of portal tracts, features highly suggestive of hepatic adenomatosis. IHC staining showed membranous and cytoplasmic positivity in hepatocytes for B-catenin consistent with multiple hepatic adenomatosis. Hepatic adenomatosis is a new clinical entity in the hepatological practice characterized by the presence of 10 or more nodules in the liver known for its major complication of bleeding. Hepatic adenomatosis is managed by regular imaging and resection of large (> 5cm) superficial and painful adenomas along with liver function tests and tumor markers to rule out malignant transformation. However, the potential cure being the liver transplantation.
Gerday A*, Marbaix E, Squifflet JL, Mazzeo F and Luyckx M
<h2>Abstract</h2><p>We describe here the case of a 23-year old woman with small cell carcinoma of the ovary of the hypercalcemic type (SCCOHT) with SMARC-A4 mutation who benefited from surgery in two steps leading to a total hysterectomy with bilateral salpingo-oophorectomy, omentectomy, pelvic and lombo-aortic lymph nodes dissection. She also received 6 courses of poly-chemotherapy after the surgery. A close follow-up was then performed by clinical examination every three months with determination of serum calcium and CA125 level as well as imaging with thoraco-abdominal CT scan. To date, the patient has a disease-free survival of more than 9 years. We also reviewed the literature on this topic and discuted the new diagnostic and prognostic genetic tool SMARC-A4 mutation.</p>
Chronic occlusive arterial disease of the periphery is primarily caused by atherosclerotic disease. In young patients with no identifi able risk factors for atherosclerosis, who present with symptoms of claudication or critical ischemia, other rare causes need to be suspected. Cystic adventitial disease is one such condition affecting young healthy patients. Although it has been reported most commonly in relation to the popliteal artery, other sites including the iliac artery can also get affected. Isolated short segment stenosis or occlusion can lead to signifi cant disabling symptoms restricted to one side. Imaging studies show pristine arterial anatomy with no evidence of systemic atherosclerotic disease and an isolated area of luminal stenosis. Defi nitive treatment involves open surgical excision with interposition grafting for optimal long-term results. We report a case of cystic adventitial disease affecting the external iliac artery in an otherwise healthy young man.
<h2>Introduction</h2><p>Everyone can be placed somewhere on an exercise continuum with the idle at one end and the hyperactive at the other. At both extremes, health suffers. Exercise is essential to health and managing it is the responsibility of individuals but few know what they should do. Doctors seldom teach how to be healthy and act only when repair is needed.</p>
Broad medleys of research have recognized the microglial activation in perilous psychiatric maladies such as schizophrenia, bipolar disorder, and major depressive disorder. There is a scenario of enlivening of peripheral monocytic cells along with the microglial interactions within the body while considering the Pathogenesis of psychiatric disorders.this review, epitomize and discuss the activation of microglia and monocytic cells in psychiatric disorders, thereby showcasing the potential association between these cell types and the Pathogenisis of the ailment , and proffer perspectives for future research on these processes.
Abdul Wahab, Gul Majid Khan*, Mohsen Sharifi, Ahmad Khan, Amjad Khan and Naqab Khan
In this investigation, solid dispersions were prepared and characterized to improve the solubility and dissolution of poorly water soluble drug Ketoprofen, using glucosamine HCl as a carrier. For the improvement of the solubility and dissolution rate of poorly water soluble drugs different techniques are used such as solubilization, salt formation, particle size reduction and solid dispersion etc, but in the present study, solid dispersions (SDs) of poorly water soluble NSAID Ketoprofen were prepared to improve its solubility and dissolution rate, using solvent evaporation method with drug-carrier ratio of 1:1, 1:2 and 1:3. Our results indicate that all solid dispersions of Ketoprofen and Glucosamine HCl exhibited more enhancements in solubility and dissolution rates than corresponding physical mixtures. The DSC thermograms and X-ray diffraction patterns showed a slight reduction in crystallinity in solid dispersions which were further verified by FT-IR and SEM. It is concluded that solid dispersion is an effective technique for enhancing the solubility and dissolution rate of poorly water-soluble drug Ketoprofen using Glucosamine HCl as a carrier. This amino sugar (Glucosamine HCl) could be used as a novel potential carrier for preparation and formulation of SDs and would have potential commercial benefits.
The Cloquet’s canal (CC) is the remnant of the primary vitreous and it disappears in the intrauterine developmental period of an eye. Rarely it can persist in mature eyes and cause low visual acuity. We detected a persistent CC and low visual acuity in a 36 year-old patient. Fundus fluorescein angiography and optical coherence tomography examinations were completely normal in our case and low visual acuity was directly associated with opacification of the fibrovascular persistent CC tissue. Persistent CC can cause low visual acuity due to directly media opacity effect of fibrovascular tissue without any complication.
Geosynthetics used in landfills provides a technical and economic advantages over traditional clay liners. It may create stability issue and even lead to landfill failure due to its low interface or internal shear strength if improperly designed and/or constructed. The most common failure mechanism in geosynthetic-lined landfills is transitional failure involving waste and bottom liner (deep-seated failure) or only final cover system (shallow failure). Shear strengths of geosynthetic-geosynthetic and geosynthetic-soil have a wide range of variations. Shear strengths of interface from literature may be used in preliminary design. For final design, site-specific interface shear strengths shall be used. Internal shear strengths of unreinforced geosynthetic clay liner (GCL) are less than those of reinforced GCLs. Unreinforced GCLs are not recommended for slopes steeper than 1:10 (1 Vertical and 10 Horizontal). Peak shear strength of interface and internal GCLs can be used in bottom liner; residual shear strength of interface and internal GCLs shall be used for geosynthetic placed along the slopes. Site-specific shear strengths of waste are recommended to be used in the design. Landfill failure could be triggered by static loadings including excessive leachate, pore pressure above the bottom liners, gas pressure, and excessive wetness of the geomembrane-GCL, and earthquake loading. The factor of safety of 1.5 is recommended for static loading and 1.0 for earthquake loading. A higher factor of safety is recommended if a failure could have a catastrophic effect on human health or the environment, and if large uncertainty exists in input parameters to calculate the factors of safety. The main objective of this review article is to provide a comprehensive knowledge of slope failure mechanisms, causes, and probable remedies in one place.
Reza Ebrahimi, Mohammad Kermansaravi and Abdolreza Pazouki*
We read with interest the case report entitled “Dieulafoy’s Lesion related massive Intraoperative Gastrointestinal Bleeding during Single Anastomosis Gastric Bypass necessitating total Gastrectomy: A Case Repor't published in Archives of Surgery and Clinical Research b Ashraf Imam et al. [1]. We appreciate the authors for managing such a complicated case and for sharing their experience but, we have some conϐlict about the management, and we wanted to add some comments regarding the importance of EGD before bariatric surgery.
An investigation into the pathological lesions of Cypermethrin on the testes, accessory sexual and pituitary glands of Yankasa rams was carried out. Sixteen Yankasa rams aged 18 - 30 months and weighing between 21.5 - 46.5kg were used. The 16 rams were divided equally into two groups (A and B) A served as the treatment group while B served as the control. Group (A) were given Cypermethrin (3%) at the dose rate of 3mg/kg (0.1ml/kg) body weight, topically. Group (B) rams were given distilled water at the same dose rate and route. These treatments were repeated every two weeks for a period of 12 weeks. The rams were sacrificed at the end of 12 weeks and the following organs (testes, pituitary, vesicular and prostate glands), were collected and weighed, gross pathological lesions were observed and photographs were taken. The samples were kept for histopathology. Results showed that there were no gross pathological lesions found on the testes, pituitary, prostate glands and the seminal vesicles of both groups. The mean weight of the pituitary gland, the prostate glands and the seminal vesicles of the treated and control groups were statistically not significant (P>0.05). No histologic lesions were found on them. The mean testicular weights of the treated (143.81±7.71g) and the control (130.43±0.63g) were significantly different (P<0.05). There was a reduced number of spermatozoa in the lumen of the seminiferous tubules of the treated group. It was concluded that Cypermethrin reduced spermatozoa in the lumen of the seminiferous tubules.
Jiawei Zhao, Zhihong Yang, Min He, Qinghua Wang and Renming Hu*
Although exercise has been proposed to be beneficial to type 2 diabetes, its effects on β-cell function and mass remain unclear. In the present study, the effects of long-term swimming training on the function and mass of β-cells in diabetic OLETF rats were examined. At 44 weeks of age after developing diabetes, the OLETF rats were divided into two groups: a control group and an exercise group. The exercise group had a daily swimming for 12 weeks. While not found with the control rats, in the obese OLETF rats, the exercise reduced the weight gain which was associated with improved glucose tolerance and elevated circulating insulin levels as determined by the oral glucose tolerance test and insulin ELISA. The exercise improved plasma total cholesterol and triglyceride levels, and also significantly increased the islet β-cell mass and pancreatic insulin content associated with decreased β-cell apoptosis and elevated activation of the serine/threonine kinase, Akt. The present studies suggest that exercise improves diabetes symptoms via enhancement of the β-cell mass and function through decreasing glucolipotoxicity and reducing β-cell apoptosis by activating Akt in obese OLETF rats.
Ruiz Alvarado Cristina*, Soto Ortiz Roberto, Cervantes Diaz Lourdes, Nunez Ramirez Fidel, Celaya-Michel Hernán and Rueda Puente Edgar O
Phytosanitary inspectors play an important role in diagnosing diseases in foreign plant material. However, some deficiencies have been detected in the detectionc ausing the entrance of many microorganisms.Therefore, it was of great interest to detect the presence of Clavibacter michiganensis subsp. michiganensis (Cmm) in foreign tomato and chili seed in the agricultural area of Sinaloa, Mexico, besides the growth and cell density of Cmm was evaluated in different selective media under continuous illumination and photoperiod. The results indicate that seeed of 35 varieties of tomatoes was collected; while for Chili seed were 18. This study was supported by farmers (225) which represent 79% of all growers and 32 business engaged in the sale of agro-supplies, provided seeds of varieties and hybrids. Those growers are from six areas (Culiacan, El Tamarindo, Navolato, Culiacan, El dorado and Badiraguato). For detection of Cmm in tomato seed, from 35, only four was variability considering Immunochromatography and ELISA techniques; however, considering chemical and physiological test, the result was negative. Similar results were in 18 varietes of chili seed, where eight showed variability to detect Cmm, and negative by chemical and physiological test. According to the growth and cell density of Cmm, the optimal medium was YDC under pH stable and continuous light conditions. It is recommended to consider the fusion of diagnostic techniques in the emission of a result.
Ibtasam Ahmad, Muhammad Haris, Amnah Javed and Muhammad Azhar*
Objectives: The prime focus of the present study was to evaluate the most occluded coronary artery (OCA) among non-ST elevated myocardial infarction (NSTEMI) patients, and risk factors associated with occluded and non-occluded NSTEMI. Also, major adverse cardiovascular event (MACE) were evaluated among patients during index hospitalization.
Methods: A retrospective, cross-sectional study was conducted in Multan Institute of Cardiology, Pakistan between 1st February, 2017, and 31st September, 2017. The data were collected from medical records of the outpatients and inpatients who were index hospitalized. Data were analyzed by using Statistical Packages for Social Sciences (IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.) And Microsoft Excel (MS Office 2010).
Results: Among 624 patients, angiographic findings revealed that 63.9% were suffering from non-occlusive NSTEMI while 36.1% of the patients had occluded NSTEMI. In occluded NSTEMI patients, 30.3% were having single vessel occlusion while 5.8% were having multi-vessel occlusion. Also, 49.8% were having occlusion of right coronary artery (CA) while 44% were having occluded left anterior descending (LAD) artery. Multivariate analysis revealed that age (p=0.001) and left ventricular ejection fraction (LVEF) (p=0.001) had a statistically significant association. The incidence of MACE was high among non-OCA patients as compared to OCA patients but no statistically significant association was found (p=0.44).
Conclusions: Angiography confirmed that most of the NSTEMI patients had OCA. But the MACE rate was not significantly differ among OCA and non-OCA patients. The risk factors associated with OCA were low LVEF and age.
Luisetto M*, Behzad Nili-Ahmadabadi, Hossein Nili-Ahmadabadi, Ghulam Rasool Mashori, Gamal Abdul Hamid, Kausar Rehman Khan, Behrooz Nili-Ahmadabadi, Ahmed Yesvi Rafa and Luca Cabianca
According to literature, about 90% of death from cancer is related to metastasis. Metastatic process present many similarity to some other biological processes. Once we have examined some relevant biomedical literature, by understanding the real causes of metastasis, it would become much more possible to introduce new therapeutic strategies to delay or in some cases even to stop this kind of killer process. Breast cancer, as an example, produces metastasis to different organs, which seems to be related to the subtype. We believe that a deep understanding of the roles of breast cancer cells and their interactions with the liver microenvironment in early breast cancer metastasis could be a crucial factor for the design and development of effective BCLM breast cancer liver metastases therapeutic strategies and to better understand the general process. Let’s suppose the secondary organ or organs can be considered as incubator/s for the primary metastatic cells. What kind of consequences we can have in therapy field if there is an active regulating role in determining the location of secondary cancers?
Let’s observe the role played by liver, bone marrow, CNS central nervous system, lungs, lymphocytes and other secondary locations/organs a little bit closer or maybe from a different angle let’s suppose we try to come up with just a hypothesis. Just let’s take this as a possibility, and we take the thread to see where it takes us.
Maurizio Falso*, Laura Forti, Silvia Iezzi, Gloria Cottali, Eleonora Cattaneo, Marco Zucchini and Franco Zucchini
Background: Supporting our adolescent people in realizing his/her self ability to reorganize and to establish a cross-linked paraspinal muscle control can be considered the most effective approach for muscle rehabilitation in adolescents affected by “AIS. Aim of this study was to evaluate the SEMG activity of paraspinal erector muscles by using an innovative dynamic and asymmetric spine brace called “BRIXIA” in the conservative treatment of patients affected by adolescent idiopathic scoliosis (AIS).
Methods: Five patients affected by adolescent idiopathic scoliosis were recruited for the aim of this study in line with an informed consent and simple inclusion criteria. Each patient underwent a first task-specific evaluation at time T0 and T1 and a secondary experimental course at time T2, T3 and T4. After a first postural and total spine X-ray evaluation, recruited patients began to use our innovative spine brace called BRIXIA (time T0 and T1). During the second experimental phase, a SEMG bilateral activity of the trunk large rhomboid, the latissimus dorsi and the quadratus lumborum was investigated without spine brace, by using a common Chenêau brace and afterwards the dynamic BRIXIA spine brace, with the acquisition of the so-called RMS SEMG Ratio value. The SEMG measurements were acquired in six study conditions: a. SiRP=Sitting Resting Position; b. SiRCP=Sitting Recruiting Position with a so-called pneumothorax thrust; c. StRP = Standing Resting Position; d. StRCP = Standing Recruiting Position; e. BA = Anterior Trunk Bending; f. BARC = Anterior Trunk Recruiting Bending. At the end of this SEMG evaluation, each patient received (for a daily use around 18 hours per day) the final version of the BRXIA spine brace and began an individualized educational postural rehabilitative treatment course (time T2). At time T3 and T4 a second and third SEMG assessment was made without using a spine brace and by using BRIXIA, with each patient evaluated in a resting condition and realizing a self-made cross-linked postural correction. Finally, a functional, radiographic and postural evaluation were made to define and quantify an amelioration and modification of patients’ postural attitude at the end of a combined rehabilitative and device supported treatment.
Findings: A comparative analysis of our SEMG data acquired in six study conditions showed different trends in all patients recruited proceeding from time T2 to time T5. Particularly, we observed at time T2 an homogeneous grade of paraxial muscle recruitment acquisition, expressed by the RMSsEMG ratio index, without using spine brace (53,3%) and by using Chêneau and BRIXIA brace (46,7%); specifically, a 57,14% of our patients used BRIXIA brace and a 42,86% Chêneau brace; the most homogeneous response was acquired in BA study condition; a symmetric paraxial muscle recruitment acquisition without using spine brace was observed in an 80% of our patients; the most grade of not homogeneous muscle activity response was observed in SiRP and StRCP study conditions; at time T3, an homogeneous grade of symmetric paraxial muscle recruitment activity, expressed by the RMSsEMG ratio index, was observed by using BRIXIA brace (56,7%); all patients recruited (100%) showed in SiRCP study condition the most homogeneous and symmetric paraxial muscle recruitment by using BRIXIA brace; in SiRP and StRCP study condition this trend was observed in an 80% of our patients with a reversion of this trend in StRP and BRAC conditions; at time T4, an immodification of the grade of symmetric paraxial muscle recruitment acquisition, expressed by the RMSsEMG ratio index, was observed in a 56,7% of patients who were using BRIXIA brace; all patients recruited (100%) showed in BARC study condition the most homogeneous and symmetric paraxial muscle recruitment by using BRIXIA brace, while in SiRP condition this trend was observed in an 80% of our patients. In a comparative and time-related analysis between our clinical and RMS data, Cobb angle trend showed a statistical significant correlation with RMS data, acquired at time T4 in BARC condition and without BRIXIA brace, and similarly with RMS data acquired at time T4 with BRIXIA brace. In line with the Visual Postural Analysis trend, our rehabilitative model showed a sensible capacity to modify patient’s individual sense of posturality, to increase the acquisition of cross-linked self-correction strategies and to induce a progressive rebalancing between the anterior and posterior kinetic muscle chains recruitment. These rehabilitative principles were perfectly in line with the perceptive and pro-rehabilitative value of our innovative BRIXIA brace.
Interpretation: This study will underline the professional attitude of all physiotherapists to use in a critical and task-specific way our dynamic and asymmetric spine orthesis called “BRIXIA”. This innovative brace allows to achieve: a. an individualized peripheral neuromodulation of patient’s sense of postural attitude (peripheral perceptive re-modulation of paraxial muscle recruitment); b. a neurorehabilitative re-learning device of postural self-correction strategies (peripheral neurosensitive facilitation of a dynamic process of motor corticalization device-related); c. an increase of patient’s quality of life in term of appearance and relational sense (life-impact device-related).
The Physical benefits of Islamic prayer on the human body are discussed in this article. The act of prayer requires the worshiper to move through several distinct bodily postures while reciting a specific supplication. Salah involves a certain level of physical activity which includes standing, bowing prostration and sitting consecutively. Each position involves the movement of different parts of the human body in ways that Some muscles contract isometrically (same length) and some contract in approximation or isotonically (same tension). The prayer movements would enhance flexibility and general muscular fitness. This results in moderate physical exercise particularly to the large muscle group and encourage health and wellbeing. Besides being an excellent form of exercise, physical activity breaks the monotony of chores.
Alopecia is associated with an increased risk of coronary heart disease, and it appears that there is a relationship between the degree of hair loss and the risk of coronary heart disease, meaning, the greater the severity of alopecia, the greater the risk of coronary heart disease. Alopecia is also associated with an increased risk of hypertension, hyperinsulinemia, insulin resistance, metabolic syndrome as well as elevated serum total cholesterol and triglyceride levels. It has not been definitively established whether patients with androgenetic alopecia have a higher cardiovascular risk or prevalence of metabolic syndrome, and results of recent studies indicate that androgenetic alopecia patients do not show differences in insulin resistance or the prevalence of metabolic syndrome. However, androgenetic alopecia patients do show a higher cardiovascular risk, characterised by increased inflammatory parameters and Lp(a) levels. Data collected from female populations are scarce, but it would be interesting to extend our clinical knowledge with this type of data to further our understanding of the connection between androgenetic alopecia, metabolic syndrome and cardiovascular risk. The divergence in results from different studies done in this context may simply be a result of the composition of the study populations with respect to age, gender, severity of alopecia, sample size and perhaps ethnicity. In this connection, a large group of androgenetic alopecia patients is necessary, including different representative groups and varying severities of alopecia. Furthermore, it is recommended that all women and men with androgenetic alopecia be thoroughly examined and that lifestyle changes are made early on to reduce the risk of various problems associated with metabolic syndrome, since androgenetic alopecia can be considered an early marker of metabolic syndrome.
Ruíz-Alvarado Cristina, Juan Jose Reyes-Perez, Hernández-Montiel Luis Guillermo, Murillo Amador Bernardo and Rueda Puente Edgar Omar*
Diseases are a major cause of post-harvest losses depending on season, region and management practices. Chemical control is the most used but with serious consequences for human health and the environment. This forces us to carry out more exhaustive studies on botanical products.The general objective of the present study was to evaluate the effect of citrus extracts for the control of pathogens that cause post-harvest diseases in tomato fruit. The product to be evaluated is of botanical origin from citrus extracts. Doses were evaluated (0, 666, 1000, 2000, 4000, 8000 ppm). The treatments were located at a temperature of 25°C±2 and 45% relative humidity (rH). The design used corresponded to a completely random design. The least significant difference was estimated by Tukey Multiple Range test at P=0.05. The statistical tests were performed through the SAS computer program. The results indicate that the pathogens detected and identified correspond to Alternaria tenuissima; Botrytis cinerea; Cladosporium fulvum; Colletotrichum coccodes; Fusarium oxysporum; Geotrichum candidum; Rhizopus stolonifer and Stemphylium macrosporoideum. Our conclusion is that the efficient doses correspond to 666, 2000 and 8000 ppm. With the application of citrus extracts, the damage percentage of tomato fruit was reduced in relation to the control treatments. Based on the results with the application of citrus extracts, the shelf life of the tomato was lengthened.
Luisetto M*, Behzad Nili-Ahmadabadi, Ghulam Rasool Mashori, Ahmed Yesvi, Ram Kumar Sahu, Heba Nasser, Cabianca luca and Farhan Ahmad Khan
Starting from observation of pathogenesis of KURU disease we try to investigate the immunologic role played by central nervous systems. A deeply knowledge in the transmission model of this pathology can be an imaging/diagnostic tool to Verify the progression of this prion molecule from gastro intestinal systems to the brain. (After cannibalistic behavior). The prions can be considered a sort of trace ant in KURU to monitoring this process and immune- brain relationship. Interesting information can be obtained useful to produce new pharmacological strategies in some other degenerative brain disease involving innate immune system activation.
Hafiz Muhammad Bilal*, Shazia Ayaz and Neelam Iqbal
Objectives: As the cancer patients are at higher risk of premature deaths due to candidemia. So, the present study aims to evaluate the predictors of candidemia along with its outcomes among hospitalized adults and pediatric cancer patients.
Methods: A retrospective study was conducted at a tertiary care cancer hospital in Lahore, Pakistan. The data was collected from the medical records of all the patients who were found positive for Candida species between 1st January 2017 and 31st June 2017. Data were analyzed by using Statistical Packages for Social Sciences (IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.) and Microsoft Excel (MS Office 2010).
Results: Overall, 135 patients were detected with candidemia. Based on blood culture test results, it was found that out of 100 cultures positive for any microorganism there were 2 cases of candidemia. Multivariate analysis revealed that hematological malignancies (AOR: 2.1), and shock (AOR: 9.1) were significantly associated with high risk of mortalities during the index hospitalization, while risk of mortality among cancer patients suffering from Candida albican infection (AOR: 0.47) and those who were administered with antifungal agent after sensitivity report of the fungal culture (AOR: 0.2) was significantly less. Also, there was no significant association of empiric therapy of antifungal agent with the risk of mortality before a positive culture found (p>0.05).
Conclusion: Although, no risk factor was found to be associated significantly with candidemia among cancer patients. But hematological malignancies, non-albican candidemia and shock were predictors of higher risk mortality during index hospitalization.
Gehan Farid*, Reem Mohammed Kamal*, Mohamed AH Swaraldahab and Sarah Rabie Ali
<h2>Abstract</h2><p><strong>Objectives:</strong> To check if there is any significant difference in the immediate outcome of pregnancy with diabetes using the new values of FBS & 2hrs post prandial with 75g OGTT for 1 year (from 1st June 2013-31st May 2014) in comparison to the previous data done in the same institute with other values and with international figures.</p><p>The data in our study included fetal, maternal morbidities, intra partum and postnatal outcomes, in order to help, if possible, on deciding the best values to use for screening for gestational diabetes mellitus. Furthermore, to know the new percentages of gestational diabetes mellitus in SFH by utilizing the new values of Blood Sugar readings</p><p><strong>Design: </strong>Retrospective cohort study</p><p><strong>Setting:</strong> Security Forces Hospital-Riyadh-Saudi Arabia</p><p><strong>Patients:</strong> Done (from 1st June 2013 – 31st May 2014), on patients who had attended Security Forces Hospital, Riyadh, Saudi Arabia. This chosen year’s data was compared with data collected in the three previous years using different figures.</p><p><strong>Main Outcome measured:</strong> Average age of mother, maternal aspects of parity, history of GDM, number of abortions estimated blood loss in labor, associated medical disorder, complications of previous pregnancies, methods of control of GDM, gestational age for IOL and associated intrapartum complications. Immediate neonatal outcome in cases of GDM, comparison of birth weights of babies & any specific congenital abnormalities and delayed causes of admission to NICU in the 4 years studied were also reviewed.</p><p><strong>Results:</strong> The percentage of diagnosed cases of gestational diabetes mellitus (GDM) after screening was 24 % as compared with 14.5% in previous study of 2003-2004 & with the number of screened patients amounting to 93% out of the total number of deliveries between 2013-2014 (in both years universal method of screening was used). The multidisciplinary set up of our GDM specialized clinic which was composed of dieticians, diabetic educators, endocrinologists and obstetric physicians operating together, helped to reduced the use of insulin in combination with diet to only 24% in comparison to 76% of patient using diet and exercise alone. The study showed a mean age of 33years and weight of 77kg. It was also noted that 16% of the patients diagnosed with GDM were multiparous averaging 1-5 deliveries. Almost 62% of patient didn’t give any history of GDM and no history of previous medical diseases. The majority of the patient with GDM delivered without complications during labor, with 30% having vaginal lacerations & 73% of patient had an estimated blood loss of less than 500cc. NICU admissions secondary to hyperbilirubinaemia averaged almost 17% in comparison to previous studies and only one baby expired in a GDM patient. Our study revealed a good fetal and maternal out come with less delivery complications and less incidence of postpartum hemorrhage (5.7%).</p><p><strong>Conclusion:</strong> It is concluded that Universal Screening of Pregnant women whether with previously used glucose value or new ones for gestational diabetes mellitus is a better option, which has proven to improve both maternal and fetal outcomes. The 75 OGTT test is a cost effective test and with both easy accessibility and good screening pick up number (92.5%) of the patients in Security Forces Hospital, Riyadh.</p><p><strong>Recommendation:</strong> We recommend annual follow up for patients, both the mother and the baby after postpartum, to prevent the development of type 2 diabetes.</p>
Mumtaj S, Dhamodharan K*, Hari Prasad K and Kamesh Gautham B
The Coal conveyor system forms an integral part in Thermal Power plant owing to the fact that the overall efficiency of the plant is dependent on the rate at which the coal is carried to the crusher unit. But, as of now, only manual labors are employed to regularly monitor the operation of conveyor system which is highly risky. Hence, by means of a Microcontroller like PIC makes the controlling process much easier. The flaws that occur in the conveyor system are mostly due to the temperature at which the coal is carried and also due to the attrition in the belt. By means of a Temperature sensor and an IR sensor this could be regularly monitored and during any abnormal situation, this initiate Cooling fan in case of high temperature and signals an alarm whenever there is any fault in the system.
Subglottic hemangioma is the most common vascular tumor of the larynx of pediatrics; in contrast, it is relatively uncommon, accounting for an estimated 1.5% of congenital laryngeal anomalies [1].
Background: Beta 2- micro globulin (β2-MG) is involved in human malignancies. Increased synthesis and release of β2-MG, as indicated by elevated serum, plasma, or urine β2-MG concentration, occurs in several malignant diseases.
Objective: The study was designed to assess the role of serum Beta2- micro globulin in the support of the diagnosis of different types of pediatric malignancies.
Subjects and Methods: This case - control study was carried out on 137 children and adolescents with newly diagnosed pre-treated malignant diseases who were admitted to pediatric oncology center at Basra Children’s Specialty Hospital, their ages ranged from 3 months to 15 years, during the period from the 1st of November 2014 till the end of October 2015, 71 were males and 66 were females and 148 healthy children and adolescents (83 were males and 65 were females) matched for age and sex regarded as control group. Cases and control characteristics were assessed from data collection by special questionnaire. All patients and control group were investigated for Beta2- microglobulin by the enzyme-linked immunosorbent assay.
Results: The study had revealed that level of Beta2-microglobulin was significantly higher in patients with malignancy in comparison to control group, P value < 0.001.Also the serum Beta2- microglobulin level for both hematological malignancies and solid malignancies was assessed and it was found that significantly higher percentage of elevated serum Beta2- microglobulin level was present in patients with hematological malignancies in comparison to solid malignancies, P value <0.01.The study also had revealed that there was a significant correlation between the initial white blood cells count ≥ 50000 cells/ml and abnormal serum Beta2- microglobulin level, P value < 0.01,but there was no significant differences in serum Beta2- microglobulin level in relation to risk groups and immunophynotypes of acute lymphoblastic leukemia ,morphological subtypes of acute myloid leukemia, stages of each type of lymphoma (Hodgkin lymphoma and non-Hodgkin lymphoma) and the histopathological subtypes of non-Hodgkin lymphomas. After subjecting variables (specific to acute lymphoblastic leukemia) to logistic regression analysis, the significant independent risk factor that associated with abnormal serum Beta2- microglobulin level was high initial white blood cells count (≥50000 cells/ml).
Conclusion: Serum Beta2- microglobulin level is significantly higher in patients with hematological malignancies and high initial white blood cells count(≥50000cells/ml) .From this study, serum Beta2- microglobulin could be recommended in the initial work up for diagnosis of childhood malignancy.
<h2>Summary</h2><p>This report provides an insight into a very unusual problem in the First trimester of pregnancy, and describes the unfolding of a series of potential blunders.</p><p>We all know that most problems in gynecologic oncology become terribly magnified when the patient is pregnant. HB had a routine ultrasound in the first trimester of pregnancy, and a large, extremely vascular mass occupying most of the lower anterior abdominal wall, was found (Figure 1). Because she had received methotrexate two years earlier for a persistent elevation of the hCG titer following surgery for an ectopic pregnancy, she was referred to the gynecologic-oncology service with the working diagnosis of metastatic gestational trophoblastic disease (GTD). An MRI showed a vascular mass in the subcutaneous tissue invading the rectus sheath and muscle, but not attached to the uterus (Figure 2). The report stated, in no uncertain terms, that the mass was strongly indicative of a metastasis from GTD. However, the hCG level was consistent with the estimated gestational age, and a mass such as this would represent an extremely unusual way for this disease to present. She had been told that she would need the have the pregnancy terminated, followed by chemotherapy to reduce the size of the mass prior to its removal.</p>
Objective: To describe pathological findings on pre-treatment dental panoramic tomograms of edentulous jaws taken before complete denture treatment.
Design: Descriptive cross-sectional study.
Setting: Prosthetic division, Department of Conservative and Prosthetic Dentistry.
School of Dental Sciences, University of Nairobi.
Results: Data was obtained from clinical records and OPGs of 163 edentulous patients seen at the prosthetic clinic between 2010 and 2016 for complete denture therapy. From history and examination alone, clinicians reported significant findings on 50.3% of records, while 43.6% had no such findings. Ten (10) (6.1%) records were unclear. Examination of OPGs revealed 79.1% of the films had no pathological findings while in 20.9% had. Most of the findings (70.0%) were retained roots, 6% were radio-lucencies, 12% were other radio-opacities, 9% were impacted teeth while 3% had both retained root and radio-opacity. Most pathologies (64%) were located in the posterior region of jaws while the other findings were evenly distributed in the anterior and posterior regions of the jaws. There was no predilection of pathological findings to any other factor other than gender. In 83.4% records, queries on clinical notes coincided with significant findings on OPGs; while 16.6% were either unclear or did not coincide. Most (71%) OPG findings led to modification of treatment plan.
Conclusion: Pathological findings are common on pre-treatment OPGs. It may be good practice to take an OPG for edentulous patients prior to complete denture therapy where such services are available, to prevent complications from intra-bony pathologies. However, Most of the findings are either detectable by clinical exam or may not be of major consequence to the health of patients. Complete denture may be done without OPGs for new and old denture wearers where the service is not available.
Results: Data was obtained from clinical records and OPGs of 163 edentulous patients seen at the prosthetic clinic between 2010 and 2016 for complete denture therapy. From history and examination alone, clinicians reported significant findings on 50.3% of records, while 43.6% had no such findings. Ten (10) (6.1%) records were unclear. Examination of OPGs revealed 79.1% of the films had no pathological findings while in 20.9% had. Most of the findings (70.0%) were retained roots, 6% were radio-lucencies, 12% were other radio-opacities, 9% were impacted teeth while 3% had both retained root and radio-opacity. Most pathologies (64%) were located in the posterior region of jaws while the other findings were evenly distributed in the anterior and posterior regions of the jaws. There was no predilection of pathological findings to any other factor other than gender. In 83.4% records, queries on clinical notes coincided with significant findings on OPGs; while 16.6% were either unclear or did not coincide. Most (71%) OPG findings led to modification of treatment plan.
Setting: Prosthetic division, Department of Conservative and Prosthetic Dentistry.
School of Dental Sciences, University of Nairobi.
Results: Data was obtained from clinical records and OPGs of 163 edentulous patients seen at the prosthetic clinic between 2010 and 2016 for complete denture therapy. From history and examination alone, clinicians reported significant findings on 50.3% of records, while 43.6% had no such findings. Ten (10) (6.1%) records were unclear. Examination of OPGs revealed 79.1% of the films had no pathological findings while in 20.9% had. Most of the findings (70.0%) were retained roots, 6% were radio-lucencies, 12% were other radio-opacities, 9% were impacted teeth while 3% had both retained root and radio-opacity. Most pathologies (64%) were located in the posterior region of jaws while the other findings were evenly distributed in the anterior and posterior regions of the jaws. There was no predilection of pathological findings to any other factor other than gender. In 83.4% records, queries on clinical notes coincided with significant findings on OPGs; while 16.6% were either unclear or did not coincide. Most (71%) OPG findings led to modification of treatment plan.
Conclusion: Pathological findings are common on pre-treatment OPGs. It may be good practice to take an OPG for edentulous patients prior to complete denture therapy where such services are available, to prevent complications from intra-bony pathologies. However, Most of the findings are either detectable by clinical exam or may not be of major consequence to the health of patients. Complete denture may be done without OPGs for new and old denture wearers where the service is not available.
Spinal muscular atrophy (SMA) is a genetic and gravely disease, portrayed by motor neuron (MN) death, thereby leading to progressive and accelerating muscle fragility, respiratory collapse, and, in the most severe cases, it even pave the way to death.At the neuromuscular junction (NMJ), abnormally have been reported in SMA, including neurofilament (NF) aggregation at presynaptic terminals, immature and smaller endplates, lowered transmitter release, and, eventually, muscle denervation. In this review the role of Agrin in SMA is studied. This review highlights the antagonizing role of Agrin in SMA.
Between 2003 and 2011, 17 patients with heart failure were treated with stem cells as part of our Foundation’s Regenerative Medicine program. In several centers and countries 4 with ischemic cardiomyopathy of which 3 were surgically implanted with autologous bone marrow stem cells (ABMSC) plus bypass surgery.One patient was treated with hyperbaric medicine plus bypass surgery. Patients with idiopathic cardiomyopathy were implanted surgically with 2 different types of stem cells. Ten patients were implanted with stem cells derived from human fetuses (HFDSCs) and three patients with autologous bone marrow stem cells (ABMSC). The ejection fractions of the coronary artery bypass graft off pump OPCAB (control group) versus coronary artery bypass group off pump OPCAB plus stem cell transplantation were as followsin the entire serie: preoperative, 30.7% +/- 2.5% compared to 29.4% +/- 3.6%; 1 month, 36.4% +/- 2.6% versus 42.1% +/- 3.5%; 3 months, 36.5% +/- 3.0% vs. 45.5% +/- 2.2%; And 6 months, 37.2% +/- 3.4% versus 46.1% +/- 1.9% (p <0.001). The first patient performed at our center in Argentina in this series is alive and asymptomatic 15 years after implantation, and the rest of this series we do not have current data. A patient without visible vessels in the anterior wall of the left ventricle was treated with 18 hyperbaric chamber sections from one hour at 1.4 AT. After creating angiogenesis, the patient was operated on receiving 2 grafts (mammary and venous) without extracorporeal circulation in the anterior descending artery and diagonal artery. The preoperative ejection fraction was 33% at 90 months of follow up the ejection fraction was 58%. The patient at 90 months was asymptomatic. Of the idiopathic heart disease group, nine patients underwent median sternotomy, and received human fetal stem cells (HFDSCs from ectopic pregnancy or spontaneous abortion, three patients received autologous bone marrow stem cells ABMSC) and 1HFDSCs for Minimally Invasive Surgery.
Patients with HFDSC, compared to baseline, improved: The mean (±SD) NYHA class decreased from 3.4 ± 0.5 to 1.33 ± 0.5 (P = 0.001); Mean EF increased 31%, from 26.6% ± 4.0% to 34.8% ± 7.2% (p = 0.005); the yield in ETT increased 291.3%, from 4.25 minutes to 16.63 minutes (128.9% in metabolic equivalents, 2.45 to 5.63) (P <0.0001); the mean LVEDD decreased 15%, from 6.85 ± 0.6cm to 5.80 ± 0.58cm (P <0.001); the mean performance on the 6-minute walk test increased 43.2%, from 251 ± 113.1 seconds to 360 ± 0 seconds (P = 0.01); the mean distance increased 64.4%, from 284.4 ± 144.9m to 468.2 ± 89.8m (P = 0.004); and the mean score in the Minnesota congestive HF test decreased from 71 ± 27.3 to 6 ± 5.9 (p <0.001). Kaplan-Maier’s probability of survival at 40 months was 66%. No rejection or cancer was observed at follow-up, in this series follow-up was discontinued at 4 years. In idiopathic patients receiving autologous cells by Mininvasive technique preoperative NYHA was 3.6 (+/- 0.70) 6 months after receiving stem cell therapy. The mean value of the functional class was 1.9 (+/- 0.90) (p <0.005). ) showing marked clinical improvement. The preimplantation ejection fraction was 28% (+/- 3.6%) and at 6 months 44% (+/- 4.7%) (p <0.005). There was a similar change in ventricular diameters: After 6 months LVESV went from 50mm (+/- 3.3) to 42mm (+/- 4.5) (p <0.05). Two of the three patients in this group received re-synchronization therapy; one died at 10 years and 4 months, another at age 11 and another one alive at 12 years of the implant. More experience should be performed with different techniques and cells to find the appropriate treatment in this type of patients.
The lymphatic system consists of small non-contractile lymph vessels which collect fluid from the interstitial space and carry it to the major contractile lymphatic vessels with valves that maintain a unidirectional flow to the lymph nodes and is responsible for returning proteins, lipids and water from the interstitium to the venous system near the junction of the subclavian vein and internal jugular vein on both sides. Lymphedema would be the result of the failure of transport with the further accumulation of fluid rich in protein at the interstitium, especially in limbs.
Primary lymphedema, which affects 1.15 / 100000 children (especially pre-pubescent girls), not always clinically evident at birth, is a genetic disorder that represents many different subsets of phenotypes: congenital or congenital lymphangiectasia, congenital trofoedema family or Meige, congenital amniotic band and essence or idiopathic.
The most common form of presentation is due to congenital absence or abnormality of the lymphatic tissue caused by a genetic mutation of the genes responsible for the development of lymphatic vessels that is characterized by the difficulty of draining lymph vessels. This genetic alteration may be sporadic or inherited.
Mauro luisetto*, Behzad Nili-Ahmadabadi, Ghulam Rasool Mashori, Ram Kumar Sahu, Farhan Ahmad Khan, Cabianca luca and Heba Nasser
In the actual medical therapy of BPH, we can see: antibiotics, alpha blockers, 5-ARI, fitotherapeutics/natural products (Serenoa repens) with different which display clinical activities and other molecules such as FANS (local or systemic dosage forms) cortisones and others. Relationship between immune systems and chronic prostatitis are strictly involved in BPH progression. A vicious cycle that involve chronic flogosis, tissue remodeling, grow factors, inhibition of apoptosis, and other phenomena. Observing BPH pathogenesis under an immunologic point of view make possible to search new pharmacological strategies, to improve actual therapy.
The aim of this work is to observe some relevant literature in our opinion related the management of BHP and its progression under a pharmaceutical and immunological point of view. A deep knowledge in the pharmaceutical properties of some molecules (antimicrobials, anti-phlogosis agents, Anti-androgenic agents, alpha blockers, 5-ARI and other treatments, techniques, interventions or instruments) can help the physicians to pick the right choice.
David Crompton OAM*, Ross Young, Jane Shakespeare-Finch and Beverley Raphael AM
Objectives: Natural disasters confront individuals, communities and governments with the challenge of rebuilding and addressing psychosocial sequelae. With the increasing number of natural disasters it is timely to evaluate the efficacy of interventions and strategies to address the mental health needs of individuals and the community.
Method: An evaluation of literature related to the psychological impact of natural disasters, treatment efficacy and government strategies to confront the social and psychological impact of natural disasters for the period 1983-2016 was undertaken.
Results: Epidemiological studies following natural disasters despite the use of differing psychological measures demonstrate significant psychological morbidity - anxiety (7-42%), complicated grief (28-41%), depression (6.5-38%), post-traumatic stress disorder (11-89%) and substance misuse (1.3-24%). Intervention studies post-disaster demonstrate efficacy variability.
Conclusions: The increase in the number and impact of meteorological and hydrological events since the 1980s and the psychological, social and economic consequences of these events has resulted in the development and implementation of government policies to confront the immediate and long-term adverse outcomes. The focus is typically on resources and infrastructure redevelopment with less focus on social and mental health interventions with long-term evaluation of interventions uncommon. The consequence of natural disasters emphasizes the importance developing strategies to ensure effective evaluated psychosocial interventions are available across at-risk communities.
Moataz M El Semary*, Nawal A Abou Shady, Hayam Mahmoud Sayed and Mohamed El Said Al Awaady
Aim: The aim of this study was to evaluate the ankle-knee-hip interaction during sit-to-walk (STW) movement and clinical functional abilities of the lower limbs in Parkinson’s patients.
Methods: Twenty male patients, ages ranged from 55 to 70 years, stage ΙΙ & ΙΙΙ according to modified Hoehn and Yahr (1997) classification of disabilities and ten male healthy elderly subjects, ages ranged from 55 to 70 years, participated in this study. All subjects were assessed for; clinical functional abilities of the lower limbs, ground reaction force (GRF) & spatiotemporal data and range of motion (ROM) of hip, knee and ankle joints during STW movement.
Results: The results showed very significant differences in the GRF among the normal subjects and Parkinson’s patients during STW movement. There were significant differences in hip, knee and ankle joints ROM during STW. There were significant differences in spatiotemporal findings during STW movement. The Parkinson’s disease patients did not merge the two tasks of STW while the elderly subjects merged it. There was impairment in clinical functional abilities of the lower limbs in Parkinson’s patients.
Conclusion: A continuum of STW performance and clinical functional abilities whereby the healthy elderly people performed the task more efficiently than PD patients.
Background: After the closure of patent processus vaginalis (PPV) in boys with indirect inguinal hernia (IIH) or hydrocele, large scrotal hydroceles can occur on rare occasions despite the complete occlusion of internal inguinal ring (IIR). We present some cases that may help to explain the cause of this rare occurrence.
Materials: During last 14 years, six boys exhibited non-communicating large scrotal hydroceles (2 right, 1 left, 3 bilateral) among 352 children who underwent laparoscopic repair for hydroceles. Ages ranged from 7 months to 15 years with a median of 12 years. Five of them had a history of repair for hydrocele or IIH prior to the definitive surgery and one boy underwent an initial operation.
Results: In all the patients, laparoscopic inspection at the definitive surgery revealed completely closed IIRs. One infant with primary hydroceles was found to have large hydroceles bulging into the peritoneal cavity. All the patients were treated with subtotal removal of the sac without any recurrence. Marked thickness of the sack walls with abundant lymph vessels was characteristic histopathological findings.
Conclusions: The complete occlusion of the PPV does not always prevent the recurrence of hydrocele through alternative pathogenesis. The pathological findings of resected specimens suggested a disturbance in lymph flow in the testicular system. The subtotal removal of the sac is the treatment of choice. Diagnostic laparoscopy prior to a direct cut-down approach to the neck of the seminal cord is advisable to identify non-communicating hydroceles to avoid further impairment of lymph drainage around the IIR.
Phanisri Alaparthi, Shobhana Nayak Rao* and Pradeep Shenoy M
TEmphysematous pyelonephritis (EPN) is a rare but potentially life-threatening necrotizing renal parenchymal infection characterised by the production of intra-parenchymal gas. The approach and the management of emphysematous has changed dramatically over the last two decades with the advent of computed tomography (CT)-based diagnosis and advances in antibiotic therapy as well as multidisciplinary intensive care of sepsis leading to an overall decline in mortality rates to 20-25%. The previously standard treatment for EPN which included nephrectomy of the affected kidney has been replaced by minimally invasive and nephron sparing surgery with better patient outcomes. We present our case series of 12 patients with EPN over a short period of two years treated at our tertiary care centre in South Western India.
Background: Mechanical chronic neck pain is very common musculoskeletal dysfunction among people, manifesting one or more pain-induced movements and disability impairments. Clinical guidelines suggest passive cervical mobilization and thoracic manipulation as manual therapy interventions.Mulligan concept has positive effect in patients with lumbar and thoracic spine mechanical chronic pain. Study objective was to investigate possible clinical effects of Mulligan techniques in patients with cervical pain according to pain and disability status.
Methods: forty participants diagnosed with mechanical chronic cervical pain, randomly assigned into experimental and control group. NAG, SNAG and self-SNAG joint mobilization in a nine-sessions protocol implemented to the study group, while SHAM-Mulligan techniques applied to control group. Self-reported questionnaires Numeric Pain Rating scale (NPRT) and Neck Disability Index (NDI) were used for the measurement of pain and disability levels respectively. Possible Interactions among Factors (TIME X GROUP) and simple effects in three-time measurements of pre, post and one-month follow-up concerning NDI and NPRS variables, were detected with Mixed-ANOVA test.
Results: Baseline scores of pain and disability resulted in no differences between groups. A significant Group and Time factors interaction founded and simple main effects analysis showed that Mulligan concept-group had significant improvement in post-intervention NPRT and NDI scores (p<.001), compared to baseline scores. Follow-up also differed compared to post-treatment score (p<.001). SHAM-Mulligan control group had no significant differences in dependent variables at any level of TIME factor (p>.001). Significant differences were found between groups according to second and third measurement phase (p<.001).
Conclusion: Our findings suggest that Mulligan concept techniques improve symptoms of pain and disability in chronic mechanical neck pain patients in short and mid-term effect level.
Summary: Mobilization techniques of SNAGs, NAGS and self-SNAGs reduces pain and improve function in patients with mechanical neck pain. Taken into consideration the safety and simplicity of application, future studies are encourage to examine the underline mechanism of action.
Gehan Farid*, Sarah Rabie Ali* and Reem Mohammed Kamal
<h2>Abstract</h2><p>Gestational diabetes mellitus is becoming a very common medical disorder associated with pregnancy especially so in the Middle East and more so in Saudi Arabia, thus putting the women and fetuses at an increased risk of maternal and neonatal morbidity and mortality.</p><p>Screening for Gestational diabetes mellitus was recommended because of its asymptomatic nature and good proportion of patients with no classic risk factors. We recommended universal screening because of the beneficial effect of screening, diagnosis and subsequent treatment.</p><p>The most recent study done in Security Forces Hospital showed a significant decrease in morbidity and mortality with application of the new values of screening, in spite of the increase of incidence of Gestational diabetes mellitus from 14.5 % in 2005 study, to 23.9 % in the recent study in 2015.</p><p><strong>Objectives:</strong> To highlight and determine the best screening method values of FBS and 2hrspp used to diagnose gestational diabetes mellitus.</p><p>Maternal & neonatal out come and associated risks for patients who had Gestational diabetes mellitus, where scrutinized.</p><p>The study was done in the period from June 1st 2013-31 of May 2014.</p><p><strong>Design:</strong> Retrospective cohort study.</p><p><strong>Setting:</strong> Tertiary centre (Security Forces hospital _Riyadh_Saudi Arabia).</p><p><strong>Patients:</strong> Out of 6849 patients who had their delivery in Security Forces Hospital between June 2013 and May 2014 (one year), 6340 patients (92.5 %) were screened for gestational diabetes mellitus, and out of these 1516 patients (23.9 %) were labeled as Gestational diabetes mellitus after exclusion of cases of IDDM and NIDDM.</p><p><strong>Main outcome measured:</strong> The purpose of this study is to advise on using new values for diagnosis of gestational diabetes and to assess the outcome of pregnancy after new values are implemented in security forces hospital for diagnosis. The outcome included ages of mothers, parities, number of abortions, associated medical disorders, and estimated blood loss. Control methods were also reviewed, gestational age of induction of labor. Associated intrapartum complications as well as fetal outcome were also reviewed. The weight of babies, congenital abnormalities, admission to neonatal intensive care unit were also studied. The different values used , and percentages of diagnosed values of last 3 studies done in Security Forces Hospital in comparison to the most recent study with new values(2014-2015) as shown in table 11.</p><p><strong>Results:</strong> The incidence of gestational diabetes mellitus increased from 14.5 % in the year 2003 - 2004 to reach 23.9 % in 2014, in the same institute (Security Forces Hospital), where the study was done using different values. In our study in Security Forces Hospital we recorded a significant decrease in morbidity and mortality on applying the new values.</p><p>A significant reduction in the number of expired babies of mothers who were diagnosed as gestational diabetes with new values with a decrease from 5.6 % in previous years studied to reach 1.5 % in 2014, reflecting the effective control and the good catch for the new values.</p><p><strong>Conclusion:</strong> Universal screening, with whatever values to blood sugar used, is a better method screening than the selective one: Using 75 gram of Oral Glucose Tolerance Test proved to be cost effective, easily accessible, and with good pickup rate of up to 93 % of patients in Security Forces Hospital.</p><p><strong>Recommendations:</strong> To continue using the new values that will be universally implemented, with long term follow-up of mothers and newborn.</p>
Vitamin K was discovered as nutrient of blood clotting. There are two main types of vitamin K, vitamin K1, and vitamin K2. Although the structure of vitamin k is stable but also, there are differences between them. Vitamin k1 is mainly present in dark green leafy plant; while vitamin k2 present in animal and fermented plant. There are different sources of vitamin k. The normal human body is required about 200µg/day from vitamin k in both forms. Vitamin k1 can easily converted into vitamin k2.There is big difference between work of types of vitamin k, where each one responsible for special job. Vitamin k play important role in various metabolic process; vitamin k especially k2 play important role in protect the body from heart attack , in addition to reduce the development of osteoporosis and bone disease in combination with vitamin D and calcium. Vitamin k responsible for increase the secretion of male sex hormone and infertility. Vitamin k is consider one of the most important vitamin, it can save human from death as result of precipitation of calcium on arteries. Due to the importance of vitamin k, this article will discuss vitamin k, its presence, and role in different diseases.
Remzi Gonul, Lora Koenhemsı, Handan Aydın Vural*, Tevfik Gulyasar, Hasret Demırcan Yardıbı, Erman OR and Bora Barutcu
Carazolol is a non-specific β-adrenargic reseptor blocking agent. It ıs structurally analogous to catecholamins, in that, when administered, it forms reversible bonds with β-adrenergic, however, induce adrenergic effects, and it inhibits the actions of the catecholamins in times of stres by saturing their sites of operation. The purpose of the research was to investigate the effects of carazolol on some serum enzymes, trace elements and cardiovascular status in sheep. Seven sheeps (age 6 months, 35 ± 10 kg) were used in this study. Carazolol administered by the intramuscular route at the dose of 0.01 mg/kg. Serum levels of urea, creatinin, ALT, AST, G-GT, LDH, T. protein, Ca, P, Mg, Cu, Fe, Zn, Se were investigated. Although all serum enzymes did not show any difference, serum Fe and Zn levels were decreased. Important results were obtained in electrocardiography (abnormal T wave and ST segment depression).
These results suggest that carazolol may increase incidence rate of myocardiyal ischemia risk in sheeps and it investigated by new researches.
<h2>Abstract</h2><p><strong>Background:</strong> The study aimed to evaluate the effects of a 4-week Bergamot Polyphenolic Fraction (BPF Gold; Bergamet Sport) supplementation on serum nitric oxide (NO), asymmetric dimethyl-arginine (ADMA), Endopat indices of endothelial function and maximal oxygen uptake (V_ O2max) of athletes.</p><p><strong>Methods</strong>: The effects of dietary supplementation (BPF Gold, 650 mg twice a day for 4 weeks) and placebo administration on flow-mediated dilatation (via Endopat measurements), serum markers (NO, ADMA), lipid profile, and V_ O2max were analysed in 30 athletes both before and after dietary protocols.</p><p><strong>Results</strong>: Significant differences between pre- and post-intervention baseline NO levels were observed after BPF Gold dietary protocol. Higher post-intervention baseline NO level was observed after BPF Gold diet compared with placebo. Moreover BPF Gold Sport increased baseline NO concentration (ΔNO). The positive correlation was observed between baseline post-intervention NO concentration and maximal oxygen uptale and also between ΔNO and ΔVO2max in response to BPF Gold supplementation. There was an association between a higher Edopat values of endothelial function and higher V O2max after Bergamet Sport diet compared with lower values of placebo.</p><p><strong>Conclusions</strong>: These findings suggest that an increase in NO release in response to BPF Gold Sport supplementation may play a central role in cardiovascular adaptive mechanisms and enhanced exercise performance in athletes.</p>
Based on different properties of structure of helical protein molecules some theories of bio-energy transport along the molecular chains have been proposed and established, where the energy is released by hydrolysis of adenosine triphosphate (ATP). A brief survey of past researches on different models and theories of bio-energy, including Davydov’s, Brown et al’s, Schweitzer’s, Cruzeiro-Hansson’s, Forner‘s and Pang’s models were first stated in this paper. Subsequently we studied and reviewed mainly and systematically the properties and stability of the carriers (solitons) transporting the bio-energy at physiological temperature 300K in Pang’s and Davydov’s theories. However, these theoretical models including Davydov’s and Pang’s model were all established based on a periodic and uniform proteins, which are different from practically biological proteins molecules. Therefore, it is very necessary to inspect and verify the validity of the theory of bio-energy transport in really biological protein molecules. These problems were extensively studied by a lot of researchers and using different methods in past thirty years, a considerable number of research results were obtained. I here reviewed the situations and progresses of study on this problem, in which we reviewed the correctness of the theory of bio-energy transport including Davydov’s and Pang’s model and its investigated progresses under influences of structure nonuniformity and disorder, side groups and imported impurities of protein chains as well as the thermal perturbation and damping of medium arising from the biological temperature of the systems. The structure nonuniformity arises from the disorder distribution of sequence of masses of amino acid residues and side groups and imported impurities, which results in the changes and fluctuations of the spring constant, dipole-dipole interaction, exciton-phonon coupling constant, diagonal disorder or ground state energy and chain-chain interaction among the molecular channels in the dynamic equations in different models. The influences of structure nonuniformity, side groups and imported impurities as well as the thermal perturbation and damping of medium on the bio-energy transport in the proteins with single chain and three chains were studied by differently numerical simulation technique and methods containing the average Hamiltonian way of thermal perturbation, fourth-order Runge-Kutta method, Monte Carlo method, quantum perturbed way and thermodynamic and statistical method, and so on. In this review the numerical simulation results of bio-energy transport in uniform protein molecules, the influence of structure nonuniformity on the bio-energy transport, the effects of temperature of systems on the bio-energy transport and the simultaneous effects of structure nonuniformity, damping and thermal perturbation of proteins on the bio-energy transport in a single chains and helical molecules were included and studied, respectively. The results obtained from these studies and reviews represent that Davydov’s soliton is really unstable, but Pang’s soliton is stable at physiologic temperature 300K and underinfluences of structure nonuniformity or disorder, side groups, imported impurities and damping of medium, which is consistent with analytic results. Thus we can still conclude that the soliton in Pang’s model is exactly a carrier of the bio-energy transport, Pang’s theory is appropriate to helical protein molecules.
The patient is a 28-year old Caucasian man with six month history of arthralgia and crampy abdominal pain who presented with acute dyspnea and cough for 6 months associated with migratory polyarthralgias involving his knees, ankles, wrists, and shoulders.
Swethika Sundaravel*, Jonathan Nieves and Seth Baum
Hypertension (HTN) is a widely prevalent disease across the globe. Recent reports from National Health and Nutrition Examination Surveys (NHANES) indicate that the prevalence of HTN is 29% in adults more than 18 years in the US [1]. This is about 72 million adults. Worldwide, about 1.3 billion people are affected by HTN [2]. This number is projected to increase several-fold in the coming years. Given the huge burden of this disease to the healthcare system and the many deleterious effects that can result from uncontrolled HTN, we need strong guidelines to manage the same. The recently published 2017 ACC/AHA guidelines [3] on hypertension management are very meticulous and include a comprehensive stepwise approach in treating hypertension. Here we present a summary of the major changes and a concise review of the new guidelines.
Bhaskar C Das*, Sribidya Pradhan, Devi Prasana Ojha, Arpita Das, Narayan S Hosmane and Sasmita Das
Amyloid-β peptide (Aβ) and tau protein deposits in the human brain are the pathological hallmarks of Alzheimer’s disease (AD). Tau is a class of proteins that are abundant in nerve cells and perform the function of stabilizing microtubules. However, in certain pathological situations, Tau proteins become defective and fail to adequately stabilize microtubules, which can result in the generation of abnormal masses that are toxic to neurons. This process occurs in a number of neurological disorders collectively known as Tauopathies. Tau protein is the major factor of the intracellular filamentous deposits that relate to a number of neurodegenerative diseases which includes the progressive supranuclear palsy (PSP), Pick’s disease, and Parkinsonism. The identification of mutations in Tau established that dysfunction or misregulation of tau protein is sufficient to cause dementia and neurodegeneration. In this review article, we discussed the etiology of the tau formation and role in AD and subsequently therapeutic approach for disassembling and Tau inhibition.
Danrley Mariel Egidio Sanchez, Jocimar de Souza, Yoko Oshima-Franco and Sandro Rostelato-Ferreira*
In this work we used semi-isolated heart of the cockroach Nauphoeta cinerea for the investigation of the pharmacological effects of extracts (aqueous, 1:1, 1:2, 1:4 and 1:8) from Nephrolepis exaltata L. leaves, a popular ornamental fern considered to be safe.The use of insects in experimental studies has grown due to the easy handling, proliferation/growing assuring its rapid obtention, and absence of ethical issues. An aqueous extract 0.2 % was obtained after maceration of 1 g N. exaltata leaves powder with 20 mL of distilled water (1:20). Diluted extracts in water were obtained to have the following proportion 1:1, 1:2, 1:4 and 1:8. Experiments (n=4) consisted of 200 µL addition onto semi-isolated heart preparation of N. cinerea with concomitant heart beating counting. Aqueous, 1:1 and 1:2 extracts paralyzed completely the heart beatings of cockroachs (p<0.05 compared to saline control), but not 1:4 or 1:8, which showed only a slight decline (p>0.05 compared to saline control). A preliminary thin layer chromatography showed the presence of unidentified terpenoid in aqueous extract of N. exaltata. These pharmacological findings of N. exaltata can be exploited for future use as insecticide or as dose-dependently cholinergic agent.
<h2>Abstract</h2><p>Female genital mutilation / cutting remains a widespread practice throughout Africa. There has been a worldwide effort to do away with FMG/C, but tensions exist between those who aim to abolish FGM/C and those who desire to perpetuate the tradition. While many Western and African experts and organizations agree on the health risks and human rights concerns with FGM/C, others fear that Westerners are imposing their ideas and lack of cultural understanding, trying to eliminate a practice central to the identity of many Africans. The issue must be approached respectfully and collaboratively, with great effort on the part of Westerners to understand the cultural context and rationale of this tradition. Ultimately, if FGM/C is to be eradicated in the foreseeable future, whole African communities and international support agencies must be engaged and empowered to collectively evaluate the implications of the practice and accelerate its demise.</p>
Ubiquitination is a kind of posttranslational modification of proteins in eukaryotes, and it plays an important role in the growth and development of organisms. The ubiquitination of proteins is a cascade enzymatic reaction involving three enzymes. The homologous to E6-AP carboxy terminus ubiquitin-protein ligases (HECT E3s) family is an important ubiquitin-protein ligases family. The family all have a HECT domain of approximately 350 amino acids in the C-terminus. However, studies on plant HECT E3s, such as structural features, prediction of HECT domain function, and their regulatory mechanisms, are very limited. In this paper, Arabidopsis thaliana HECT family genes were analyzed, including gene structure and functional domains and its limited known functions in protein degradation, gene transcription regulation, epigenetically regulation or other functions, finally speculate their roles in plant morphologies, aging or responsive to environmental stress.
Anatomical separation of the retinal pigment epithelium from the Bruch membrane is defined as retinal pigment epithelial detachment (PED) andit is classified as drusenoid, serous, and vascularized. Vascularized PED is mostly associated with choroidal neovascularmembrane due to age-related macular degeneration and the risk of vision loss is high in this situation. Studies show that all of baseline values including BCVA, PED height, subretinal fluid, central macular thickness, PED volume, vertical dimension, presence of coincident macular pathology, reflectivity and morphology on optical coherence tomography have prognostic importance. Current treatment protocols mainly based on intravitreal injection of anti-vascular endothelial growth factor (VEGF).Even the bevacizumab was the first anti-VEGF that was used for treatment in PED, there are several reports show the insufficiency of bevacizumab. In treatment-naïve eyes, both of ranibizumab and aflibercepthave similar effect in vascularized PED. In treatment-resistant eyes, high dose bevacizumab or switching therapy of anti-VEGF procedures can be effective when considering of all cases, aflibercept seems more effective than other options.We aimed in this manuscript, to give a general information about different characteristics of PEDs and to investigate the treatment strategies in the light of current literature.
Joseph B Pryor*, Ali J Olyaei, Joseph B Lockridge and Douglas J Norman
Thymoglobulin is a rabbit-derived anti-thymocyte antibody directed at T-cells and commonly used for induction immunosuppression therapy in solid organ transplantation, especially in immunologically high risk kidney transplant recipients. Despite its frequent use and efficacy, the heterologous makeup of thymoglobulin can induce the immune system resulting in serum sickness which typically presents with rash, fever, fatigue, and poly-arthralgia in the weeks following drug exposure. ATGAM is another anti-thymocyte antibody, targeting the same epitopes, but differs from thymoglobulin by the animal in which the preparations are generated (equine vs. rabbit). Herein, we present a case of a patient with a known history of thymoglobulin-induced serum sickness, who presented with evidence of acute cellular and vascular rejection at their 12-month post-operative visit. Given their immunologically high risk status, they were successfully treated with ATGAM with improvement in their rejection and kidney function. To the author’s knowledge, this is the first case report of successful administration of ATGAM in a patient with a documented history of thymoglobulin induced serum sickness, demonstrating a possible treatment option for acute rejection in patients with reactions to thymoglobulin.
Danielle D Wadsworth*, Colleen M Daly and Shelby J Foote
<h2>Abstract</h2><p><strong>Purpose:</strong> This study aimed to identify physical activity, enjoyment, and factors for future activity between an active video game (AVG) condition and self-paced exercise (SPE) among college-aged students.</p><p><strong>Methods</strong>: Thirty college-aged volunteers (age=22±1.68 years) completed 4-45 minute physical activity sessions (2 AVG; 2 self-paced). A survey and a brief structured interview followed.</p><p><strong>Results</strong>: Overall, participants expended more calories, accumulated more steps, and more physical activity during SPE; however, participants in the AVG condition met daily exercise recommendations. The majority of participants (81%) enjoyed playing the AVG. Autonomy and competence were found as common themes among those who preferred the SPE condition; whereas, lack of knowledge and exercise variety were emergent themes among those who preferred AVG.</p><p><strong>Conclusions</strong>: This study provides evidence that college students could meet daily exercise recommendations by participating in AVG interventions; although AVGs that provided autonomy and allowed users to demonstrate competence would be preferable.</p>
Ratko Pavlovic*, Zoran Radic, Irina Juhas and Mensur Vrcic
<h2>Abstract</h2><p>Anthropometric characteristics, represent one of the most important subsystems within the “system” of man, and which can be in affected by physical exercises in the direction of the desired transformation.Very often the anthropometric parameters (height and weight) are used in the assessment of the morphological status of an individual, and on the basis of the results of Body Mass Index (BMI) bring certain estimates and conclusions. BMI as a statistical measures, is used in many public health campaigns as an approximate measure of the ideal body mass and the degree of nutrition of a population. The main goal of the research was to determine and analyze differences in BMI parameters between male and female students, aged 18±0.5 years, and determine the trend of changes. Using the T-test module, the obtained results confirmed that there are statistically significant differences in body height (t=8,17; p<0.001) and body weight (t=5,29; p<0.001), while in BMI values there are not statistically significant differences (t=-0.68, p>0.001). Based on BMI values, a positive trend of somatic changes of both poles is evident.</p>
<h2>Abstract</h2><p>Pregnancy is a happy stage in life of every woman, but at the same time it is a rather difficult period, since pregnancy represents a serious strain on the body. In the body of a woman during this period there are significant physiological changes that ensure the correct development of the fetus, prepare the body for the upcoming delivery. In this difficult period, the burden on all organs and systems of the woman’s body is significantly increased. Especially often suffer joints; there is a risk of permanent pain, the development of diseases or exacerbation of existing diseases. One of the most common problems is Temporomandibular Dysfunction or Disorder (TMD) which many women face, but still hasn’t been explained.</p>
Vestibular disorders and anxiety are closely related, probably because they share some neuronal pathways. Ageing and patient comorbidities are important facilitating factors, and multiple vascular risk factors could contribute to the onset of a vestibular syndrome called vascular vertigo. White matter lesions (WML) are often seen on magnetic resonance imaging (MRI) scans of elderly people and are related to various geriatric disorders, including dizziness. The cause of this correlation could be the disruption of neuronal networks that mediate higher vestibular cortical function. Numerous neuronal pathways link the vestibular network with limbic structures and the prefrontal cortex modulates anxiety through its connections to amygdala. The aim of the present work was to investigate the correlation between WML, amygdala and cognitive functions.
Treatment of various inflammatory processes, including acute pneumonia(АP), over the past decades is identical and does not reflect the specifics of a particular disease. The basis of such treatment is «antibiotics alone». The need for additional therapeutic efforts is realized by the use of General therapeutic techniques, regardless of the diagnosis. This does not take into account the important fact that the localization of inflammation not only determines its clinical picture,but,above all,the mechanisms of influence on other organs and systems of the body.
Attempts to cure fundamentally different diseases with the help of one aid package cannot give the expected result even theoretically. The futility of this approach is illustrated by the current dynamics of the results.Reducing the effectiveness of antibiotics and the emergence of new resistant strains of microorganisms forces the constant development of new antimicrobials. However, the success of pharmacists can not stop the continued increase in the number of purulent complications of АP even in developed countries with maximum capacity to provide patients. There is a solution to the existing problem and it lies in another plane.
Martin Rosas-Peralta, Gabriela Borrayo-Sanchez*, Janal Santiago-Lopez, Erick Ramirez Arias, Rosalba Garcia Mendez, Victor Hugo Borja-Aburto, Ana Carolina Sepulveda-Vildosola and Jose de Jesus Arriaga-Davila
The new report of American College of Cardiology/American Heart Association task force on Clinical Practice Guidelines for High Blood Pressure in Adults was published online ahead of print November 13, 2017. The new American recommendation was focused on the criteria to define Hypertension. 130/80 mmHg or more is now considered as the new cut off point to define Hypertension. It is not new if we consider cumulative evidence in the las two decades has been broken the idea to consider 140/90 mmHg as the point to start medical actions. Thus, in México with current ACC/AHA definition it is estimated today around 48 million of adult hypertensive population. In the Mexican Institute of Social Security (IMSS) several strategies has been developed to improve prevention as the key action to confront non communicable chronic disease including hypertension. This updated guideline from ACC/AHA is an extraordinary opportunity to reinforce our preventive programs to high blood pressure control. In this brief report we analyze the epidemiological situation in Mexico and its possible consequences of the new criteria for hypertension diagnosis. The main current strategies that are applied into the IMSS to confront cardiovascular risk factors are directed to prevention. The IMSS is prepared to attend situations as the change of criteria diagnoses in Hypertension and new preventive models are in progression.
Luisetto M*, Ghulam Rasool Mashori and Cabianca luca
In this review After Observing biomedical literature (starting from some heart disease) results that some pathological phenomena are deeply involved in some metabolic endocrine condition: Kinetics and gradients in metabolism, catabolism, time related, toxic like effect, electrical cell membrane status, smooth vascular muscle cell hyper-reactivity, platelet iperactivations, central autonomic control after acute stroke, great electrolytes unbalances et other factors as pro-hypertrophic signaling and oxidative stress. Observing actual current therapy in some metabolic endocrine therapy often is used association of drugs (in example in type II diabetes). In Many other pathologies efficacy drug therapy exist, and often only 1 pharmacological molecule resolve the pathological condition. But in many disease even associating 2-3-4 drugs the % of cure not increase (efficacy, effectiveness). It mean that this drugs strategies are not the really best? Or it mean a low active level? Why for this pathological condition this association drugs in currently use not do the right works as really needed? There is the need for new really efficacy drugs strategy that show a profile of efficacy as requested in order to resolve the pathological condition? Or to be added to the actual therapy? The actual pharmacological strategies in some metabolic endocrine disorder is really the best? Or other strategies can be introduced?
Sumbal Nasir Mahmood*, Kunwer Naveed Mukhtar, Osama Kunwer Naveed and Ahmed Kunwer Naveed
A 50-years old female presented with dysarthria, inability to swallow and quadriparesis for three weeks. She had rapid correction of her serum sodium (Na) from 99meq/l to 138meq/l within 24 hours 1 week prior to development of these symptoms. She was diagnosed as a case of Osmotic demyelination syndrome (ODS) formerly known as central pontine myelinolysis (CPM) which was confirmed by MRI. She underwent Plasma Exchange (PE) on the 20th day since her symptoms started and underwent 7 cycles of PE with complete neurological recovery. Pt was discharged with ability to ambulate independently and complete recovery of speech and swallowing. Hence, we report that PE is beneficial in chronic ODS.
Kavitha B*, Sugasini D*, Poorna CR Yalagala, Hemalatha C, Kanchana S, Meenakshi V and Umamaheswari R
The quality characteristics of selected black gram varieties viz., VBN 5, VBN 7, ADT 3, T9 and CO 6 and were evaluated for their suitability for the preparation of thick pancake. The foaming stability and foaming capacity were found to be maximum in VBN 5, CO 6 and T9. Maximum rise in volume was recorded in CO 6 (149 ml) followed by VBN 5 (148 ml) and T9 (147 ml) which is an indication good quality of thick pancake. Thick pancake prepared using 5 black gram varieties were analyzed for the physicochemical and microbial load. The texture profile viz., springiness, cohesiveness, chewiness and gumminess was evaluated for VBN 5, CO 6, T9 and VBN 7 respectively. The protein content was higher in thick pancake prepared from VBN 5 (25.47/100 g) compared to CO 6 (24.66 g/100g). Among the selected varieties, CO 6, T9 and VBN 5 had good batter content, texture, and microstructure and were found to be most suitable for thick pancake preparation.
Gastroesophageal reflux disease (GERD) is a quite common disease caused by the reflux of gastric contents into the esophagus and manifested by heartburn and acid regurgitation. Apart from the esophageal manifestations.
Post-translational modification (PTM) refers to the covalent and enzymatic modification of proteins during or after protein biosynthesis. In the protein biosynthesis process, the ribosomal mRNA is translated into polypeptide chains, which may further undergo PTM to form the product of mature protein [1].
Objective: To determine the association between serum magnesium level and asthma, by establishing the difference in serum magnesium level between children with asthma and controls.
Method: Serum magnesium levels of 44 children with acute asthma and 44 controls of the age group of 6-16 years was determined and statistically compared. Lung function tests (FEV1%) were done and correlated with serum magnesium levels using Pearson’s comparison coefficient.
Results: The mean serum magnesium value of cases (1.9136±0.44) is lower than the controls (2.0042±0.26), with 32 cases showing a deficiency of serum magnesium. Pearson’s correlation coefficient, reveals positive correlation between FEV1% with serum magnesium levels, r=0.819, P<0.001.
Conclusions: This study reveals that the serum magnesium levels, even if in normal range, are statistically lower amongst asthmatics. It also brings out the relationship between magnesium levels and lung function tests, showing an improvement in the latter with increase in the former.
A 36-year-old woman pregnant, G2 P1, presented at 27 weeks of gestation after two previous visits elsewhere, as an outpatient in a gynecological clinic. An ultrasound examination revealed bilateral hydronephrosis. Also, ureteral dilation and bladder overdistension was present (Figures 1-3). We evaluated that the cause was a urinary tract obstruction. Specifically, we are dealing with posterior urethral valves. The anteroposterior diameter of the pelvis on a transverse view of the abdomen was 6 mm. The amniotic fluid index (AFI) was 3 cm, so, oligohydramnios. Fetal Biometry responds to the 27th week of gestation. The sex of the fetus was male. Following identification of urinary tract dilation, a detailed anatomic scan was performed to exclude the presence of associated extra-renal anomalies. After corticosteroid regimens, at week 30 of pregnancy, due to the fetal diagnosis previously determined and now anhydramnios, with the informed consent of both parents, are deciding to end a pregnancy with Caesarean section. On 17.07.2017, at 8:45 AM, the baby of the male sex is born, with body weight 1700 grams, and Apgar score was; 7 in the first minute, 8 in the fifth minute. Shortly after birth, because of the prematurity and the manifestation of the signs of Infant respiratory distress syndrome (IRDS), the baby is transferred to the Neonatal Intensive Care Unit. The treatment started according to the protocol with fluid, antibiotic therapy, and surfactant administration. Even despite therapy, the condition is constantly worsening the baby is intubated and passes on mechanical ventilation. The baby’s condition continues to worsen even further until cardiac arrest, even despite reanimation measures, the baby died within a few hours.
In the present work, samples of building material are analyzed for their naturally occurring radioisotope activity such as uranium, radium, and radon. The radon emission rates, and the annual effective doses, “AED”, are also investigated.The activity of twenty-four samples, taken from the local markets of Saudi Arabia, was determined using the "Sealed-cup Technique” and Solid State Nuclear Track Detectors, "SSNTD.” The uranium concentration activity of the samples is found to vary from 0.62 to 4.68 ppm with an average of 1.92±0.42 ppm. The radium concentration varies from 0.61 to 4.64 Bq·kg−1, with an average of 1.91±0.42 Bq·kg−1, the radon concentration in the samples varies from 42.29 to 319.97 Bq·m−3 with an average of 131.53±28.94 Bq·m−3. The value of the dissolved radon concentration in the collected samples varies from 12.99 to 98.97 Bq·m−3 with an average of 40.41±8.89 Bq·m−3. The mass exhalation rates are found to vary from 1.54 to 11.65 mBq·kg−1·h−1, with an average of 4.79±1.05 mBq·kg−1·h−1, while the surface inhalation rates vary from 76.97 to 582.35 mBq·m−2·h−1, with an average of 239.38±52.66 mBq·m−2·h−1. The AED due to indoor uses varies from 1.07 to 8.07 mSv·y−1, with an average of 3.32±0.73 mSv·y−1. The AED due to indoor plus outdoor uses varies from 1.47 to 11.10 mSv·y−1, with an average of 4.56±1.0 mSv·y−1. The results of this study show that the values obtained for most samples are within the internationally accepted recommended values. Therefore, these samples can be used as building materials as they do not pose a major risk to humans.
Sabaa Asif*, Sumbal Nasir Mahmood and Osama Kunwer Naveed
Posterior reversible encephalopathy syndrome (PRES) is a neurological syndrome with clinical features of altered sensorium, headaches, visual problems and seizures. It has been associated with uncontrolled hypertension (HTN), thrombotic thrombocytopenic purpura (TTP) and immunosuppressive drugs. Rituximab has also been implicated as a cause of PRES that usually occurs after the first dose. We report a case of PRES that occurred after the second dose of Rituximab. A twenty three years old female known case of resistant TTP treated with multiple courses of steroids and plasmapharesis was admitted with renal failure, severe volume overload ad lower respiratory tract infection. She was treated with hemodialysis, intravenous antibiotics, steroids and plasma exchange (PEX). She did not responded and due to worsening thrombocytopenia and persistent hemolysis was administered Rituximab as an adjunct therapy. She tolerated the first dose well, however 48 hours after the second dose she developed uncontrolled HTN of 190/110 associated with generalized tonic clonic seizures and altered sensorium requiring intubation and mechanical ventilation. MRI findings were suggestive of PRES. Seizures did not get controlled with conventional therapy and patient underwent two consecutive cycles of PEX to remove the drug which resolved the seizures.
However, the patient developed Ventilator associated pneumonia (VAP) and sepsis and expired after family withdrew ventilator support.
The patient with an oncological disease presents a series of discomforts related to the psychological sphere such as depression, pain, sense of usefulness, anger, but also inconveniences related to food sphere. Neoplastic disease interferes with eating behaviour for several reasons. The communication of the diagnosis can create a state of anorexia as a result of the shock; certain tumours of the gastrointestinal tract-gold (mouth, esophagus, stomach, colon and rectum, but also pancreas and liver) are directly responsible for the possible alteration of food intake; alteration in eating behaviour may be secondary to the main therapeutic treatments. The link between food and cancer is not only evident in case of disease, but also in case of prevention, in fact a growing number of studies indicates more an more clearly the close correlation between a healthy diet and prevention of oncological diseases although at present time it is not still possible to give definitive results. The diagnosis of a person is like a melody in which some notes are repeated but their combination is almost infinite, because each person has different eating needs, as well as different psychological needs, and the starting point for a good professional must necessarily be a ‘customized’ diagnosis. This ‘diagnosis of well-being’, tailor-made for each person, involves professionals in both the food and psychological and behavioural sectors, since the individual needs have to be evaluated globally.
Finally, the professionals of human behaviour in food consumption, and the chemical and science processing experts, have the duty not to limit themselves to a single refusal against the use of certain foods, but framing the phenomenon in a wider perspective and, as experts of human health, to propose alternatives. The patient with an oncological disease presents a series of discomforts related to the psychological sphere such as depression, pain, sense of usefulness, anger, but also inconveniences related to food sphere. Neoplastic disease interferes with eating behaviour for several reasons. The communication of the diagnosis can create a state of anorexia as a result of the shock; certain tumours of the gastrointestinal tract-gold (mouth, esophagus, stomach, colon and rectum, but also pancreas and liver) are directly responsible for the possible alteration of food intake; alteration in eating behaviour may be secondary to the main therapeutic treatments. The link between food and cancer is not only evident in case of disease, but also in case of prevention, in fact a growing number of studies indicates more an more clearly the close correlation between a healthy diet and prevention of oncological diseases although at present time it is not still possible to give definitive results. The diagnosis of a person is like a melody in which some notes are repeated but their combination is almost infinite, because each person has different eating needs, as well as different psychological needs, and the starting point for a good professional must necessarily be a ‘customized’ diagnosis. This ‘diagnosis of well-being’, tailor-made for each person, involves professionals in both the food and psychological and behavioural sectors, since the individual needs have to be evaluated globally. Finally, the professionals of human behaviour in food consumption, and the chemical and science processing experts, have the duty not to limit themselves to a single refusal against the use of certain foods, but framing the phenomenon in a wider perspective and, as experts of human health, to propose alternatives.
Alexis Alvarez-Aliaga*, Andrés Jose Quesada-Vazquez, Alexis Suarez-Quesada and David de Llano Sosa
Introduction: The high morbidity and mortality by hypertensive cardiopathy demand the construction and validation of tools to stratify the risk of developing this condition.
Objective: To design and validate an index, based on risk factors, that permits to predict the development of hypertensive cardiopathy in patients with a diagnosis of essential arterial hypertension.
Methods: A prospective cohort study was done in hypertensive patients assisted at the specialized arterial hypertension physicians’ office of the “Carlos Manuel de Céspedes” Specialty Policlinic attached to the General University Hospital, Bayamo Municipality, Granma Province, Cuba from January 1st, 2010 to December 31, 2016. Internal and external validity and the internal consistency of the index were determined.
Results: The index sensitivity was of 97, 20 (IC: 93, 93-94.09) and specificity of 65, 38 (IC: 76, 25-76, 20). Both the index discriminative capacity (area under the ROC curve= 0,944; interval of confidence: 0.932-0.956; p<0.0005) and calibration (p=0.751) were adequate.
Conclusions: The present study proposes an index to predict the risk of developing hypertensive cardiopathy, with adequate discriminative capacity and calibration (external validity). The index can be used as a tool of clinical and epidemiological surveillance since it permits to identify subjects with greater probability of developing the condition and to stratify the risk.
Salivary stone (sialothiasis) is a calcifying concentration within the ductal system of salivary gland [1]. The majority of salivary calculi occur in the submandibular gland duct because of its length, upward course and the thicker mucus [2].
Submandibular salivary stone is a common cause for recurrent submandibular gland swellings [3]. Recurrent obstruction of salivary flow is the main cause for salivary gland swellings, which makes salivary gland removal in some of these cases inevitable, despite the considerable advances in salivary gland calculi management [4-6]. Large salivary stones (>10 mm) are relatively uncommon [7-9]. Reviews of cases of giant salivary stone were attempted by different authors [7,10,11]. However, the review done by [12], was the most comprehensive one. They reported 90 cases of giant salivary stones between 1942 and 2014. Apart from 8 cases included in their review, all the reported stones were between 30-65 mm in size.
Submandibular salivary gland stones perforating the floor of the mouth, reported in the literature, are even less common. In the last decade 7 cases have been described. The reported cases with perforating submandibular stones were large (≥22 mm). Table 1 summarises the features of the reported cases.
Submandibular salivary gland stones perforating the floor of the mouth, reported in the literature, are even less common. In the last decade 7 cases have been described. The reported cases with perforating submandibular stones were large (≥22 mm). Table 1 summarises the features of the reported cases.
Hector Galvan Oseguera, Martin Rosas Peralta*, Jose Manuel Enciso Munoz and ANCAM group for HBPM
Hypertension remains the most common modifiable cardiovascular risk factor, however, control of hypertension rates remain dismal. Home blood pressure (BP) monitoring has the potential to improve the control of hypertension. Home BP monitoring is now defended evenly for the evaluation and management of hypertension. This paper shows the experience of the National Association of Mexican Cardiologist in a group of patients with hypertension under drug treatment to evaluate the control in a real world clinical practice in Mexico. One hundred and fifty one patients were included. They were followed during two weeks with three home measurements at day (8:00, 14:00 and 20:00hr). An Ambulatory blood pressure of 24hr was performed at the middle of study. At the end of the study 36% (54/151) patients still uncontrolled by systolic blood pressure (>135 mmHg) and 31% by diastolic blood pressure similar results were detected by ambulatory blood pressure. During afternoon and night uncontrolled values were more common. Home blood pressure monitoring, results in a better form to detect uncontrolled patients and help clinical judgment to adjust pharmacological therapy. This practice should be recommended in Mexico.
Today, there is a considerable increase in localizing adrenal bulks with the bringing radiologic diagnosis methods having high technology into use and improvement in diagnostic tests. Adrenal glands are vital tissues for the organism due to the hormones they secrete. Death is a natural result in the absence of adrenal cortex.Adrenal bulks can be seen with different clinical, laboratory and radiological data. These bulks are often benign and rarely malign. They can be functional or non-functional. Major treatment methods used fort he treatment of adrenal gland primary tumors or metastases are surgery, arterial embolisation, chemical ablation, radiofrequency ablation and radiotherapy [1-4].
Spleen is one of the most important organ of the reticuloendothelial system and coordinates the immune response. Splenectomy is performed for hypersplenism, and staging of hematological malignancy. In conservatively followed patients, radiation therapy can be used to reduce hypersplenism symptoms. Splenectomy or palliative radiotherapy to spleen may probably cause an immune suppressive condition. This may probably local and systemic complications.
German surgeon, Vincenz Czerny, transplanted a patient’s own lipoma located in the hip to it’s breast after gland excision due to mastitis in 1895. Dr. Vincenza reported that for at least a year he didnt observe any problem on the operated breast [1].Injection of adipose tissue to the breast has been used in breast cancer patients during breast reconstruction and lumpectomy. And in cases of revision autologous tissues are used for reconstruction. In clinical practice, many breast cancer patients apply to the clinics mostly after radiotherapy for reconstruction. Rigotti et al used purified autologous lipoaspirates in breast cancer patients with late term complications of radiation therapy and observed increase in neovascularization and wound healing [2]. Panettiere and colleagues compared aesthetic and functional features of fat grafts in radiotherapy received breast cancer patients and control group. In the fat graft group, all clinical symptoms and aesthetic scores were significantly higher than the control group [3].
Among eye diseases, cataract is the most commonly encountered lens disease and the leading cause of reduced vision. Cataract caused by radiation develops due to neck & head, central nervous system tumors, eye localized tumors and total body irradiation. Today, the only treatment of cataract is surgery.
Beta radiation is seen to have an important place both in the etiology and treatment of cataract. Beta-radiation creates cataract in the lens as an adverse effect. However, beta radiation implementation is used for delay or prevention of cataract in glaucoma surgery. Effects of beta-radiation on the etiology and treatment should be supported by further prospective clinical studies.
Ayse Gul Kocak Altintas*, Cagri Ilhan and Mehmet Citirik
Irvine-Gass syndrome, is one of the most common causes of painless decrease in vision following even uneventful cataract surgery. It usually responds well to medical therapy, but, there are no widely acceptedconsensus on the efficacy of various therapeutic options for the treatment of Irvine-Gass syndrome. The patient presenting in this case report, has systemic hypertension and chronic obstructive pulmonary disease and he use oral anti-hypertension medication and inhaler steroid. He diagnosed as Irvine-Gass syndrome due to presence of decrease in visual acuity and macular edema with hyporeflective cystic intraretinal spaces in optical coherence tomography (OCT) since4th weekcontrol visitfollowing uneventful cataract surgery. After the responsiveness of several medications including topical steroid and non-steroidal anti-inflammatory drugs and intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF), intravitreal sustained-release dexamethasone implant was applied. The visual acuity improved to 0.00 logMAR at 1st month after intravitreal dexamethasone therapy and consecutive OCT images showed complete resolution of macular edema with a normalization of the foveal profile.The visual acuity and foveal architecture remained stable in 2-year follow-up period and additional treatment was not needed. To the best of our knowledge, this is the first reportthatmentions the increment of visual acuity after a single dexamethasone implant, even though it did not response anti-VEGF combined with topical steroid and non-steroidal anti-inflammatory drugs.
Romulo M de Moraes Filho*, Edilton de Albuquerque Cavalcanti Jr., Jackeline Gade A Rossiter, Angelica Virginia Valois Montarroyos and Luiza Suely Semen Martins
Psidium guajava (guava) is an important crop and economic resource in many tropical countries and Brazil stands out as one of its major commercial producers. The guava crop has been severely attacked by the plant parasitic nematode Meloidogyne enterolobii which has caused drastic reduction of productivity and, in some cases, even total loss of cultivated areas.The use of resistant rootstocks that are tolerant to these soil pathogens can be a low-cost solution to this pathogen, which has established itself as one of the major constraints for the cultivation of guava in Northeast Brazil. The objective of this work was to evaluate the reaction of P. guajava and P. guineense to M. enterolobii infection under greenhouse conditions, with an infection period of 60 days. 12 P. guineense, and 4 P. guajava were evaluated. The host response to the nematode infection was evaluated according to the following parameters: gill index (GI), reproductive factor (RF), and reduction of reproductive factor (RRF). Considering the RRF criteria, the P. guineense genotypes, AR1, AR3, AR4 and AR10 were considered resistant. The RF index was considered inadequate to evaluate resistance in the 60 days period, due the slow development of the parasite in P.guineense.
Alexander Christakis, Brian Tashjian, Anne M Gilroy and Stephen O Heard*
A 53-year-old male presented to the Emergency Department (ED) with multisystem trauma and respiratory distress following a blunt-force injury to his anterior left neck. CT imaging showed extensive subcutaneous emphysema and pneumomediastinum. A chest X-ray showed elevation of the left hemidiaphragm suggesting phrenic nerve injury which was confirmed by bedside ultrasonographic examination of the left hemidiaphragm. Flexible bronchoscopy demonstrated tracheal rupture. The patient was treated supportively and recovered without surgical treatment. Trauma-induced hemidiaphragmatic paralysis is rarely reported. This case represents a clinical scenario with demonstrable anatomic correlations, and a clinical reminder that phrenic nerve injury should be included in the differential diagnosis of respiratory distress in a trauma patient.
Barca Martín A, Ochoa de Ocariz LA, San Juan-Sanchez I and De la Vega R*
<h2>Abstract</h2><p>This paper analyses the effect of virtual reality visualization (VRV) on climbers, with respect to the traditional visualization methodology. The study sample was made up of 21 novel climbers: Control Group CG (N=7), Traditional Visualization Group TVG (N=7) and Virtual Reality Group VRG (N=7).In order to implement the mental imagery through virtual reality, a 360º Ricoh Theta S camera and a pair of Woxter Neo VR1 goggles were used. The data analysis was carried out with a simple ANOVA of three means. No statistically significant differences were found. The results are discussed and future lines of research are established.</p>
Ismail Selvi, Numan Baydilli* and Emre Can Akınsal
Introduction: Prune Belly syndrome is a disease characterized by abdominal muscle defect, bilateral cryptorchidsim and urinary system anomalies (reflux megaureter, hydronephrosis, etc.). Pulmonary, cardiac, and gastrointestinal anomalies may also be present. Management of these rare cases is very important. In this case, the clinical course of a patient with Prune Belly syndrome with megaurethra is presented.
Case: The patient from the first gestation and parturition with birth weight of 2500 g and 38 weeks was hospitalized because of the bilateral hydronephrosis. His physical examination revealed undescended testicles and a large penis. The abdominal muscles were not very atrophic. The size of the kidney was small, bilateral hydroureteronephrosis and wide posterior urethra on the ultrasound. Renal function tests were progressively disturbed and the patient underwent cystourethroscopy for diagnostic purposes in terms of posterior urethral valve. A large diverticulum was found in anterior urethra. Prune Belly Syndrome was thought because the orifices were in appearance of reflux. The vesicostomy was applied. After vesicostomy the renal function tests got better but he was hospitalized due to urosepsis two times. In cystoscopic examination, the diverticulum in the urethra was filled with urine and the drainage was very slow. Phimosis was opened with dorsal slit technique. Cutaneous urethrostomy was proximal to the anterior diverticulum.
Conclusion: Prune Belly syndrome should be considered in patients with megaurethra and postrenal or renal insufficiency although there are no obvious clinical findings. In Prune Belly cases, via a large penis with obstruction signs, anterior urethral diverticulum should be considered.
Gloria Tosi, Giovanni Vittadini, Ines Giorgi, Caterina Pistarini*, Elena Fiabane and Paola Palladino
Background: This study aims to retrospectively investigate the comorbidity of ADHD multiple symptoms (behavioral) with alcohol addiction in a sample of adult alcohol-dependent patients and to test their current attentional skills (behavioral and cognitive).
Methods: Thirty-two adult alcohol-dependent patients were examined for ADHD using a semi-structured interview and the Mini Mental State Examination to evaluate attention and inhibition functions. Brown ADD Scales were used to specifically examine ADHD syndrome. Patients were compared with thirty matched control participants selected from healthy population in few measures of attentional control and working memory.
Results: 50% of patients showed evidence of primary ADHD symptoms: specifically, 28.12% showed criteria for ADHD highly probable, 12.50% for ADHD probable but not certain and 9.38% for ADHD possible but not likely. Patients also revealed several deficits in the selective visual attention, interference control and verbal working memory compared to the control group.
Conclusions: These results revealed that adult alcohol-dependent patients had retrospectively high comorbidity with ADHD and significant current deficits of the executive functions. These findings suggest the importance of early diagnosis and treatment of ADHD in order to prevent the development of alcohol dependence.
Founder mutations are rare causes in arrhythmogenic cardiomyopathy including TMEM43 und phospholamban mutations. The incidence is approximately 1%. P.S358L TMEM43 mutations cause aggressive, in most cases biventricular arrhythmogenic cardiomyopathy [1], with the necessity of primary prophylactic ICD implantation in men and in women>30 years for sudden cardiac death prevention.The mutation increases the stiffness of the cell nucleus thus producing the massive loss of cardiomyocytes [2]. P.Arg14del phospholamban mutations cause biventricular arrhythmogenic cardiomyopathy with predominant heart failure, and in some cases, secondary sudden cardiac death [3]. Both founder mutations have characteristic electrocardiographic appearance, together with typical ECG manifestations of arrhythmogenic cardiomyopathy like right precordial T-wave inversions, terminal activation delay and epsilon waves in right precordial leads. Typical ECG manifestations in TMEM43 mutations are poor R-wave progression in right precordial leads (Figure 1), often associated with T-wave inversions in lateral leads [4]. Typical ECG manifestations in phospholamban mutations are low voltage ECG [5], more than complete right bundle branch block [6], epsilon waves in right precordial leads and in lead aVR [7] and right precordial T-wave inversions (Figure 2). Atrial fibrillation occurs frequently.
The global obesity epidemic that was previously reported [1,2] is now to worsen with obesity to double in 73 countries around the world [3,4]. Improving the health of obese individuals by dietary restriction, anti-obese foods and increased physical activity [1] has not reduced the global obesity epidemic. Obesity is linked to nonalcoholic fatty liver disease (NAFLD) [5,6] with complications relevant to the metabolic syndrome and cardiovascular disease [7]. Appetite control has become critical to endocrinology and metabolism with the apelinergic pathway and nuclear receptor Sirtuin 1 (Sirt 1) now connected to the endocrine system [8] and critical to metabolism. The apelin-Sirt 1 interaction involves nitric oxide (NO) [9] that is now considered as the defect [10] in the interaction between the peptide apelin and calorie sensitive gene Sirt 1 involved in NO imbalances in the adipose tissue, liver and the brain.
To facilitate understanding some issues of cochlear implantation for new beginners we wrote 1- “The Instruction for audiologists and cochlear implanted patients” and created 2-Demo-program MIMIC. Here are opinions of readers of “The Instruction” and participants of MIMIC. All the ratings are from positive to enthusiastic.
The problem of the alcohol misuse in Russia is well known; but there is a tendency to exaggerate it, which seems to be used to disguise shortages of the healthcare and public assistance.In this way, responsibility for the relatively low life expectancy is shifted onto the patients, who are supposed to drink excessively. In parallel, there is a tendency to exaggerate successes of the anti-alcohol campaign (1985-1989) and to trivialize the harm caused by the campaign e.g. mass consumption of surrogates [1]. The bias can be illustrated with the example of papers by Yuri Razvodovsky [2-5]. Yuri asked me per e-mail to write a “friendly” letter to the Editor referring to his article. An excerpt from the correspondence is presented here as documentary evidence (Figure 1). In reply, I cited the phrase: “The official statistical data do not support the claims that the… аnti-alcohol campaign contributed to the dramatic growth in fatal poisonings by non-beverage alcohol surrogates” [4] and commented that I witnessed mass poisonings with window cleaner in 1988. Considering the large scale of the window cleaner sales, it was knowingly tolerated by authorities. Poisonings with methanol and organochlorides (used e.g. in dry cleaning) were known to occur as well. Yuri replied that “there are two realities: one, which we both witnessed, and another-official statistics” (Figure 1). Obviously, Razvodovsky should have discussed in his articles the “realities we both witnessed”, i.e. common knowledge and observations, otherwise his papers are misleading.
Background: The majority of aggregate econometric studies indicate that higher taxes and real prices on alcohol significantly reduce the alcohol consumption.
Objectives: To estimate the effects of recent alcohol taxation and pricing policies on vodka sales per capita in Russia.
Methods: Trends in the affordability of vodka, excise tax rates on vodka, real and minimum price of vodka and per capita vodka sales between 2010 and 2015, were compared.
Results: A Pearson’s correlation analysis suggests a positive and statistically significant association between the affordability of vodka and per capita vodka sales. The association between vodka sales and excise tax rates on vodka, the real price of vodka and minimum price of vodka was negative.
Conclusions: These findings indicate that pricing policy has potential to reduce binge drinking of vodka in Russia.
Nagat S EL-Shmaa*, Mohamed El-Kashlan and Eman Ramadan Salama
Objective: To evaluate the impact of adding two different doses of dexmedetomidine to local anesthetic mixture on the quality of single injection peribulbar block in vitreoretinal operations.
Design: A prospective, double-blinded and randomized study.
Setting: carried out in operating room of our university hospital.
Patients: The study included 120 patients with viteroretinal diseases who were scheduled for vitreoretinal operations during the period from April 2016 to March 2017.
Interventions: 120 patients were randomly allocated to three groups of 40 patients each. Group I (the control group) received 5-7 ml mixture of lidocaine 2% and Levobupivacaine 0.5% with 120 IU of hyaluronidase, group II received5- 7 ml mixture of lidocaine 2% and Levobupivacaine 0.5% with 120 IU of hyaluronidase +15 µgdexmedetomidine, and group III received5- 7 ml mixture of lidocaine 2% and Levobupivacaine 0.5% with 120 IU of hyaluronidase + 30 µg dexmedetomidine.
Measurements: The primary outcome was to evaluate the impact of adding two different doses of dexmedetomidine on the onset of globe anesthesia and akinesia. Secondary outcomes were the duration of globe anesthesia and akinesia, overall patient satisfaction and surgeon satisfaction.
Results: The onset of globe anesthesia was significantly shorter in group II and III in comparison with group I. Adding dexmedetomidine to the local anesthetic mixture prolonged the duration of globe analgesia, and this difference was statistically significant in group II and III in comparison with the group I.
Conclusion: Adding dexmedetomidine to a mixture of lidocaine 2% and levobupivacaine/hyaluronidase mixture in single injection peribulbar block shortened sensory and motor block onset, extended the analgesia period and the motor block duration with high patient and surgeon satisfaction.
Farahnaz Fallahian*, Seyed Ali Javad Moosavi, Frouzandeh Mahjoubi, Samira Shabani, Pegah Babaheidarian and Tayebeh Majidzadeh
Background: Pulmonary fibrosis is a clinical problem with an enigmatic etiology with no effective therapy. Current therapies for lung fibrosis are ineffective for progression of lung fibrosis and preventing respiratory failure.
Objectives: The aim of this study is to explore the expression of Desmin, α-smooth muscle actin (α-SMA) and the telomerase subunit: human telomerase reverse transcriptase (h-TERT) in a spectrum of lung tissue samples consist of lung fibrosis, lung cancer, and healthy controls.
Materials and Methods: The expression of Desmin, α-SMA and hTERT were studied in samples of 15 pulmonary fibrosis samples, 16 samples of lung cancer and 14 healthy controls investigated. We evaluated Desmin, α-SMA as well as the expression of components of telomerase (TERT), by methods: RNA Extraction and cDNA synthesis, Real-Time quantitative PCR, Immunohistochemistry, all prepared from lung tissue paraffin blocked.
Results: α-SMA marker detected 1(8.3%) of healthy control and 11(91.7%) of lung fibrosis samples. The difference between groups was significant (p<0.001). Also the difference between healthy control 1(6.7%) and lung cancer 14 (93.3%) for α-SMA marker was a significant (P<0.001). It was a significant difference between healthy control and lung cancer for TERT expression (P=.005). TERT was not positive in any sample of neither healthy control nor lung fibrosis. For TERT, it was a significant difference between lung fibrosis and lung cancer by Fisher’s Exact Test (P=.004). Expression of TERT and α-SMA between small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) was not statistically significant (P=.700, P=0758), respectively.
Conclusions: We recommend more investigation to regard α-SMA, Desmin in patients with lung fibrosis and follow them for possible cancer risk. Also, more study is needed to regard TERT as a marker in lung cancer. Assessment of these markers may have future implication to explain the same way of pathogenesis and carcinogenesis of fibrosis and cancer and for prevention or treatment
luisetto M*, Behzad Nili-Ahmadabadi and Ghulam Rasool Mashori
In order to suggest new pathogenetic hypotesys in some heart disease we think is interesting to observe some biomedical literature: Can we think some endogenus toxicologic movens in some heart pathologies?
Activated platelet can trigger coronay artery spasm in some patients, and in SCD many patients not show Anatomic abnormalities and this can be involved sudden vigorous exertion untrained subjects (also in young) in seems to show an inadeguate methabolic response. Also severe artmia can be due by electrolyte umbalance.
Federico Benetti*, Natalia Scialacomo and Bruno Benetti
Stem cell treatments depend not only on the type of cell to be used but also on the different implantation techniques. Intravascular cell injections are known to rapidly separate from the vessels On the other hand, it is also well known that direct injection into the myocardium provides better coupling within the heart muscle.That were the cases of Embriofetal stem cell (HFDSC) or Autologous stem cells (ABMSC) in our experience focused on direct approaches. When we have to deal with different stimuli, such as parietal stress or direct myocardial injury leading to hemodynamic overload, the heart responds with hypertrophy, able to initially compensate for loss of function. Later, and over a long subclinical period, progressive dilation continues to be compensated for by varying degrees of hypertrophy.
In the final stage, as described by Meerson et al. [1], dilatation overcomes hypertrophy and changes in cellular organization appear, such as: 1) myofibrillar lysis; 2) Increased lysosomes; 3) Distortion of the sarcoplasmic reticulum; 4) replacement of myocardial cells by fibrous tissue. Simultaneously, capillary density and contractile reserve decrease, and diffuse myocyte necrosis is a characteristic of both idiopathic and ischemic dilated cardiomyopathy [2,3]. Therefore, idiopathic dilated cardiomyopathy can be described from a pathological point of view [4], as a dilated heart with hypertrophied walls; macroscopically the dilatation exceeds hypertrophy. Microscopically the heart is invaded by areas of interstitial and perivascular fibrosis, adjacent to necrotic areas and myocytes that may be atrophic or hypertrophic, with loss of the extracellular matrix. Cell therapy in these patients is directed at restoring and repopulating the myocardium, thus restoring lost function by supplying cells that are able to differentiate into myocardial cells.
The use of mesenchymal or stromal cells as precursors of non-hemopoietic tissues was first attempted by the German pathologist Conheim in 1867 [5]. It was later demonstrated in tissue cultures that they were able to form various tissues, such as bone, cartilage, muscle, ligaments, tendons, etc., and to intervene in tissue repair [6]. An extremely interesting study showed that stromal stem cells treated with 5 Azacytidine a week formed interconnected with micro-tubuli cardiomyocytes. After 2 weeks they begin to beat and this contraction becomes synchronous after three weeks develop natriuretic peptide and stained with antibodies against actin and myosin and have a potential for action of cardiac cells [7]. Trans-differentiation in the cardiac phenotype requires an adequate microenvironment. It depends on the cellular interconnection for the generation of cardiac transcription factors (GATA-4 and myocyte factor 2 that was also observed) [8]. This was also confirmed by other investigators, emphasizing the importance of intercellular integration of cardiomyocytes with trans-differentiated cells [9]. Among the various cell types studied, stromal stem cells were shown to have the ability to differentiate into muscle and vascular cells and produce angiogenesis.This work was conducted by Weisel and Lee of the University of Toronto in 1999 [10]. This differentiation in the myogenic lineage with the development of actin, myosin and tropomyosin was demonstrated, as well as the presence of Conectin 43, a protein responsible for cellular interconnection.
The bio-energy released by the hydrolysis of adenosine triphosphate, which relate to plenty of life activities and is transported in a solution, and its theory of transport are first stated and built in helix protein molecule. In order to confirm and verify the correctness of the transported theory we here systematically summarized and reviewed a great number of experimental investigation and evidences obtained by us and other researchers in past 30 years, involving the real existences of the solution and its features and lifetimes. In this survey we outlined and presented concretely the features of infrared spectra of absorption, Raman spectra and specific heat of the molecular crystal-acetanilide collagen, bivine serum albumin, myoglobin proteins and E.Coli. cell as well as the lifetimes of the solution in acetanilide and myoglobin measured by using pump-probe techniques and free-electron laser experiment, in which we give not only experimental data but also their comparisons with theoretical results. These experimental data and evidences provided here are enough to verify and affirm the true existences of the new solution, which can complete itself functions of bio-energy transport in the lifetime, and the correctness of the new theory of bio-energy transport in the acetanilide and protein molecule. Thus we can affirm the correctness of theory of the bio-energy transport in helix protein molecule, which can greatly promote the development of molecular biology.
Background: Popliteal artery aneurysms (PAAs) are rare, but the diagnosis should not be missed because of the limb and life threatening complications. The purpose of this study was to reach a consensus about the management of PAA based on our own experience and the available literature.
Materials and Methods: This is a retrospective analysis of all patients who underwent an open surgical PAA repair at our institution from January 2015 to December 2016. Demographic data, risk factors, clinical presentation, aneurysm characteristics, type of repair and results were reviewed. Results include patency and major complications.
Results: Seven patients underwent an open surgical PAA repair (six men). Median age was 72 years. A posterior approach (PA) was chosen four times and a medial approach (MA) was chosen three times. We performed six resections with interposition of a graft and only one ligation with a bypass. Five patients recovered well, did not develop any complication and did not need a second intervention to guarantee patency. These patients underwent a resection of the aneurysm and interposition of a graft (four via a PA and one via a MA). One patient treated by resection and interposition of a Dacron graft via a MA underwent an above-the-knee amputation at postoperative day 14. This patient had a preoperatively dysfunctional leg since several months with no patent outflow vessels. Our patient treated by ligation and bypass via a MA, developed an acute ischemia four months postoperatively because of an extreme flexion of the knee during several hours while watching TV. After unsuccessful trombolysis, he underwent a femorotibial bypass and a partial forefoot amputation. No long-term results are yet available.
Conclusions: In our opinion, open surgical repair of PAAs by resection of the aneurysm and interposition of a venous graft has the best results. Depending on the relation to the knee joint and thus the accessibility of the aneurysm, a posterior approach is preferred. We are not convinced of endovascular techniques in the treatment of popliteal artery aneurysms
Seyyede Masoume Athari and Seyyed Shamsadin Athari*
Asthma is a chronic respiratory disease which characterized by recurrent air flow obstruction, wheezing, chest tightness and coughing. Management of allergic asthma especially in children, is main problem for industrial world. Immunological factors have critical role in pathogenesis of allergic asthma.
Introduction: Most police officers work long hours in day and night shifts and this exposure can harm your health.
Objective: Know the Body Mass Index (BMI) of a group of policemen of both sexes chosen at random to calculate the degree of overweight / obesity of the observed population.
Material and Method: An cross-sectional study was carried out on 75 elements of the municipal police of sexes, obtaining age, height, and weight with which the corresponding Body Mass Index was obtained. Descriptive statistics were used.
Results: Measurements were taken at 75 (100%) policemen of both of them sexes, 60 (80%) male and 15 (20%) female. And the following results were obtained: ideal weight 5 (6.6%), overweight 21 (28.0%) elements and obesity 49 (65.3%).
Discussion: Obese workers are prone to getting sick, missing work, disability and early retirement when compared to non-obese workers. Obesity can be a predictor of early mortality; therefore, with a BMI of 30-35, life expectancy decreases from 2 to 4 years and with a BMI of 40-45 it decreases from 8 to 10 years. In our study we found 70 (93.3%) policemen were overweight and obese BMI> 25).
Conclusions: Our findings recommend the implementation of diverse programs for the improvement of the health of this labor group with a multidisciplinary team as well as the adequate physical spaces for the practice of the corresponding activities.
Roberto Carlos Burini*, Mariana Santoro Nakagaki, Edilaine Michelin and Franz Homero Paganini Burini
The responsiveness of hypertensive subjects to different types of physical exercises and length of intervention, has been investigated in samples of our dynamic cohort study (“Move for Health” program) based on spontaneous demand for healthy lifestyle with supervised exercises and dietary counseling. After clinical selection and baseline assessments they were spontaneously assigned to exercise protocols of strength (PAc) isolated or combined with endurance (walking) exercises (PMi) daily or in alternated days(PMiA), hydrogymnastics(PHy) and tread mill high- intensity exercises(PHit), applied during 10(experiment 1) and 20(experiment 2) weeks of intervention. Baseline demographic, socioeconomic, anthropometric and physical activity and fitness characteristics were similar among protocols. Ten-week training improved VO2max. Similarly in all protocols while hand grip increased only in PAc. In average, there was a 16% reduction rate of hypertension rate from baseline with both, SBP and DBP, reduced by PHy and only SBP by the PMi. After adjustments hypertension was more reduced by PAc, PMi and PHy. In the 20-week experiment, higher SBP was similarly reduced by PAc or PMiA and DBP by PMiA, after adjustments. Hence, so far, our generated data suggest physical exercises as an effective tool for hypertension reduction, from 10 weeks to 3 year-long supervised protocols composed by surface or aquatic activities with strength or endurance exercises. PAc takes longer and short-period responsiveness can be achieved by either combined (strength-endurance) or hydrogymnastic exercises. Thus, exercise training is a time-and type-dependent tool, feasible, costless and scientific-based rheostatic-allostatic alternative for the current “sick-care” drug-dependent homeostatic approach to hypertension med care.
Ana Elisa Serafim Jorge, Michele Luise de Souza Simao, Ana Carolina Fernades, Aline Chiari, Antonio Eduardo de Aquino Junior*, Anderson Luis Zanchin and Vanderlei Salvador Bagnato*
<h2>Abstract</h2><p>Osteoarthritis of the hand is a chronic condition that involves hand joints, but receives less attention. Few studies have investigated the use of ultrasound therapy and laser therapy for the treatment of hand osteoarthritis.The objective was to evaluate the effect of the conjugated treatment of therapeutic ultrasound and laser therapy on the pain and joint function of a patient with hand osteoarthritis. The is case of a woman, 57 years old, with a diagnosis of osteoarthritis on hand for 3 years, presenting constant pain and worsening after manual activities. The pain and function were evaluated, respectively, by Visual Analog Scale (VAS) and Australian Canadian Osteoarthritis Hand Index questionnaire (AUSCAN). After 12 sessions using ultrasound and laser therapy application, there was an expressive improvement in the pain and functional indexes of the patient. The combined application of therapeutic ultrasound and laser therapy, through the unified field action of the therapies used, proved to be efficient in reducing pain and improving the functionality.</p>
Lai Poh Soon*, Mohamad Helmee Mohamad Noor, Nor Fadhilah Madon, Mohd Hilmi Saidin, Mansharan Kaur Chainche Singh and Kunasilan Subramaniam
Urinary bladder distension is traditionally regarded as a sign of intoxication at autopsy, however, to date there is very little literature available to support this hypothesis. The purposes of our study were to correlate alcohol and/or toxicological analysis with calculated urinary bladder volumes and its sensitivity as well as to test the validity by using the radiologically calculated urinary bladder volumes (UBVs) from CT images. The study population was all the postmortem cases involving with blood and/or urine samples sent for alcohol and/or toxicology analysis in 2016 at the Kuala Lumpur Hospital. Out of that 485 cases, there were 127 postmortem cases retrieved with positive alcohol and/or toxicology results Positive toxicology results in this study was referring to drug of abuse (DoA) including amphetamine type stimulants, opiates, cannabis and ketamine.
Due to the advances in high-throughput sequencing technologies, the gut vriome is increasingly being perceived as one important component of the gut microbiome, where the number of viral biological entities is believed to far outcompetes that of the bacterial populations [1,2]. The human virome are primarily composed of bacteriophages, animal-cell viruses, endogenous retroviruses and viruses causing persistent and latent infections. Collectively they contains a more diverse genetic entity than the gut bacteria [3,4]. While the composition of them in the gut is precipitately being revealed, their roles in human health remain largely unexplored. It is undeniable that certain gut viruses are deleterious to human health. Interestingly, enteric viruses however, in some cases, can recapitulate the beneficial effects of commensal bacteria through different mechanisms, including modulating the innate and adaptive immunity of the host [5-7].
Over 50% of all deaths are because of chronic diseases, that we call lifestyle diseases. It means, 50% of the deaths can be prevented by lifestyle modifications. Even 40% of cancer, the disease which is the dreaded the most, can be prevented through healthy lifestyle. According to the World Health Organization (2005), the estimated loss in India’s national income due to heart diseases, stroke and diabetes in 2005 was US $9 billion. These losses are projected to exceed US $200 billion in the next decade, unless preventive measures are taken in which case, an accumulated economic growth of US $15 billion can be expected [2].
Such is the power of prevention. People need to be made aware of the risk factors and healthy lifestyles and it can remove a big burden from the healthcare system of the country. On an individual level too, it will help a great deal as people will be empowered to lead a healthy life.
It’s high time we give preventive health care its log due respect and make this world a healthier and happier place.
As the saying goes “prevention is better than cure…”, but such is the wrath of chronic diseases that the saying should be rephrased into “prevention is better than NO cure at all”.
Hausatu Babayi*, Ojo Olufunmilola Praise, Labake Fadipe Ajoke, Israel Kayode Olayemi, Elisha Baba and Oladosun Oluwale Peter
The effects of Leech Salivary Extract (LSE) on some haematological, immunological and organ weight parameters in rats, during a twenty eight days oral administration of 25, 50 and 100 mg/kg body weight doses, was investigated. LD50 and sub chronic toxicity was determined using standard methods. The oral LD50 was above 5000mg/kgbw. Oral administration of LSE (25mg/kgbw, 50mg/kgbw, 100mg/kgbw) for 28days had no significant (p>0.05) effect on the differential white blood cells (lymphocytes, monocytes, basophils, neutrophils, eosinophils), red blood cell indices (RBC count, PCV, HB, platelets, MCHC and MCH), feed intake, body weight gain and relative organ weight of lung, heart, liver, kidney, spleen and stomach of rats. However, the LSE evoked a significant (p>0.05) increase in the level of MCV in treated rats compared to the control. These results, indicating low toxicity and no negative significant effects of LSE on haemato-immunological indices in rats, suggest that the extract is safe for development and use as therapeutic for managing clinical conditions.
Pandey Prashant, Agarwal Nitin*, Das Suryasanta and Dharmendra Kumar
Background and Aims: the Aim of the study was to find the level of protection among the healthcare workers (nurses, doctors, housekeeping staff and general duty assistants) by doing Anti-HBsAb titer and vaccinate those who were not properly immunized against HBV infection.
Materials and Methods: The study was approved by the Institutional review board of the Hospital. The study group included doctors, nurses, technical staff and lab attendants. Anti-HBs antibody titer was done on Vitros 3600 (OCD, USA). Tests were performed according to manufacturer’s instruction. Vaccine provided was Engerix B (GSK Glaxo, Belgium). Vaccination was provided to all employees had titer below 10 miu/ml.
Results: 489 of 794(61.5%) HCW had no history of previous vaccination and only 293 (36.9%) subjects had complete vaccination. Only 60.8 % (482/794) of the total subjects had titer above 10 miu/ml and were protected against Hepatitis B. Around 80.6% (246/305) of those who were fully vaccinated and 40.8% (237/489) of those who were not vaccinated previously had protective anti-HBs titers(>10 miu/ml). Majority (86.8%, 271/312) who had titer below 10 miu/ml were unvaccinated. Two of eight employees who had history of needle stick injury in past were found non-immune to Hepatitis-B infection.
Conclusion: Despite being involved in the procedures with high chances of infections through needle stick or other exposures, only one third of health care workers were vaccinated against hepatitis B. We recommend that all the HCWs should be vaccinated for Hepatitis B and their anti-HBs levels determined at regular intervals.
Conclusion: Despite being involved in the procedures with high chances of infections through needle stick or other exposures, only one third of health care workers were vaccinated against hepatitis B. We recommend that all the HCWs should be vaccinated for Hepatitis B and their anti-HBs levels determined at regular intervals.
Results: 489 of 794(61.5%) HCW had no history of previous vaccination and only 293 (36.9%) subjects had complete vaccination. Only 60.8 % (482/794) of the total subjects had titer above 10 miu/ml and were protected against Hepatitis B. Around 80.6% (246/305) of those who were fully vaccinated and 40.8% (237/489) of those who were not vaccinated previously had protective anti-HBs titers(>10 miu/ml). Majority (86.8%, 271/312) who had titer below 10 miu/ml were unvaccinated. Two of eight employees who had history of needle stick injury in past were found non-immune to Hepatitis-B infection.
Conclusion: Despite being involved in the procedures with high chances of infections through needle stick or other exposures, only one third of health care workers were vaccinated against hepatitis B. We recommend that all the HCWs should be vaccinated for Hepatitis B and their anti-HBs levels determined at regular intervals.
Background: Pyogenic liver abscesses (PLA) are frequent in immunosuppressed patients. We review the characteristics of patients with PLA at a tertiary academic Spanish hospital in Asturias.
Methods: A retrospective observational study for 10 years, between 2006-2015. Epidemiological, clinical, analytical characteristics, treatment and hospital stay of the patients with PLA were analyzed.
Results: 99 patients, 62 (62.6%) men, with age ≥65 years (72.7%). The most frequent etiology was: Biliary (40%), postsurgical (15%) and intestinal origin (11%). The most frequent clinical signs were fever, showing significant differences, abdominal pain (p=0.001) and nausea (p=0.02) between biliary PLA and the rest of the PLA. Microbiological results were confirmed in 63% (62 cases). All were treated with antibiotic therapy, along with percutaneous drainage (44.4% (44 cases)); and surgical drainage (12.1% (12 cases)). The overall mean stay was 23.1 days without significant differences between those treated with percutaneous drainage or surgical drainage.
Conclusion: PLA predominate in patients ≥65 years. Biliary PLA are the most frequent, diagnosed at an older age than the intestinal PLA (p=0.005).
- The treatment is based on systemic antibiotherapy and percutaneous drainage, especially in PLA only >5cm (p=0.019).
- There are no significant differences in average stay of patients treated with percutaneous drainage or surgical drainage.
The probiotic effects of Bacillus coagulans and Bacillus subtilis were studied on survival, growth, concentrations of basic biochemical constituents, activities of digestive enzymes, and their colony establishments in the gut of Macrobrachium rosenbergii post-larvae (PL). Eleven groups of PL (2.03±0.05 in length and 0.18±0.01g in weight), each consists of 35 individuals maintained in 25 L of ground water and fed ad libitum with five serially diluted concentrations, 10-1, 10-3, 10-5, 10-7 and 10-9 of B. coagulans, and B. subtilis incorporated diets containing 40% protein, for 45 days. Diet without incorporation of any of these probiotics was served as control. These probiotics were found to be alive in the respective feed even on day-15 after their formulations. Significant improvement in survival, nutritional indices (weight gain, specific growth rate, food conversion ratio and protein efficiency ratio), contents of basic biochemical constituents (total protein, amino acid, carbohydrate and lipid) and activities of digestive enzymes (protease, amylase and lipase) were observed (P<0.05), particularly in 10-7 concentration of B. coagulans, and B. subtilis incorporated diets fed PL when compared with control. The biochemical confirmation tests revealed that presence of Escherichia coli, Acetonobacter sp., Salmonella sp., and Pseudomonas sp., in the gut of control PL. In the gut of PL fed with B. coagulans incorporated diet, Acetonobacter sp., Salmonella sp., and Pseudomonas sp., were found to be competitively excluded, whereas, in the gut of PL fed with B. subtilis incorporated diet, Acetonobacter sp., and Salmonella sp., only were found to be excluded competitively. Actually, colonies of Bacillus sp., and Lactobacillus sp., were found to be establishment in the gut of PL fed with B. coagulans, and B. subtilis incorporated diets. Overall, these probiotics incorporated diets produced better growth and survival due to better FCR and activities of digestive enzymes, which in turn led to better nutritional profile. Therefore they are recommended as feed additives for sustainable culture of M. rosenbergii.
Jonathan Cardona-Velez* and Laura Ceballos-Naranjo
Erectile dysfunction (ED) is a common disorder whose prevalence increases with age. Over time a strong correlation between erectile dysfunction and cardiovascular disease has been established as the result of the same pathophysiological process: endothelial dysfunction and atherosclerosis. Because small vessels of the penis can be affected by atherosclerotic plaque earlier than coronary arteries, carotids or femoral arteries, men often have symptoms of ED long before the signs of cardiovascular disease appear. For this reason, ED can act as a marker of early atherosclerosis that predicts the onset of cardiovascular disease at a later time.
Patrícia J Thyssen*, Marina FK Aquino, Natane CS Purgato, Edmilson Martins, Alexandre A Costa, Carolina GP Lima and Claudemir R Dias
In homicide cases, knowledge about time of death is important as it directs police investigation towards the discovery of authorship, including or excluding suspects of a crime, and determining nature of death. In Brazil, entomological evidence is still neglected by official forensic organizations and for this reason cases using insects to estimate post-mortem interval (PMI) are still rare. Dipteran specimens collected and analyzed by the staff of Criminalistics Institute (CI) from São Paulo State, Brazil, made it possible to elucidate circumstances of the death, including suspects to the crime scene, in five occurrences involving discovery of cadavers. In all cases, blowflies were collected and were identified as belonging to species Chrysomya albiceps (Wiedemann, 1819), Chrysomya megacephala (Fabricius, 1794), Chrysomya putoria (Wiedemann, 1830), Hemilucilia semidiaphana Rondani, 1850 and Lucilia eximia (Wiedemann, 1819) (Diptera: Calliphoridae), while only in one case Sarcophagidae (Diptera) flies were also collected. PMI estimate was calculated taking into account laboratorial developmental rate data of mentioned species on the environmental temperature on which bodies and insects were exposed, along with comparisons to field research previously conducted in those areas. Based on larval age and behavior, the course of the investigation had changed, pointing to the crime author (case I), as well as the nature of the crime (cases I-III) and associated suspects to the criminal act (cases IV-V). Results show how promising is the use of entomological evidence during investigations of violent deaths.
Mohamed Abdul Wajid, Pratik Chandra, Rohit Kulshrestha*, Kamlesh Singh, Ramji Rastogi and Vinay Umale
The term open bite is referred as no contact between anterior or posterior teeth. The complexity of open bite is attributed to a combination of skeletal, dental and habitual factors. Etiology of open bite can be attributed to genetics, anatomic and environmental factors.However, the tendency toward relapse after conventional or surgical orthodontic treatment has been indicated. Therefore, open bite is considered one of the most challenging dentofacial deformities to treat. The aim of this article is to emphasize that early etiological diagnosis, dentofacial morphology and classification are essential to the successful outcome of the technical intervention. Failure of tongue posture adaptation subsequent to orthodontic and/or surgical treatment might be the primary reason for relapse of open bite. Prolonged retention with fixed or removable retainers is advisable and necessary in most cases of open bite treatment. The treatment of open bite remains a tough challenge to the clinician; careful diagnosis and timely intervention with proper treatment modalities and appliance selection will improve the treatment outcomes and long-term stability.
Correcting class II malocclusion has always challenged an orthodontist owing to the complex and multifactorial aetiology. Age of patient and selection of the appliance plays an important role in the outcome of the treatment. Growth modification using functional appliances achieves stable results in class II patients. An orthodontist has wide variety of fixed and removable appliances for addressing a class II malocclusion. In this review article an attempt has been made to compile various available fixed functional appliances.
Introduction: The refractoriness in treatment of chronic prostatitis (CP) could be due to repeated infection. This reinfection could be caused by Helicobacter Pylori present in human saliva.
Methods: The oral cavities seem to be the important reservoirs for the reinfection. The transmission from these reservoirs could be stopped by avoiding contact between male urethera and saliva.
Results: Three patients suffering from refractory symptoms of CP were advised to avoid contact between their urethera and saliva and were prescribed antibiotics. All patients had complete response.
Conclusions: The oral cavity serve as reservoir of microorganisms (H.Pylori) which infects patient’s urethera repeatedly in patients of CP.
Type 2 diabetes is a common disease in these days and day by day it is arising. The main focus of the study was to investigate association of packed cell volume (PCV), Mean Corpuscular Volume (MPV), Mean Corpuscular Hemoglobin Concentration (MCHC), Red Cell Distribution Width (RDW) with glycemic marker HbA1c. So that PCV, MPV, MCHC, RDW could be used as a predictor of glucoregulation in type 2 diabetes instead of HbA1c value. This study included 87 DMT2 patients, which divided into two groups, A (n=41, presence in diabetics≤6.5-6.9%) and B (n=46, target in diabetes≥7.0%), according to HbA1c values. Spearsman correlation co-efficients were calculated to evaluate the relationship between RBC count, MCHC, RDW with random blood sugar (RBS) and PCV, MCV, MCHC with HbA1c value. Binominal logistic regression analysis was performed to estimate the relationship between glycemic control, as dichotomous outcome of MCHC, RDW, PCV, and MCV as the main prognosticator. MCHC and RDW were significantly higher in the group B compared to the group A. RDW and MCHC may be applied as the auxiliary indicators of deterioration of glucoregulation.
<h2>Abstract</h2><p>The purpose of this study was to determine the relationship between Navicular drop (ND) and Hallux valgus (HV) angles and their effects on foot-specific health related quality of life. Sixty female patients with bilateral HV aged between 32-60 participated in this study. The patients with the HV deformity degree of “2” or “3” according to the Manchester scale were included.</p><p>HV angle were obtained from standing (weight bearing) bilateral antero-posterior radiographs. HV angle (A angle), intermetatarsal angle (B angle), hallux interphalangeal angle (C angle) were measured. Subtalar pronation was measured the navicular drop (ND) test. ND test were performed for both feet and recorded in millimeters. Foot-specific health related quality of life was measured using the Manhester-Oxford Foot Questionnaire (MOFQ).</p><p>There was a strong positive correlation between the ND qtest and the angles A, B, and C for the right foot (rho=0.749, 0.761 and 0.749 p<0.001, respectively,). There was a strong positive correlation between the MOFQ subscales and the angles A, B, and C for the right foot (p<0.001). There was a strong positive correlation between the MOFQ subscales and the angles A, B, and C for the right foot (p<0.001).</p><p>In conclusion, there were relationship between ND, HV angular severity and foot-specific health related quality of life. As the HV angular severity increased, there was greater drop in the navicula and reduction in quality of life.</p><p> </p><p>In conclusion, there were relationship between ND, HV angular severity and foot-specific health related quality of life. As the HV angular severity increased, there was greater drop in the navicula and reduction in quality of life.</p><p> </p>
Simon Dimmick*, Jillian Patterson, Patrick Sheehan, Suzanne Anderson and Graeme MacDougal
<h2>Summary</h2><p><strong>Background:</strong> To determine the spectrum of shoulder pathologies suffered by surfers.</p><p><strong>Methods:</strong> Prospective descriptive study. Surfers with shoulder injuries who were referred to a sub-speciality orthopaedic shoulder private practice situated on the Northern beaches of Sydney (Australia) were recruited over a three-year period.</p><p><strong>Results</strong>: 42 shoulders in 37 subjects were included-12 acute injuries (29.3%), 9 acute on chronic (22%) and 20 chronic injuries. Average age 48 years (range 20-72 years). Seventeen subjects (46%) had manual occupations and 20 subjects (54%) had office-based occupations. Spectrum of pathologies included rotator cuff tendon tears, long head of biceps tendon pathology, labral tears, acromioclavicular and glenohumeral joint osteoarthritis.</p><p><strong>Discussion</strong>: There is a wide spectrum of acute and chronic shoulder injuries sustained by surfers. The most common presentation was for chronic pathology. The average age of 48 suggests that age may play a role in attritional/degenerative change and therefore an increased likelihood of injury.</p>
Allison Buchanan, Kelli J Wilkerson and Han-Hung Huang*
Background and Purpose: Transverse myelitis (TM) is a rare neurological diagnosis found in 1-4 per million people. Rehabilitation is recommended secondary to steroid treatment.There is limited clinical research on physical therapy (PT) for TM. The purpose of this case report is to present PT examination and management strategies for a patient with TM.
Case Description: A 25-year-old female patient diagnosed with TM was referred to PT. She presented foot drop causing ataxic gait, decreased sensation in bilateral lower extremities, significant fatigue, and low back pain. The patient required significant rest time between all tests and measures due to severely increased fatigue. PT plan of care was focused on therapeutic exercises per patient tolerance, passive range of motion (ROM) administered by the therapist, and gait training when activity tolerance was increased.
Outcomes: The patient was able to tolerate bouts of exercise as prescribed through home exercise program. She responded very well to passive ROM treatment during breaks between exercises to maintain ROM and decrease rigidity. Active ROM exercise was used to build activity tolerance while being mindful of limited ability due to fatigue. Upon increased activity tolerance, the patient was able to tolerate gait training with multiple breaks and maintain corrected gait when addressed during treatment.
Discussion: PT intervention was helpful for this patient with TM. Breaking down functional activities based on patient tolerance is important when treating people with TM. More experimental research is needed to support the benefits of PT for TM.
Emilce Artur de la Villarmois, Maria Florencia Constantin, Claudia Bregonzio and Mariela Fernanda Perez*
Background: Benzodiazepines are usually prescribed for anxiety and sleep disorders in a long-term fashion that may cause drug dependence. Discontinuation after prolonged administration may lead to withdrawal expression, being anxiety the most predominant sign. It has been described that a context-dependent associative learning process underlies diazepam dependence. Nitric oxide is a crucial player in learning and memory processes, hippocampal transmission, as well as in benzodiazepines withdrawal. Considering that previous results from our laboratory showed an increase in hippocampal functional plasticity only in diazepam dependent rats, the aim of the present investigation is to determine whether diazepam dependence could alter neuronal nitric oxide synthase enzyme (NOS-1) expression within the hippocampus, by using western blot.
Results: chronic diazepam-treated animals that developed dependence showed increase in NOS-1 expression in dorsal, but not in ventral hippocampus, while no-dependent or control animals presented similar NOS-1 protein levels.
Conclusion: withdrawal from long-term diazepam exposure could be associated to increased nitric oxide neurotransmission within dorsal hippocampus induced by NOS-1 over-expression. This mechanism could underlie the improved hippocampal synaptic transmission previously observed in diazepam withdrawn animals. Confirmatory experiments need to be addressed to determine the mechanisms by which nitric oxide participates in benzodiazepines withdrawal in order find new molecular targets to develop pharmacological tools to prevent the withdrawal syndrome.
Nobody doubts that mathematics plays a crucial role in medical achievements. It is certain that is being mainly used in statistics and physics for biomedical problems [1]. For sure that we have already heard about how mathematics can improve the anticancer arsenal [2].Quantitative genetics have triggered a giant potential in medical care [3,4]. And mathematical algorithms, provided by artificial intelligence, continuously boost new therapeutic paradigms [5,6]. Nonetheless, one cannot ignore the ability of mathematics for analyzing ideas. One can see that when Soares dos Santos and colleagues [7] wondered what mathematics is able to say about how to optimize the performance of implantable medical devices, they wondered about the optimality of their research projects in the first place. What mathematics says about how to design “optimal” devices? It says that current devices are not able to ensure such performance. Will new or improved surgical techniques solve device failures? Mathematics also says «no». Will new or improved materials solve device failures? Mathematics says «it is possible, but it will be harder». Harder than what? Mathematics says: «Harder than instrumented active devices. Medical devices can perform optimal performances if they are active, i.e., if they are able to monitor their own state and the physiological states of the tissues surrounding the device, and if they are able to apply therapeutic actuations to such tissues so that the failure state is conducted to a without-failure state» [7-11]. And mathematics also says that this analysis can be applied to the overall implantable medical devices [7]. One cannot deny that mathematics is a powerful tool to identify what are the key challenges that must be addressed for unsolved problems in medicine. Thanks to mathematics, the universe of concepts is not apart from the clinical practice. However, medical research is being conducted by considering the paradoxicality of mathematics in medicine [1] as an assumption-the first challenge must be to question mathematics about the real accomplishments that our research projects can achieve.
Jose Bernal Alzate, Edgar Omar Rueda Puente*, Onecimo Grimaldo Juarez, Daniel Gonzalez Mendoza, Lourdes Cervantes Diaz and Alejandro García Lopez
Vegetable production by grafting is a technique which it has made possible to resume agricultural soils which previously could not be produced due to stress generated by various abiotic factors, like a lack of water,stress by high or low temperatures, and or heavy metal contamination, among them. It has been documented and defined a number of graftings which they are tolerant to different factors; however, when it comes to auscultating information related to understand the molecular responses and observe what are the biochemical changes and physiological responses of grafted plants, it is dispersed. The current paper attempts to provide basic information documented on technique, addressing the molecular, biochemical and physiological responses, and thus get a clear perspective on the use of grafts, making this practice be used with most frequently by all its advantages.
Plant hormones are versatile chemical regulators of plant growth. The concept of hormone ‘interaction’ [1] has gained much importance and several key players of hormonal network are uncovered for major plant hormones.The fact that hormones are structurally unrelated and their interaction elicits different genomic and non-genomic responses suggest hormone interaction involve co-regulation at multiple levels [2]. Recent studies suggest that hormonal interaction involves control over biosynthesis genes [3-6], key components of signalling pathways [7,8], hormone distribution [9,10], and interaction at the level of gene expression [11-13]. The spatial and temporal changes in hormone sensitivity add further complexity as they are developmental stage-dependent [14]. Understanding how these mechanisms are integrated would allow us to manipulate hormone interaction-regulated growth response under environmental changes. One such prominent emerging hormone interaction is ethylene and abscisic acid (ABA) in several growth processes. In this short review, I discuss some of the common transcriptional regulators of ethylene and ABA.
<h2>Abstract</h2><p><strong>Background:</strong> With the development of sports science and badminton equipment, the roles of badminton shoes, such as to alter lower - extremity biomechanical parameters, prevent sports injuries and enhance performance, were confirmed by a mass of studies.</p><p><strong>Methods</strong>: In this study, a serial of methods including literature review, visualization analysis, mathematical statistics, are used to describe the progresses of the badminton shoes relate to exercise in some training aspects, which can be searched by CNKI and SCOPUS databases.</p><p><strong>Results</strong>: Among the exiting research, most mainly focused on evaluation and design of badminton shoes, sports injuries and performance, some have tested and verified the roles mechanism of badminton shoes. However, there are still some disadvantages to can’t ignore, such as the quantities of studies the designed level and the mechanism exploration.</p><p><strong>Conclusions</strong>: To sum up, the roles of the badminton shoes in sports training still need to be explored and confirmed.</p><p> </p>
Ocular disorders encompass a multitude of diseases that are unique in their cause, therapy and degree of severity. Due to distinctive morphology of the eye, efficient ocular drug delivery has proven to be a difficult task. Current treatments of ophthalmological diseases include the usage of both intrusive as well as nonintrusive methods such as injections, eye drops, ointments, gels etc. The current state of the art drug delivery methods are associated with low bioavailability and therefore nanotechnology based drug delivery approached are evolving as for improving the therapeutic index of currently used drugs against variety of ocular disorders. This review highlights the recent developments in nano-formulations for ophthalmic treatment and also offers discussions towards the future prospectus of nano-formulations in the mainstream of ophthalmic diseases.
Introduction: The HRMT (Human Resting Myofasial Tone) factor plays an important role to initiate the trigger the inflammation at the disease site in Ankylosing spondylitis (AS) as in all spondyloarthropathies. The incidence of fibromyalgia is higher in AS and a limiting factor to undergo the exercise program.
Aim of the study: To know the effectiveness of soft tissue mobilisation in patients with Ankylosing Spondylitis when it used as an adjuncts to the conventional exercises.
Methodology: 40 subjects were randomly assigned in to experimental and conventional group. Experimental group (n=20) received conventional exercises along with soft tissue mobilisation and the conventional group (n=20) received only conventional exercises (flexibility exercises, aerobic exercise and breathing exercise) for a period of 4 weeks, 5days/week.
Results: The result of the study showed that both the conventional and experimental groups improved significantly in stiffness, pain and physical function aspects after treatment. However the experimental group had a greater change as compared to conventional group.
Conclusion: The study demonstrates that soft tissue mobilisation has an effect when it used before the conventional exercise in patients with ankylosing spondylitis.
Fungi cause a variety of diseases and are difficult to treat owing to their eukaryotic nature resulting in dearth of antifungal targets at hand. This problem is further elevated many folds due to the resistance mechanisms of fungi through which they circumvent the antifungal drugs administered for therapeutic purposes. Fungi have a variety of strategies for obtaining these resistances, amongst them pivotal role is played by the ABC and MFS transporters. This article encompasses the important genes and their respective roles of both the classes of the transporters in different species of fungi.
Brachial plexus tumours are rare. It comprises of only 5% of all tumours of upper limb [1]. The two most common brachial plexus region tumors are schwannomas and neurofibromas [2 4].Both are benign and arise from the nerve sheath. XiaotianJia et al., published a large case series of 143 patients with primary brachial plexus tumors in 2016. In his series, there are 119 schwannoma and 12 neurofibromas [3]. Schwannomas are most frequently found in the head and neck region, which comprises 25% of all Schwannomas. There are only about 5% of schwannomas present as brachial plexus tumours [5].
The most common clinical presentation of primary brachial plexus tumor includes palpable mass, pain, numbness or paresthesias, weakness etc. [3-6], Brachial plexus schwannoma can present as neck mass, axillary mass, supraclavicular mass or apical lung mass [7-10]. On CT, most schwannomas are iso-dense relative to brain parenchyma. Calcification or areas of hemorrhage are rare and the enhancement pattern is typically homogeneous. On MRI, schwannomas are iso-intense to hypo-intense on T1-weighted MRI and enhance with gadolinium [11,12]. Malignant transformation of schwannoma is very rare, but it has been reported in literature [13]. Outcome of surgical removal of brachial plexus schwannoma has been reported to be satisfactory [14].
Mesenchymal stem cells (MSCs) are multipotent adult stem cells that can self-renew and differentiate into a variety of cell types including chondrocytes, osteocytes and adipocytes.MSCs reside in bone marrow, adipose tissues, cord blood, peripheral blood, placenta, Wharton’s jelly, fetal liver and lung among others. MSCs represent one of the most promising stem cells for regenerative medicine due to their multipotency, immunoprivileged properties and easy expansion in vitro. So far, MSCs are already in various phases of clinical application [1-4]. Their most immediate use is in the orthopedic context due to the clear demonstration of their ability to differentiate into bone and cartilage [5-8]. It has been 5 decades since Friedenstein et al described clonal and plastic adherent stromal cells from bone marrow in the 1960s [9,10]. Although there are a handful of genes suggesting possible MSC stemness markers, the molecular basis underlying MSC stemness, especially the key transcription factor to MSC stemness, is still poorly understood.
There are several reasons for poor understanding of MSC stemness. First of all, the heterogeneity of MSCs greatly hamper in-depth MSC study. Variations exist among MSCs from different sources and culture conditions, even fast and slow growing CFU-derived MSCs from the same patient also display differences [11,12]. So far, the factors that affect the heterogeneity of the MSC population is still largely unknown. Secondly, the limited lifespan of MSCs increases the difficulty to study MSCs, especially in case of large number of cells needed. Like other adult stem cells, MSCs undergo the replicative senescence after only a finite number of times in culture. At around passage 10, MSCs demonstrate morphological abnormalities, enlargement, attenuated expression of specific surface markers, and ultimately proliferation arrest [13,14]. In the meanwhile, MSCs reduce differentiation potential during prolonged in vitro culture [15]. The limited lifespan of MSCs also greatly compromises the therapeutic application of human MSCs due to limitation in cell number. Thirdly, little is known about MSC niche. Stem cell niche is a specific microenvironment, in which stem cells are able to self- renew and maintain the undifferentiated state. So far, the MSC niche remains poorly understood.
Jose Aviles-Herrera, Karla C Arana-Pazos, Leonardo Del Valle-Mondragon, Carolina Guerrero-García and Alberto Francisco Rubio-Guerra*
Endothelial dysfunction and inflammation play a key role in the pathophysiology of diabetic nephropathy; Tetrahydrobiopterin (BH4) is an essential cofactor for nitric oxide synthase, when BH4 is reduced to dihydrobiopterin (BH2), endothelial dysfunction is induced.
Purpose: The aim of this study is to evaluate the relationship between the levels of biopterins with albuminuria in type-2 diabetic hypertensive patients.
Methods: We studied 30 hypertensive type-2 diabetic patients in whom biopterins levels were measured by reverse phase high performance liquid chromatography with fluorescence detection. Additionally, 24 h urinary albumin excretion was also measured (nephelometry). The levels of biopterins and albuminuria were correlated with the Pearson correlation coefficient.
Results: We did not find a significantly correlation between biopterins levels and albuminuria, However, we found a significantly inverse correlation (R= -0.498, p<0.005) between the BH4/BH2 ratio and albuminuria.
Conclusion: Our results suggest that the BH4/BH2 ratio instead of biopterins levels may be a marker of nephropathy in hypertensive type-2 diabetic patients.
Awais Ahmed, Abdu Hafeez Baig*, Mirza Akmal Sharif, Umair Ahmed and Raj Gururajan
Purpose: The purpose of the study is to access the prevalence of accessory right inferior hepatic veins and their relevant significance in liver transplantation.
Materials and Methods: A retrospective study was done in which the CT of 82 potential liver transplant candidates between January 2012 and March 2013 were reviewed. The presence of the accessory right inferior hepatic vein was examined; the diameters of the accessory inferior hepatic veins and the distance between the point where they open into the inferior vena cava on the coronal plane and to the right hepatic vein-inferior vena cava junction was measured.
Results: Out of 82 patients, 42 (51%) had accessory right inferior hepatic veins. Right accessory inferior hepatic veins larger than 3 mm were detected in 23 (28%) patients. The distance of these veins to the right hepatic vein-inferior vena cava junction was more than 4 cm in 13 (15%) patients.
Conclusion: The precise preoperative knowledge of accessory right inferior hepatic veins is essential in living donor liver transplantation.
Deepak Mishra*, Megha Gulati, Prashant Bhushan, Nilesh Mohan and Bibhuti Sinha P
Objective: To study the epidemiology of xerophthalmia in children 2-6 years of age in North India.
Methods: A prospective clinical study was done at two tertiary care centers of North India between 2010 to 2016, Cases were selected from routine OPD and children less than 6 years of age were examined by an ophthalmologist. Diagnosis and classification of Xerophthalmia was done according to WHO classification. All the data recording demographic profile, socioeconomic status, other health problems etc were recorded in a fixed proforma. Data was analyzed by SPSS version 16.
Findings: Two thousand nine hundred forty six cases were included in the study after satisfying inclusion and exclusion criteria. The prevalence of night blindness was estimated to be 2.93% (95% Confidence Interval [CI]: 2.53-3.33) among children between 2 and 6 years of age. Xerophthalmia prevalence was 4.43% (95% CI: 4.19-4.67). Prevalence was more in girls than boys and higher in low socioeconomic status.
Conclusion: Vitamin A deficiency is recognized to be a severe public health problem leading to corneal opacity and childhood blindness in most of the areas of North India.
The normal levels of thyroid hormones (THs; thyroxine, T4 & 3,5,3′-triiodo-Lthyronine, T3) are necessary for the normal development [1-48], particularly the fetal and neonatal cardiac growth and development [49].The actions of THs are facilitated genomically by thyroid receptors (TRs, α and β) and non-genomically at the plasma membrane, in the cytoplasm and in cellular organelles [4,49-55], by stimulation of Na+, K+, Ca2+ and glucose transport, activation of protein kinase C (PKC), protein kinase A (PKA) and mitogen activated and protein kinase (ERK/MAPK) [4]. In addition, the transport of T4 and T3 in and out of cells is controlled by several classes of transmembrane TH-transporters (THTs) [56], including members of the organic anion transporter family (OATP), L-type amino acid transporters (LATs), Na+/Taurocholate cotransporting polypeptide (NTCP), and monocarboxylate transporters (MCTs) [4,49,57,58]. Adding additional complexity, the metabolism of T4 and T3 is regulated by 3 selenoenzyme iodothyronine deiodinases (Ds: D1, D2 and D3) [59-61]. On the other hand, the congenital hypothyroidism can cause the following [49,62-64], (1) congenital heart diseases; (2) diastolic hypertension; (3) reduced cardiac output, stroke volume and a narrow pulse pressure; (4) dilatation and overt heart failure; (5) elevation in the systemic vascular resistance [65-68]. Similarly, the chronic hyperthyroidism can cause the following [49,64]: (1) cardiac hypertrophy; (2) increase in the cardiomyocyte (CM) length rather than width; (3) noticeable diminution in systemic vascular resistance; (4) elevation in the cardiac contractility; (5) systolic hypertension; (6) increase in the cardiac output, venous volume return, blood volume and pulse pressure; and (7) reduction in the systemic vascular resistance [49,69]. T3-therapy can induce DNA synthesis and cardiomyocyte proliferation, and improve the cardiac contractility; though, this action is as still unidentified [49,70-74].
Burak Turgut*, Feyza Calis Karanfil and Fatos Altun Turgut
Neuro-ophthalmological emergency disorders usually occur with symptoms of visual loss, diplopia, ocular motility impairment and anisocoria. In this mini-review, we aim to take look the common neuro-ophthalmological emergency disorders. The delayed diagnosis of the neuro-ophthalmological emergencies puts the patient at risk of death or blindness. If these are well-known, the discrimination and management of these emergency conditions will be easier.
In this work an efficient method developed for the synthesis of 125I-benzofuran-2-yl) pyridin-2-amine (125IBPA), followed by radioiodination with 125I by using Chloramine-T at pH 8. The reaction proceeds within 10 min at room temperature (20-25°C). The radiochemical yield determined by Thin-Layer Chromatography (TLC) using hexane:ethyl acetate (1:6 v/v) and the purity analyzed by high-performance liquid chromatography using a reversed-phase RP18column and acetonitrile:0.1 M ammonium bicarbonate (pH 7.5) (1:1) as the mobile phase at a flow rate of 1 ml×min−1. The radiochemical yield using aH2O2 oxidant found equal to 96.5% with a radiochemical purity of 125I-BPA of over 96.5%. The biodistribution data in normal mice indicated a high initial uptake of 6.54±0.10 (% ID/g±SD) in the brain within 30 min post-injection. These results promote a further the use of 125I-BPA as a novel agent for brain imaging.
From biomedical literature “autism disorder are involved in young patient, that we have abnormalities (Imaging, histology) in some brain areas, and a comples symptomatology. Genetic and environment can produce some unbalances in brain grow and immunitary situation is involved. Apoptotic signal contribute in brain growth and immunologic shock can unbalance the environment producing abnormalities”.
We can see that some pharmacological molecules are been introduced in therapy in some brain pathologies with a specific mechanism: modulating the immune systems. We can see that some systemic immune modifications can unbalance this systems producing pharmacological effect in local place (as Brain). We can observe this phenomena like a kind of toxicity that can be deeply investigate to discover new Pharmacological strategies.
Aim of this work is to observe this kind of pathologies under a specific immune-toxicological aspect. We think that in this field are needed deeply new approach in order to adequately focus this kind of disorder. A different way to set this kind of pathologies can help in searching new pharmacological strategies.
Coroner and medical examiner offices are charged with the medicolegal investigation of deaths to determine the cause and manner of death. We describe the recent high-profile case of Otto Warmbier, who tragically died shortly after his return in a coma from North Korea and in which the coroner failed to conduct a complete autopsy, and failed to satisfy the needs of the local, national, and international communities.
Medico legal death investigation offices, including both medical examiner and coroner offices, have a legal responsibility and duty to investigate deaths in the public interest for public safety and public health purposes. Although, they serve the families of the deceased as they can, their raison d’être and priority is service to the greater public good. Thus, they may conduct investigations and even autopsies over the objections of the next-of-kin. Full investigations include a complete forensic autopsy. The utilitarian public interest should, within the constraints of the office resources, drive the decision of whether to autopsy or not. Failure to autopsy can sometimes constitute a breach of faith that the public entrusts in these offices. Empirically, this seems to be a greater problem in coroner jurisdictions than in medical examiner offices. Specifically, we believe the recent case of Otto Warmbier is such a case.
Awad Magbri*, Mariam El-Magbri and Eussera El-Magbri
The case is that of 83 year-old African American man with hypertension, hepatitis C induced decompensated cirrhosis with ascites, end-stage renal disease (ESRD) on hemodialysis, fluid overload with peripheral edema and chronic hypotension. The patient was referred to the dialysis access center of Pittsburgh, PA for evaluation of his prolonged bleeding from the left upper arm brachial-basilic arterial-venous fistula (BBAVF).
On examination, he was found to be severely hypoxic with oxygen saturation of 80-92 mm Hg. Chest was clear on auscultation. Abdominal examination showed hepatosplenomegaly with ascites. Extremities showed 3+ peripheral edema bilaterally. His chest x-ray showed cardiomegaly with clear lung fields. His laboratory workup showed, WBC of 3.4, RBC 3.69, MCH 31.2, MCHC 32, and platelets 104 K/L. Chemistry showed Na 134, Cl 99, CO2 24, Total protein 7.2 with albumin of 2.9. SGOT was high at 44, vitamin D 42. Laboratory data were also indicative of chronic liver disease with bilirubin of 2.8, INR of 1.2, and albumin of 2.9, and platelet count of 104. Immunology for Hepatitis B Ag was negative, Hepatitis B Ab was 22 H, Hepatitis C Ab was positive. Arterial blood gas analysis showed PaO2 of 54 mmHg while breathing room air.
The catamenial pneumothorax is defined as the accumulation of air in the pleural cavity that appears in women infrequently and spontaneously with various clinical presentations. Actually, it is considered as an extremely rare entity with few cases described in the literature, that is the reason why the etiology is still discussed. However, a strong association with thoracic endometriosis syndrome has been found. We want to emphasize how the importance of conducting a diagnosis and having a timely management would improve the quality of life of the patient and give a better prognosis of the disease. Thus, a case report of a 38-year-old female patient who was receiving hormone therapy as a treatment for abdominal endometriosis and repetitive pneumothorax was presented. In the video-assisted thoracoscopy we saw diaphragmatic lesions and pneumothorax during the perioperative and postoperative period. Emphasize the importance of a detailed inspection of each intrathoracic organ during the surgical procedure, we also showed how the intraoperative pleurodesis, the placement of a mesh on the diaphragm and the continuity of the hormonal treatment, seems to be an effective therapy to prevent recurrences and have a better control of the disease.
<h2>Abstract</h2><p>Lipoma is a benign mesenchymal tumor with a thirteen percent incidence in head and neck region. Posterior triangle is the most common location while anterior neck lipoma is a rare one. Giant lipomas >10cm have been reported in different parts of the body but rarely in the anterior neck. Giant lipomas of the neck can present as a cosmetic disfigurement or can produce pressure symptoms. Most lipomas do not pose any difficulty in diagnosis. Surgical excision remains the treatment of choice. We here present a case of giant anterior neck lipoma. </p>
One of every four visits to eye care professionals is for dry eye disease which affects an estimated 7-34% of Americans [1].Knowledge regarding etiology and treatments has advanced exponentially in the last 20 years. As recently as 1997, in the mega textbook Cornea, it was stated “The mechanism for lacrimal gland dysfunction in this condition is unclear” [2]. A recent study entitled “The Dry Eye Workshop ll Report”, defines dry eye as “a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film and accompanied by ocular symptoms in which tear film instability and hyperosmolarity, ocular surface inflammation, and damage and neurosensory abnormalities play etiological roles” [3]. A 2003 study regarding the morbidity ratings of dry eye showed utility assessments for moderate and severe dry eye were parallel to historical reports for more severe (class lll/ lV) angina [4]. The tear film is responsible for the greatest optical power of any ocular surface, since the greatest change in the index of refraction occurs between the air and the tear film [5]. Double pass retinal imaging shows increased light scatter in dry eye patients which can decrease retinal image quality 20-40% [5]. Ophthalmologists now understand the critical necessity to normalize the ocular surface prior to cataract surgery; otherwise, they risk an unhappy patient with a less than ideal visual result. Increased use of electronic devices, such as smart phones, tablets, and computers, by youth in the last ten years has resulted in a broader age range of dry eye patients, to now include adolescents and teens. A study of urban school age children showed that 8.2% had dry eye (vs 2.8% in a rural group), presumably due to high incidence of smart phone use.6 In fact, with cessation of phone use for four weeks, dry eye resolved completely in 100% of subjects [6]. Only two FDA approved dry eye medications are available: cyclosporine ophthalmic emulsion, 0.05%, (approved in 2003) and lifitegrast, 5%, (approved in 2016), both of which require chronic treatment. The focus of this discussion involves an emerging paradigm in treating ocular surface disease: a nutraceutical containing omega-3 essential fatty acids.
Iman Ibrahim Sarhan, Hussein Sayed Hussein, Islam Omar Elshazly* and Mahmoud Salah Hassan
Intravenous iron is used in combination with erythropoi esis-stimulating agents to treat the anemia of hemodialysis patients, however, there is variety in the dose and the frequency. So we compare bolus intravenous iron administration protocol vs an intermittent intravenous iron infusion protocol for 3 months in a single blinded design that was conducted on 30 patients randomized into 2 matching groups. Iron parameter, hemoglobin level, and CRP were monitored before and at the end of study. Patients with end stage renal disease on regular hemodialysis with iron deficiency anemia can be treated with intravenous iron administration either by the protocol of divided doses of IV iron through the sessions of hemodialysis or by giving the total dose of iron needed as a single large dose on only one session of hemodialysis, obtaining the same outcome in correction of iron parameters in treatment of iron deficiency anemia.
Sorbellini Elisabetta, Pinto Daniela, Marzani Barbara and Fabio Rinaldi*
Lichen Planopilaris is known as the form of Lichen Planus typical of the scalp. It is classified as a lymphatic disease and is characterized by chronic inflammation which leads to cicatricial alopecia. Its causes are not yet well characterized but its etiology seems to strongly correlates with infection, sensitization and pollution. A clear and objective diagnosis of Lichen Planopilaris is not simple but the evolution and strongly negative outcomes on scalp of people affected by, pose the need of an early diagnosis.
In this work we report the case of a 27-year-old male and a 54-year-old female, respectively, in which a correct diagnosis of Lichen Planopilaris, followed the incorrect previous ones, was made by means of dermatoscopy and histopathological analysis, decisive tools for the diagnosis of this kind of pathology.
Multiple studies have investigated the relationship between androgenetic alopecia and cardiovascular disease, including studies that have identified elevated rates of cardiovascular disease in patients with vertex hair loss, vertex and frontal hair loss, early onset hair loss and rapidly progressive hair loss. In addition, increased risks for hypertension, excess weight, abnormal lipids, insulin resistance, carotid atheromatosis and death from diabetes or heart disease have been reported in this population. Studies investigating an association between androgenetic alopecia and metabolic syndrome have yielded conflicting findings. Distinct guidelines for the detection and prevention of cardiovascular disease in individuals with androgenetic alopecia have not been established. In addition to the traditional risk factors for developing cardiovascular disease, included in the definition of the metabolic syndrome, several skin diseases have recently been shown to be markers of conditions relating to the patient’s overall health. Physicians should be aware of the possible connection between relatively frequent skin diseases, such as psoriasis and hair growth disruptions, including androgenetic alopecia and female pattern hair loss and cardiovascular disease. This review is concentrated on the association between insulin resistance, type 2 diabetes, abdominal fat, cardiovascular disease and hair growth disruptions as an early indicator of these underlying conditions. We have investigated the importance of robust primary clinical treatment measures to address the manifestation of hair loss due to a disruption caused by metabolic syndrome as an effective means to alleviate further stress induced hair loss, which can exacerbate the underlying cause.
Elisa Borsani, Luigi Fabrizio Rodella, Elisabetta Sorbellini, Rita Rezzani, Daniela Pinto, Barbara Marzani, Giovanna Tabellini, Mariangela Rucco and Fabio Rinaldi*
Regenerative medicine is a modern approach of dermatological treatment, using Epidermal Cells of the interfollicular epidermis (ESCs) for their effect in skin regeneration in chronic ulcers and burns, melanoma, vitiligo, junctional epidermolysis bullosa.Intraepidermal injections of autologous epidermal cell suspension can be a new and very promising treatment for many other cutaneous disorders as non-scarring alopecia (Alopecia Areata, Androgenic Alopecia) or scarring alopecia (Lichern Plano Pilaris alopecia, Discoid Lupus Erithematosus alopecia), anti-aging therapies. The intraepidermal injection of an autologous epidermal cell suspension is a simple, fast and safe surgical procedure: a small, thin portion of the epidermis of the patient undergoes a treatment where a suspension with all the cells collected from the epidermis and cultured for 7 days is injected into the skin. Our preliminary study shows that a suspension contains a significant number of viable cells that survive at day 7 in culture.
Our research is ongoing and is focusing on the typing of the different cells in the suspension and evaluation of the presence and the nature of stem cells.
Polyamines are aliphatic amines found in all living cells, and they are necessary for several fundamental cell processes. Their protective role against various abiotic stress factors has been reported in different plant species,while the mechanism by which polyamines act during plant-microbe interaction is still poorly understood. The several types of the interactions between the plants and the microbes outline a divers and complex picture of the action mechanisms. The present review focuses on this aspect of the mode of action of polyamines and polyamine metabolism during biotroph and necrotroph interactions between plants and pathogens. It seems that apoplastic metabolism of polyamines of the host and the accumulation of H2O2 as a result of polyamine catabolism play important signalling role in plant-pathogen interactions. The manipulation of the members of the polyamine-induced signalling pathways could increase the host plant resistance to biotic stresses.
Zhi-Gang Feng*, Miguel Cortina, Jennifer KW Chesnutt and Hai-Chao Han*
Tortuous microvessels alter blood flow and stimulate thrombosis but the physical mechanisms are poorly understood. Both tortuous microvessels and abnormally large platelets are seen in diabetic patients. Thus, the objective of this study was to determine the physical effects of arteriole tortuosity and platelet size on the microscale processes of thrombotic occlusion in microvessels. A new lattice-Boltzmann method-based discrete element model was developed to simulate the fluid flow field with fluid-platelet coupling, platelet interactions, thrombus formation, and thrombotic occlusion in tortuous arterioles. Our results show that vessel tortuosity creates high shear stress zones that activate platelets and stimulate thrombus formation. The growth rate depends on the level of tortuosity and the pressure and flow boundary conditions. Once thrombi began to form, platelet collisions with thrombi and subsequent activations were more important than tortuosity level. Thrombus growth narrowed the channel and reduced the flow rate. Larger platelet size leads to quicker decrease of flow rate due to larger thrombi that occluded the arteriole. This study elucidated the important roles that tortuosity and platelet size play in thrombus formation and occlusion in arterioles.
Aurely Ameller*, Yann Le Strat, Marion Cadranel, Celine Portalier and Caroline Dubertret
Introduction: DSM-5 mentions autoerotic asphyxia in the paraphilic disorders section, as a specifier for the diagnostic of sexual masochism disorder. Strangulation activities have also been observed in the “choking game”. The term “strangulation activity” is considered as more appropriate than “choking game”. While sharing a same behavior, autoerotic asphyxia and non auto-erotic strangulation activities might represent a very distinct pattern of disorders. We describe here a case report of a 25-year old male internship student who has practiced manual self-strangulation up to 40 times a day since adolescence. In the examination of this case we identify individual clinical aspects of this case in a process-based holistic case conceptualization.
Case description: The patient is a 25 years old male with a post-graduate degree who presented with a recent history of poor work performance and work-related stress during an internship. He has a concomitant history of both ketamine and cannabis use disorders, and reports urges to self-strangulate, sometimes specifically avoiding contact with friends engage in this behavior and that he has never attempted to discontinue self-strangulation. Neuropsychological assessment found a cognitive functioning below that expected given his educational level. Our intervention consists of a 3-weeks cognitive and motivational therapy program in addiction unit with associated abstinence.
Conclusion: Autoerotic asphyxia is a behavior observed not only in the context of sexual masochism disorder, but also as a specific addictive behavior, in the absence of sexual arousal, possibly as a result of emotional dysregulation.
Madhav Prasad Yadav, Sanjana Ballal and Chandrasekhar Bal*
Prostate specific membrane antigen, a type II transmembrane protein is an excellent target for the radionuclide therapy in advanced prostate cancer patients due to its high expression in the prostate cancer cells.We present the case of a 69-year old man with advanced metastatic castration resistant prostate cancer. In view of rising serum PSA levels despite hormonal and chemotherapy, we decided to perform a 68Ga-PSMA-HBED-CC PET/CT scan (prostate specific membrane antigen). It revealed intense radiotracer uptake in the prostate, lymph nodes and multiple skeletal sites. Five cycles of 177Lu-PSMA-DKFZ-617 radioligand therapy were administered in the patient followed by an intrim 68Ga-PSMA-HBED-CC PET/CT. Intrim 68Ga-PSMA-HBED-CC PET/CT scan demonstrated a near complete remission of disease with a corresponding decrease in the sPSA levels. During the follow-up duration of 12 months, the patient did not develop haematological, kidney and liver toxicity during the course of treatment and follow-up. 177Lu-PSMA-DKFZ-617 is a promising therapeutic option in metastatic castration resistant prostate cancer (mCRPC) patients.
Fatma Ibrahim Abo El-Ela*, Hossny Awad El-Banna, Manal B El-Deen and Tohamy MA
Investigation the influences of vitamin (vit) E over a period of 5 days on the pharmacokinetics of florfenicol after single and multiple oral administrations in broiler chickens. Total of 12 broiler chickens had been taken single and multiple oral administrations of florfenicol (30 mg/kg) alone or pre-treated with vit E (2 mg/kg). The serum concentrations of florfenicol were determined using microbiological assay with Bacillus subtilis (ATCC 25922) as a tested microorganism. The mean serum concentrations of florfenicol alone were markedly lower when compared with florfenicol pre-treated with vit E after single and multiple dosing. The peak serum concentrations (Cmax) were 5.9±0.46, 7.48±0.3 ug/ml, absorption half-life (t0.5ab) of 0.51±0.06, 0.71±0.1 h and elimination half-life (t0.5el) of 2.72±0.34, 3.34±0.5 after single florfenicol alone and florfenicol pre-treated with vit E respectively. While, after multiple dosing, (Cmax) were 7.4±0.3, 8.04±0.3 ug/ml, (t0.5ab) 0.82±0.04, 0.81±0.04 h and (t0.5 el) 3.77±0.2, 4.52±0.7 h after multiple dosing of florfenicol alone and florfenicol pre-treated with vit E respectively. In conclusion Vit E alter the disposition kinetics of florfenicol after single and multiple oral administrations as, vit E allows prolongation of the duration of action for more 24 and 48 h of the drug concentration in the serum indicated by prolonged elimination half-lives and MRT reflecting the importance of this combination for the drug duration in serum but the increase in the serum concentration of florfenicol increasing its efficacy not toxicity as florfenicol of wide safety margin so, it’s advisable for poultry farms owners to use this combinations.
Dry eye or keratoconjunctivitis sicca, is commonly seen in the dog. Veterinary ophthalmologists diagnose this aqueous tear deficiency using the Schirmer tear test (STT), but this measures tear production and does not indicate ocular surface pathology. The vital dye Rose Bengal is commonly used in the diagnosis of dry eye in human patients but until now has not been reported in veterinary patients. Here we corelate the degree of Rose Bengal staining with the STT value and find a reasonable association between dye staining of the ocular surface and tear production, although clearly other factors are also important in the genesis of ocular surface damage in dry eye.
Wee MYK*, Isaacs RA, Vaughan N, Dubey VN and Parker B
Objective: The primary aim of this study was to measure pressure generated on a Tuohy needle during the epidural procedure in labouring women of varying body mass indices (BMI) with a view of utilising the data for the future development of a high fidelity epidural simulator. High-fidelity epidural simulators have a role in improving training and safety but current simulators lack a realistic experience and can be improved.
Methods: This study was approved by the National Research Ethics Service Committee South Central, Portsmouth (REC reference 11/SC/0196). After informed consent epidural needle insertion pressure was measured using a Portex 16-gauge Tuohy needle, loss-of-resistance syringe, a three-way tap, pressure transducer and a custom-designed wireless transmitter. This was performed in four groups of labouring women, stratified according to BMI kg/m2: 18-24.9; 25-34.9; 35-44.9 and >=45. One-way ANOVA was used to compare difference in needle insertion pressure between the BMI groups. A paired t-test was performed between BMI group 18-24.9 and the three other BMI groups. Ultrasound images of the lumbar spine were undertaken prior to the epidural procedure and lumbar magnetic resonance imaging (MRI) was performed within 72h post-delivery. These images will be used in the development of a high fidelity epidural simulator.
Results: The mean epidural needle insertion pressure of labouring women with BMI 18-24.9 was 461mmHg; BMI 25-34.9 was 430mmHg; BMI 35-44.9 was 415mmHg and BMI >=45 was 376mmHg, (p=0.52).
Conclusion: Although statistically insignificant, the study did show a decreasing trend of epidural insertion pressure with increasing body mass indices.
Sumeet Manandhar, Sujin Ju, Dong-Hyun Choi and Heesang Song*
Cardiovascular diseases are the leading cause of death worldwide. There are many evidences that the dysfunctioning lipotoxicity is the one of major factors of cardiovascular diseases such as, atherosclerosis, hypertension, and coronary heart disease. Obesity and diabetes increase circulating lipids that are likely with more generation of toxic intermediates, which leading to the complications associated with cardiovascular diseases. Indeed, lipotoxicity is a metabolic syndrome caused by abnormal lipid accumulation, which leads to cellular dysfunction and necrosis. Here we review the factors that induced pathogenesis of cardiovascular diseases by lipid accumulation and the mechanisms underlying the lipotoxicity.
The seasonal nature of most fruits available in the market coupled with inadequate storage and processing facilities has limited their consumption by majority of the people in the country. Jams made from fruits are good bread spread rather than any other food products because they serve as adequate balance diet and it contains antioxidant such as vitamin C and A which play an important role in preventing cancer, cardiovascular problem and improvement of eyesight. Pawpaw and watermelon fruits have been reported to be nutritive and high in antioxidant properties that can scavenge free radicals, thereby improving the antioxidant status of the body. It is therefore deemed fit to produce jam from these perishable commodities in other to make them available all through the year and as well as adding to varieties of food products. The aqueous extracts of watermelon with pawpaw juice were processed into jam and the physicochemical properties of the jam samples were analysed. The resulting jam samples showed moisture content ranging between 30.60-35.30%, protein 0.40-0.80%, fat 0.20-0.40%, ash 1.20-1.70%, crude fibre 0.10-0.30%, carbohydrate 62.10-67.16%, β-carotene 610-1350µg/100g and ascorbic acid 9.60-15.40mg/100g. The jam samples were found to be very nutritive and high in antimicrobial and antioxidant properties that can scavenge free radicals, thereby can improve the antioxidant status of the body. Sensory evaluation tests showed that the samples were acceptable and compared favourably with the commercial imported brand while sample AA had the highest preference in all the sensory attributes evaluated by the panellists. Microbiological examination also showed that the jam samples had total plate count ranging from 4.10x101 to 2.00 x101 cfu/g, yeast and mould count ranged from 2.10x101 to 1.00 x101cfu/g with no observable coliform count.
Robert W Pettitt , Jacob B Mehrhoff, David S Mandeville , Cherie D Pettitt and Steven Ross Murray*
<h2>Abstract</h2><p>Hand-to-hand bioelectrical impedance (HH BIA) is a low-cost method to estimate percent body fat (%BF). The BIA method is consistently reliable, but questions on validity remain.We have observed anecdotally that elbow position can render consistently different measures of %BF while using HH BIA, thus leading to the question: Does elbow angle influence the validity of measures derived using HH BIA? The purpose of this study was to assess the effect of elbow position (i.e., IN=flexed to 90° versus OUT=fully extended) on the reliability of HH BIA on 44 male and 24 female healthy adults (age=21±2 yrs, BMI=23±3). An additional aim was to assess the validity of the HH BIA %BF on a subset of subjects (n=12) using air displacement plethysmography (BOD POD®) as the criterion measure. The IN position was ~4%BF lower than the OUT position for HH BIA (p=0.05, effect size=0.67). Measures of %BF for both trials for the IN [intraclass correlation coefficient (ICC)=0.99, coefficient of variation (CV)=2.99%] and OUT (ICC=0.99, CV=1.48%) conditions were highly reliable. On the subsample, the OUT (18.3±6.7 %BF) position exceeded both the IN (14.5±7.4 %BF) and the BOD POD® (16.1±7.8 %BF) measures (p<0.05); however, IN and BOD POD® measures of %BF did not differ (p=0.21). These findings support that HH BIA is a reliable measure at both elbow positions; however, %BF estimations vary considerably (~4%) with respect to the criterion measure depending on elbow position. The OUT position was found to overestimate criteria %BF. Further research may reveal an optimum elbow angle position for HH BIA estimates of %BF.</p>
Purpose: To evaluate the efficacy of ranibizumab in hastening the recovery of acute CSCR when given immediately at time of diagnosis.
Methods: In This retrospective case series, a total of 72 patients diagnosed with acute CSCR where reviewed, of which 63 received Ranibizumab at presentation. The patients were evaluated using Best corrected visual acuity, Ophthalmic examination, Optical coherence tomography (OCT) and fluorescein angiography, in addition to indocyanine green angiography and OCT angiography in some cases, at presentation, one week, one month and two months’ post injection.
Results: From the total 72 patients diagnosed with acute CSCR, 63 of them received intravitreal ranibizumab and the remaining 9 patients preferred to go for observation. The mean age of patients was 41.2 year old. The ratio of male to female was 8:1. The mean BCVA at presentation was 6/15 on Snellen chart. All patients who received ranibizumab injection showed an improvement after 1 week, with a mean improvement in BCVA of two lines. Of them, 43 patients were back to BCVA of 6/6 after 2 months and showed complete resolution of sub retinal fluid. The remaining 20 patients showed an additional mean of improvement of one line (over the previous two lines) after the 2 months.
Conclusion: Intravitreal ranibizumab hasten the recovery of both the BCVA and central macular thickness on OCT in acute CSCR when given immediately at presentation.
Necrotizing fasciitis is a quickly progressing soft tissue infection that can be described with diffuse necrosis of subcutaneous tissue and superficial fascia. The cause of this can be infectious process of odontogenic origin, most commonly caused by mixed gram+ and gram- , aerobic and anaerobic microorganisms that are found in patients that are predisposed to infections. In a case of undiagnosed illness, there is a possibility of life threatening complications. This case analysis introduces the diagnostic criteria of the disease and treatment plan, encouraging doctors to devote more attention to prevention of infections.
Madhvi Bhardwaj, Shantanu Khattri and Rohit Kulshrestha*
Direct bonding of a lingual retainer is challenging because it requires a long working time on the lingual aspect of the anterior teeth. Due to no direct vision there is a risk of contamination from saliva and moisture, which can cause bond failure; and it is difficult to apply the adhesive exactly where it is needed. The indirect method described in this article shows an easy way to increase better-quality bonding of the retainer.
Ramiro Galvez-Valdovinos*, Juan francisco Funes-Rodriguez, Ernesto Marin Y Santillan, Gustavo Lopez Ambriz and Juan Francisco Ramirez-Arias
Background: The band erosion (BE) is defined as the partial or complete movement towards the lumen of the stomach, is also known as migration, gastric incorporation and gastric inclusion. The presentation of this complication involves failure of bariatric procedures being ineffective and consequently requires the removal of the laparoscopic adjustable gastric banding (LAGB), usually through laparoscopic surgery.
The objective of this study is to describe the clinical presentation, diagnostic methods, surgical procedure, postoperative evolution in the integral treatment of BE. Material and Methods: We captured the data of patients with BE since January 2010 to October 2017. Database included the year of patient care, age, and sex, BMI before band placement, percentage of excess weight loss, number of device adjustments, clinical data and surgical procedure performed for resolution.
Results: A total 379 LAGB complications were diagnosed in our Institution; 210 patients with BE were diagnosed and treated, the average age was 39 years; range from 19 to 66 years, sex was 178 women and 32 men. The diagnosis was endoscopic in the 210 patients (100%). The surgical procedure to solve the problem was: to remove the LAGB, the fistulous orifice was closed and patch of omentum. The hospital stay was 3-5 days. The motility was zero. Complications were minor in 3% of the 210 patients (fever, atelectasis, wound infection). One patient was re-operated for evolving to residual abscess.
Conclusions: The BE is a serious failure in bariatric surgery. The resolution in this group of patients was to remove the band, direct closure of the fistulous orifice with patch of omentum. The surgical technique that was performed in this complication is safe, effective and easily reproducible.
Red blood cell (RBC) alloimmunization can be a life-threatening complication for patients with thalassemia major and sickle cell disease (SCD) who must receive chronic therapeutic transfusions. Chronic transfusions can lead to erythrocyte alloimmunization, patients continue to develop alloantibodies due to the transference of the immunogenic antigens on the donor RBCs. Many complications are possible. Difficulty in finding compatible match units for the patients can cause transfusion delays delayed, or present alternative risks to the patients from delayed hemolytic transfusion reactions. This review discusses the possible mechanisms, risk factors associated with alloimmunization formation and the hemolytic transfusion reactions and also describe the guideline for transfusion management of these patients, including opportunities and emerging approaches for minimizing this life-threatening complication.
In the current study, we have investigated pros and cons controversy on molecular imaging and dynamics of double-standard DNA/RNA of human preserving stem cells-binding Nano molecules with Androgens/Anabolic Steroids (AAS) or Testosterone derivatives through tracking of Helium-4 nucleus (Alpha particle) using synchrotron radiation. In this regard, the enzymatic oxidation of double-standard DNA/RNA of human preserving stem cells-binding Nano molecules by haem peroxidases (or heme peroxidases) such as Horseradish Peroxidase (HPR), Chloroperoxidase (CPO), Lactoperoxidase (LPO) and Lignin Peroxidase (LiP) is an important process from both the synthetic and mechanistic point of view.
Konstantinos A Zorbas*, Sunil S Karhadkar, Kwan N Lau, Andreas Karachristos and Antonio Di Carlo
Morbidity and mortality of HIV-infected patients have been improved over the last decades with the advent of combined antiretroviral therapy. As a result, other comorbidities such as chronic kidney and chronic liver diseases have emerged in the HIV population. A considerable percentage of end-stage liver disease (ESLD) in HIV population is attributed to hepatitis C co-infection and reactivation, and a growing need for solid organ transplantation has emerged among those patients. On the other hand, several studies on liver transplantations of patients co-infected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) have shown discouraging results both in patient and graft survival rates. As a result, HIV-HCV co-infection has been considered a relative contraindication for liver transplantation. Thankfully, new drugs for HCV treatment have been discovered, acting direct on viral replication of HCV and they have changed the whole clinical course of HCV/HIV co-infected liver transplant recipients. Our case illustrates the long-term efficacy and safety of the new combination of Sofosbuvir/Ledipasvir in HCV/HIV co-infected liver transplant recipients.
Petya Ganova, Lyudmila Belenska-Todorova and Nina Ivanovska*
Sepsis refers to a generalized inflammatory response of the organism to an infection or to bacterial products in circulation, rather than the development of an infection per se. Despite recent advances in clinical practice and overall medical care, sepsis remains a great health care problem and is still the most common cause of death in critically ill patients with infection. We suppose that during the course of sepsis the expression of TRAIL in different organs correlates with acute mortality and further development of multiple organ dysfunction syndrome (MODS). It is expected that dendritic cells (DCs) might become targets for apoptotic processes in a result of elevated TRAIL expression. This hypothesis is a bias for detailed investigations for in vivo studies in animal models and for in vitro studies of septic patients.
Noodles are strips or strands cut from a sheet of dough made from flour, water and either common salt or a mixture of alkaline salt. Noodles consumption represents about 40% of the total wheat flour which are mainly consumed by school children. The use of composite flour has been encouraged since it reduces the importation of wheat. Utilization of locally available, inexpensive materials like cocoyam that can substitute a part of wheat flour without adversely affecting the acceptability of the product will be a product development. This study therefore studied the chemical composition and organoleptic properties of instant noodles from the blend of wheat and cocoyam starch. Cocoyam starch was substituted into wheat flour at 20, 40, 60 & 80%. Analysis revealed higher carbohydrate (63.50-70.05)%, moisture (4.54-5.07)% and vitamin A (10.01-30.47) mg/100g, B1 (11.43-32.15) mg/100g but lower protein (4.56-8.79)%, phosphorus (0.34-0.52)%, calcium (1.83-0.98)%, iron (0.15-0.32) % and ash (1.19-3.20)%. The composite noodles revealed higher carbohydrate and mineral but lower protein than the commercial noodles. The sensory analysis revealed that 20% cocoyam compared favourably with the commercial noodles in terms of all the sensory attributes evaluated. This shows the possibility of producing noodles from cocoyam tubers which serves as novel food. This will further help to promote and improve utilization of cocoyam tuber.
Background: Acute kidney injury (AKI) is a frequent and serious clinical complication in patients with severe malaria. The purpose of this study was to assess the incidence of AKI in a large population of hospitalized patients with a primary admission diagnosis of malaria, and to investigate the robustness of the KDIGO criteria for predicting the need for dialysis, length of hospital stay and hospital mortality.
Results: We studied 695 consecutive patients admitted with primary diagnoses of malaria, in a 6 months period. AKI occurred in 86 (12.4%) patients (Stage 1 in 30.2%, Stage 2 in 23.3% and Stage 3 in 46.5%), and 19 (22.1%) patients required hemodialysis. No patient in the no-AKI or AKI Stage 1 groups (admission or maximum AKI Stage) required hemodialysis, and the requirement of hemodialysis was higher in patients with AKI Stage 2 (23.1%) and Stage 3 (42.4%). The length of hospital stay was longer (7.3±7.4 days vs 5.1±3.0 days; t=4.996, p<0.0001), and mortality was higher in patients who developed AKI than in those who did not (22,5% vs 2,5%; χ2=79.52; p<0.0001). Patients with AKI Stage 1, 2 and 3 had significantly higher hospital mortality (11%, 23% and 30%, respectively), compared with 2.5% for patients without AKI [odds ratio 5.2 (1.40-19.11, p=0.0331), 13.2 (4.24-41.06, p=0.0002), and 16.9 (7.26-36.65, p<0.0001)], respectively.
Conclusion: In a relatively large cohort of patients with falciparum malaria infection, the KDIGO criteria identified 12.4% with a diagnosis of AKI. The KDIGO classification was robust in this population for predicting the need for dialysis, length of hospital stay and hospital mortality. The results support the utilization of the KDIGO criteria in diagnosis and to predicting outcomes for patients with malarial AKI.
Malnutrition is the largest risk factor caused by inadequate nutrition that leads to childhood morbidity and mortality, as well as inadequate growth and development. Infants are at increased risk of malnutrition by six months, when breast milk alone is no longer sufficient to meet their nutritional requirements. However the factors associated with nutritional status of infants after 6 months of age have received little attention in pastoralist communities of Ethiopia. The aim of this study was to assess the complementary foods of infants and young children (6-23 months) in Gode town of Kebele 01. The prevalences of wasting, stunting and underweight among infants and young children were 6.1%, 56.1%, 10.0% reespectively. Undernutrition is a public health problem among infants and young children in Gode town of Kebele 01. Breastfeeding was slightly positive associated with lower chances of wasting at r=0.61, p= 0.01 and underweight at r=0.331, p=0.01. While diarrheal disease was associated with higher chances of wasting and underweight. Initiation of complementary food was slightly positive association with wasting at r=0.179, p=0.05.
Alagbu Chukwubuikem Eugene*, Alagbu Chinwe Adline, Chike Ijezie Ifeoma Blessing and Agwubike Elias Okey
<h2>Abstract</h2><p>High blood pressure under medical palance is associated with a variety of circulatory diseases, and it has been estimated that over 12% of all deaths in the world is directly or remotely connected with hypertension. It is said that one out of every five persons, can expect to have high blood pressure at one time or the other, during one’s life time. Based on hemodynamic equation, the mean arterial pressure is equal to cardiac out-put, times resistance (p means=Q x R). Hence hypertension is usually as a result of either an increased cardiac output and/or an increased resistance. The most common form of high blood pressure in humans is called “essential hypertension”, while is said to have no known cause. However this research aims at showing how a 12-week moderate exercise with bicycle egometer (i.e., use of non-pharmacologic approach to reduce the resting heart rate and blood pressure of 6 volunteer retired civil servants from Anambra state civil service and 6 retired academic staff of Nnamdi Azikiwe university in Awka. The paired T-test analysis of data obtained revealed a statistical significant effect of the moderate 12-week exercise on bicycle egometer, on the resting heart rate and blood pressure of the experimental group of the respondents. Hence it could be concluded that the administration of moderate exercise on bicycle egometer could be an effective use of non-pharmacologic intervention in the control and prevention of high blood pressure or hypertension among the elderly.</p>
Corredor-Osorio Rafael*, Massaro-Corredor Martha Gabriela and Buitrago-Corredor Vanessa Gabriela
Reconstruction of the eyelids, especially medial canthal area, is one of the greatest challenges faced by the oculoplastic, head and neck surgeons. A patient with a medial canthal defect, following oncological resection involving the medial canthus, upper and lower eyelids, and nose is presented. The defect was reconstructed using a transnasal bilobed flap. The transnasal bilobed flap is a simple and effective for medial canthal reconstruction and provides in one-time reconstruction and preserves the local anatomy.
Alagbu Chukwubuikem Eugene*, Alagbu Chinwe Adline, Chike Ijezie Ifeoma Blessing and Agwubike Elias Okey
<h2>Abstract</h2><p>The research investigated the perception of nutrition and exercise as a tool in controlling Cardiovascular Diseases (CVDs) among elderly civil servants in Anambra State of Nigeria.A total of 250 respondents comprising 150 elderly academic staff Nnamdi Azikiwe University Awka and 100 senior civil servants in the Anambra state civil service, who willingly, volunteered to participate in the study. Their ages ranged between 55-65 years purposively selected. The instrument for data collection was a self-structured questionnaire, with a reliability value of 0.73 using the test retest method. All data collected were subjected to descriptive statistics of frequency, percentages and chi square tested at 0.05 level of significance. Findings from the study showed that nutrition (diet) and exercise have significant effect in the prevention/control of (CVDs) among the elderly. It is therefore recommended that at the civil service secretariats, universities and other establishments/parastatals, should establish high standard eateries (restaurants) where qualified caterers, would regularly provide nutritious diet, at subsidized rate for workers in this category. In order to enable these class of workers have at least one good meal per day, in addition to a mandatory one- work-free afternoon (2.00pm-4.00pm) for routine/regular physical exercises for these class of workers.</p>
Aim: To assess and learn oral health awareness and hygiene practices among geriatric patients and also to identify important barriers in the establishment of oral health services, disease prevention and oral health promotion programmes for the same.
Materials and Methods: A total of 500 patients in the age group of 50 years and above were selected using random sampling technique. A self‑administered structured questionnaire including 20 multiple choice questions was given to them. The results were analyzed using percentage.
Results: The result of this study shows an acute lack of oral hygiene awareness and limited knowledge of oral hygiene practices. In Rohini, few people use tooth brush.
Conclusions: Hence, there is an urgent need for comprehensive educational programs to promote good oral health and impart education about correct oral hygiene practices.
Observing relevant biomedical literature we have see that clinical pharmacist play a crucial role in ICU settings with reducing in mortality rate and improving some clinical outcomes.
Selective alveolar decortication and periodontal augmentation with a bone graft were the two procedures used for the correction of the skeletal class II malocclusion in the case reported.A 25-year-old male patient presented with a skeletal class II malocclusion with increased bi-maxillary dento-alveolar protrusion, increased overjet, deep bite and imbricated and rotated mandibular incisors with bilateral presence of supernumerary teeth in the maxillary right and left premolar regions. Extraction of supernumerary in the maxillary right and left premolar region, and impacted UL5 was done. Pre-adjusted edgewise appliance, Roth’s prescription (0.022x0.028-inch slot), was bonded and a week later full thickness labial and lingual flaps were reflected in the maxillary and mandibular arches. Circumscribed corticotomy cuts was done and subsequently augmented with a bone graft. Orthodontic treatment was commenced immediately after surgery and orthodontic adjustments were performed every 2 weeks. The entire orthodontic treatment was completed in 9 months. Regional acceleratory phenomenon, triggered by the alveolar decortication, was responsible for the rapid correction of the malocclusion and the augmentation with the bone graft provided adequate bone volume for housing the teeth, thereby decreasing the possibility of subsequent relapse.
Matthew E Sharbaugh, Timothy R Shope and Timothy R Koch*
In 1955, nutrient malabsorption following upper gut surgery was shown to be related to altered upper gut microbiome. In individuals with abdominal symptoms after Roux-en-Y gastric bypass, we have reported that small intestinal glucose malabsorption is associated with upper gut bacterial overgrowth.We hypothesize that individuals with abdominal symptoms after vertical sleeve gastrectomy have glucose malabsorption associated with upper gut bacterial overgrowth, and to test this hypothesis, bacterial overgrowth and potential glucose malabsorption are examined after sleeve gastrectomy. This is a retrospective study of individuals with medically-complicated obesity who underwent sleeve gastrectomy from 2013 to 2016 with subsequent glucose hydrogen breath testing to evaluate abdominal symptoms. A fasting breath hydrogen or methane of ≥10 PPM or rise of ≥8 PPM ≤45 minutes after oral glucose is bacterial overgrowth, while glucose malabsorption is a second rise of ≥8 PPM at >45 minutes. Seven females (mean age: 48.0 years; mean body mass index at surgery: 45.7 kg/m2) are described. Five subjects (71%) have an early rise in hydrogen or methane, while three (43%) have a second rise in hydrogen or methane >45 minutes after glucose. The mean percent excess weight loss at one year was 40% in three individuals with a second peak and 46% in four subjects without a second peak. After sleeve gastrectomy, subjects have glucose malabsorption associated with the presence of bacterial overgrowth. Completion of a larger prospective study is needed to confirm and expanding upon these findings. Further work should examine the potential effects of bacterial overgrowth on expression of intestinal glucose transporters.
The process of hypothermia in the clinical setting has been practiced for 50 years and is known for its neuroprotective properties. This paper describes histopathological changes either by an ice sludge mimicking accidental hypothermia (S-group n=7) or by endovascular core-cooling (C-group n=7). Focal infiltrates of neutrophilic granulocytes were found in five of seven brains in the S-group and in one of seven brains in the C-group. These granulocytes were found in the arachnoids, in vessels, in vessel walls, and in the cerebral cortex. Fungi, bacteria, lymphocytes or plasma were not found.
Mohammad Reza Javan*, Mohammad Reza Zamani, Saeed Aslani, Ghader Dargahi Abbasabad, Masoud Beirami Khalaj and Hamed Serati-Nour
Background: Multiple sclerosis (MS) is an autoimmune disorder of the central nerve system (CNS), which affects the brain and spinal cord. Experimental autoimmune encephalomyelitis (EAE) is the most commonly applied experimental model for studying the MS. The aim of this study was to determine the effects of Sesamum indicum seeds oil on Experimental Autoimmune Encephalomyelitis (EAE) in mice.
Methods: Sesame oil was administrated intraperitoneally three days before immunization. IFN-γ, IL-10, IL-17 and TGF-β levels and mRNA expression in supernatant of and within cultured mononuclear cells were assessed.
Results: According to our results, sesame oil treated mice demonstrated significant disease severity reduction (P=0.01 and 0.001, respectively). Treated EAE mice also represented statistically significant delay in the onset of symptoms in comparison with control group. The average IFN-γ levels and mRNA of sesame oil treated EAE mice were less than untreated EAE group. IL-10 and TGF-β levels and mRNA did not differ significantly in sesame oil treated EAE mice in comparison to untreated EAE group. IL-17 levels and mRNA were also found to be decreased significantly in treated mice in comparison to untreated mice.
Conclusions: Even thoughTH1 and TH17 cells through secretion of IFN-γ and IL-17, respectively, are involved in the pathogenesis of multiple sclerosis and EAE, but IL-10 has been shown to exhibit suppressive effects on these disorders. It can be concluded that sesame oil is able to induce TH2 and TH17-related immune responses and suppress TH1 type in EAE.
Parth B Patel, Allison L Boden*, Bryan J Sirmon, Spero G Karas and Michael B Gottschalk
<h2>Abstract</h2><p><strong>Case:</strong> A 45 year old male, >1 year status post left elbow lateral debridement for lateral epicondylitis, presented with a two week history of a progressive, tender mass on the lateral aspect of his left elbow.MRI showed evidence of a defect in the joint capsule, consistent with the formation of a seroma. The patient underwent revision of the left lateral epicondyle debridement with ECRL/EDC tendon repair and capsular reconstruction.</p><p><strong>Conclusion: </strong>Tendon repair and capsular reconstruction is an effective and successful method for the treatment of a seroma caused by leakage of joint fluid after lateral epicondylar debridement.</p>
Maurizio De Luca*, Nicola Clemente, Cristiana Visentin, Natale Pellicano, Cesare Lunardi, Alberto Sartori, Gianni Segato, Luigi Angrisani, Marcello Lucchese and Nicola Di Lorenzo
Background: To date, the scientific community has mainly focused on outcomes of obesity surgery such as weight loss and resolution of associated complications. Adverse post-operative events and reoperation rates have been poorly reported even if they are a marker of surgical safety and therefore of great importance in guiding patients and surgeons in the choice of the more suitable operation.
Methods: This retrospective multicenter observational study is based on the data extracted from the Italian Society of Bariatric Surgery and Metabolic Disorders (S.I.C.OB.) database, which covers almost all the bariatric operations performed in Italy. We analysed the 30 days post-operative complications occurring, in the period from 2009 to 2015, after Roux-en-Y Gastric Bypass (RYGB), Sleeve Gastrectomy (SG) and Mini Gastric Bypass/One Anastomosis Gastric Bypass (MGB/OAGB) qualitatively, quantitatively and on the basis of the Clavien-Dindo classification of surgical complications. Complications following surgeries were tested using the 95% confidence interval. Statistical analysis was performed with Statistical Analysis System (SAS).
Results: In the 2009-2015 time frame, a total of 31,624 operations were performed of which 6,864 RYGB, 10,833 SG and 992 MGB/OAGB. The complication rate was 4.39 %, 4.04 % and 3.83% respectively. The most frequent complications were hemoperitoneum (0.9%) and perforation, fistula and dehiscence (1%) which were higher in SG when compared with RYGB (with a statistical significance) and when compared with MGB/OAGB (without a statistical significance). When dividing the complications by the different grades of the Clavien-Dindo classification, the only significant difference encountered, from a statistical standpoint, was between MGB/OAGB and SG. MGB/OAGB was associated with a lower grade I Clavien-Dindo complication rate (1.31% versus 2.34%).
Conclusions: This study supports a safe profile of obesity surgey in Italy, along with positive bariatric outcomes. The rate of 30 days post-operative complications is progressively lower after MGB/OAGB (3.83%), SG (4.04%) and RYGB (4.39%) respectively. In particular, MGB/OAGB records statistically less low-grade Clavien-Dindo complications compared to SG and RYGB.
This review examines of the concept of a defective chloride channel in epithelial cells being a major cause of cystic fibrotic pathophysiology. The central concept of the defective chloride ion channel paradigm is that faulty CFTR protein or failed delivery of CFTR protein to the mucosal membrane of epithelial cells is the basis of cystic fibrosis. Defective placement or function of CFTR prevents hydration of bronchial mucus that is normally caused by epithelial cells; these are capable through chloride ion secretion of transporting fluid to the mucosal surface. This concept relies heavily on a paradigm taken from intestinal physiology-namely that the intestinal epithelial cell secretes chloride ion and fluid and that this has conferred heterozygote selective advantage in carriers of the cystic fibrosis gene. This present review examines the evidence for that hypothesis and assembles evidence from past studies that it is the smooth muscle cell that is of greater relevance. This review does not aim to provide an overview of current research into cystic fibrosis. The intention is to provide an overview of past research that led to the concept of a failure of epithelial cells to hydrate bronchial mucus because of compromised CFTR function. It is important to present all past evidence for aspects of the chloride secretion hypothesis and its associated heterozygote advantage concept so that the important evidential milestones can be re-assessed.
Suneeta Dubey*, Baswati Prasanth, Lokesh Chauhan and Saptarshi Mukherjee
Background: Glaucoma is a multi-factorial optic neuropathy characterized by a loss of retinal ganglion cells with subsequent loss of the retinal nerve fibers ultimately resulting in visual impairment. The macula region has a high density of retinal ganglion cells thereby being a likely region to detect early cell loss .Since glaucoma affects mainly the inner layers of the retina, Ganglion Cell Complex (GCC) mapping can help to detect glaucomatous damage early as compared to the total retinal thickness.
Purpose: To map GCC thickness and average Macular Retinal (MR) thickness with high-speed Fourier-Domain Optical Coherence Tomography (FD-OCT) and correlate it with the Retinal Nerve fiber layer (RNFL) thickness in preperimetric glaucoma.
Design: Observational cross-sectional study.
Methods: Forty four eyes diagnosed as preperimetric glaucoma were studied. GCC, MR thickness and RNFL thickness was mapped using the RTVue FD-OCT system. The GCC thickness map, the deviation map and the significance map were obtained in all cases. Average GCC thickness and MR thickness were correlated with the RNFL thickness.
Results: Average GCC of patients was 85.99±6.9 µm. There was GCC loss in 35 (87.5%) eyes which correlated well with areas of RNFL loss (r=0.408, p<0.001). Nine (22.5%) eyes were seen to have decreased MR thickness. GCC loss correlated well with the loss of average RNFL thickness and MR thickness. Further GCC loss was also seen in 23 (74.19 %) eyes with a normal MR thickness.
Conclusion: GCC analysis may prove to be a robust diagnostic parameter and is complementary to RNFL analysis in preperimetric glaucoma.
The story of Nuremberg code in human experiments was evolved by a 70-year old historical link, aiming to provide an alert message for scientists in case of nonprovisional disaster caused by immoral human experiment. It played a safeguard role standing on the front line [1].
Previous clinical, observation and epidemiologic studies have demonstrated strong association between serum uric acid (SUA) and cardiovascular disease (hypertension, heart failure, and asymptomatic atherosclerosis), metabolic states (abdominal obesity, diabetes mellitus, metabolic syndrome, insulin resistance) and kidney disease. There is a large body of evidence regarding the role of SUA as predictor of CV events and CV mortality in general population and individuals with established CV disease and metabolic diseases. However, SUA may exhibit protective effects on endothelium and vasculature as well as attenuate endogenous repair system through mobbing and differentiation of cell precursors. Although SUA lowering drugs are widely used in patients with symptomatic hyperuricemia and gout beyond their etiologies, there is no agreement of SUA below target level 6.0 mg/dL in asymptomatic individuals with kidney injury and CV disease and data of ones are sufficiently limited. The short communication is depicted on the controversial role of SUA as primary cell toxicity agent and secondary cell protector against hypoxia, ischemia and apoptosis.
Pain is a complex phenomenon which is unpleasant. Different cosmetic procedures are associated with varying degrees of pain. Various modalities are adopted to decrease the severity of pain. The commonly used is the administration of analgesics (opioid or non-steroidal).
I-Hsuan Wu, Hua Chen, Patrick Bordnick, Ekere James Essien Michael Johnson, Ronald J Peters and Susan Abughosh*
Background: Schizophrenic patients have a lot higher smoking rates when compared to people in the general population. A variety of pharmaceutical cessation aids are available, which include nicotine replacement therapy (NRT), Bupropion SR, and Varenicline. Our objective was to assess which cessation medication would have lower risks in developing risk factors of cardiovascular diseases.
Methods: A population-based retrospective cohort study was conducted using the General Electric (GE) electronic medical record database (1995-2011). The cohort consisted of patients with a diagnosis of schizophrenia or schizoaffective disorder (ICD-9 code 295.00-295.99) and who had newly initiated use of any smoking cessation medication. We excluded our cohort who (1) were not prescribed atypical antipsychotics and (2) already had diagnosis of diabetes, hyperlipidemia or hypertension prior to index date. Follow up period was from 12 weeks onwards index date up to one year. The hazard ratio of developing cardiovascular risks was assessed using Cox proportional hazards regression model after controlling for other covariates.
Results: A total of 580 patients were included in our cohort. Among those, nearly half (n=276, 47.59%) developed one or more criteria of the metabolic syndromes. We found that smokers who were prescribed NRT were less likely to develop metabolic syndromes as compared to those who were prescribed Varenicline.
Conclusions: Physicians are advised to carefully weigh the risks against the benefits before prescribing cessation medications since risks for metabolic syndromes were found to be very high. Healthcare providers should monitor patients’ lab data regularly as this minority population is under higher risks.
The main goal of hyperthermia is to elevate the tumor temperature to kill tumor cells and improve local control. The usage of hyperthermia is combination with radiotherapy or chemotherapy. Hyperthermia is delivered in different types of cancers like breast cancer, melanoma and sarcoma.Breast cancer treatment enroll surgery, chemotherapy, radiotherapy and hormone therapy. Hyperthermia is given once or twice a week concomitantly with radiotherapy or chemotherapy. This short review will enlight the types, physics, and the results of hyperthermia especially in the management of breast cancer therapy.
Grygorieva Nataliia*, Povorozyuk Vladyslav and Rybina Olena
<h2>Abstract</h2><p>The purpose of this study was to assess the peculiarities of vertebral pain syndrome, parameters of physical performance and quality of life indices in women of older age depending on the presence of vertebral fractures (VF). This study was performed with participation of 215 women aged 50-89 years old which were divided into two groups: first one-women without any previous osteoporotic fractures (n=143), second group - patients with VF in thoracic and/or lumbar spine (n=72).</p><p>The presence and intensity of pain in the thoracic and lumbar spine were evaluated using the 11-component visual analog scale (VAS), physical performance-with following functional tests: 3-, 4- and 15-meter tests (gait speed), static balance (a side-by-side position, a semi-tandem position and a full-tandem position), 8-feet test and «five timed chair stands» (coordination and strength), hand grip strength (by dynamometer), measurement of arterial pressure (systolic and diastolic), heart and respiratory rates, breath holding, chest excursion (mean and on the inhalation and the exhalation), lateral trunk lean, Schober and Thomayer tests.</p><p>It was demonstrated that the intensity of vertebral pain (pain at the time of investigation, the most common level of pain, pain in the best periods of the disease) and some physical performance tests (lateral trunk lean and chest excursion (mean index, during the inhalation and exhalation), hand grip strength, 15-meter gait speed test and five-repetition sit-to-stand test) are significantly worse in women with VF than corresponding parameters in persons without fractures. It should be taken into account during the assessment of physical performance and development of rehabilitation programs for older age women with vertebral fractures.</p>
In the current study, combinatorial therapeutic approaches to DNA/RNA of human cancer cells and Benzylpenicillin (Penicillin G), Fluoxetine Hydrochloride (Prozac and Sarafem), Propofol (Diprivan), Acetylsalicylic Acid (ASA) (Aspirin), Naproxen Sodium (Aleve and Naprosyn) and Dextromethamphetamine nanocapsules with surface conjugated DNA/RNA of human cancer cells to targeted Nano drugs for enhanced anti-cancer efficacy and targeted cancer therapy using Nano drugs delivery systems were investigated.
Eucalyptus camaldulensis (Ec) is considered as a traditional medicinal plant with valuable therapeutic effects. Here we evaluated the antiviral activity of its ethanolic leave extract on different herpes viruses. Vero cells were infected with either of the tested viruses [herpes simplex virus -1 and 2 (HSV-1, HSV-2) and Varicella-Zoster Virus (VZV)] with or without treatment with Ec extract and viral infection development was evaluated by plaque assay. Our results showed significant antiviral activity of the examined extract against all tested viruses. The 80%-MeOH fraction of this extract offered the highest activity against these viruses with 50% inhibitory concentration (IC50) of 0.1±0.08, 0.3±0.02 and 1±0.03 μg/ml against HSV-1, HSV-2 and VZV respectively and 50% cytotoxicity (CC50) at 700 μg/ml. The highest antiviral effect of this fraction was obtained mainly when it was added during and post infection (p.i.) or when it was added only p.i. Also, this fraction significantly reduced the amount of infective endogenous viral particles in cells that were treated with the 80%-MeOH fraction only post viral entry into the host cells. A synergistic antiviral effect against all tested viruses was also observed when cells were treated with a combination of acyclovir (ACV) and 80%-MeOH fraction of Ec. Further study is required for the isolation and identification of the anti-virally active component/s of this fraction.
Parnesh Raniga, Patricia Desmond, Paul Yates, Olivier Salvado, Pierrick Bourgeat, Jurgen Fripp, Svetlana Pejoska, Michael Woodward, Colin L Masters, Christopher C Rowe and Victor L Villemagne*
This case report presents in-vivo findings on the spatial and temporal relationship between focal Ab-amyloid deposition, cerebral micro-haemorrhages and superfi cial siderosis.A 65-year-old woman underwent 11C-PiB PET scans that revealed an atypical focal and asymmetrical pattern of Ab-amyloid deposition and MRI scans that revealed cerebral micro-haemorrhages and superficial siderosis. Almost all micro-haemorrhages were associated with focal Ab-amyloid deposition. Follow-up 11C-PiB PET and MRI scans showed progression of the disease. We speculate that Abamyloid deposition affects the structural integrity of arterioles, thereby predisposing them to micro haemorrhages. In support of this hypothesis, progression of MRI lesions was observed only in areas associated with Ab-amyloid deposition.
Amit Baruaa, Monalisa Pattnaik and Patitapaban Mohanty*
Introduction: Chronic low back pain is one of the most prevalent musculoskeletal disorders. Studies have shown certain relations between physical fi tness and chronic low back pain (CLBP) by examine some measures of physical fi tness. The aim of study was to measure lung function using winspiro PRO in patient with CLBP versus normal healthy individual, and relation of lung function with duration and intensity of CLBP.
Methodology: The study population is comprised of a total of 120 adult persons. 60 subjects with chronic low back pain (41 male and 19 female) with a mean age of 30.69 years (+4.34) and 60 normal individual (39 male and 21 female) with mean age of 29.00 years (+5.34).
Results:The result of comparison of the respiratory parameter forced vital capacity (FVC), and maximal voluntary ventilation (MVV) of individual with CLBP show a significant difference as compare to the normal healthy population. In unrelated ‘t’ test the patient with CLBP (N=60) of age 30.51(SD±4.33), height 169cm (SD±1.23), weight 57.86(SD±7.73) and body mass index (BMI) 20.46 (SD±2.54) show a significant difference in respiratory parameter FVC ( t=17.244, P=0.000), and MVV ( t=11.048, P=0.000) as compare to the normal healthy persons (N=60) of age 29.79 (SD±5.28), height 170cm (SD±1.13), weight 59.40(SD±6.97) and BMI 21.59 (SD±3.29).In patient group- FVC range is 34.0% to 75.00% (52.85%±9.30). MVV range is 45.0% to 86.80%. (63.11%±12.06)In control group FVC range is 63.90% to 98.83% (83.63%±7.59). MVV range is 63.00% to 98.00% (78.96%±7.86).
Conclusions:The overall result of the study show that there is a significant difference in the respiratory parameter that is FVC (forced vital capacity), and the MVV (maximum voluntary ventilation) in persons with chronic low back pain as compare to the healthy person of same age, height, weight and body mass index (BMI).
Results:The result of comparison of the respiratory parameter forced vital capacity (FVC), and maximal voluntary ventilation (MVV) of individual with CLBP show a significant difference as compare to the normal healthy population. In unrelated ‘t’ test the patient with CLBP (N=60) of age 30.51(SD±4.33), height 169cm (SD±1.23), weight 57.86(SD±7.73) and body mass index (BMI) 20.46 (SD±2.54) show a significant difference in respiratory parameter FVC ( t=17.244, P=0.000), and MVV ( t=11.048, P=0.000) as compare to the normal healthy persons (N=60) of age 29.79 (SD±5.28), height 170cm (SD±1.13), weight 59.40(SD±6.97) and BMI 21.59 (SD±3.29).In patient group- FVC range is 34.0% to 75.00% (52.85%±9.30). MVV range is 45.0% to 86.80%. (63.11%±12.06)In control group FVC range is 63.90% to 98.83% (83.63%±7.59). MVV range is 63.00% to 98.00% (78.96%±7.86).
Martin A Nzegwu *, FMCPath Nig, DB Olusina Francis Ikechukwu Ukekwe and Victor Nzegwu
The paper reviews enclosure asphyxia as a cause of death of three Nigerian children aged three years, five years and seven years respectively, who were found dead and locked in the boot of a Mercedes Benz 200E Sedan car a day after they were declared missing. The first two were siblings of the same parent whose fathers actually owned the car, while the older child was a neighbour kid all of whom were well known to each other as friends and playmates. They had gone missing for a few hours prior to being seen playing together. Search parties were raised and they were never found until the following day when they were found dead in the boot of the car parked a few meters away from the house under a tree. Incidentally the same car was driven round the neighbourhood for 3 hours during the search the previous day with no inkling that they were in the boot of the car. Autopsy was ordered by the coroner to determine the cause of death.
Myriam Ben Salah*, Hafedh Abdelmelek and Manef Abderraba
Increased exposure to electromagnetic fields such as radio frequencies used by Wifi technology raise questions and concerns about their impact on health. For answer these questions, several scientific studies have carried out followed by results publication in prestigious scientific revues. Literature conducted on the effects of non-ionizing radiation and Wifi waves is vast and sometimes controversial. Epidemiological studies and the results of in vitro and in vivo experimental studies have showed the biological effects of electromagnetic field in different frequencies range. These effects caused disorders at the molecular and behavioral level. However, these studies were insufficient to confirm the directly related effects to the cause. Therefore, further research must be done to raise the controversy about the safety of wireless waves.
ATPases is known to be a crucial in many biological activities of organisms. In this study, physicochemical properties and modeling of ATPases protein of fish was analysed using In silico approach. ATPases a protein selected from fish species, including Gold fish (Carassius auratus auratus), Zebra fish (Hypancistrus zebra), White fishes (Coregonus autumnalis), Grass carp (Ctenopharyngodon idella) and Anabas testudineus (Koi) were used in this study. Physicochemical characteristics showed with molecular weight (25045.58-25148.57Da), theoretical isoelectric point (9.30-9.97), extinction coefficient(26470-34950), aliphatic index(147.31-150.35), instability index(32.84-42.67), total number of negatively charged residues and positively charged residues (5/7-6/8), and grand average of hydropathicity (1.014-1.151) were computed. All proteins were classified as transmembrane proteins. In secondary structure prediction, all proteins were composed of random coils as predominant, followed by extended strands, alpha helix and beta turn. Three dimensional structure of protein were predicted and verified as good structures. All model structures were evaluated being accepted and reliable based on structural evaluation and stereo chemical analysis.
Oswaldo Rivera Rodriguez, Juan Jose Ramos Alvarez, Juan Carlos Segovia Martínez, Francisco Javier Lopez-Silvarrey Varela and Ricardo De la Vega Marcos*
<h2>Summary</h2><p>The purpose of the present study was to experimentally assess the effect of cognitive strategies of association and dissociation while running on central nervous activation. A total of 30 long distance runners volunteered for the study. The study protocol consisted on three sessions (scheduled in three different days): (1) maximal incremental treadmill test, (2) associative task session, and (3) dissociative task session. The order of sessions 2 and 3 was counterbalanced. During sessions 2 and 3, participants performed a 55 min treadmill run at moderate intensity. Both, associative and dissociative tasks responses were monitoring and recording in real time through dynamic measure tools. Consequently, was possible to have an objective control of the attentional. Results showed a positive session (exercise+attentional task) effect for central nervous activation. The benefits of aerobic exercise at moderate intensity for the performance of self-regulation cognitive tasks are highlighted. The used methodology is proposed as a valid and dynamic option to study cognitions while running in order to overcome the retrospective approach.</p>
Levels of electrically evoked stapedial reflex thresholds (eESRTs) are frequently used as most comfortable levels (MCL) in cochlear implant fitting. The problem of routine one-channel-technique of reflexometry is long duration of this procedure. In order to “compress the time” we suggest method of consecutive stimulation of all electrodes of implant with simultaneous registration of stapedial reflexes-SWEEP-session. Practical implementation of the SWEEP-session is described here. This method has been successfully used in several hundred CI patients. Registration of evoked electrical stapedial reflex thresholds (eESRTs) during CI fitting is long procedure. In order to “compress the time” we suggest our SWEEP-session method. Practical implementation of this SWEEP-session is described here in accordance with the patent of Russian Federation.
The paper presents and develops the issue of Cumulative Effect Assessment (CEA) in the Environmental Impact Assessment (EIA) screening procedure established by the State and Regional regulations In Italy. In the period 2001-15 in the territory of the Venice province (north east Italy, Veneto region) n. 328 projects (and the related environmental preliminary/definitive studies) were applied to competent Authorities (6% to the State, 39% to the Region and 55% to the Province). All the Environmental Impact Studies (EISs) and Environmental Preliminary Studies (EPSs) referring to the this territory officially applied to competent Authorities in the period 2001-2010, have been analysed with focus on the identification and assessment of cumulative effects (CEs); the projects considered and analysed for this purpose comprise a total of n. 181 EIA screening and ordinary procedures; the remaining 147 projects in the period 2011-15 (for a total of 328) are here considered only for statistical reason to an update assessment of project typologies in the same territory.
The methodology applied for the analysis of the sample of environmental studies in the period 2001-10 refers to that presented by Cooper and Sheate (2002) with modifications. The investigation has been developed looking for the way in which the topic is performed by practitioners in the environmental studies as from qualitative as well as quantitative point of view. Specific attention has been paid to waste management plants which are always subject to EIA screening procedure since 2008 according to Directive 97/11/EEC and in case to the whole EIA procedure. The approach proposed by Lombardia Region (North Italy; 2010) for EIA screening procedure of waste management plants has been applied to identify CEs and modified according to the characteristics of the considered territory; it allows the performance of the project-based approach and must be completed with a regional-based approach (Dubè, 2003). The proposed approach can be useful in case of waste management and IPPC (Integrated Pollution Prevention and Control, Directive 96/61/EEC, amended with Directives 2008/1/EC and 2010/75/EU) plants to define the financial warranties required for the authorization of operative activity of the plants to cover potential environmental damages produced in cases of accidents and other conditions as required in Europe (art. 14 Directive 2004/35/EC on environmental liability).
Several project categories were chosen and their EISs analysed as an exemplificative case according to the potential generation of cumulative impacts and the characteristics of the territory. With reference to the completed procedures where the competent Authority presented a final judgement, it has been observed that the CEA has been seldom developed due to not compulsory legal requirements as already observed by Burris and Canter (1997). Moreover, when it is considered, the methodology is limited and not systemized. Indices of impact have been identified according to emission for the main environmental components focussed with the analysis of the pressure factors of the plants. The study points out the need to analyse and evaluate the cumulative effects (CEs) at a strategic level (within the Strategic Environmental Assessment-SEA- procedure) with a view to preparing the study for EIA/EPS framework procedure for the projects derived from the corresponding plan/program. A sound knowledge of the considered territory and in particular of its pressure sources is of main importance for CEA assessment and impacts’ prevention. Geographic Information Sytesm (GIS) application is strongly needed for pressure sources’ census and control data storing.
Natural dyes have become a viable alternative to expensive and rare organic sensitizers because of their low cost, easy attainability, abundance of supply of raw materials and environmental friendliness.Chlorophyll, the most abundant pigment, can be extracted from plant leaves with simple and inexpensive methods, but it’s difficult to use as a Dye-Sensitized Solar Cells (DSSC) sensitizer due to the absence of OH and COOH groups. The opposite is true for xanthophylls, a particular class of carotenoids that contain free hydroxyl groups and thus may be considered as potential DSSC sensitizers. In this work we describe a new and inexpensive method of chlorophyll extraction from leaves based on the use of a basic solvent that provides the creation of COOH groups, allowing chlorophyll binding on the TiO2 layer. This modified chlorophyll dye showed a higher DSSC efficiency level (0.72%) compared to xanthophylls, which had lower efficiency.
Krishanu Das*, George P Abraham, Kishnamohan Ramaswai, Datson George P, Jisha J Abraham, Thomas Thachill and Oppukeril S Thampan
Introduction: Laparoscopic approach is emerging as a standard of care approach for management of masses amenable to partial nephrectomy. Laparoscopic partial nephrectomy is a challenging surgery and its successful performance depends on various factors. We aim to evaluate the influence of tumor characterestics on the operative performance for laparoscopic partial nephrectomy.
Methods: Patients undergoing laparoscopic partial nephrectomy in our institution were recruited for this study. The tumor profile was evaluated by a senior radiologist from cross sectional imaging (computed tomography or magnetic resonance imaging). Tumor characerestics was defined by assessing tumor size, tumor location and RENAL score. The operative performance was evaluated in terms of warm ischemia time, blood loss, operation duration and any significant operative complications. Statistical inference was drawn.
Results: 37 patients who underwent laparoscopic partial nephrectomy between January 2010 and June 2012 were included in this study. The mean tumor dimension was 3.81 cms. 21 tumors involved left kidney and 16 involved right kidney. 12 were located in upper pole, 8 were located in midpole and 17 were located in lower pole. The average RENAL score was 6.56. The mean warm ischemia time, blood loss and operation duration was 26.29 minutes (min), 256.76 millilitres (ml) and 208.11 min respectively. Statistically significant correlation was appreciated between tumor location (polar location, side, anterior/ posterior location) and RENAL score and operative parameters (warm ischemia time and operation duration). Tumor size did not have any correlation with the operative parameters.
Conclusion: The operative performance of laparoscopic partial nephrectomy is significantly influenced by the tumor location and RENAL score.
Bacteria has been known to grow in pipes of water distribution systems and bottled drinking water. Its growth in reusable drinking water bottles is not clear even though they have become more popular and used by children and adults daily everywhere. This study found that there is an extremely high level of bacteria content and a rapid microbial growth in reusable drinking water bottles. The bacteria content tested by heterotrophic plate count (HPC) is in a range of 0-2.4x105 CFU/mL with an average of about 34,000 bacteria counts/ml for bottles used by children and 75,000 bacteria counts/ml for bottles used by adults. Bacteria number can quickly increases to 1-2 million counts/ml in the bottles one day later. Considering the high level of HPC bacteria content in the reusable drinking water bottles, it may be necessary to have some control measures to reduce the bacteria level and to minimize the associated likely health risk of the disease spreading since many people use reusable water bottles every day.
Sergey N Larionov*, Sorokovikov VA and Rudakova AV
Syringomyelia in combination with inherent or acquired hindbrain abnormalities is the non seldom and at the same time controversial issue.
Purpose: The etiology and pathogenesis creates a lot of discussion.
Methods: Experimental syringomyelia was induced in 20 anesthetized rabbits by injecting 0.5 ml of 25% kaolin suspension into the cisterna magna. Six rabbits with puncture and injection sterile saline NaCl were used as a control. The animals were sacrificed 1, 2, 4 and 6 months after the kaolin injection. Four hydrocephalus rabbits were sacrificed in 17 hours after the puncture of lateral ventricle with injection of solution of colloidal gold labeled human albuminum. The sections of the brain and spinal cord were stained with hematoxylin and eosin by Nissle and Marchi methods and with immunogold technique. Retropharyngeal lymph nodes of the animals were examined by electron microscopy.
Conclusion: Our observation showed that water hammer effect and internal destruction of the spinal cord may lead to continuous antigen stimulation of regional lymph nodes and play an important role in pathogenesis of experimental syringomyelia.
Introduction: One of the essential requirements for efficient oral and maxillofacial surgeon is comprehensive knowledge in anatomy of head and neck regions. Authors believe that asking students to draw anatomical sketches will assist them to improve their imaginary memory for human anatomy. However, drawing, as learning aid in anatomy, has not been given enough attention as a learning aid for human anatomy.
Aim of the study: To determine dental students’ level of appreciation to drawings as practical learning aid in human anatomy.
Materials and methods: Seventy nine first year dental students in Ibn Sina University for Medical and Pharmaceutical Sciences College of Dentistry for the academic year 2016-2017, were requested to complete a questionnaire. The questions were mostly related to the importance of drawing in anatomy and its relation to Anatomy education. The participation in the questionnaire was optional.
Results: This study showed highly significant relationship between the ability to understand anatomy subject and the importance of drawing (P=0.006). It also showed highly significant relationship between the importance of drawings and giving clinical examples during lectures or anatomical labs (P=0.006). Furthermore, the results showed no significant relationship between the importance of drawings and the load of anatomical material, introduced in anatomical lectures and labs (P=0.639).
Conclusion: Anatomical drawings, from first year dental students’ perspective, are a useful learning tool and can relate to different aspects of proper education of human anatomy. Drawings can be implemented as practical tool in human anatomy curriculum for undergraduate dental education.
Luisa Cornegliani*, Federico Leone, Francesco Albanese, Mauro Bigliati, Natalia Fanton and Antonella Vercelli
Background: Topical therapy with antimicrobial agents is used in otitis treatment. Due to increase of antibiotic resistance, new strategies are needed. Antiseptics are used but they may induce contact dermatitis. Natural antimicrobial peptides may represent future effective drugs.
Objectives: The objectives were to test the efficacy of an 11% lactoferricin otological solution (LCF) in bacterial and yeasts otic overgrowth and compare LCF with a commercial one containing chlorhexidine (CLX) 0.05%.
Materials and methods: Forty-one dogs diagnosed with bacterial or yeasts otitis overgrowths were included according to general good practice. They were randomly assigned to lactoferricin or chlorhexidine group for treatment. Otological solution were applied twice a day for a week and then daily for another week. Clinical and cytological score was assessed at day 1 and day 14. At the end of the study, the owners had to express an opinion on the overall efficacy of the products. Statistical analyses were performed using Wilkoxon’s test and T test for paired samples. Results in lesional and cytological score were significative with a p<0.05.
Results: Forty dogs completed the study. All cases, receiving lactoferricin or chlorhexidine, were successfully treated with clinical signs remission and regression of infection (p<0.05). The owners’ judgment was good in 87%, mild in 13% for LCF group. For CLX they scored good in 41%, mild in 24% and unuseful in 35% of cases.
Conclusions: Lactoferricin, an antimicrobial natural peptide, showed the same efficacy of chlorhexidine in the treatment of otitis characterized by bacterial or/and yeast overgrowth.
Background: Telerehabilitation has been identified as an effective treatment that promotes exercise rehabilitation in individuals with multiple sclerosis (MS). Social support is recognised as a core element of such interventions. However further research is needed to consider the role and value of different social support domains.
Aim: Review available literature to assess and synthesise the use and value of social support within telerehabilitation interventions for individuals with MS.
Method: A narrative synthesis was conducted. A systematic search of included articles was conducted. Electronic databases were searched from inception to January 2017. Other search methods were undertaken. Evaluation and synthesis of included articles utilised risk of bias assessment and a 4-stage synthesis process.
Main Results: A total of fourteen studies, involving 718 participants (505 female, 213 male; aggregated mean age 47.6 years) with MS, were included. Esteem support was the most frequently reported method of social support, followed by informational, emotional and tangible. It would appear social support can be beneficial in assisting participants to adhere to treatment interventions. Visual feedback may be directly beneficial to improve impaired balance in individuals with MS. A model for future interventions is provided.
Conclusions: Social support appears to increase the adherence of participants with MS to telerehabilitation interventions. Unique findings provide an indication for the direction and content of future interventions. Further research is necessary to ascertain the optimal types and frequencies of social support delivery and its effect on health outcomes for participants with MS.
Background: Proximal humerus fractures (PHFs) are common injuries particularly in older adults. Evidencebased protocols for PHF rehabilitation are lacking and physiotherapists use a variety of interventions.
Purpose: To determine practice patterns and perceptions of physiotherapists who treat adults with PHF in Ontario, Canada.
Method: A paper and pencil survey asking about respondent demographics and management of Neer Group 1 (minimally/nondisplaced) and complex (displaced 3- and 4-part) PHF was mailed to 875 randomly selected physiotherapists who were registered with the College of Physiotherapists of Ontario in 2013/2014 and working in practice areas likely to be accessed by adults with PHF.
Results: The response rate was low (10%); 83 physiotherapists completed the survey - 80% had experience managing PHF. Respondents treated 1-5 individuals with PHF annually; more treated Neer Group 1 PHF (89%) than complex PHF (68%). Most individuals with PHF were older than 60 years (64%), female (76%) and accessed physiotherapy through a doctor’s referral (91%) more than 1 month post injury (33%).
Main findings: Physiotherapists manage PHF using multi-component interventions and a minimum of 76% include the following elements: education and progression of passive, active assisted, active range of motion exercises and muscle retraining to build coordination and strength. Use of other elements was variable. The main factors influencing the treatment plan were the ability of the individual with PHF to comply, bone quality, and fracture type. Most respondents were unsure that there is sufficient PHF rehabilitation literature to guide treatment.
Conclusions:This environmental scan is the first North American study to document practice patterns and attitudes of physiotherapists providing PHF rehabilitation. Elements used by physiotherapists in Ontario treating small numbers of individuals with Neer Group 1 or complex PHFs each year align well with the limited PHF rehabilitation literature available.
Potential implications:Multi-disciplinary collaborations to design and conduct large, high quality, multi-centre prognostic studies and RCTs that evaluate the effectiveness of key aspects of non-surgical PHF rehabilitation in various patient groups are needed. Meanwhile, consensus guidelines should be developed in the context of region-specific physiotherapy service models to inform best practice in PHF rehabilitation management.
There are a lot of controversy about the usage of graft for reconstruction of the TMJ, many researchers tried in the past different technique to be applied in the TMJ [1], for restoration of growth and all failed and some of these techniques may be used for one trial without success.
The Chondro-Ossous graft is the most valuable graft been advocated since 1986 for reconstruction of the temporomandibular joint (TMJ). There is two successful graft been used for reconstruction of the TMJ in children, the Costo-Chondral graft and Chondro-Ossous graft, Costo-Chondral graft been studied clinically by Kennett 1973 and experimentally on Mecaca Iris Monkeys 1974 by Poswillo to assess the viability of the graft [2,3], his work was a breakthrough in research and in reconstruction with restoration of growth of TMJ and this graft been widely used for reconstruction of the TMJ for few decades [4].
<h2>Abstract</h2><p>Gastric mucosal calcinosis is a very rare pathology of the gastric mucosa. It may develop secondary to several diseases but may also be idiopathic in some cases. In this case, gastric mucosal calcinosis was diagnosed with endoscopic biopsy performed for a patient who presented to our clinic with heartburn and abdominal discomfort. This case involves a very rare gastric pathology, and is being studied here with reference to literature data.</p>
Giulia Anna Follacchio*, Viviana Frantellizzi, Francesco Monteleone, Giuseppe De Vincentis and Mauro Liberatore
Ra-223 dichloride is a first-in-class alpha-emitting radiopharmaceutical recently introduced into clinical practice for treatment of men with Castration-Resistant Prostate Cancer (CRPC) and symptomatic bone metastases.Due to the proven benefit on Overall Survival and the favorable toxicity profile, Ra-223 therapy is gaining widespread use in both US and Europe. In this article, we describe the routinary management of patients undergoing Ra-223 treatment in our Institution.
Currently, Ra-223 therapy is indicated for 6 intravenous injections (55 kBq per kg of body weight) administered every 28 days. In comparison to other radiopharmaceuticals, Ra-223 handling and administration do not need any additional training for authorized users. Due to the minimal external dose rate emission, Ra-223 dichloride can be delivered in an outpatient setting. Moreover, no particular precautions other than standard hygiene measures must be taken by patients’ family members or caregivers. Ra-223 therapy is associated to a favorable hematologic toxicity profile, while non-hematologic adverse events are generally mild and easy to manage.
Given the favorable toxicity profile of this treatment, clinical trials are currently ongoing to evaluate efficacy and safety of Ra-223 treatment in combination or sequence with recently approved drugs such as abiraterone acetate, enzalutamide and sipuleucel-T. In addition, the recent interest in Ra-223 bone lesion dosimetry could open the way to a dosimetric-based therapeutic approach with Ra-223. In this new scenario, results of these promising clinical trials may help clarifying the optimal sequencing of new therapeutic possibilities for metastatic CRPC and the appropriate eligibility criteria for Ra-223 treatment in oncologic patients.
Chemotherapy is one of the main treatment options for cancer. However, chemotherapeutic agents usually suffer from poor pharmaceutical properties that restrict their use. Targeted therapy drugs have been developed to specifically target changes in cancer cells that help these cells to grow. Such drugs often work when standard chemotherapeutic drugs do not, they often have less severe side effects and they are most often used for advanced cancers. The objective of this article is to give an overview about the 16 FDA-approved targeted therapy drugs to treat non-small cell lung cancer.
Two of the most recent LABA/ICS combinations for treatment of persistent asthma are Fluticasone furoate/Vilanterol 92/22 μg (Ellipta) and Beclomethasone dipropionate/Formoterol 100/6 μg (Nexthaler).
Objective: To compare once-daily Fluticasone/ Vilanterol combination with twice daily Beclomethasone/ Formoterol association in moderate asthma, in terms of quality of life and lung function.
Methods: Fourty patients with moderate asthma treated with Beclomethasone/Formoterol 100/6 µg or Fluticasone/Vilanterol 92/22 µg. We revalued patients in terms of lung function and Asthma Control Test, at 4, 8 and 12 weeks to assess any differences between the two groups. After 4 weeks, thirty-one of the fourty patients were evaluated in terms of respiratory function at predetermined time intervals.
Result: In patients treated with beclomethasone/formoterol FEV1 presented a mean value of 78% at the third visit and of 79.1% during the final check, compared with 74.5% and to 75.8% in patients in treatment with fluticasone/vilanterol (p 0.01). Mean values of IC and MMEF25-75% were higher in patients treated with beclomethasone/formoterol compared with fluticasone/vilanterol. For the dyspnea it was a difference at the third observation. For the nocturnal symptoms and the use of rescue drug there was a significant difference, except at the beginning. For the perception of control by patients, there was a difference in the two groups at the beginning, after 4 and 8 weeks. Total ACT score showed a significant difference after 4, 8 and 12 weeks. In the group treated with beclomethasone/formoterol FEV1 value was significantly higher at a distance of four hours after drug administration (p 0.04) and after the second dose (p 0.02) compared with the group treated with fluticasone/vilanterol.
Discussion: Patients in treatment with beclomethasone/formoterol showed improved asthma control and nocturnal symptoms and more stable respiratory function compared with patients receiving fluticasone/vilanterol.
Result: In patients treated with beclomethasone/formoterol FEV1 presented a mean value of 78% at the third visit and of 79.1% during the final check, compared with 74.5% and to 75.8% in patients in treatment with fluticasone/vilanterol (p 0.01). Mean values of IC and MMEF25-75% were higher in patients treated with beclomethasone/formoterol compared with fluticasone/vilanterol. For the dyspnea it was a difference at the third observation. For the nocturnal symptoms and the use of rescue drug there was a significant difference, except at the beginning. For the perception of control by patients, there was a difference in the two groups at the beginning, after 4 and 8 weeks. Total ACT score showed a significant difference after 4, 8 and 12 weeks. In the group treated with beclomethasone/formoterol FEV1 value was significantly higher at a distance of four hours after drug administration (p 0.04) and after the second dose (p 0.02) compared with the group treated with fluticasone/vilanterol.
<h2>Abstract</h2><p>As people get older, chronic diseases become an important reason of disability while a decline in physical functions is related to aging among the elders, which may lead to dependency and isolation of the older adults. Body asymmetry and imbalance body alignment can bring added stress to the joint structures that can cause dysfunction of the joint, ligaments, tendons, bursas, and related muscles, which in return brings about problem while walking or during activities of daily living. Joint Functional Screening (JFS) is a systemic clinical examination with clinical reasoning of the entire human joints body, with or without causative limitation to derive a holistic analysis of musculoskeletal system. JFS profile helps to assess body disorder of older people. This clinical screening include documentation of balance of the body, lower and upper body strength, joints flexibility, body composition, and body alignment. This is an innovation build to profile a normal musculoskeletal state to decode any anomaly in an otherwise a normal subject, who might be preparing to take up any activities in one’s lifespan that could elicit an injury which could be prevented. JFS could be a useful tool for physiotherapists, exercise therapist or even the personal trainers to screen a body prior to rehabilitative or an exercise program; and this clinical screening is presently a best guidance to prevent risk of fall or injury among individual healthy people and older adult.</p>
Capsicum spp. is one of the most important economical horticulture crops due to its high consumption either by fresh vegetable or dried spice. Molecular genetic markers offer a number of applications in the genetic improvement of crop plants, which plays an important role in the areas of plant classification and breeding programs.The polygenetic characters of rare species, which are difficult to analyze by traditional methods can, be analyzed easily and classified by using molecular markers. In our study, genetic relationships of twenty-two paprika species were examined to estimate their genetic variations/similarities and to detect the polymorphism present within and among the paprika species by using RAPD-PCR markers. The results revealed that the maximum similarities among the 16 ICBD lines were 100%. The ICBD 03 had 76% similarity compared with other ICBD lines. The CC01 had comparatively low similarity with ICBD forms (30%), followed by EC01 (28%), EC02 (33%), CC02 (35%), and Kt.Pl-19 (60%). The similarity between EC01 and EC02 were 54%. Kt.Pl-19 showed different similarities compared to CC01 (41%), CC02, EC01 (38%), EC02 (29%) and ICBD 03 (40%). The different combinations were tried to optimize the RAPD-PCR profile, which helped to assessing the polymorphism/similarities within and among the Paprika germoplasms were studied.
Yi Li*, Ayman Al-Salaimeh, Elizabeth DeGrush and Majaz Moonis*
Here we reported an interesting case of an 84-year-old woman with acute onset of paresis of left arm and paresthesia of left face and arm. The symptoms resolved within two hours. She also had a similar prior episode two weeks ago with only left arm paresthesia.Her MRI revealed different stages of lacunar ischemic lesions. Interestingly, the SWAN sequences showed lateralized rather than global multiple microhemorrhages over the right MCA and PCA territory, and the sulcal hyperintensity on FLAIR was also seen with no associated susceptibility effect and minimal enhancement, indicating probable cerebral amyloid angiopathy (CAA) based on Boston Criteria.
It has been acknowledged that the CAA could manifest with certain localization preference. Cerebral microinfarct and white matter disease in CAA have been more often observed in the posterior circulation territory, however the restricted lateralization reported in our case has not been seen. Since CAA is often diagnosed when the characteristic MRI findings are picked up incidentally, recognizing this as a potential “TIA mimic” will be important for guiding treatment due to its higher risk of bleeding. In summary, this case highlights that the CAA could present as restricted lateralized lesions and occur as transient neurologic deficits, which to our knowledge has not be reported before. Recognition of it as a potential manifestation of CAA will be valuable in the clinical diagnosis process.
Several articles have been written about hyper inflated sinus structures. Never before, however, a complete overview of all possible pressure induced variations of sinus anatomy have been published. The aim of this study was to make an inventory of the most common CT signs of hyper inflated paranasal sinus structures. During a period of 2 years all CT-scans of the paranasal sinuses made in an ENT-department were studied and the most typical shapes of hyper inflated sinus structures were recorded.
The authors documented 9 different anomalies of the anterior paranasal sinus complex (frontal sinus, frontal and supra-orbital recess and anterior ethmoid), 8 of the ethmoid and 1 of the sphenoidal sinus. These hyper inflated paranasal sinus structures can only be generated by high positive intranasal pressures. The nose blowing manoeuvre is the only manoeuvre that generates extremely high pressures and as such it might be the driving force in the generation of these hyper inflated paranasal structures and consequently play a role in the pathophysiology of chronic sinusitis.
Pneumatisation of the sinuses starts at birth and is a lifelong process. Sometimes, however, pneumatisation can be extreme and will result in facial deformities. Pneumosinus dilatans, is such a condition, characterized by an abnormal dilatation of a paranasal sinus cavity, containing air only. Most reports describe pneumosinus dilatans of the frontal sinus, but also other sinuses can show this phenomenon: maxillary sinus and in one case a unilateral pneumosinus dilatans of nearly all sinuses (maxillary, ethmoid, and sphenoid sinus) was described.
Recently Kalavagunta et al., described a less dramatic expansion of the maxillary sinus and named it “Extensive Maxillary Sinus Pneumatisation” (EMSP). They were surprised to see that EMSP has received little attention in the literature. Neuner et al., described 9 different atypical pneumatisation abnormalities of the paranasal sinus anatomy.
Most of deformities of the sinus pneumatisation are growth deformities of the thick bones that make up the frame of the sinuses. Only a few articles, deal with specific deformities of thinner bone structures such as “wavy orbital floor” and “frontal cells”. Never before, however, an article was published that studied all possible deformities due to increased pressures and tried to make a classification. So the aim of this study was to make an inventory of the most obvious pressures related deformities that can be seen on CT-scans of patients with rhinosinusitis.
Haakon H Eilertsen, Peer K Lilleng, Bjorn Maehle and Inge Morild*
This study presents the frequency of old myocardial infarctions (OMI), and the frequency of unrecognized myocardial infarction (UMI) in elderly people in a forensic material. It was also examined if predisposing factors of UMI could be identified. Of special interest was also to investigate the value of the police's records as a source for medical information in a forensic setting. The study is based upon medico-legal autopsies of persons above the age of 60 at the time of death during the period 1999-2003. The study included 325 cardiovascular deaths. Of these, 166 died from OMI. UMI accounted for 123 of these (74%). Most UMI were located in the interventricular myocardial septum and left anterior wall (>60%), but no significant differences could be found between UMI and recognized MIs (RMI). No obvious reason could be found as to why the UMI remained unrecognized. Police records were inferior to the hospitals records, regarding medical information to the pathologist, with information about cardiac disease in about 60%, and with information about OMI in 11-17%. Hospital records supplying information about OMI were found in half the cases. It is concluded that unrecognized myocardial infarction is not uncommon among elderly persons, and with a high risk of sudden death. More emphasis should be put in recognizing OMI in ECGs to attempt to reduce the risk of sudden cardiac death.
Pyridine and pyrimidines are amongst the most important, well known heteroaromatic rings, owning to their bioactive importance. Herein, an idea about how to design the synthetic pathway for these rings using retrosynthesis analysis techniques.
Ajay Kumar, Shweta Verma, Arun K Mishra and Sushil Kumar*
A series of Schiff bases of diphenylamine derivatives have been synthesized and evaluated in vitro for their antibacterial activity against pathogenic both Gram-positive bacteria B. subtilis and Gram-negative bacteria E. coli using ciprofloxacin as standard drug at conc. of 50 µg/ml and 100 µg/ml. The structures of these compounds were established on the basis of IR and 1H-NMR spectral analysis. The compound (3d) displayed potent antibacterial activity against Bacillus subtilis (17 and 15mm) and Escherichia coli (19 and 17mm) by disc diffusion method.
Di Zazzo Erika, Bartollino Silvia* and Moncharmont Bruno
The Positive Regulatory Domain (PRDM) protein family gene is involved in a spectrum variety of biological processes, including proliferation, differentiation and apoptosis: its member seem to be transcriptional regulators highly cell type and tissue peculiar, towards histones modifications or recruitment of specific interaction patters to modify the expression of target genes. In this study we analyzed the expression profile of different member of PRDM gene family focusing our attention on the role of PRDM2, PRDM4 and PRDM10 genes in mouse C2C12 cell line, during the differentiation of myoblasts into myotubes and speculate about the role of the protein Retinoblastoma protein-interacting zinc finger protein 1-RIZ1, coded by PRDM2 gene, as a regulator of the proliferation/differentiation switch.
Results showed a reduction of PRDM2, PRDM4 and PRDM10 expression level during the commitment of the differentiation of myoblasts into myotubes. The RIZ1 silencing stimulated myoblasts differentiation, similar to the effect of serum deprivation on these cells, associated with an increase of Myogenin expression level, which is considered to be involved in the differentiation of myoblasts into multinucleated myotubes. As demonstrated by chromatin immunoprecipitation experiments, RIZ1 is associated with Myogenin promoter in proliferation condition and after 24h from differentiation induction, negatively controlling therefore Myogenin expression. Moreover RIZ1 silencing induced a reduction in PRDM4 and PRDM10 expression levels leaving us to speculate that the PRDM genes have a redundant role and they are hierarchically organized.
Marzia Cottini*, Lappa A, Donfrancesco S and Francesco Musumeci
The Transcatheter Aortic Valve Implantation (TAVI) had emerged more and more in the last twenty years. According to the scientific literature, this is an approved, suitable and alternative therapeutic choice to conventional surgery for aortic valve disease in high risk patients. The most of patients are octogenarians or nonagenarians, with multiple comorbidities (neurological,vascular,oncologic, haematological, etc). The evolution of TAVI techniques and its devices have improved the quality of results and reduced the peri- and post-procedural complications. Cardiac anaesthesia and analgesia in TAVI patients is very important and fundamental to a quickly and complete clinical restoring after the procedure. An optimal balance of drugs and peri-procedural management could reduce the neurological events (such as delirium), the days of hospitalization and the admission of intensive care unit. According to our experience in transapical approach, the low dose of propofol and desflurane allowed to optimal cardiac anaesthesia and rapid mechanical ventilation weaning in complex patient undergone to transcatheter valve implantation with transapical approach. Moreover, our protocol reduced considerably the incidence of perioperative delirium.
Lijuan Chen, Xia Zhang, Cuibin Tang and Xiaohong Gan*
In order to provide theoretical foundation for forestation of Phyllostachys bambusoides f. shouzhu Yi, the site factors, and the morphological character and biomass of standard bamboo were investigated in 16 sample spots of bamboo forest in Liangping county, Chongqing City, and then the effects of site factors on the clonal growth was discussed.Three site factors as the slope position, altitude, species diversity, had significant effects on the clonal growth of the bamboo. The effects of the gradient, slope aspect, humus thickness, and soil thickness were little, but that of slope aspects was not significant. The altitude of above 800 m, the upper slope, the steep slope and slope, and the thin soil were not suitable for its clonal growth. The results showed that (1) the main site factors affecting the growth of P. bambusoides f. shouzhu were slope position, soil thickness and humus thickness; (2) The forestation site of P. bambusoides f. shouzhu should be selected at the flat ground and the gentle slope of the hills below altitude of 800 m, and the slope position of the forestation site should be selected at the mid and lower position of a hill; (3) Soil thickness and humus thickness should be kept at a suitable level; (4) The diversity of plant species in the bamboo forest should be kept at a suitable level for keeping its growth environment.
Mevludin Hasanovic*, Izet Pajevic and Osman Sinanovic
It is known today that psycho-trauma and PTSD cause different levels of mental and social dysfunction. Human spirituality and capacity to meet further life difficulties become severely damaged. There is wide accepted attitude today that in holistic approach in process of healing PTSD and psycho-trauma is necessary to include other professionals from community resource regarding needs of trauma victims. In Bosnia and Herzegovina after very severe war (1992-1995) as mental health professionals, we are faced with increasing number of different mental health disorders as result of severe trauma experiences. Regarding community based care orientation it is necessary to include and religion professionals. According national and religious background of majority of our population in Tuzla Canton that is Muslim, we meet spiritual needs of our clients as needs for Islamic explanation of life and death meaning. Our clients need to talk about spiritual issues in daily therapy and to practice daily religious rituals. Regarding that in this paper we tried to interface Islamic principles and it’s beneficial toward psycho-trauma and PTSD, as well as Muslim perspectives in attempt to apply spiritual practice in therapeutic tools for better efficacy in spiritual healing of mental dysfunction’s of believers who survived severe trauma, especially war trauma.
• To assess the short term effects of intravitreal Lucentis (IVTL) on intraocular pressure in patients with ocular hypertension and glaucoma.
• To determine rate of anterior chamber paracentesis (ACP) required post-injection according to departmental protocol.
Methods
This was a prospective, observational study carried out between August 2011 and February 2012 in the Department of Ophthalmology, Maidstone Hospital. 24 participants (13 female, 11 male) with established ocular hypertension (OHT) or glaucoma were chosen from a cohort of patients receiving intravitreal (IVTL) Ranibizumab (Lucentis) treatment for wet age related macular degeneration (wARMD). Apraclonidine 1% was given pre-injection, and baseline IOP was measured 30 min. after this, just before IVTL. IOP was measured at baseline, within 1 min of injection, 5 min, 15 min, 30 min up to 60min following a single IVTL treatment.
Anterior paracentesis was performed if:
• Immediate post injection IOP > 50mm Hg and OHT.
• Immediate post injection IOP > 40 mm Hg and there was evidence of disc damage only.
• Immediate post injection IOP > 30mm Hg with evidence of disc damage and visual field loss.
• Immediate post injection IOP > 30mm Hg with evidence of disc damage and visual field loss
Alexis Alvarez-Aliaga*, Julio Cesar Gonzalez-Aguilera, Liliana del Rosario Maceo-Gomez, Lic David del Llano Sosa, Raul Leyva-Castro and Rosa Ojeda-Vazquez
Introduction: Hypertensive cardiopathy is the target organ lesion caused by arterial hypertension (HTN) that exhibits the highest morbidity and mortality rates. Although the importance of hemodynamic overload exerted by HTN on the onset of cardiopathy is well established, several non-hemodynamic factors may contribute significantly to its development.
Objective: To evaluate the influence of different non-hemodynamic risk factors in the development of hypertensive cardiopathy.
Methods: A prospective cohort study was carried out in hypertensive patients assisted at the specialized arterial hypertension physicians’ office of the “Carlos Manuel de Céspedes” Specialty Policlinic attached to the General University Hospital, Bayamo Municipality, Granma Province, Cuba from January 5, 2006 to December 31, 2015. The study included 18-to-55-year-old hypertensive patients with a stage 1 arterial hypertension diagnosis for less than a year1.
Results: The multivariate analysis showed a significant and independent relation among the majority of the factors studied and the risk of developing cardiopathy. The major factor was C-reactive protein (HR: 5.020; IC 95%: 3.383-7,448; p<0.005) followed by microalbuminuria (HR: 2.649; IC 95%: 1.932-3.631; p<0.005). The area under the model ROC curve was 0.887 (p<0,005).
Conclusions: The results showed that it is possible to estimate the risk of developing hypertensive cardiopathy with the application of the regression model to major risk factors.
Sannia Mia Sveningsen Sjostedt*, Eva Hebbelstrup Rye Rasmussen, Anette Bygum and Line Kanstrup Springborg
A 21 year-old woman presented with cervical lymphadenopathy and night sweats. Initially, lymphoma was suspected and one of the enlarged lymph nodes was excised in order to make a diagnosis. Histopathological examination revealed Kikuchi’s disease, which is usually a benign syndrome with spontaneous resolution. The disease is very rare, particularly in Caucasian populations. A higher incidence is seen in patients of Asian descent.
The patient had persistent swelling of cervical lymph nodes over several months and further lymph nodes were removed as malignant transformation was suspected. However examinations showed only Kikuchi’s disease. There was given no specific treatment. Follow-up appointments were performed biannually and the patient is currently awaiting removal of yet another swollen lymph node on suspicion of relapse of her Kikuchi’s disease.
The work is an attempt to create a complete system of conditions which influence genesis, existence, and response characteristics of stapedial reflex in impedance audiometry. The author divides the conditions into the internal-reflex arc integrity, temporal acoustic summation, mixed-external auditory meatus and middle ear, and internal-side of stimulation and energy content of the stimulus. The system of conditions that influence stapedial reflex is based on a criterion, that stapedial reflex depends on energy, which is percepted by the inner ear as subjective loudness. The system of conditions stated in this work is based mainly on the author’s own experiments and measurements, which are herein also documented. At the same time, these results are in accordance with data in literature as quoted. This system is not closed-it potentially may be completed using the basic criterion and further knowledge.
Allergen immunotherapy (AIT) is the unique curative treatment to help allergic patients to get over their allergies. With a personalized approach, AIT is the best example of precision medicine. After a century of intensive studies and innovative discoveries, allergists have in their hands many tools to orchestrate the best strategy to re-educate the hypersensitive immune systems that decrease the quality of life of their patients. This review describes both the historical and the promising acquisitions in this field, focusing the biochemical and Bioengineering tools that render an allergen more suitable for a secure, convenient and effective immunotherapy.
Pirabu Sakthivel*, Chirom Amit Singh, and Suresh Chandra Sharma
A 63 year old gentleman presented with ulcer over the lower alveolus for the past 4 months duration. The patient also had pain, loose lower central incisors and occasional bleeding from the ulcer while brushing. On examination an ulceroproliferative growth was seen involving lower alveolus along with adjoining mucosa of the lower lip with mobile central incisors. There was associated bilateral submandibular area lymphadenopathy. Histopathological examination of the ulcer revealed moderately differentiated squamous cell carcinoma. The patient underwent wide local excision with central arch resection of mandible with bilateral modified neck dissection and pectoralis major myocutaneous flap for reconstruction followed by postoperative radiotherapy. During the follow up, patient developed severe “Andy Gump deformity” [Figure 1]. Surgical reconstruction was offered to the patient but denied consent for further intervention.
Prosenjit Pramanick, Subrata Trivedi, Sufia Zaman and Abhijit Mitra*
A study was undertaken during August 2017 to evaluate the effect of salinity on chlorophyll a, chlorophyll b, total chlorophyll, and carotenoid and proline contents of hydroponically grown seedlings of Bruguiera gymnorhizza. The primary aim was to observe its tolerance to changing salinity. The selected seedlings were exposed to five different salinity levels (2,5,10,15 and 20psu) for a period of 30 days and observations were done at a regular interval of 7,14,21 and 30 days respectively. The concentrations of chlorophyll exhibited significant positive correlations with salinity (p<0.01). The chlorophyll a:b ratio in the plant varied between 2.39 to 3.71 throughout the period of investigation. The salinity fluctuation did not affect the carotenoid level and proline content in the leaves of the species as evidenced from the insignificant r values. The results show that Bruguiera gymnorhizza of Indian Sundarbans region can tolerate and adapt to high saline condition as witnessed in the central sector of the deltaic complex around the Matla River.
Marco Cirillo*, Marco Campana, Anna Bressanelli and Giovanni Troise
Fiber-based model of the left ventricle is known since 1628 but the complex 3D structure of myocardial fibers has not taken into account in normalcy or in disease until the last decade. We here present the case of a 60-year-old female patient affected by ischemic cardiomyopathy and severe left ventricular dysfunction. Left ventricle was reconstructed according to a novel surgical technique aimed at rebuilding an elliptical ventricular chamber and redirecting myocardial bundles of fibers in a near-normal orientation, by means of an original suturing technique. Left ventricular torsion was restored, proving the reorientation of myocardial fibres’ bundles. The restored physiologic shape was maintained along the years, gradually improving global ejection fraction and diastolic indices, showing a positive remodeling induced by the optimised geometrical and functional parameters.
The unexpected and never proven before renewal of ventricular torsion is an adjunctive element of ventricular efficiency, mainly in ventricles that work at a critical mechanics. A new fiber-based reading of heart function could improve clinical and functional outcomes and address some unsolved issues in the surgical treatment of ischemic cardiomyopathy as well as in medical approaches to the diseased myocardium.
Age related macular degeneration is a severe disease of mainly elderly people and leads to central vision loss because of the degeneration of the retinal pigment epithelium [1]. Genetic and environmental factors are responsible for the accumulation of extracellular material and deposit formation near the retinal pigment epithelial (RPE) layer, which leads to loss of photoreceptors and induction of chronic inflammation.The deposits are composed of lipids and proteins including many complement proteins, indicating the involvement of the complement system in the degenerative process and chronic inflammation [2]. So far there is no treatment for the dry form of AMD, except nutritional supplementation with antioxidants and vitamins [3]. Combined with a prolonged lifetime expectation in developed countries, AMD is developing to a social and economic burden. Therefore, there is an urgent need for a treatment of AMD that can delay disease manifestation and progression for several years.
In a recent manuscript, Saini and colleagues analyzed a vitamin B derivate, nicotinamide (NAM), as a potential treatment strategy of AMD [4]. The anti-inflammatory activity of NAM is not entirely new and may have inspired the investigators to look in detail at the effect of this drug for AMD treatment. In 2008, Temple and her group reported about the treatment of 3 x Tg-AD mice, a mouse model for Alzheimer’s disease (AD), with NAM. Their work suggested that NAM treatment selectively reduces a phosphorylated species of tau associated with microtubule depolymerization and implicated in AD. Treatment of mice restored cognitive decline related to AD pathology indicate a readily available therapeutic for the treatment [5]. Collectively NAM was identified as a cytoprotectant that blocks cellular inflammatory cell activation, early apoptotic phosphatidylserine exposure, and late nuclear DNA degradation [6]. Therefore, NAM supplementation was suggested for the treatment of chronic diseases with an immune system dysfunction as seen in diabetes and age-related diseases.
Sinai et al. [4], investigated the effects of NAM in a human induced pluripotent stem cell (iPSC) model of AMD which they they previously established. The advantage of this model is evident. The investigators used cells from AMD patients with or without a specific ARMS2/HTRA1 risks haplotype as well as from control people to generate iPSCs and to compare the effects of NAM. The authors showed that iPSC cells express a broad panel of drusen like deposits and AMD associated molecules. Also, iPSC-RPE from all AMD patients studied, demonstrated an increased expression of inflammatory and complement factors as compared to controls. The expression of complement genes C3 and CFI was significantly enhanced in patient cell lines carrying the homozygous ARMS2/HTRA1 risk alleles. Interestingly, the expression of the classical complement components C1s and C1r was enhanced in AMD derived iPSC-RPE, thus indicating a role of the classical pathway in AMD.
Melissa Popowski, Bum-kyu Lee, Cathy Rhee, Vishwanath R Iyer and Haley O Tucker*
Research into regulation of the differentiation of stem cells is critical to understanding early developmental decisions and later development growth. The transcription factor ARID3A previously was shown to be critical for trophectoderm and hematopoetic development.Expression of ARID3A increases during embryonic differentiation, but the underlying reason remained unclear. Here we show that Arid3a null embryonic stem (ES) cells maintain an undifferentiated gene expression pattern and form teratomas in immune-compromised mice. However, Arid3a null ES cells differentiated in vitro into embryoid bodies (EBs) significantly faster than control ES cells, and the majority forming large cystic embryoid EBs. Analysis of gene expression during this transition indicated that Arid3a nulls differentiated spontaneously into mesoderm and neuroectoderm lineages. While young ARID3A-deficient mice showed no gross tissue morphology, proliferative and structural abnormalities were observed in the kidneys of older null mice. Together these data suggest that ARID3A is not only required hematopoiesis, but is critical for early mesoderm differentiation.
An enquiry into the lack of attention awarded to serotonin antagonism in the treatment of arterial thrombosis revealed that the mode of action of serotonin and its platelet receptor antagonists was an action upon thrombus growth, and not, as with other anti-platelet drugs upon the initiation of thrombosis. This lack of effect could explain why this approach has been considered not to be effective. However under conditions of arterial stenosis in which there is platelet activation by increased shear stress, and during the growth phase of arterial thrombi, serotonin 5HT2A antagonism has been demonstrated to have great potentcy in dispersing thrombotic obstruction to blood flow. This mode of action, the lack of participation of serotonin in haemostasis, and the absence of serotonin in wounds accounts for the proven lack of effect of effect of pure specific 5HT2A antagonists (i.e., not those with other actions) on operative bleeding and skin bleeding times. This lack of effect on haemostasis solves the dosing problem encountered with other anti-thrombotic drugs, with which drug concentration cannot be controlled with single fixed doses, leading to the association between increased anti-thrombotic efficacy and increased bleeding complications. Thus 5HT2A antagonism appears to be the preferred approach, from the point of view of safety and lack of bleeding risk; this consideration applies particularly to thrombosis therapy in the context of traumatic accidents, surgical operations and invasive procedures such as angioplasty.
Background: Knowledge of pulmonary complications (PCs) in children after hematopoetic stem cell transplantation (allo-HSCT) is limited; most data are from adult studies.
Case: We describe a 8 year old girl with high risk acute myeloid leukemia who developed graft versus host disease (GVHD) on Day 20, Cytomegalovirus (CMV) pneumonia on Day 50 and Cryptogenic organizing pneumonia (COP) on Day 170 after allo-HSCT.
Case: We describe a 8 year old girl with high risk acute myeloid leukemia who developed graft versus host disease (GVHD) on Day 20, Cytomegalovirus (CMV) pneumonia on Day 50 and Cryptogenic organizing pneumonia (COP) on Day 170 after allo-HSCT.
Discussion: Cryptogenic organizing pneumonia is a rare noninfectious PCs that can be idiopathic or have several risk factors as a secondary causes, such as viral respiratory infections, drugs, GVHD and allo-HSCT. Viral respiratory infections and alloimmune lung syndromes have been reported in a few patients who have undergone transplantation.
Conclusion: Transplant physicians should be kept in mind for the development of alloimmune lung syndrome in the form of COP following CMV pneumonia in patients after allo- HSCT
Discussion: Cryptogenic organizing pneumonia is a rare noninfectious PCs that can be idiopathic or have several risk factors as a secondary causes, such as viral respiratory infections, drugs, GVHD and allo-HSCT. Viral respiratory infections and alloimmune lung syndromes have been reported in a few patients who have undergone transplantation.
Conclusion: Transplant physicians should be kept in mind for the development of alloimmune lung syndrome in the form of COP following CMV pneumonia in patients after allo- HSCT
Discussion: Cryptogenic organizing pneumonia is a rare noninfectious PCs that can be idiopathic or have several risk factors as a secondary causes, such as viral respiratory infections, drugs, GVHD and allo-HSCT. Viral respiratory infections and alloimmune lung syndromes have been reported in a few patients who have undergone transplantation.
Conclusion: Transplant physicians should be kept in mind for the development of alloimmune lung syndrome in the form of COP following CMV pneumonia in patients after allo- HSCTCase: We describe a 8 year old girl with high risk acute myeloid leukemia who developed graft versus host disease (GVHD) on Day 20, Cytomegalovirus (CMV) pneumonia on Day 50 and Cryptogenic organizing pneumonia (COP) on Day 170 after allo-HSCT.
Discussion: Cryptogenic organizing pneumonia is a rare noninfectious PCs that can be idiopathic or have several risk factors as a secondary causes, such as viral respiratory infections, drugs, GVHD and allo-HSCT. Viral respiratory infections and alloimmune lung syndromes have been reported in a few patients who have undergone transplantation.
Conclusion: Transplant physicians should be kept in mind for the development of alloimmune lung syndrome in the form of COP following CMV pneumonia in patients after allo- HSCT
A previously healthy 26-year-old gentleman, referred from a state hospital with history of alleged fall from 10 feet height at a construction site on the same day. Glasgow coma scale (GCS) at that hospital was E2 V2 M5. He was brought in to our Emergency Unit, Hospital Kuala Lumpur with GCS of E1 V2 M4 (7/15). Pupils were 5mm+ /3mm+. He sustained left ear bleed. Otherwise vital signs were stable, with no other extracranial injury. Computed tomography (CT) scan brain (Figure 1) showed right frontotemporal acute subdural hematoma with left frontotemporoparietal acute subdural hematoma, with underlying subarachnoid hemorrhage, mass effect and midline shift to left side more than 0.5cm and obliteration of basal cistern.
Zidouh S*, Jidane S, Nabhani T, Chouaib N, Sirbou R, Belkouch A and Belyamani L
We report a case of 79-year-old man who presented to our emergency department (ED) for lipothymia. The patient developed significant bradycardia with hypotension. His EKG objectified a slow atrial fibrillation .the patient rapidly installed a coma. A non-contrast CT brain scan showed a bilateral vertebrobasilar ischemic stroke.
Ashraf Imam, Khalayleh Harbi*, Miller Rafael, Khoury Deeb, Buyeviz Victor, Guy Pines and Sapojnikov Shimon
Introduction: Immediate postoperative gastrointestinal bleeding following bariatric bypass surgery is a major complication, and usually results from staple line hemorrhage or conventional gastro-esophageal causes. Dieulafoy`s lesion is a rare cause of gastrointestinal bleeding and is usually managed by endoscopic means. Herein we present a case of massive intraoperative bleeding resulting from gastric Dieulafoy`s lesion single anastomosis gastric bypass surgery necessitating resection of the gastric pouch. This is the first description of this complication, and the difference of such a lesion from the sporadic ones is discussed.
Discussion: Gastric bypass saurgery is an effective procedure for morbid obesity. The approach we have adopted for massive upper GI hemorrhage in the immediate postoperative period should be distinguished from delayed bleeding after gastric bypass. In these latter cases, marginal ulceration is more common than bleeding from the remnant gastric pouch. It is also likely that bleeding from a Dieulafoy`s lesion following gastric bypass surgery represents a different disease compared to other Dieulafoy's cases.
Conclusion: This is the first description of an intraoperative Dieulafoy's lesion bleeding during the conduct of a single anastomosis gastric bypass procedure which required gastric pouch resection. Such a lesion differs from sporadic Dieulafoy`s cases, and must be considered in every case of intraoperative bleeding during gastric bypass.
A thought-provoking debate in the popular literature concerning vaccination has blossomed in recent years [1-6]. While “traditionalists” support universal immunization against a variety of infectious diseases, many influential individuals hold that vaccinations do far more harm than good.The web sites vactruth.com and anhinternational.org are typical web sites to visit to understand their concerns. More details on the debate, offering commentary on both sides of the issue, can be explored at wikipedia.org/wiki/Vaccine_controversies. In essence, however, those arguing for the universal use of vaccines point to the many millions of lives saved since mass immunization programs were introduced and further argue that resistance to routine vaccination is almost always based on false information. Those arguing against the routine use of vaccines usually either contend that the vaccines are unsafe (often maintaining that vaccine components such as formaldehyde or thimerosal are highly toxic) or alternately argue that governments simply do not have the moral authority to encroach on an individual’s freedom to make medical decisions for themselves or for their children.
I would like to offer my sociological analysis of this debate. I believe that central to the debate are two competing belief systems concerning what kinds of evidence can be used to establish an informed opinion on clinical matters. The traditionalists hold that the way to truth is through the method of scientific investigation, which includes studies in basic immunological mechanisms at the cellular level, experiments on animals, and clinical trials on humans. They hold that the resulting publications in the peer-reviewed scientific literature are the “canon of truth” from which opinion on clinical matters must be established.
But not everyone is a believer in this approach. Individuals in this second community are suspicious of the scientific method on several grounds. Some argue that “big pharma” or the medical profession at large, in their own self-interest, has been suppressing valuable “alternative” approaches to treating patients. They further argue that any formal clinical trials that members of this alternative clinical community have conducted are rejected from publication from mainstream scholarly journals (these journals forming the canon referred to above) purely because of self-interest and bias. As a result, they are forced, they argue, to make their results available to the public by alternative means: web sites, personal communication, “alternative” health fairs, articles in the popular press, and books. This is not to suggest that mainstream medical journals do not discuss complications from vaccination; potentially serious, even lethal, complications do exist, especially in immunologically compromised individuals. Some individuals obviously should not be vaccinated.
Of interest, one particularly noteworthy publication on the harmful effects of vaccinations came from The Lancet, a particularly well-respected medical journal [7]. This study was true canon material. Unfortunately, the study was completely fraudulent [8,9] and the first author of the study (Andrew Wakefield) even lost his medical license after an investigation found that he had acted “dishonestly and irresponsibly” [10].
In the case of the vaccine debate the potential consequences are critically important. Some arguments against vaccination have succeeded in reducing vaccination rates in certain communities, leading to increased outbreaks of preventable, and sometimes lethal, childhood illnesses [11].But even accepting that vaccines are safe and effective, another debate centers around whether society has the right to mandate vaccinations to protect society at large. Like the debate on seatbelts for car occupants and helmets for motorcyclists, the question as to what interventions the government should enforce will likely continue for some time.
I would like to offer my sociological analysis of this debate. I believe that central to the debate are two competing belief systems concerning what kinds of evidence can be used to establish an informed opinion on clinical matters. The traditionalists hold that the way to truth is through the method of scientific investigation, which includes studies in basic immunological mechanisms at the cellular level, experiments on animals, and clinical trials on humans. They hold that the resulting publications in the peer-reviewed scientific literature are the “canon of truth” from which opinion on clinical matters must be established.
But not everyone is a believer in this approach. Individuals in this second community are suspicious of the scientific method on several grounds. Some argue that “big pharma” or the medical profession at large, in their own self-interest, has been suppressing valuable “alternative” approaches to treating patients. They further argue that any formal clinical trials that members of this alternative clinical community have conducted are rejected from publication from mainstream scholarly journals (these journals forming the canon referred to above) purely because of self-interest and bias. As a result, they are forced, they argue, to make their results available to the public by alternative means: web sites, personal communication, “alternative” health fairs, articles in the popular press, and books. This is not to suggest that mainstream medical journals do not discuss complications from vaccination; potentially serious, even lethal, complications do exist, especially in immunologically compromised individuals. Some individuals obviously should not be vaccinated.
Of interest, one particularly noteworthy publication on the harmful effects of vaccinations came from The Lancet, a particularly well-respected medical journal [7]. This study was true canon material. Unfortunately, the study was completely fraudulent [8,9] and the first author of the study (Andrew Wakefield) even lost his medical license after an investigation found that he had acted “dishonestly and irresponsibly” [10].
In the case of the vaccine debate the potential consequences are critically important. Some arguments against vaccination have succeeded in reducing vaccination rates in certain communities, leading to increased outbreaks of preventable, and sometimes lethal, childhood illnesses [11].But even accepting that vaccines are safe and effective, another debate centers around whether society has the right to mandate vaccinations to protect society at large. Like the debate on seatbelts for car occupants and helmets for motorcyclists, the question as to what interventions the government should enforce will likely continue for some time.
I would like to offer my sociological analysis of this debate. I believe that central to the debate are two competing belief systems concerning what kinds of evidence can be used to establish an informed opinion on clinical matters. The traditionalists hold that the way to truth is through the method of scientific investigation, which includes studies in basic immunological mechanisms at the cellular level, experiments on animals, and clinical trials on humans. They hold that the resulting publications in the peer-reviewed scientific literature are the “canon of truth” from which opinion on clinical matters must be established.
But not everyone is a believer in this approach. Individuals in this second community are suspicious of the scientific method on several grounds. Some argue that “big pharma” or the medical profession at large, in their own self-interest, has been suppressing valuable “alternative” approaches to treating patients. They further argue that any formal clinical trials that members of this alternative clinical community have conducted are rejected from publication from mainstream scholarly journals (these journals forming the canon referred to above) purely because of self-interest and bias. As a result, they are forced, they argue, to make their results available to the public by alternative means: web sites, personal communication, “alternative” health fairs, articles in the popular press, and books. This is not to suggest that mainstream medical journals do not discuss complications from vaccination; potentially serious, even lethal, complications do exist, especially in immunologically compromised individuals. Some individuals obviously should not be vaccinated.
Of interest, one particularly noteworthy publication on the harmful effects of vaccinations came from The Lancet, a particularly well-respected medical journal [7]. This study was true canon material. Unfortunately, the study was completely fraudulent [8,9] and the first author of the study (Andrew Wakefield) even lost his medical license after an investigation found that he had acted “dishonestly and irresponsibly” [10].
In the case of the vaccine debate the potential consequences are critically important. Some arguments against vaccination have succeeded in reducing vaccination rates in certain communities, leading to increased outbreaks of preventable, and sometimes lethal, childhood illnesses [11].But even accepting that vaccines are safe and effective, another debate centers around whether society has the right to mandate vaccinations to protect society at large. Like the debate on seatbelts for car occupants and helmets for motorcyclists, the question as to what interventions the government should enforce will likely continue for some time.
Jochen Hardt*, Lisa Weyer, Malgorzata Dragan and Wilfried Laubach
Background: Various studies examined the effect of birth order. First born children show usually better cognitive performance than their later born siblings. Studies on emotional aspects yield heterogeneous results, sometimes in favour of first born, sometimes in favour of later born children. Studies comparing only-children with children with siblings are rare.
Method: An internet survey was performed in 508 Polish and 500 German subjects. Only-children, first born, middle born and latest born children were compared regarding body mass index, depression, anxiety and partnership.
Results: No differences among first born, middle born and latest born children were detected. Only-children reported significantly less symptoms of social phobia than first born children (z=0.50, p< 0.01).
Conclusions: Except for suicidality, the results of this study question the sense of further investment in studying effects of birth order. In contrast, examining differences between only-children vs. children having siblings seems to have the potential to yield interesting and new results. Optimally, such research would combine self-report measures with reports from others, such as parents, teachers or clinicians.
Frequency specific microcurrent (FSM) has been used to treat myofascial pain syndrome [1,2] fibromyalgia associated with spine trauma [3], delayed onset muscle soreness [4], acute and chronic neuropathic pain [5] and chronic scarring in burn patients [6].In this case, its use was modified to include not only the treatment of neuropathic pain but the treatment of neural adhesions in a patient with a ten year history of pain at rest and painful restricted range of motion following an ulnar nerve anterior transposition surgery in 2001. Eleven standard physical therapy sessions including augmented soft tissue mobilization using plastic tools, and muscle strengthening exercises and stretching failed to resolve symptoms. Three sessions of frequency specific microcurrent produced complete resolution of pain and symptoms. Patient remained symptoms free at one-year follow up.
Background: Primary lymphedema occurs as a result of genetic abnormalities of the lymph system. Currently, complex decongestive therapy is accepted as the standard treatment of the lymphedema. In this case presentation, we described the management of bilateral primary lower extremity lymphedema and the use of complex decongestive therapy.
Case Report: A 62 years old female patient had stage III primary lymphedema on her left lower extremity and stage II primary lymphedema on her right lower extremity. The patient, who had morbid obesity, also had untreatable sleep apnea, urinary incontinence, umbilical hernia and hypertension controlled by drugs. She had stage 4 gonarthrosis according to Kellgren – Lawrence classification in her both knees. The patient received complex decongestive therapy as an outpatient.
After 27 sessions of complex decongestive therapy, edema reduced in both lower extremities. Before the treatment started, the patient couldn’t go up and down stairs, get out and had difficulty mobility in the home. But after the treatment, the patient could go up and down 16 stairs by holding the railing, get out by two walking sticks and had less difficulty mobility in the home. However, due to gonarthrosis in her knees, her pain did not diminish.
Conclusion: Complex decongestive therapy is effective in the management of bilateral primary lower extremity lymphedema, which progressed with multiple health conditions.
Veterinary and agricultural surfactants are supposed to be inert additives, yet these substances commonly exert biological side-effects, in given cases synergistic with those of the active ingredients of these preparations. This is explicitly seen in altered toxicity of veterinary or pesticide formulations compared to their active ingredients alone. Neither the individual effects of these excipients, nor such combination effects are well-studied in toxicology, and therefore, possible toxicity consequences are occasionally not being considered at sufficient significance in the authorization, use and control of these substances. Risk assessment of these substances should cover all hazards they may represent, and corresponding levels of exposure. Surfactants used in veterinary and pesticide formulation enter the environment either by direct dispersion or by indirect release through excrement, leaching, sewage waters or sludge, and in turn, create potential exposure to a number of non-target organisms. Biochemical and (eco)toxicological hazards recently identified regarding certain agricultural surfactants include cytotoxicity (on cell lines of epithelial, neural and other tissues, as well as stem cells and tumor cells), endocrine disrupting effects, as well as aquatic ecotoxicity. This Mini Review summarizes toxicological effects identified in our studies in aquatic toxicity tests, in cell viability and cytotoxicity tests, in estrogenic activity assays, correlated with biochemical analysis of the surfactants and their decomposition. The conclusions are hoped to facilitate environmentally precautious revision of surfactants widely used in agriculture.
Osman TM, Ali AM*, Hussein MO, El Ghali A and Salih DA
This study was conducted in Nyala, South Darfur State, Sudan during August-September 2015 to study the seroprevalence of ovine and caprine theileriosis and to identify the tick infesting sheep and goats. For this purpose, total of 150 samples (ticks, blood smear and sera) were collected from sheep (n=61) and goats (n=89) of different age groups, breed and both sex. Three age groups were included: less than one-year-old, one-two years-old and more than two-year-old. Two diagnostic techniques were used, blood smears, and indirect fluorescent antibody test (IFAT). Out of 150 samples, 9 (6%) were positive for Theileria spp. piroplasms in blood smears, and 81 (54%) were positive for Theileria lestoquardi antibodies. Out of 61 sheep, 3 (4.9%) were positive for Theileria spp. piroplasms, and 25 (41%) were positive for T. lestoquardi antibodies. Out of 89 goats, 6 (6.7%) were positive for Theileria spp. piroplasms, and 56 (62.9%) were positive for T. lestoquardi antibodies. The highest prevalence of T. lestoquardi was recorded among sheep and goats more than two-year-old. Two genera and 4 species of ticks were infested sheep and goats. These included Rhipicephalus evertsi evertsi, R. s. sanguineus, Amblyomma variegatum and A. lepidum. The study concluded that the malignant ovine theileriosis is endemic in Nyala town.
Introduction: A 17 years old male patient was treated at the University orthodontic department. He had the chief complaint of unaesthetic appearance of his teeth, mostly for anterior crowding. The pretreatment records showed a Class II skeletal relation, moderate upper and lower anterior crowding, 0.5mm of overbite and 2mm of overjet.
Materials and Methods: It was suggested Osteogenic Accelerated Orthodontics (OAOTM), the treatment option was very attractive to the patient although it required a surgical procedure and a more expensive type of treatment.
Results: The overall treatment time was 6 months, facial balance was improved and the final occlusal relationships from the functional and aesthetics perspective were good.
Conclusion: OAOTM is a good alternative to reduce extractions rate as it increases the scope of tooth movement and strengthen the periodontal tissues thru bone grafting, although these claims require more scientific data to be validated.
Upadhyaya H*, Roy H, Shome S, Tewari S, Bhattacharya MK and Panda SK
Nanoparticles affects growth and development of Plant. Zinc is an important micronutrient that regulates various physiological responses in plant. Application of nanoparticles for modulating plants physiological response is a recent practice. Zinc nanoparticles has been widely used in industry for several decades. However, no significant work had been made on its potential use in agriculture. Understanding physiological effect of Zn NP on rice seed germination could suggest the basis for its prospective application in agriculture to improve plant growth. In the present experiment effect of Zn NP was studied in Kmj-6-1-1 which is a commonly growing rice cultivar of Karimganj district of Assam, India. An exposure to Zn NP (0 mg/L, 5mg/L,10mg/L, 15mg/L, 20mg/L & 50mg/L) caused significant changes in radicle and plumule length , mass ( fresh & dry mass) and seed moisture content in rice. Antioxidant enzymes like guaiacol peroxidase (GPx), catalase (CAT), superoxide dismutase (SOD) and gluthathione reductase (GR) also increased due to ZnNP treatment. This suggest that Zn NP may significantly alters antioxidant metabolism during rice seed germination. In conclusion, Zn NP protected rice plants from ROS damage by improving levels of antioxidant enzyme activities during germination. As a consequence the Zn NP treated seeds, showed better potential for germination. Further, genomic analysis of germinating rice seeds are needed to elucidate the molecular mechanisms by which Zn NP modulates germination process in rice.
Felipe Monnerat Marino Rosa, Renato Vidal Linhares*, Jose Quaresma, Joao Regis Ivar Carneiro, Valeria Bender Braulio, Roberto Simao Denise Pires de Carvalho and Jose Fernandes Filho
Introduction: Number of obese people is growing on a daily basis in Brazil, including morbid obese ones, but there is still a lack of studies with this subject. Due to this, the main goal of this study was to identify body profile, physiological variables behavior and oxygen consumption in grade III obese women, submitted to an ergospirometric test in arm ergometer.
Method: Take part in this study, thirteen (13) female grade III obese patients between 20 and 40 years. They were submitted to an electric bioimpedance test for body composition measurement and an Ergospirometric test in arm ergometer for oxygen consumption, heart rate, and oxygen saturation, systolic and diastolic arterial pressure, resting and after exercises, analysis.
Results: The patients revealed a BMI of 46.5±3.81 kg/m², 51.9±1.59% of body fat percentage. The patients reached 168.2±4.57bpm of heart rate, didn’t make any hypertensive response to the effort reaching an arterial pressure of 171.1±22.15mmHg x 87.5±4.18mmHg. Oxygen saturation was 98±0.71% and oxygen consumption peak was, also in average, 12.3±2.75ml.kg.min-1.
Conclusion: It was verified that there was no oxygen saturation drop nor hypertensive response and all of the patients reached the maximum heart rate.
Alaa K Dhayef*, Jawad K Manuti and Abdulwahab S Abutabiekh
Objective: Anemia, a common complication of chronic kidney disease, usually develops because of erythropoietin deficiency. Maintaining target hemoglobin (Hb) with minimal variability is a challenge in hemodialysis (HD) patients. The aim of this study is to compare the long- and short-acting erythropoietin erythropoietin stimulating agents such as Mircera and Eprex in achieving these targets.
Results: The response rate in the evaluation period was higher in patients treated with methoxypolyethylene glycol-epoetin beta (Mircera) than with epoetin (Eprex) alfa: 36 of 50 (72%) mean Hb concentration (10.51g/dl) versus 29 of 50 (58%) mean Hb concentration (9.81), with statistically significant p-value <0.0001.
Conclusion: Treatment with (Mircera) administered intravenously once monthly was superior to treatment with (Eprex) administered subcutaneously three times weekly for maintaining haemoglobin concentrations in patients with chronic kidney disease on hemodialysis.
Objective: In end stage renal disease, the synthesis of vitamin D is disturbed.Hyperparathyroidism is one of the key factors in the pathogenesis of many of the complications of dialysis mainly bone and cardiovascular complications.Aim:This study aimed at assessing vitamin D receptor gene polymorphisms BsmIand FokI in Egyptian patients with end stage renal disease on maintenance haemodialysis and the assosciation of these polymorphisms with cardiovascular complications and hyperparathyroidism among these patients.
Methods: One hundred subjects, recruited from Medical Research Institute, from March to July 2014, divided into two main groups; the control group which included thirty apparently healthy subjects and the patients group which included seventy patients with end stage renal disease on maintenance haemodialysis with median 4 years. To all studied subjects, detailed history was taken, thorough physical examination, carotid intima media thickness, presence of plaques and ECG ischemic changes. Laboratory investigations included serum levels of: glucouse, urea, creatinine, uric acid, albumin, total cholesterol, low and high density lipoproteins, calcium, phosphorus, and CRP as well as plasma PTH level. For molecular studies, the detection of BsmI and FokI polymorphisms using polymerase chain reaction and restriction fragment length polymorphism (PCR / RFLP) technique.
Results: 1.No statistically significant difference could be detected in both BsmI and FokI gene polymorphisms between the hemodialysis patients and the controls, suggesting that the development of ESRD had no relation with either VDR BsmI or FokI gene polymorphisms.2.No statistically significant difference were found in these polymorphisms between the hemodialysis patients with or without cardiovascular complications or between patients with PTH level less or more than 300 pg/ml. These results suggest that the development of cardiovascular complications and secondary hyperparathyroidism among Egyptian patients on maintenance haemodialysis cannot be attributed to these two gene polymorphisms.
Conclusion: No association could be found between the variant alleles of BsmI and FokI gene polymorphisms and the development of ESRD, cardiovascular complications and secondary hyperparathyroidism among the studied samples of Egyptian patients on maintenance haemodialysis.
Aim: To identify the possibility of correction of motor function of the gastro-intestinal tract in experimental pancreatitis with the administration of infliximab.
Material and methods: Pancreatitis was modeled by the administration of picrylsulfonic acid retrogradely into the pancreatic duct of rat (n=5) and 4 animals were control. Electromyogram (EMG) of the pancreatic duct was monitored immediately after the administration of picrylsulfonic acid and on the 15th day of pancreatitis simulation before and after the administration of infliximab. The morphological investigation of pancreas was conducted on the 15th day of development of pancreatitis and on the 15th day of treatment of pancreatitis with infliximab.
Results: Infliximab restores the motor function of pancreatic duct and structure of pancreas during acute pancreatitis.
Conclusion: Protective action of infliximab during acute pancreatitis was shown.
Ellen Goudsmits, George P Sharples and Jason W Birkett*
The application of monolithic material sorption extraction, specifically MonoTrapTM, to the extraction of organic gunshot residue (OGSR) compounds from unburnt propellant powders is described. Four different MonoTraps were assessed for their capability to extract OGSR compounds from two different ammunition types. Extracts were analysed using gas chromatography-mass spectrometry. Results indicated that the carbon disc was suitable for the extraction of OGSR compounds from unburnt propellant powders. Quantities for major compounds were comparable to methanol extractions. The method was successfully used to detect a wide range of OGSR compounds, including nitrotoluenes, nitroglycerin, diphenylamines and centralites and is expected to be applicable to a wide range of ammunition types.
Konstantinidou P, Chatzifotiou E, Nikolaou A, Moumou G, Karakasi MV, Pavlidis P and Anestakis D*
Potter syndrome (PS) is a term used to describe a typical physical appearance, which is the result of dramatically decreased amniotic fluid volume secondary to renal diseases such as bilateral renal agenesis (BRA). Other causes are abstraction of the urinary tract, autosomal recessive polycystic kidney disease (ARPKD), autosomal dominant polycystic kidney disease (ADPKD) and renal hypoplasia. In 1946, Dr Edith Potter characterized this prenatal renal failure/renal agenesis and the resulting physical characteristics of the fetus/infant that result from oligohydramnios as well as the complete absence of amniotic fluid (anhydramnios). Oligohydramnios and anhydramnios can also be due to the result of leakage of amniotic fluid from rupturing of the amniotic membranes. The case reported below, concerns of stillborn boy with potter syndrome.
Ibrahim TA*, Adaramola-Ajibola KM, Adesuyi AT Olanrewaju SO and Akinro EB
This study was carried out to evaluate the effect of pretreatments and drying methods on the chemical quality and microbial density of wild edible oyster mushroom. The mushroom samples were pretreated by steeping in 0.5% citric and sodium metabisulphite at room temperature for 10 minutes before being subjected to sun and cabinet drying until a constant weight was reached. The dried samples including the control samples (Samples not pretreated with chemicals) were evaluated for proximate, mineral composition and microbial density. The proximate analysis (protein, ash, fat, moisture and fibre) showed that untreated mushroom samples (both sun and cabinet dried) had the overall best results followed by samples pretreated with 0.5% sodium metabisulphite while samples pretreated with 0.5% citric acid had the lowest values. The mineral analysis (calcium, sodium, magnesium and potassium) of the mushroom samples followed the same trend as the proximate analysis. The microbial density of the samples showed that samples pretreated with 0.5% citric acid had the lowest count followed by samples pretreated with 0.5% sodium metabisulphite while the untreated samples had the highest microbial density. This implies that pretreatment with citric acid and sodium metabisulphite reduced the microbial density which may invariably extend the storage life of the edible oyster mushroom.
This review gives a brief introduction to the microarray technology and its experimental design and data analysis and a discussion of recent global progress in research using microarray technology in fish biology and aquaculture. DNA microarrays have been reported to have been used for the analysis of gene expression during various physiological, developmental or cellular processes in fish. During the recent past, investigators have begun to use microarrays on fish to address ecological, evolutionary and environmental questions including the variability of gene expression in natural populations, speciation, ecotype diversity, environmental remediation and host-pathogen interactions. The study suggests that a lot of gene expression studies have been conducted on salmon and zebrafish in Europe and USA. The same may be applied on Indian Major Carps and Catfishes to augment productivity from aquaculture sector.
From the First case of primitive cardiac surgery (CS), treatment of stab wound of the heart (Dr. Daniel Hale Williams, 1893), to recent surgical procedures and device implantations for end-stage heart failure (HF), the CS has grown and emerged in the public health more and more [1].
The heart valve disease had interested immediately since the non-cardiopulmonary era because of the multitude of rheumatic patients and congenital valve disease. In the 1952, Hufnagel implanted the first valve in descending aorta and it was the sign of the first step of the CS evolution. New prosthesis and heart valve techniques were tested between 1970 and 2000 with optimal results in patients’ quality of life and survival, at the same time of CPB evolution.
Background: The reaction of 2-(benzo]d[thiazol-2-yl)-3-oxopentanedinitrile 4 with DMF/DMA has been investigated to explore the synthetic potentialities of this novel activated nitrile in heterocyclic synthesis.
Results: Pyrano, pyridino, pyrazolo, azepino and oxothiepano carbonitrile derivatives could be obtained starting from 4 and plausible mechanisms for their formations are reported.
Conclusion: The newly synthesized compounds were assessed for their antimicrobial activity. Compounds 7, 10 and 12 exhibited broad spectrum antibacterial profile against the tested organisms.
Roya Vahdatinia, James Keane, Victoria Troncoso and Leonard B Goldstein*
Tinnitus-derived from the Latin “tinnire” meaning “to ring” is a perceived ringing, buzzing, or hissing in the ear(s) or around the head-which has multiple etiologies and is sometimes idiopathic. As of 2009 in the United States, approximately 50 million Americans were affected for six months or greater, while a United Kingdom study in 2000 reported a 10% prevalence in the adult population [1].Tinnitus may vary widely with regard to pitch, loudness, description of sound, special localization, and temporal pattern [2]. Most often, tinnitus is associated with other aural symptoms, such as hearing loss and hyperacusis [3]. Tinnitus may result in sleep disturbances, work impairments, and distress. The severity varies within this cohort of chronic sufferers, with some unable to fulfill daily activities. Though tinnitus is more likely to affect adults and the incidence increases with age, children can experience tinnitus as well [4]. Males are more likely to suffer as are individuals who smoke [5].
Farid E Ahmed*, Nancy C Ahmed, Mostafa Gouda and Chris Bonnerup
Colon cancer (CC) screening is important for diagnosing early stage for malignancy and therefore potentially reduces mortality from this disease because the cancer could be cured at the early disease stage. Early detection is needed if accurate and cost effective diagnostic methods are available. Mortality from colon cancer is theoretically preventable through screening. The Current screening method, the immunological fecal occult blood test, FOBTi, lacks sensitivity and requires dietary restriction, which impedes compliance. Moreover colonoscopy is invasive and costly, which decreases compliance, and in certain cases could lead to mortality. Compared to the FOBT test, a noninvasive sensitive screen that does not require dietary restriction would be more convenient. Colonoscopy screening is recommended for colorectal cancer (CRC). Although it is a reliable screening method, colonoscopy is an invasive test, often accompanied by abdominal pain, has potential complications and has high cost, which have hampered its application worldwide.
A screening approach that uses the relatively stable and nondegradable microRNA molecules when extracted from either the noninvasive human stool, or the semi-invasive blood samples by available commercial kits and manipulated thereafter, would be more preferable than a transcriptomic messenger (m)RNA-, a mutation DNA-, an epigenetic-or a proteomic-based test. That approach utilizes reverse transcriptase (RT), followed by a modified quantitative real-time polymerase chain reaction (qPCR). To compensate for exosomal miRNAs that would not be measured, a parallel test could be performed on stool or plasma’s total RNAs, and corrections for exosomal loss are made to obtain accurate results. Ultimately, a chip would be developed to facilitate diagnosis, as has been carried out for the quantification of genetically modified organisms (GMOs) in foods. The gold standard to which the miRNA test is compared to is colonoscopy. If laboratory performance criteria are met, a miRNA test in human stool or blood samples based on high throughput automated technologies and quantitative expression measurements currently employed in the diagnostic clinical laboratory, would eventually be advanced to the clinical setting, making a noticeable impact on the prevention of colon cancer.
Silvia Bartollino*, Alessandro Medoro, Donatella Mignogna, Erika di Zazzo and Bruno Moncharmont
Molecular interactions between proteins or between proteins and small molecules are pivotal events for selective binding of biological structures and, consequentially, for their correct function. In this scenario, the evaluation of kinetic parameters, characterizing a molecular interactions, is considered a crucial event to reveal the nature of binding processes.
The focus on peculiar forces involved in the molecular recognition represents an opportunity to explore biological interactions in real time, and to develop a number of innovative biotechnological methods for diagnosis and/or therapy.
Currently, optical biosensors, offering an increasingly effective technology to detect in real time molecular binding, are usually composed by a detector, a sensor surface and a sample delivery system: only definite substances, which are able to interact specifically with the biological part, lead to an optical or electrical signal of the physical transducer.
In this review we want to highlight the exponentially-growing interest of Surface Plasmon Resonance (SPR) based optical biosensors for molecular binding analysis in different research fields.
Tarek Boutefnouchet*, Thomas Laios and Keshav Mathur
<h2>Abstract</h2><p><strong>Background: </strong>There is paucity in studies reporting long-term results following anterior cruciate ligament (ACL) rupture. A UK national ligament registry (NLR) designed to collect demographic, clinical and outcome data on patients undergoing ACL reconstruction was launched in 2013. There was therefore an emergent question on the role of such registry as an additional source of evidence.</p><p><strong>Study aims: </strong>A framework analysis aimed to provide a basis for the evaluation of outcomes following ACL management and formulate a structure of the evidence, which can be derived from the registry.</p><p><strong>Methods: </strong>A systematic approach was adopted to select relevant studies. Qualitative thematic and meta-narrative analyses were conducted. Level-1 registry data were recorded for all primary ACL reconstruction procedures from January to June 2016. Registry data content and validity were evaluated.</p><p><strong>Results: </strong>Seven studies were suitable for analyses yet none defined the pattern of meniscal injury following initial treatment. When reported the incidence varied markedly between 23% and 80%. There was evidence of collection of at least one principal outcome measure in at least 85% of participants across all studies. Thematic analysis identified four key domains of outcome measures (1) intervention selection, (2) Knee stability evaluation, (3) Patient reported outcomes, (4) Radiographic evaluation and risk of secondary osteoarthritis. Graft choice, rate of meniscal and chondral injuries and cumulative risk of revision surgery had incomplete and inconsistent reports. Comparison of demographic and clinical data with the first registry report demonstrated: predominately younger patient population; older female patients at time of intervention; and higher incidence of meniscal tears.</p><p><strong>Conclusions: </strong>Registry data driven quality and research improvement open a new paradigm in ACL reconstruction evidence base and future practice. Early observations have consolidated the importance of associated meniscal injuries in the management of ACL rupture. Further work is needed to improve registry data completeness, accuracy and validity. A proposed data migration process using available technologies can help harmonise data collection without the added burden on clinical services.</p>
Tilmicosin (TMC) is a semi synthetic macrolide antibiotic of tylosin derivatives commonly used by veterinaries, has been shown to reveal beneficial pharmacological activities. In the current study, the potential wound healing activity, Anti-oxidant effect (ulcer and hepatoprotective) were investigated. Anti-inflammatory, antipyretic, analgesic (central and peripheral), hypnotic and antispasmodic activity were also screened. This study included adult both sexes of rats (200-250 gm), mice (20-25 gm) and adult rabbits. Experimental wound was induced on the anterior-dorsal side of each rat whereas, ulcer induced by ethanol causing mucosal damage in rats. The oral anti-inflammatory induced through formalin producing edema, antipyretic (Brewer’s yeast induced hyperthermia) and analgesic (writhing test, hot plate method, tail immersion method) while hypnotic effects induced through thiopental sodium. Anti-spasmodic effect on isolated organs (intestinal and uterine muscles) using new method of Modular Single Chamber Organ Bath were carried out on experimental animals. Tilmicosin antibiotic at different two doses of 20 and 40 mg/kg b.wt., has an important role in treatment of ulcer (cytoprotective effect) and improvement the wound healing processes besides anti-inflammatory, analgesics, and anti-pyretic effects. Tilmicosin revealed also hypnotic and intestinal anti-spasmodic effects but showed Pharmacovigilence hepatotoxic effect through the histopathological studies which revealed sever hepatic damage especially at larger dose.
Three distinct oyster mushroom strains including Pleurotus florida (PF), Pleurotus eous (PE) and Pleurotus sajor-caju (PS) were successfully cultivated on cattail weed substrate. A comparative analysis of different parameters viz., biological efficiency (BE) and protein, carbohydrate, crude fiber and fat content in fruitbodies were evaluated. According to biological efficiencies obtained PF (90%) was superior strain, while order can be represented as 90%> 89%> 82% respectively in PF>PS>PE. The highest protein (4.8 g), lipid (0. 61 g) and dietary fiber (31.6g) values were obtained in the fruitings of Pleurotus sajor-caju. However, the utmost level of carbohydrate (41g) was recorded in Pleurotus eous. On the basis of the observation of the present study we recommend use of cattail weed substrate for cultivation of oyster mushrooms for better nutrients.
Maurizio Falso*, Eleonora Cattaneo, Elisa Foglia, Marco Zucchini and Franco Zucchini
Background: Orthoses need to support physiotherapy as well as surgical treatment. Related to patient’s rehabilitative goals and pathological gait pattern, orthotists have to produce an orthoses that using an adjustable ankle joint system with preloaded disc springs can store the energy brought in by the body weight and produce a tuning effect on patient’s gait and sense of balance.The purpose of this study was to establish how a personalized proprioceptive individualized rehabilitative treatment could influence the functional response of different AFOs (Ankle Foot Orthoses) in a cohort of patients affected by neurological gait pattern.
Methods: Five patients affected by different neurological gait pattern and volunteered to participate to this study were recruited. The comparative spatio-temporal and functional effect on gait pattern of 3 types of AFOs was investigated under 4 study conditions: 1) without AFO or free-walk (FW); 2) wearing a Codivilla spring, 3) wearing a carbon unjointed AFO (“Toe-Off”); 4) wearing an innovative carbon-kevlar dynamic joint DAFO (DAFONS=Dynamic Ankle Foot Orthoses with Neuroswing). In line with our rehabilitative model, patients underwent to a weekly treatment session, 80 minutes duration per session, for 4 weeks. Evaluation was made before (time T3=time of recruitment) and after our individualized rehabilitative treatment course (time T4=1 month from T3) by using: a. G-Walk sensor (by BTS) spatio-temporal measures in different gait performances; b. clinical/functional outcome measures (Modified Ashworth Scale or MAS for the affected upper and lower limb; Medical Research Council or MRC; orthostatic stability evaluation by using the Berg Balance Scale or BBS).
Findings: A comparative analysis of clinical and instrumental data, performed in the pre-defined four investigational conditions, showed:
√ a statistical insignificant change of MRC and MAS scales at time T4, with a significance trend outcome observed at the same time by using the Wilcoxon Signed Rank Test
√ a statistical significant difference between test duration (sec) by using Toe-Off vs DAFONS and by using Codivilla spring vs Toe-Off
√ a statistical significant increase of the stride length on the left side (% cycle length) by using DAFONS compared to Toe-Off for patient P1, P3 and P5 with a parameter decrease by using DAFONS compared to Codivilla spring and Toe-Off use for patient P2
√ a statistical significant correlation between BBS trend and test duration (sec) by using Codivilla spring at time T3 and T4
√ in a comparative post-treatment visual gait analysis a modification of each patient’s static and dynamic postural assessment by using 3 different types of orthoses
Interpretation: In line with our study design we noted at the end of the proposed rehabilitative treatment an amelioration of gait quality with the use of DAFONS in all those patients (P1, P3 and P5) who showed a neurocognitive competence with a related functional grade of neurorehabilitative re-learning attitude of the physiological gait pattern and with a compromised perceptive control of gait and core stability. The proprioceptive profile of our rehabilitative program could promote the pro-adaptive and facilitation properties of a personalized gait control, induced by an innovative dynamic ankle foot orthoses with a modulable ankle joint system called Neuroswing. In the daily clinical practice, the personalized integration of a neurorehabilitative program and DAFONS can perform an individualized peripheral neuro-facilitation of gait cycle (peripheral perceptive facilitation), a neurorehabilitative re-learning process of physiological gait pattern (peripheral assisted neuroplasticity facilitation DAFONS induced) and an increase of patient’s motor abilities and quality of life in all daily performances.
Interpretation: In line with our study design we noted at the end of the proposed rehabilitative treatment an amelioration of gait quality with the use of DAFONS in all those patients (P1, P3 and P5) who showed a neurocognitive competence with a related functional grade of neurorehabilitative re-learning attitude of the physiological gait pattern and with a compromised perceptive control of gait and core stability. The proprioceptive profile of our rehabilitative program could promote the pro-adaptive and facilitation properties of a personalized gait control, induced by an innovative dynamic ankle foot orthoses with a modulable ankle joint system called Neuroswing. In the daily clinical practice, the personalized integration of a neurorehabilitative program and DAFONS can perform an individualized peripheral neuro-facilitation of gait cycle (peripheral perceptive facilitation), a neurorehabilitative re-learning process of physiological gait pattern (peripheral assisted neuroplasticity facilitation DAFONS induced) and an increase of patient’s motor abilities and quality of life in all daily performances.
√ a statistical significant correlation between the BBS trend and the double gait support duration on the right side (% cycle) with number of left step cycles by using DAFONS at time T3 and T4
√ a statistical significant correlation between the BBS trend and the double gait support duration on the right side (% cycle) with number of left step cycles by using DAFONS at time T3 and T4
Findings: A comparative analysis of clinical and instrumental data, performed in the pre-defined four investigational conditions, showed:
Jorge Villalpando, Jay I Peters* and Sandra G Adams
Chronic asthma accounts for a significant amount of unscheduled office and emergency department (ED) visits. According to the latest World Health Organization statistics, asthma worldwide affects 300 million individuals and creates a substantial health burden by restricting the patient’s lifetime activities. Data estimate that asthma causes a loss of disability-adjusted life years over 150,000/year [1].
Abirami Murugesh-Warren#, Ranu Malhi#, Yogini Jani, Christopher Corrigan, David Walker, Harsha Kariyawasam and Joanna Lukawska*
Background:While recognition and documentation of true drug allergy is critically important, most physicians acknowledge that its prevalence is likely overestimated, often on the basis of historical, sometimes anecdotal evidence. Correct or not, once applied, drug allergy labels may result in altered, potentially inferior therapy, increased costs and prolonged hospitalisation.
Objective:Estimate the point prevalence, accuracy and symptomatology of self-reported drug allergy in a typical, large NHS Acute Trust adult inpatient population. In the subset with penicillin allergy (PA), estimate additional management costs from the use of alternative antibiotics and readmission rates in the previous 5 years.
Methods:Data on self-reported drug allergies were extracted from 440 adult inpatient prescription charts over a 4 month period. Where penicillin allergy (PA) was reported, alternative antibiotic regimens were recorded and their additional costs calculated. Hospital electronic records were used to assess readmission rates of PA patients.
Results:194/440 inpatients (44.5%) reported at least one drug allergy. Antibiotic allergy was most commonly reported (51%), followed by analgesic (23%) and antiemetic (12%) allergy. PA accounted for 76% of reported antibiotic allergy. The commonest reported symptoms were cutaneous (42%) and gastrointestinal (18%). Where antibiotic therapy was required for patients with PA to manage acute infections, Ciprofloxacin, Clarithromycin, Teicoplanin, Clindamycin and Cefuroxime were the most commonly employed alternatives. Extrapolation of these figures to include the entire Trust inpatient population suggested that the use of alternative antibiotics in PA patients incurred additional annual expenditure of £268,000. Further, 87% of PA patients had been admitted more than once in the preceding 5 years, with 74% requiring further courses of antibiotics during these admissions.
Conclusion:Self-reported drug allergy, and in particular PA, is common in hospital inpatient populations and, in addition to the potentially unnecessary hazards to individual patients resulting from the use of alternative antibiotics, results in a considerable additional financial burden to the healthcare system. This problem could be eliminated by the provision of a nationwide and equitable tertiary Allergy service.
Ayfer Gozu Pirinccioglu*, Deniz Gokalp and Murat Soker
Background: Hypoparathyroidism is well known to occur in thalassemia major patients, but it is thought to be uncommon and its incidence is considered to be decreasing with improvements in chelation therapy. The objective of this study was to assess the prevalence of parathyroid dysfunction in the first decade of life of the patients with thalassemia major.
Patients and Methods: Ninety children with beta-thalassemia major (55 males and 35 females) with a mean age of 7.17±3.78 years (1-13 years) and age and sex matched control group of 60 healthy children (36 males and 24 females) with a mean age 6.98±3.66 years (1-13) years. Serum parathyroid hormone (PTH), serum total Calcium (Ca), serum phosphorus (P), serum alkaline phosphatase (ALP), serum 25-hydroxyvitamin D (25-OHD) and serum ferritin levels were measured.
Result: PTH levels were higher than normal range in 23 (25.6%) patients with a mean value of 75.2±31.3 µg/mL compared to those having normal range level (35.3±15.2 µg/mL). Ca levels were found low in 11 patients (12.2%), and P levels were found high in 2 (2.22%) and low in 4 (4.44%) patients while high ALP levels were found in 6 (6.67%) patients. 25-OHD levels were low in all patients with a mean value of 24.95±5.82.
Conclusion: Reports in the literature indicate that parathyroid dysfunction due to iron overload generally occurs in 2nd or 3rd decade of patients with thalassemia major. However, our study shows that PTH due to iron overload may develop in a significant number of thalassemia major patients, therefore, all thalassemics should be carefully watched for endocrine organ function such as hyperparathyroidism might occur even in the first decade of the patients with thalassemia major.
Background: The electrocardiogram (ECG) is a simple and noninvasive bedside diagnostic tool with a well-established role in the diagnosis of coronary artery disease (CAD). We aimed to study the diagnostic value of electrocardiographic ST-T wave changes in lead aVL in prediction of site of coronary artery stenosis in patients with chronic stable angina.
Patients and Methods: study was conducted on 156 patients referred for invasive coronary angiography with history of stable CAD as proved by non- invasive tests, 12 lead ECG was recorded and fully interpreted with more focus on T wave direction in aVL lead. T waves in aVL were categorized into one of three groups: upright, flat or inverted.
Results: regarding T wave in lead aVL, inverted T wave was reported in 71(45.5%) patients, 58 (37.2%) patients were with upright T wave in lead aVL and 27(17.3%) patients were with flat T wave in lead aVL, and we found that inverted T wave in lead aVL was most evident in 56(73.7%) patients with mid LAD with (highest κ value equal to 0.550[moderate agreement], and p value<0.001.
Conclusions: This study confirmed the diagnostic value of T wave inversion in lead aVL in prediction of mid left anterior descending artery lesions in patients with stable coronary artery disease.
Mustafa Recep Kacal, Huseyin Ali Karatas and Ferdi Akman*
The absorption parameters such as total mass attenuation coefficients, molecular, atomic, and electronic cross sections, effective atomic numbers and electron densities were calculated for some selected enzyme inhibitors in the photon energy range from 1 keV up to 100 GeV.The changes in the absorption parameters were interpreted with the photoelectric effect, Compton scattering and pair production processes. It is observed that the 2-Imino-1-imidazolidineacetic acid enzyme inhibitor has more radiation shielding feature when compared to other chosen enzyme inhibitors. The present investigation is anticipated to be useful for researchers studying with radiation in several fields and cancer researchers.
Eghoihunu Ireo*, Prashant Gupta and Ganapathy Dhanasekar
Since the advent of antibiotics, lateral sinus thrombosis is an infrequent complication of otitis media. Lateral sinus thrombosis may occur by thrombophlebitis or penetration by offending pathogens through the dura of middle and posterior cranial fossae. We present a case of right-sided sigmoid and transverse venous sinus thrombosis as a rare complication of chronic suppurative otitis media in an adult. We discuss the patient’s imaging, management and relevant literature to offer clinical recommendations.
A 39-year-old woman presented with headache, neck pain, vomiting, fever and photophobia with a tender right mastoid on examination. Computerised Tomography, Magnetic Resonance Imaging and Magnetic Resonance Venogram of the head revealed complete opacification of the right mastoid air cells and middle ear, with absent flow void in the right transverse and sigmoid sinus, consistent with thrombosis. After discussion with neurosurgery, she was commenced on anticoagulants. The patient was readmitted with right otalgia and otorrhea refractory to medical treatment, and ultimately underwent right mastoid exploration.
A 39-year-old woman presented with headache, neck pain, vomiting, fever and photophobia with a tender right mastoid on examination. Computerised Tomography, Magnetic Resonance Imaging and Magnetic Resonance Venogram of the head revealed complete opacification of the right mastoid air cells and middle ear, with absent flow void in the right transverse and sigmoid sinus, consistent with thrombosis. After discussion with neurosurgery, she was commenced on anticoagulants. The patient was readmitted with right otalgia and otorrhea refractory to medical treatment, and ultimately underwent right mastoid exploration.
Conclusion: Lateral sinus thrombosis may occur with other intracranial or extracranial complications of otitis media. Clinicians should approach any complication of otitis media with vigilance as antibiotics may mask some signs and symptoms of mastoiditis, which can progress to otogenic brain abscess.
Agbaje RB, Oloye DA*, Olatunji CA and Olawale-Olakunle OE
This study was aimed at producing a high nutritious food that will meet the nutritional requirements of consumers. Blends of malted red sorghum and defatted soybeans flour were processed and the resulting flours were formulated at ratios of 100:00; 95:5; 90:10 and 80:20 (malted red sorghum: defatted soybeans flour). The resulting products were subjected to antinutrients and minerals properties determination. The results obtained showed that the antinutrients decreased linearly with increase in the mineral elements. Antinutrients in the blends decreased from 2.25-1.80mg/g (oxalate); 2.45-2.16mg/g (phytate); 14.16-9.26g/100g (Alkaloids); 2.12-1.69/100g (saponin) and 0.18-0.13mg/g (Tannin). A percentage increase of 12.6% (sodium); 10.8% (calcium); 9.5% (potassium); 3.7% (magnesium) and 14.1% (Iron) was recorded as the quantity of defatted soybeans flour increased in the blends. The low levels of antinutrients in the blends produced make them safe and suitable for human consumption. Substitution of malted red sorghum with 20% defatted soybean flour showed a remarkable improvement in the mineral contents of the diets.
Effect of drying methods (sun-drying and cabinet oven drying) on the physicochemical properties and fatty acid composition of oils extracted from moringa seeds was investigated. Oil from the seeds was extracted using solvent (hexane) after drying. Drying increased the yield from 30.30-33.11%. The oil samples were less dense than water with specific gravities of 0.9032, 0.9075 and 0.9030 respectively. A significant difference exists in the moisture contents (0.11-0.21%); smoke point (202-2250C), flash point (310-3170C) and fire point (360-3690C). Sun-drying and cabinet oven drying brought about a decrease in the acid value (1.80-1.08mgKOH/g), saponification value (174.87-105mgKOH/g), Iodine value (16.10-13.90wijs) and peroxide value (11.24-2.3-Meq/kg). The decrease is an indication of quality improvement of the oils. More unsaturated fatty acids were present in the samples between 76.61% and 81.66%. Oleic acid was predominant (44.92% raw, 45.71% sundried and 43.60% cabinet oven dried). Sun-drying and cabinet oven drying did not have much significant effect on the physical, chemical and fatty acid compositions of the oil. The results obtained from this study showed that the three oil samples are good as edible oil and for commercial purpose.
Sathit Niramitmahapanya*, Surasak Kaoiean, Varaporn Sangtawesin, Anusorn Patpanaprapan, Narisa K Bordeerat and Chaicharn Deerochanawong
Background: Vitamin D deficiency in pregnancy increases several risks of breastfed mothers. To prevent these adverse events, vitamin D supplementation during pregnancy and lactation is recommended, but suggested dose ranges vary.
Objective: To determine whether vitamin D3 1,800 IU/d supplementation in lactating mothers improves the vitamin D status of their breastfed infants.
Materials and Methods: A randomized, placebo–controlled trial with Thai pregnant women was conducted. Lactating mothers (n=72) and their breastfed infants with insufficient maternal 25 hydroxyvitamin D (25(OH)D) levels in the third trimester were randomly assigned to two groups, one of which received 1,800 IU/d vitamin D supplementation and the other a placebo. Maternal serum 25(OH)D during lactation, cord blood, and 6-week breastfed infant serum were measured using LC-MS/MS.
Results: Mean maternal age (±SD) was 27±5 years, and pre-gestational BMI was 22.29±5 kg/m2. Maternal serum 25(OH)D at baseline was 22.29±7.15 nmol/L. At 6 weeks, both maternal 25(OH)D and infant 25 (OH)D levels had increased significantly in the vitamin D supplement group of mothers and infants (68.30±15.40, 40.40±12.56 nmol/L) compared to those in placebo groups (55.15±13.57, 24.28±17.20 nmol/L) (p <0.001, p<0.001). The changes in infant 25(OH)D levels increased substantially in the vitamin D supplement group but decreased in placebo(17.49±16.27 ng/ml compared to -1.34±19.23 nmol/L in the placebo group, p<0.001). The change of maternal 25(OH)D were positively correlation to the change of 25(OH)D level in breastmilk mothers and infants by r=0.697, p<0.001 and r=0.379, p=0.003 respectively.
Conclusions: Vitamin D3 supplementation to breastfed mother during lactation can increase serum 25(OH)D level in Thai breastfed mother and infants. Further work is needed to determine the optimum duration of vitamin D supplementation to normalized breastfed infants with 25(OH)D level >75 nmol/L.
Luisetto M*, Nili-Ahmadabadi B and Ghulam Rasool Mashori
In actual pharmacological therapy we can see that some drugs can be added to other medical instruments to improve their activity: in example we can see medicated stent for some coronary disease, or hormonal medical devices used in pregnancy prevention, but other example are known today. In example Carmustine wafer is delivered by delivery systems in some brain cancer and radioactive seed implants in prostatic cancer. Ocular intra vitreal implants for some macular degenerations (MABS or cortisones) other implants delivery systems drugs, naltrexone implant for opiate dependence. Other strategies imply carrier use to deliver the drugs in the site of action: In example MABS linked to radioactive isotopes in some relapse of severe Hodgkin disease but many other example we can see in therapy used today. So we can think that other chronic conditions can be treated using a combination of drugs with other instrument to improve the clinical outcomes. This to make possible that the ERLICH MUGIC BULLETS can act in the right site reducing the side effect. In example today we can see various medical interventional radiological strategy to treat in coronary and hearth disease with medicate stents positioning or to local use of contrast agents or other valvle surgery procedures with global good clinical results.
Fernando CN, Abeyratne WMSD, Tilakaratne WM and Siriwardena BSMS
Hairy polyp and choristoma are rare benign developmental malformations. Hairy polyp mainly occurs in the nasopharynx whereas choristoma occurs in the dorsum of the tongue. Aetiology and pathogenesis of both hairy polyp and choristoma still remain unknown. Diagnosis is made by histological examination and complete excision is the treatment of choice. We report a case of hairy polyp and choristoma on the palate and the dorsum of the tongue respectively in a seventeen days old baby.
Lai Poh Soon*, Khoo Lay See, Nazni Wasi Ahmad, Azlina Zulkapli, Nurul Kharmila Abdullah, Mohd Shah Mahmood and Ahmad Hafizam Hasmi
Taphonomic study was first time conducted in Kuala Lumpur, capital city of Malaysia. In this research model, male Oryctolagus cunicullus weighed 1.8-2.6 kg each were killed by Dolethal intravenously at the ear region. In Phase 1 study, eight subjects were wrapped in a sack and cemented within a container to be compared with the other four controls at each location labelled A (ground) and B (manmade freshwater pond). Phase 2 involved duplicating set of 15 cemented samples comparable to 1 control made up to total of 32 subjects which were all put into a compact polytank containing freshwater to simulate a case study. Taphonomic changes were observed and scored using TBS system incorporating of fresh stage, early decomposition stage, advanced decomposition stage and skeletonisation stage. The ambient temperature of surroundings with 28.81C±4.21°C and 29.21°C±4.57°C (mean±S.D.) while relative humidity of air with 74.49 %±14.61% and 79.15%±16.32% (mean±S.D.) were recorded for Phase 1 and Phase 2 study respectively. Time taken for ground control exposed and wrapped carcasses to reach first sign of skeletonised stage were four days and five days respectively. Whilst freshwater controls reached initial skeletonised stage within one week for exposed carcass and two weeks for wrapped carcass. Within the control and cemented sample carcasses, TBS scores increased from initial stages of decomposition and become plateau after advanced decomposition. The cementing factor have superseded the wrapping factor due to its stronger physical barrier effect to slow down the decomposition more than half compared to controls based on Multiple way ANOVA test. Phase 2 study has demonstrated more accurately on the decomposition rate of the cemented samples. It showed that wrapping and cementing factors have delayed the decomposition process of the rabbit carcasses about 4 times to reach the initial stage of skeletonisation compared to the control carcasses. There was absence of insect activity within the cemented samples, hence the microorganism activity would be the only contributor to the decaying process within the cemented samples at slower rate comparing to the exposed or wrapped controls.
Pokharkar KK*, Delvadia DV, Jadhav Parag B and Bhor PB
A study was undertaken the effect of pretreatments and drying methods on quality parameters of tomato slices with respect to storage using two factors as treatments i.e. 5 pre-treatment levels (P1-Peeled by hot water dip blanching, P2-Peeled by hot brine dip blanching, P3-Unpeeled by hot water blanching, P4-Unpeeled by hot brine blanching, P5-Control- No peeled and no blanched) and 2 drying methods i.e. (D1-Tray drying, D2-Sun drying) with completely randomized design of factorial concept with three repetitions at Post Graduate Laboratory of Horticulture Department, College of Agriculture, Junagadh Agricultural University, Junagadh. The quality was evaluated on the basis of physicochemical (i.e. drying time (h) and moisture content (%) at 1, 20, 40, 60 and 80th day of storage. Result of study depicts that the pretreatment P2 i.e. peeling of tomato by hot brine dip blanching followed by tray drying (D2) recorded minimum (14.50 h) drying time and the minimum changes in moisture content (4.00%-6.54%) observed in treatment P1 at 1st to 80th day of storage, respectively.
Dinesh R*, Sherry Abraham, Kathiresan K, Susitharan V, Jeyapavithran C, Paul Nathaniel T and Siva Ganesh P
Hallucinogenic fishes are fishes that can create hallucinations if their tissue is ingested. These incorporate certain types of fish found in a several parts of the tropics. The impacts of eating hallucinogenic fishes are rumored to be comparative in a few viewpoints to lysergic acid diethylamide (LSD) or dimethyltryptamine (DMT). The encounters may incorporate distinctive sound-related and visual hallucinations. This has offered ascend to the collective common name “dream fish” for hallucinogenic fish. Sarpa salpa, a species of sea bream, is commonly claimed to be hallucinogenic. In 2006, two men who apparently ate the fish experienced mind flights going on for a few days. It is misty whether the poisons are delivered by the fish themselves or by marine algae in their diet.
The effects of storage of Ogbona seed flour (Irivingia gabonensis and Irivingia excelsa), at ambient condition (30±20C, 65-74% RH) for 0-4 months on some physical characteristics were investigated. The samples were subjected to storage in air tight polyethylene bags for up to four months. Samples were removed at intervals of 0, 1, 2, 3 and 4 months for analysis. The chemical: proximate constituents, free-fatty acids and peroxide values; selected functional properties: water/oil absorption capacity, foam capacity and viscosity and sensory attributes of the samples were investigated. The result shows that there was no observable change in the chemical composition, selected functional and sensory properties of the two varieties of Ogbona seed flours when stored up to two months but decreased from third to fourth month during storage at ambient temperature. Therefore, storage at ambient temperature (30±20C, 65-74% RH) could extend the shelf life of the samples for up to two months in air-tight polyethylene bags of 0.7mm thickness without losing its quality characteristics.
Yi De Zhang, Ya Min Yu, Hou Yong Dai, Xiao Lan Chen, Li Yuan and Hui Shi*
We experienced a case of membranoproliferative glomerulonephritis (MPGN) caused by subacute infectious endocarditis (SIE). A 57-year-old male farmer complained of fatigue, lack of appetite and gross haematuria for a month; he had no cough, chest pain, or exertion dyspnea. After admission, lab tests showed mild proteinuria(1.04g/d) and heavy dysmorphic red blood cells(RBC) (543/HP), with serum creatinine(Scr) slightly elevated(1.46mg/dl) and anemia(hemoglobin Hb 85g/L). A renal biopsy revealed MPGN lesion with 16.6% cellular crescents. The echocardiogram test revealed mitra valve prolapse with perforation of the anterior lobe, vegetation, and severe regurgitation. He was diagnosed as SIE induced MPGN. Then he underwent mitral valve replacement after systemic antibiotic treatment without immunosuppressive agents. Follow-up showed that he dramatically regained normal kidney function in total 1 year after the operation. Thus, antibiotic administration and valve replacement may be efficient enough for some of SIE induced MPGN. We did a brief review of the literature on SIE induced MPGN, which was sometimes misdiagnosed due to its silent characteristics; some SIE patients may initially have other organs involved.
Objective: To report findings of improvement in patient tinnitus intensity and changes in frequency using a novel suppressive noise spectrum.
Design: Single-subject; each subject served as his or her own control. Each patient received treatment, and changes were measured over time.
Setting: Tertiary referral via university otolaryngology and hospital audiology as well as audiology clinics in the region.
Patients: Fifteen tinnitus ears in 8 patients.
Interventions: Therapeutic and rehabilitative.
Main Outcome Measures: Tinnitus frequency, tinnitus intensity, and tinnitus questionnaire.
Results (Findings): After 3 months of exposure to the customized suppressive noise spectrum therapy, patients showed a shift in tinnitus frequency in addition to a significant decrease in tinnitus intensity from the pre-treatment to post-treatment condition (p<0.05). Typically, improvement was gradual based on comparing 3 sets of data collected at baseline, 1.5 months and 3 months.
Conclusion: Using suppression in tinnitus is novel. Based on our findings, using a customized suppressive noise spectrum is effective in shifting the frequency, reducing the intensity of subjective tonal tinnitus, and improving the handicap based on THQ test. From this seminal report, factors related to maximizing its effectiveness (e.g., length of listening time, level of hearing loss, and application for alternative tinnitus types) may be considered for future research.
Cesar Raul Aguilar Garcia and Guadalupe Viridiana Ontiveros Guerra
Chronic Hepatic deficiency due to the ingestion of alcohol remains as one of the main causes of morbidity and mortality in our country. From it a variety of complications arise, one of them is the Hepatopulmonary Syndrome, which usually goes unnoticed and undiagnosed; this syndrome is distinguished by the presence of hypoxemia and pulmonary vasodilation. The gold standard to establish a diagnostic is contrast-enhanced Echocardiogram. No pathognomonic sign is known for this syndrome, which leads the present elaboration to evaluate the use of orthodeoxia by pulse oximetry as a screening test in the detection of Hepatopulmonary Syndrome cases.
Essam M Janahi, Aboul-Ata E Aboul-Ata*, I M El-Kalamawy, Kathleen Hefferon and Amal Mahmoud
Hepatitis B virus (HBV) is one of the world’s major infectious diseases with 350 million people who are chronic carriers of HBV [1]. Significant minorities go on to develop liver cirrhosis or hepatocellular carcinoma and over 1 million die annually from HBV-diseased liver.Janahi E. at faculty of science, Bahrain University, Bahrain has submitted the following information [2], on HBV-genome organization as part of his Ph.D. degree (2007) in Imperial College, England. HBV genomic organization has 4 Open Reading Frames (ORFs) i.e. Pre-S/S Gene, Pre-C/C ORF, P ORF and X ORF. Regulatory Elements has 4 promoters (pre S2, pre S1, C promoters and X promoters), Pregenomic RNA, Enhancers (Enh 1 and Enh 2) where they are involved in cccDNA formation, Glococorticoid-Responsive Element which is located in X ORF and P ORF overlapping, Polyadenylation Signal (Direct Repeat 1 (DR1) and Direct Repeat 2 (DR2)), Epsilon-Stem Loop and Post-Transcriptional Regulatory Element. HBV genotype D is prevalent in our Middle East area. The HBV genome is a partially relaxed-circular dsDNA molecule consisting of a full length strand (minus strand) with a single unique nick and a complementary (positive strand) of variable length. HBV is considered as a para-retrovirus because its replication involves the reverse transcription of an intermediate-RNA function, of pre-genomic RNA (pgRNA). Replication of HBV genome starts with the encapsidation of the pgRNA and encodes HBV polymerase into an immature nucleocapsid formed by the viral core antigen. Inside the immature nucleocapsid, the viral polymerase converts pgRNA into minus-strand DNA, which in turn is used as a template for the synthesis of the plus-strand DNA, resulting in the formation of the characteristic mature double-stranded, relaxed circular DNA molecule [2]. HBVsAg has been isolated from Egyptian samples and identified using RTPCR [3-5]. Polymerase and HBVsAg regions have been also isolated and identified [5]. HBVsAg (S) gene has been identified at the band size 25.42 kDa [3,4]. Virotherapy for plant-based vaccine structure has been speculated for future work. Proposed CMV-HBVsAg chimeric-virus construct. Cucumber mosaic virus (CMV) 26 kDa hybrid coat protein (CP D/S) gene for 2 strains (CMV/S and CMV/D) were isolated and amplified from sgRNA 4 using F and R primers. Replicase gene (RP) and 30 kDa movement protein gene (MP) were used. Promoter (35sP). Nopaline synthase terminator (Nos3T) are constructed between Right and left boarder (RB and LB). Proposed BeYDV-HBVsAg chimeric virus construct. HBVsAg (S) protein -Bean Yellow Dwarf Begomovirus chimeric virus [6]. Long and short intergenic regions (LIR & SIR) of bean yellow dwarf Gemini virus as well as capsid protein (CP), movement protein (MP) and replication-associated protein (RepA) genes and as well as 35s P and Nos3T will be constructed between Right and left boarder (RB and LB). Brief processing of vaccine production is as follow: a. Virus and RNA sources, which is HBVsAg that has isolated as two isolates from Egypt by El-Kalamawy et al. [4]. Also Mahmoud and Hashem [5], have isolated HBVsAg and HBVpAg. Also, Elghannam et al. [3], have isolated HBVsSg. b. Computer-Assisted Analysis, c. in vitro Construction of Chimeric Viruses (1. Construct Design, 2. Target Gene (Sub-units), Gene Promotors, Terminators and Orientation, 3. Virus-Based Vector (Recombinant Viral Genes), 4. CP, Replicase and Movement Protein Genes, 5. Chimeric Virus Stability. 6. Plant Bioreactor Inoculation, Vacuum and Agrobacterium infiltration, 7. Transient Expression, 8. Gene Transformation, 9. Plant-expressed Protein Vaccine Confirmation (Symptomatology, EM and WB). Scaling up vaccine-containing plants, Expressed-protein vaccine purification and dosing. Bioreactor host plant has to be chosen.
Fernanda Dias da Silva, Natalia Tribuiani, Isadora Caruso Fontana Oliveira, Regina Yuri Hashimoto Miura, Rafael S Floriano, Marcio Galdino dos Santos, Sandro Rostelato-Ferreira and Yoko Oshima-Franco*
Vochysia haenkeana extract (Vh-E) was assessed against the neuromuscular blockade induced by Bothrops jararaca venom on chick biventer cervicis (BC) preparation. Pre- and post-venom incubation treatments (Pre-vit and Post-vit) were analysed here. Contractures ACh (110 µM) and KCl (20 mM) were evoked before and after addition of venom without stimulation. Vh-E (600 µg/mL) under Pre-vit was more efficient to neutralize the neuromuscular blockade by venom (40 µg/mL) [72.5±4.6% (venom) vs. 45.2±14% (Vh-E) of blockade, p<0.05, n=4]. Vh-E (600 µg/mL) did not cause significant changes under Post-vit [72.5±4.6% (venom) vs. 63.4±8.2% (Vh-E) of blockade, n=4]. The Pre-vit inhibited the blockade of the contracture to ACh (106±17% of response; n=4) while the Post-vit was able to attenuate the effect of the venom on this contracture (55±5% of response; n=4); related to those contractures to KCl both of treatments with Vh-E attenuated the blocker effect of the venom (62.5±7.7% and 55±5% of response for Pre-vit and Post-vit, respectively; n=4). In conclusion, Vh-E neutralizes partially the neuromuscular blockade in Pre-vit, an effect that can be related to preserved function of “extrinsic” post-synaptic receptors, by measured contractures in response to ACh. The myotoxicity of the venom was significantly reduced by Vh-E in both, Pre-vit and Post-vit, by measured contractures in response to KCl.
Roberto Carlos Burini*, Hugo Tadashi Kano, Mariana Santoro Nakagaki, Patricia Baston Frenhani and Katia Cristina Portero-McLellan
The etiology of abdominal obesity is multifactorial and has environmental factors as its most expressive risk factors. This study cross-sectional analyzed the association of abdominal fatness with physical inactivity and food inadequacy of 1,557 subjects, both genders, over 35yrs. old, enrolled in an ongoing epidemiological study. Waist circumference (WC) was the primary variable and demographic, social-economic, anthropometric and dietary intake data, were the co-variables.NCEP-ATP III, WHO, IPAQ-long (version 8) and Healthy Eating Index were used for functional definition of variables. Furthermore, longitudinal data from 50 subjects in an exercise protocol for 10 week receiving either regular diet (G1, n=22) or 30g fiber adequacy (G2; =28), were analyzed. The performed statistical analyses used software SAS for Windows, version 9.1 with p=0.05. In a predominantly female sample (74%), 76% aging 35-60yrs, 64% completed elementary school, 73% were living in a low income household, 77.5% overweight. The 62.5% presenting altered WC values were predominantly older, presented higher body fatness, and were consuming low variety-poor quality diet rich in fat (mainly saturated) and lower in fruit. WC correlated negatively with fruit intake and aerobic capacity (VO2max) but only carbohydrate (positive) and fruit intake (negative) were considered independent risk factors for abdominal obesity. In the longitudinal study, both G1 and G2 groups were similar at baseline and G1 maintained the anthropometry values throughout the experiment. Conversely, G2 decreased total body (4%) and WC (7%) fatness, reducing severe obesity by 16%, minimally affecting overweight and eutrophic rates. G2 presented 211% increase in fiber intake and 150% increase in plasma beta-carotene (colorful-fiber marker). Thus, in conclusion, recommended dietary fiber intake (increased fruit and low CHO intake) and physical activity would be the recommended changes against abdominal obesity and, by associating both physical exercises and dietary fiber there was indeed a decrease in abdominal fatness and obesity, predominantly at its higher grade.
Mester et al. stated the laser effects in a review of their studies of 15 various biological systems, they observed the stimulating effect of low energy (in terms of J/cm2) laser and inhibiting effect of high energy laser and later reported the relationship of cumulative energy applied and the effects conforms to the Arndt-Schultz law.They concluded their experience with 875 healed cases and the results of their experiments had convinced them to recommend the use of lasers to stimulate wound healing [1].
Studies on the effects of Low Level Light Therapy reported pain relief [2,3] and promotion of wound healing [2]. These effects are useful in the oro-maxillofacial region and other parts of the body.
Gautam G*, Shashikala Kumari V Garima Garg and Vikram Shetty
Background & Objectives: Fluoride releasing bonding agents can help the orthodontist to minimize enamel demineralization independent of patient cooperation. This in vivo study was conducted to evaluate the efficacy of resin modifi ed glass ionomer cement (RMGIC) on reducing enamel demineralization around orthodontic brackets and confirm the superior caries-preventive effect of RMGIC by assessing the mutans streptococci (S.mutans) in plaque samples in vitro.
Methods: 60 subjects (aged 14-20 years) scheduled to have premolar extractions as part of the orthodontic treatment plan were selected and randomly divided into 2 groups of 30 each (group 1: the brackets were bonded on the teeth using light cure composite resin and group 2: the brackets were bonded using RMGIC). Plaque scores (modification of plaque index by Silness and Loe) were recorded and plaque samples were collected before bonding, one week and one month after bonding. S.mutans colonies were recorded from the plaque samples inoculated on MSB agar plates, incubated under 95% N2 and 5% CO2 for 48 hours at 370C in a CO2 jar. After 1 month, the right maxillary and mandibular first premolars were debonded, extracted and depth of enamel demineralization area was estimated using polarized light microscope.
Results: After statistical analysis, a significantly higher mean depth of demineralized lesions was noticed in group 1 as compared to group 2. A significant difference between occlusal and gingival depth was seen only in group 2, thus illustrating a wedge effect. In group 1, a statistically significant increase in the mean colony forming units (CFU) of S.mutans has been noticed at different time intervals whereas in group2, a significant increase was observed only at 1month. Unlike at 1 month, a statistically significant difference in mean CFU between group 1 and group 2 has been observed at 1 week (P<0.05).
Conclusions: Enamel lesions adjacent to the bracket base on teeth bonded with the RMGIC were smaller than those on teeth bonded with a composite resin. The high “burst effect” of fluoride release for the first few days of RMGIC after bonding is confirmed by statistically significant reduction in CFU counts of S. mutans in plaque.
Conclusions: Enamel lesions adjacent to the bracket base on teeth bonded with the RMGIC were smaller than those on teeth bonded with a composite resin. The high “burst effect” of fluoride release for the first few days of RMGIC after bonding is confirmed by statistically significant reduction in CFU counts of S. mutans in plaque.
Pirabu Diego-Abelardo Alvarez-Hernandez* and Alexia S Rivera
Yaws is recognized by the World Health Organization (WHO) as 1 of the 20 Neglected Tropical Diseases (NTDs), a group of communicable diseases that have subsisted in tropical and subtropical environments, and that affect people living in poor and marginalized societies [1].Yaws also form part of a group of chronic bacterial infections, commonly known as the endemic trepanomatoses. These diseases are caused by a spiral bacteria of the genus Treponema, which also includes bejel and pinta, being yaws the most common [2]. Like syphilis, yaws have been described in three stages; primary stage characterized by granulomatous skin lesions, secondary stage by generalized spread, and tertiary stage by chronic destructive disease of skin, cartilages and bones [3].
Rosaria Romano, Nicola Gaetano Gatta, Elenamaria Fioretti and Vittorio Gentile*
Transglutaminases are a family of Ca2+-dependent enzymes which catalyze post-translational modifications of proteins. The main activity of these enzymes is the cross-linking of glutaminyl residues of a protein/peptide substrate to lysyl residues of a protein/peptide co-substrate. In addition to lysyl residues, other second nucleophilic co-substrates may include monoamines or polyamines (to form mono-or bi-substituted/crosslinked adducts) or -OH groups (to form ester linkages). In absence of co-substrates, the nucleophile may be water, resulting in the net deamidation of the glutaminyl residue. Transglutaminase activity has been suggested to be involved in molecular mechanisms responsible for both physiological and pathological processes. In particular, transglutaminase activity has been shown to be responsible for human autoimmune diseases, and Celiac Disease is just one of them. Interestingly, neurodegenerative diseases, such as Alzheimer’s disease, Parkinson’s disease, supranuclear palsy, Huntington’s disease and other polyglutamine diseases, are characterized in part by aberrant cerebral transglutaminase activity and by increased cross-linked proteins in affected brains. Here we describe the possible molecular mechanisms by which these enzymes could be responsible for such diseases and the possible use of transglutaminase inhibitors for patients with diseases characterized by aberrant transglutaminase activity.
Arshan Nazempour##, Chrystal R Quisenberry##, Nehal I Abu-Lail and Bernard J Van Wie*
Varied exogenous chondrogenic factors (CFs) are implicated in promoting differentiation of stem cells along a chondrocyte lineage in the field of regenerative tissue engineering for articular cartilage repair. The effects of dexamethasone, transforming growth factor β3 (TGF-β3), ascorbate, and their combinations, on mRNA expression in micromass-cultured human adipose derived stem cells (hADSCs) were investigated as a function of time.Indices include chondrogenic, hypertrophic, angiogenic, fibrogenic and osteogenic markers along with mechanical properties, assessed by atomic force microscopy. Early in the culture, i.e., at day three, no significant differences in mRNA expression of SOX9, aggrecan, lubricin, Col XI, Col X, vascular endothelial growth factor, Col I, and alkaline phosphatase were observed among samples treated with different CFs. However, significant differences in mRNA expression levels of pre-mentioned markers among samples treated with each CF exist when samples were supplied with the CFs for more than three days. A new indexing scheme summing expression of chondrogenic and subtracting non-chondrogenic angiogenic, fibrogenic and osteogenic marker levels shows dexamethasone is the overall leading CF among the factors and their combinations. Based on this scheme, we have projected not only the possible signaling pathways which might be affected by addition of CFs but also hypothetical indexes that may occur upon temporal variation of growth factor regimens.
Benetti Federico*, Natalia Scialacomo, Enrique Mariani, Luis Geffner, Bruno Benetti Eng, Daniel Brusich, Yan Duarte and Ernesto Penaherrera
Introduction: Congestive heart failure is one of the main causes of morbidity and mortality in the XXI century given the promising to date of ABMDSCs and HFDSCs we investigate the safety and efficacy for the implantation of those stem cells for the treatment of idiopathic cardiomyopathy. This is the first pilot clinical study to assess the safety and feasibility of HFDSC in humans. We totally implanted 13 patients: 3 patients were implanted with ABMDSC by Mini-invasive surgical technique in March 2004 in Montevideo, Uruguay, and 10 patients were implanted with HFDSCs by using 2 different surgical techniques: minimally invasive technique (1 patient) and full sternotomy technique (9 patients) between January and February of 2005 in Guayaquil Ecuador.
The HFDSCs were obtained from fetuses of 5 to 12 weeks´ gestation from legally consent, no compensated donors who have undergone terminated ectopic pregnancies, elective abortions, or spontaneous miscarriages. At that gestation´s period, totipotent stem cells´ fetus haven´t develop yet the HLA histocompatibility complex, so there´s no possible antigenicity between donor and recipient.
Results: Patients with HFDSCs improved in association with increased contractility in these regions. Compared with baseline assessments, we noted other improvements: The mean (±SD) NYHA class decreased from 3.4±0.5 to 1.33±0.5 (P=.001); the mean EF increased 31%, from 26.6% ± 4.0% to 34.8%±7.2% (P=.005); performance in the ETT increased 291.3%, from 4.25 minutes to 16.63 minutes (128.9% in metabolic equivalents, 2.45 to 5.63) (P<.0001); the mean LVEDD decreased 15%, from 6.85±0.6cm to 5.80±0.58cm (P<.001); mean performance in the 6-minute walk test increased 43.2%, from 251±113.1 seconds to 360±0 seconds (P=.01); the mean distance increased 64.4%, from 284.4±144.9m to 468.2±89.8m (P=.004); and the mean result in the Minnesota congestive HF test decreased from 71±27.3 to 6±5.9 (P<.001) The Kaplan-Maier probability of survival at 48 months was 66%.
It is not observed rejection, these patients have not developed malignance nodules or cancer at all in the follow-up. In the AMBCSs. The preoperative average NYHA functional class was 3.4; at. 6 months of follow up the average functional class value was 1.3 (p<0,005);. After 6 months all of them remained in functional class I/II. Baseline values of LVEF were 25,28 and 30%.; at 6 months increased to 38, 40 and 46%. (p<0,05). LVESV went from 50mm to 42mm (p<0.05). After 24 months, 2 of the patients still maintained this improvement, while the 3er patient returned to the earlier values after suffering from pneumonia. At 12 years and 5 months 2 patients are alive both received a Resynchronization Therapy; at 8 years and 3 months and 9 years and 1,6 month the actual average EF are 28 and 30 %. The 3er patient died of sudden death at 10 years after the implantation. We can´t demonstrate the cause of this sudden death.
Conclusion: Irrespective of the improvement seen in this study, it is still premature to determine accurately the mechanism of action, indications, doses and type of stem cells. Therefore, is imperative and extremely important that more research is needed.
Since the discovery of the dystrophin gene (DMD gene) thirty years ago, several therapeutic approaches have been investigated to treat Duchenne muscular dystrophy (DMD). This includes cell therapy, exon jumping, exonic knockout, and the CinDel method. In this article, we present the challenges of developping a treatment for DMD and the advances of these various approaches. We included the new CRISPR-Cas9 system, which permits not only major progress in the development of new treatments based on genome editing but also the production of new animal models.
Nucleic acid-based therapy has become an increasingly important strategy for treating a variety of human diseases. In systemic therapy, a therapeutic gene must be delivered efficiently to its target tissues without side effects. To deliver a therapeutic gene such as plasmid DNA (pDNA) or small interfering RNA (siRNA) to target tissues by systemic administration, cationic carriers such as cationic liposomes and polymers have been commonly used as a non-viral vector. However, the binary complex of therapeutic gene and cationic carrier must be stabilized in the blood circulation by avoiding agglutination with blood components, because electrostatic interactions between positively charged complexes and negatively charged erythrocytes can cause agglutination, and the agglutinates contribute to high entrapment of the therapeutic genes in the highly extended lung capillaries. One promising approach for overcoming this problem is modification of the surface of cationic complexes with anionic biodegradable polymers such as hyaluronic acid, chondroitin sulfate, or polyglutamic acid. As another approach, we recently developed a sequential injection method of anionic polymer and cationic liposome/therapeutic gene complex (cationic lipoplex) for delivery of a therapeutic gene into the liver or liver metastasis. In this review, we describe recent advances in the delivery of therapeutic genes by lipid- and polymer-based carrier systems using anionic polymers.
The use of unlicensed and off-label medicines in children is widespread and has raised an increasing concern over the last years. The majority of medicines taken by children are extemporaneously compounded by pharmacist, and there is a lack of information regarding bioavailability, suitability and stability. These formulations must be prepared from pure active substance and not from commercially available dosage forms. The development of paediatric formulations, particularly those suitable for very young children, can be a challenge to pharmacists. There is limited knowledge available about the acceptability of different dosage forms, administration volume, dosage form size, taste, safety of formulation excipients regarding to age and development status. The selection of formulation and route of administration depends on the disease being treated and the clinical condition. European Guidelines and reflection papers recommend that pharmaceutical development should consider some parameters like capability, acute or long-term illness, caregiver convenience, disability, culture differences and formulations more attractive to children must be explored.
Aims: Implication of modified N-methyl-D-aspartate receptors (NMDAR) in synaptic plasticity and learning was investigated in normal and pathological conditions.
Study design: We studied the efficiency of synaptic plasticity, the development of the long-term potentiation/depression (LTP/LTD) in olfactory cortex slices, treated with antisense or sense oligodeoxynucleotides (aODNs and sODNs) to the GluN1 subunit of NMDAR.
Main outcome: aODNs induced the LTD development in slices after high-frequency tetanization. Contrariwise, in sliced treated with sODNs the enhanced LTP developed. Under conditions of severe anoxia (10 min), treatment of slices with aODNs and sODNs contributed to the preservation of synaptic activity which has been blocked in the control untreated slices. In practical implications such directed up- and down regulation of NMDAR might be useful in the readjustment of brain activity by the controlling balance of excitation/inhibition.
Chondromyxoid fibroma (CMF) is a very rare benign cartilaginous tumor representing less than 0.5% of all bone tumors while also being the rarest cartilaginous bone tumor. Common locations of occurrence include the metaphysial region of the proximal tibia and distal femur. We report a case of a 10-year-old female affected by a CMF of the left lower tibia.The radiological features demonstrated by X-ray and magnetic resonance imaging (MRI) are discussed.
S Nanthakumar*, Sumathi Bavanandam, Nirmala Dheivamani, Natarajan B and Krishna Mohan
Anemia due to gastrointestinal blood loss can occur due to many conditions and rarely to bowel structural anomalies. We report a 12 years old girl with anemia due to small bowel duplication cyst, posing diagnostic challenge intra operatively. Surgery offered cure without recurrence of bleeding. Common symptoms can be due to a rare surgical condition in practice.
Gareth Jones*, Kristina Grancharska and Mark I Johnson
<h2>Abstract</h2><p><strong>Background: </strong>Experimentally-induced delayed-onset muscle soreness of large muscle groups is frequently used in as an injurious model of muscle pain. We wanted to develop an experimental model of DOMS to to mimic overuse injuries from sports where repeated finger flexion activity is vital such as rock climbing. The aim of this pilot study was to evaluate the utility of a ‘finger trigger device’ to induce DOMS in the fingers, hands, wrists and lower arms.</p><p><strong>Methods: </strong>A convenient sample of six participants completed an experiment in which they undertook finger exercises to exhaustion after which measurements of pain, skin sensitivity to fine touch, forearm circumference and grip strength in the hand, wrist and forearm were taken from the experimental and contralateral non-exercised (control) arms.</p><p><strong>Results: </strong>Pain intensity was greater in the experimental arm at rest and on movement when compared with the control arm up to 24 hours after exercise, although the location of pain varied between participants. Pressure pain threshold was significantly lower in the experimental arm compared with the control arm immediately after exercises locations close to the medial epicondyle but not at other locations. There were no statistical significant differences between affected and non-affected limbs for mechanical detection threshold, forearm circumference or grip strength.</p><p><strong>Conclusion: </strong>Repetitive finger flexion exercises of the index finger by pulling a trigger against a resistance can induced DOMS. We are currently undertaking a more detailed characterization of sensory and motor changes following repetitive finger flexion activity using a larger sample.</p>
Background and Purpose: Injuries for the pre-adolescent female Irish Dancer (FID) are not well recognized. The purpose of this case study is to report imaging assisted diagnosis and management of atypical medial and plantar foot pain (MPFP) in an 8-year-old FID.
Description: The patient presented with chief complaint of diffuse left MPFP. The patient was initially evaluated by a Physical Therapist for persistent foot pain. The patient experienced minimal pain in non-weightbearing (NWB). Pain intensified in weightbearing (WB) escalating with a heel raise. The patient experienced pain with resistance testing, ankle passive range of motion (PROM) and first metatarsophalangeal joint (MTPJ) PROM. Diffuse tenderness with palpation over the medial column of the left foot was noted. The patient was unable to complete single leg dynamic activity on the left foot. There was suspicion for a metatarsal stress fracture (MSF). Radiographs were ordered and read as negative. The patient was treated with immobilization in a walking boot, WB as tolerated and relative rest including cessation of dance. The patient returned for re-evaluation 2 weeks after reporting no change in symptoms. Magnetic Resonance Imaging (MRI) was then ordered.
Outcome: Results of the MRI identified 2 stress fractures in the first metatarsal. The treatment plan changed to NWB status with immobilization for an additional 6 weeks. The patient returned to full WB status and participated in all dance activity 15 weeks after the initial presentation to the Physician and 27 weeks after the initial onset of MPFP.
Discussion/Conclusion: In this pre-adolescent FID, the presentation of MPFP can be misinterpreted as a soft tissue injury. It is important to consider the diagnosis of first MSF in a pre-adolescent FID to allow appropriate management.
Discussion/Conclusion: In this pre-adolescent FID, the presentation of MPFP can be misinterpreted as a soft tissue injury. It is important to consider the diagnosis of first MSF in a pre-adolescent FID to allow appropriate management.
This report presents an adult patient suffering from sacroiliitis like low back pain, lumbosacral radiculopathy and elbow swelling. Multimodality imaging revealed multiple lytic bone lesions located in supra acetabular iliac bone, sacrum, and distal end of radius. Painful numerous lesions due to the extension to the articular surfaces are not expected for Brown tumors. Less than ten cases with multiple Brown tumor due to primary hyperparathyroidism has been reported. Although Brown tumors are mostly diagnosed incidentally, this case would awake the physicians about rheumatological symptoms in the presentation of Brown tumors. Since Brown tumors are non-touch bone lesions that are expected to regress after parathyroid adenoma removal, it is important to distinguish Brown tumors from the giant cell tumors.
<h2>Case Report</h2><p>A 32-year-old G4P301LC3 woman presents to the office for a visit, with a 6-day history of vaginal discharge with an unpleasant odor. On speculum examination, the discharge was green in color and frothy in appearance. Is noticed vulvar erythema, edema, and pruritus, also is noted the characteristic erythematous, punctate epithelial papillae or “strawberry” appearance of the cervix.Vaginal pH was 6.2. Diagnosis of Trichomonas vaginalis is made via wet prep microscopic examination of vaginal swabs.But also, for diagnosis help even the exam with the speculum, concretely “strawberry” appearance of the cervix. The diagnosis is confirmed by culture.Trichomoniasis is a sexually transmitted infection [1,2], that caused by trichomonas vaginalis. Trichomonas vaginalis is a unicellular, anaerobic flagellated protozoan, that inhabits the lower genitourinary tracts of women and men, but that can cause vaginitis. Clinical findings of Trichomonas vaginalis include a profuse discharge with an unpleasant odor. The discharge may be yellow, gray, or green in color and may be frothy in appearance. Vaginal pH is in the 6 to 7.Vulvar erythema, edema, and pruritus can also be noted. The characteristic erythematous, punctate epithelial papillae or “strawberry” appearance of the cervix is apparent in only 10% of cases. Symptoms are usually worse immediately after menses because of the transient increase in vaginal pH at that time. Diagnosis of Trichomonas vaginalis is made via wet prep microscopic examination of vaginal swabs.</p>
Tolga Dogan, Mucahit Yetim, Lutfu Bekar, Oguzhan Celik, Macit Kalcık* and Yusuf Karavelioglu
Woven coronary artery (WCA) is an extremely rare and still not a clearly defined coronary anomaly. It is characterized by the division of epicardial coronary artery into thin channels which then reanastomose with the distal part of the abnormal coronary artery [1]. Since the angiographic imaging of WCA looks like an intracoronary thrombus and dissection; the differential diagnosis between atherothrombotic coronary arteries with recanalization of organized thrombi in coronary arteries and WCA may be very difficult for invasive cardiologists, especially in patients with single or two coronary artery involvements [2].
Recently, we have encountered a case of WCA associated with myocardial infarction. A 46-year-old man presented cardiology department with stable angina pectoris. An electrocardiography (ECG) showed Q waves in the inferior leads. Echocardiography examination showed akinesis of the inferior wall and left ventricle ejection fraction was 50%. The coronary angiograms showed a 70% stenosis of left anterior descending artery (LAD), 99% stenosis of circumflex artery and a twisting course of the right coronary artery lumen after it divided into multiple channels (woven right coronery artery) (Figure 1, Video1). He was transferred to the cardiovascular department for the bypass surgery.
Tolga Dogan*, Osman Akın Serdar, Naile Bolca Topal and Ozgur Yalcınbayır
Objectives: Retinal microvascular anomalies may be a marker for cardiovascular diseases. Our aim in this study was to investigate the utility of ocular fundoscopic examination as a noninvasive method in specifying the patients who carry a risk for coronary artery disease.
Material and Method: Patients who were diagnosed with coronary artery disease by coronary angiography were included in our study. Bilateral fundoscopic examination was performed in these patients. Fundoscopic findings and risk factors for coronary artery disease were evaluated.
Results: This study enrolled 100 patients (male: 72 (72%), mean age: 58.25±7.1) who were diagnosed with coronary artery disease by coronary angiography. Upon fundoscopic examination, 87% of the study population had atherosclerotic changes. Grade I atherosclerosis was found in 54% of the patients, grade II atherosclerosis was found in 32% of the patients and grade III atherosclerosis was found in 1% of the patients. Increased retinal tortuosity was present in 65% of the patients. Hollenhorst plaque was observed in 3 patients. Drusenoid bodies were observed with a statistically significantly higher rate in the patients who were not using clopidogrel compared to the patients who were using clopidogrel (p<0.001).
Conclusions: Retinal findings are frequently found in patients with coronary artery disease. Therefore, fundoscopic examination is a noninvasive and feasible examination method which can be frequently used in the evaluation of cardiac functions.
Victor Voon*, Dikshaini Gumani, Calvin Craig, Ciara Cahill, Khalid Mustafa, Terry Hennessy, Samer Arnous and Thomas Kiernan
Objectives: The clinical impact of drug-eluting balloon (DEB) coronary intervention for drug-eluting in-stent restenosis (DES-ISR) is not fully known. To further evaluate this impact, we aimed to describe the incidence of symptom-driven coronary angiography (SDCA), an under-reported but potentially informative outcome metric in this cohort of patients.
Methods: We retrospectively identified all patients (n=28) who had DEB-treated DES-ISR at University Hospital Limerick in between 2013-2015 and evaluated the incidence of subsequent SDCA as the primary endpoint. Data were expressed as mean ± SD and %.
Results: Baseline demographics demonstrate a mean age 63±9 years with 61% of DEB-treated DES-ISR presenting with acute coronary syndrome. Mean number of ISR per patient and number of DEB per lesion was 1.2±0.6 lesions and 1.2±0.6 balloons, respectively. The incidence of SDCA was 54% after mean follow-up duration of 179±241 days. 67.8% of patients had follow-up data beyond 12 months. Within the first year of follow-up, the incidence of SDCA with and without target lesion revascularization (TLR) was 11% and 36% respectively. Among patients with SDCA without TLR, 30% had an acute coronary syndrome not requiring percutaneous coronary intervention.
Conclusions: A high incidence of SDCA was observed, particularly within the first 12 months after DEB-treated DES-ISR. This under-reported metric may represent a cohort at higher cardiovascular risk but requires further confirmation in larger studies.
Thrombolysis with tissue plasminogen activator (tPA) has been plagued by inadequate efficacy and a high risk of intracranial hemorrhage (ICH), which led to its replacement by procedures like percutaneous coronary intervention (PCI) whenever possible. Since this requires hospitalization, it is time-consuming, and compromising salvage of brain tissue and myocardium. Thrombolysis is the only first-line treatment that can provide sufficiently timely treatment for optimal recovery of organ function. However, for this potential to be realized, its efficacy and safety must be significantly improved over the current method. By adopting the sequential, synergistic fibrinolytic paradigm of the endogenous system, already verified by a clinical trial, this becomes possible. The endogenous system’s function is evidenced by the fibrinolytic product D-dimer that is invariably present in blood, and which increases >20-fold in the presence of thromboembolism. This system uses tPA to initiate lysis, which is then completed by the other fibrin-specific activator prourokinase (proUK). Since tPA and proUK in combination are synergistic in fibrinolysis, it helps explain their efficacy at their low endogenous concentrations.
Oguzhan Celik, Mucahit Yetim, Tolga Dogan, Lutfu Bekar, Macit Kalcık* and Yusuf Karavelioglu
Coronary artery aneurysm is commonly defined as a localized dilatation exceeding the diameter of adjacent normal coronary segments by 50% [1]. Coronary artery aneurysms may be fusiform, involving the full circumference of the coronary artery, or saccular, involving only a portion of the circumference [2].Causes of coronary artery aneurysms include atherosclerosis (accounting for 50% of cases), Kawasaki disease, polyarteritis nodosa, infection, trauma, coronary dissection, percutaneous coronary angioplasty, and congenital malformations [3]. The abnormal blood flow within the coronary artery aneurysm may lead to thrombus formation, embolization, rupture, myocardial ischemia or myocardial infarction [4]. Here we present a case of a giant fusiform coronary artery aneurysm who passed away due to coronary rupture after acute myocardial infarction.
Microparticles (MPs) are considered important diagnostic biological markers in many diseases with promising predictive value. There are several methods that currently used for the detection of number and characterization of structure and features of MPs. Therefore, the MP detection methods have been remained pretty costly and time consuming. The review is depicted the perspectives to use coupling methods for MP measurement and structure assay. Indeed, there is large body evidence regarding that the combination of atomic force microscopy or coupling nanoparticle tracking analysis (NTA) with microbeads, plasmon resonance method and fluorescence quantum dots could exhibit much more accurate ability to detect both number and structure of MPs when compared with traditional flow cytometry and fluorescent microscopy. Whether several combined methods would be useful for advanced MP detection is not fully clear, while it is extremely promising.
Hypertension and blood pressure are closely related, and hypertension is directly related with stroke. There are different type of blood pressures such as basal, diastolic, maximum, mean arterial, systolic, mean central venous. The present report examines the determinants of systolic blood pressure for two different groups of cardiac patients. One group of cardiac patients is those who underwent dobutamine stress echocardiography, and the other group is Worcester heart attack study. Many systolic blood pressure determinants, their effects, and correlations have been focused in the current report.
Pure Erythroid Leukemia (PEL) is an aggressive and exceedingly rare form of acute leukemia. In the 2008 WHO classification PEL was one of the subtypes of acute erythroid leukemia the other subtype being erythroleukemia (erythroid/ myeloid). In the 2016 WHO classification update, erythroleukemia was merged into myelodysplastic syndrome and PEL now is the only type of acute erythroid leukemia.106 cases of acute myeloid leukemia were diagnosed in 28 months in children’s hospital Lahore and PEL constituted 0.94%. Diagnosis of PEL is made by the bone marrow morphology showing predominant Immature erythroid precursors (proerythroblastic or undifferentiated), Periodic Acid- Schiff staining and immunophenotyping. In PEL no specific genetic mutations have been described but complex karyotypes and TP53 mutations are frequently noted. Future collaborative studies to identify the molecular defects will contribute to the development of targeted therapies that might improve the prognosis.
CRISPR technology has presented a path forward for genomic engineering and gene modification. The framework for the use of CRISPR technology to manipulate the human genome is of great interest and the form of its development and application has excited the researchers and biotech communities as the number of ublications citing CRISPR gene targeting system has rose predominantly as indexed in PubMed.From a technical standpoint of view, most of us think that this would be relatively straightforward process, but technical feasibility is never the only consideration in doing experiments. Much of the discussion about CRISPR engineering has revolved mostly around its ability for treating disease or editing the genes of human embryos. In the real sense, what the biologists desire about CRISPR is its specificity: the ability to target and determine particular DNA sequences in the genome circuit.
Even though CRISPR has emerged as a revolution in genome editing within the scientific community, it has undergone a close scrutiny even within the non- scientific community. The thought of using CRISPR system for curing genetic diseases have gained support but a fewer does not support the use of this technology for editing the human germline cells which has the potential to transfer on their genetic information, has sparked a question about the role we are tempted to play in our own evolution. Interestingly, in an editorial that appeared on Science, it mentioned about a call for a moratorium on germline genome modification by discovers of CRISPR, scientists, ethicists and policymakers on using CRISPR in human subjects and cited a need for greater transparency in the CRISPR system. It also emphasised the need for optimised benchmarking and determination of off-target modifications made by the CRISPR system, the effects of which are largely unknown [1]. However, tremendous potential of CRISPR system for curing genetic diseases have been highlighted inspite of all the concerns.
Mitomycin-C, First found its way into ophthalmic use in 1969, in Japan, where recurrent pterygia were successfully treated with the drug which is an antineoplastic / antibiotic agent isolated from the soil bacterium Streptomyces caespitosus [1]. It is an anti-metabolite with anti-proliferative effect on cells showing the highest rate of mitosis by inhibiting DNA synthesis and interferes with RNA transcription and protein synthesis [2].
Eiman Al Blooshi, Farah Othman, Abeer Al Naqbi, Majid Al Rumaithi, Khawla Fikry, Mariam Al Jneibi and Hossam Al Tatari*
Objectives: The study aims to assess the knowledge, attitude and practices of physicians who deal with pediatric age group SSTIs in reference to the Infectious Diseases Society of America (IDSA) guidelines on this regard that was published in 2014.
Background: Skin and soft tissue infections rank among the most frequent infections worldwide.
It is estimated that over 11 million ambulatory healthcare visits occur each year in US for skin and soft tissue infections due to Staphylococcus aureus (S. aureus) alone.
SSTIs are clinical entities of variable presentation, etiology and severity that involve microbial invasion of the layers of the skin and underlying soft tissues. SSTIs range from mild infections, such as pyoderma, to serious life-threatening infections, such as necrotizing fasciitis. One of the main challenges in managing SSTIs is to be able to identify those who need immediate inpatient intervention versus the more stable ones that can be manages in outpatient basis. In June of 2014, The Infectious Diseases Society of America (IDSA) released evidence based guidelines that has nicely covered all aspects related to the management of SSTIs.
Method:An anonymous 20-item survey exploring knowledge, attitude and practices associated with diagnosis and management of skin and soft tissue infection was distributed to physicians of different levels of expertise (from residents to consultants) in the departments of Pediatrics, Emergency Medicine and Family Medicine in different governmental facilities in Al-Ain city which is one of the major cities in United Arab Emirates.
Priya Mohan*, Sumathi Bavanandam and Sunil Kumar KS
Obstructive jaundice in children is not uncommon and has diverse etiologies. We report a rare cause of obstructive jaundice, cholangitis and pancreatic mass in a young boy due to eosinophilic cholangiopathy who responded to oral steroids. Presence of peripheral eosinophilia, elevated serum IgE level, radiological imaging and tissue eosinophilia helped in diagnosis. Eosinophilic cholangiopathy with pancreatitis is a benign treatable cause of obstructive jaundice though it can masquerade as malignancy.
This study aimed to investigate the relationship between muscle weakness and cancerrelated symptoms in patients undergoing chemotherapy for hematological malignancies and solid tumors. We recruited hospitalized patients older than 20 years who were receiving chemotherapy. Patients were divided into a solid tumor (n=74) and hematological malignancy (n=80) group.Age, body mass index (BMI), strength and thickness of the quadriceps femoris muscle, serum albumin and C-reactive protein levels, blood hemoglobin concentration, fatigue, psychological distress and pain, and duration of hospitalization were assessed. Eight physical symptoms (fatigue, nausea and vomiting, pain, dyspnea, insomnia, appetite loss, constipation, and diarrhea) were also evaluated. Correlation and multiple regression analyses were conducted to identify factors affecting muscle strength in each group. Muscle strength was associated with fatigue in the solid tumor group and with age, BMI, muscle thickness, albumin and hemoglobin in the hematological malignancy group. Therefore, factors contributing to muscle strength might differ between patients with solid tumors and those with hematological malignancies. In particular, fatigue was an important factor in patients with solid tumors, while anemia was an important factor in patients with hematological malignancies. We therefore suggest that different treatments for muscle weakness might be considered for patients with these cancer types.
Exposure to environmental chemicals is a potential cause for the rapid increase in the prevalence of allergic asthma over the last few decades. The production of the environmental estrogen bisphenol A, the monomer of polycarbonate plastics, has increased rapidly over the last 50 years, such that bisphenol A is one of the most highly produced chemicals. It is detectable in the urine of the vast majority of the human population. While the relationship between the increase of bisphenol A in our environment and the prevalence of asthma does not prove a cause and effect relationship, it provides a strong rationale for experiments that have tested the hypothesis. Because of its small molecular size and hydrophobicity, bisphenol A is easily transferred from the mother to the fetus, via the placenta and in breast milk.
We have reviewed all the publications available on medline on the human epidemiological studies of the early bisphenol A exposure on the development of allergic asthma and experimental studies using mouse model of the effects of early bisphenol A exposure on the development of asthma. There are eight human epidemiological studies and five mouse model studies currently published.
The human studies suggest that bisphenol A exposure in early life enhances the likelihood of developing asthma on at least one of the study groups. The effects of early bisphenol A exposure were observed as an enhanced development of asthma before adolescent in the animal model.
Antonio Eduardo de Aquino Jr* and Fernanda Mansano Carbinatto
Introduction: Obesity is a global-level epidemic. Together with this disease, called chronic subclinical inflammatory disease, many other diseases, known as comorbidities, arise.
Objective: To show that the association between low-level laser therapy and physical exercise is supported, by experimental and clinical studies, being an instrument that maximizes the treatment of obesity as well as its comorbidities.
Conclusion: This manuscript brings a compendium of accomplished work by our group that allows understand the mechanism base of interaction between the photonic technology and the physical exercise, allowing to potentiate the treatment of the obesity.
Ioannis K. Karabagias*, Christos Nikolaou and Ilias Gatzias
Pine honey represents the major type of honey produced in Greece. In that sense, the aim of the present study was to investigate if specific physicochemical and bioactive properties could serve as markers of its geographical origin. For this purpose, forty pine honey samples were collected during harvesting years 2011 and 2012 from Halkidiki and Thassos, the well-known pine honey producing areas in Greece. Physicochemical parameters taken into account, using conventional and literature cited methods, were: pH, CIE colour parameters L*,a*,b*, and browning index. Furthermore, colour intensity and the in vitro radical scavenging activity were estimated by the application of spectrometric assays. Results showed that, pine honeys exhibited statistically significant differences (p<0.05) in pH, colour intensity, and radical scavenging activity, depending on geographical origin. On the basis of radical scavenging activity results obtained, pine honeys proved to have a high in vitro antioxidant “character’’. Finally, perfect Pearson’s correlations (r=1) at the confidence level p<0.01 were obtained for the sets: pH-browning index, pH-radical scavenging activity, and browning index -radical scavenging activity, with respect to geographical origin.
Dmytro V Scheglov*, Stanislav V Konotopchik, Maryna Y Mamonova and Oleg E Sviridyuk
The Objective: to improve the treatment results for patients with cerebral arterial saccular aneurysms by optimizing of differentiated approach to the using of endovascular assisting occlusion techniques.
Materials and Methods: The work is based on the comprehensive survey and treatment of 1345 patients with cerebral saccular arterial aneurysms (AA), who were treated at the SO “Scientific-Practical Center of endovascular neuroradiology of NAMS of Ukraine” from 2002 to 2016. 214 cases were selected for further clinical-instrumental dynamic observation in follow-up period. All patients were operated by endovascular approach in “before hemorrhage” period, in acute or “cold” period of the disease on for symptomatic or asymptomatic intracranial saccular AA in both vascular pools with balloon-remodeling or stent-assisting techniques using with the coiling or just detachable coils (DC) using-mono-coils occlusion technique. Depending on the initial endovascular occlusion method, the patients were divided into three groups for observation: I group (mono-coils occlusion)-82 (38.3%) patients, II group (balloon-remodeling technique using)-68 (31.8%) patients, group III (stent-assisting technique occlusion)-64 (29.9%) patients. The life quality and the level of social adaptation were evaluated before hospital discharge and at the follow-up control examinations by Glasgow Outcome Scale (GOS) and by the modified Rankine scale (mRS). AA radicalism occlusion was assessed by Modified Raymond-Roy Scale (MRRS) (Mascitelli JR, et al., 2015). AA occlusion I and II by MRRS was considered as “Effective”.
Results: 9 criteria of cerebral saccular AA complexity inherent in endovascular surgery have been developed based on the technical and surgical features of endovascular methods of the cerebral AA occlusion and X-ray-anatomical characteristics of aneurysms, which complicated the “effective” reconstructive occlusion of AA cavity.
The evaluation of the AA complexity criteria prognostic significance to achieve the “effective” primary occlusion, shown different results in different groups: high prognostic significance of 4 criteria was shown in group I, of 2 criteria - in group III, and no any criteria significance in group II.
There was no statistically significant difference between groups in the primary AA occlusion efficacy and initial good results by GOS and mRS.
It was proved that endovascular occlusion of complex cerebral AA with the assisting methods using has high efficiency in all periods of the disease, unlike the method of mono-coils occlusion, which is most effective in acute and “cold” periods.
There was no statistically significant difference between the number of intraoperative, postoperative and non-surgical complications (p>0.05).
It was found that all methods of complex AA endovascular occlusion can effectively prevent the disease recurrence despite the differences between them in the stability of the AA cavity occlusion.
Conclusions: Consideration of developed AA complexity criteria during endovascular surgery planning allows to choose the most optimal and safe individual method of primary or phased AA occlusion and helps to reduce the frequency of AA recanalization in follow-up period. The choice of the complex AA occlusion method doesn’t effect on result of primary treatment, the number of intraoperative complications and the quality of primary occlusion. However, an analysis of the long-term treatment results indicates that the assisting techniques have proven advantages according to the occlusion stability.
Mumtaz Din Wani, Mushtaq Chalkoo*, Zaheer Ahmed, Awhad Mueed Yousuf, Yassar Arafat, Syed Shakeeb Arsalan and Jaffar Hussain
Acute pancreatitis forms a major bulk of our inpatient admission due to gall stone disease. Diagnosis of acute pancreatitis remains a challenge even now. Serum amylase remains the most commonly used biochemical marker for its diagnosis but its sensitivity can be reduced by late presentation, hyper-triglyceridemia and chronic alcoholism. We conducted a study to determine the levels of serum and urinary amylase in patients with acute pancreatitis and compared their sensitivity and correlation with CT findings vis-à-vis the severity of the disease. The study was taken as a post graduate research model in the Post graduate Department of General and Minimal Access Surgery, Govt. Medical College Srinagar, J&K, India 2014-2016 and submitted for the award of masters in General Surgery. A total number of 150 patients were enrolled in the studies which were admitted in our unit as acute pancreatitis. 73 (48.7%) belonged to the age group of 30-44 years, 15(10%) patients aged >60 years with 86 (57.3%) males and 64 (42.7%) females. We had 81 (54%) patients with biliary tract diseases, followed by 21 (14%) patients with worm induced, 20 (13.3%) had hyperlipidaemia and only 4 (2.7%) patients had post ERCP etiology. Tenderness in epigastrium was the presenting sign in 111 (74%), followed by chest signs in 25 (16.7%) patients, diffuse tenderness in 19 (12.7%), icterus in 11 (7.3%), low grade fever in 9 (6%) patients, shock in 5 (3.3%). Diabetes mellitus as a comorbidity was observed in 48 (32%) patients followed by hypothyroidism 37 (24.7%) patients. Hypertension was seen in 31 (20.7%) patients, COPD in 19 (12.7%) patients and obesity in 13 (8.7%) patients. Twenty two (14.7%) needed ICU admission; while as 128 (85.3%) were managed in the general ward. All the enrolled patients in our study were managed conservatively. Out of a total of 150 patients, 148 (98.7%) survived while as only 2 (1.3%) of our patients expired. At the time of admission in the hospital, 120 (80%) patients had serum amylase level of >450 U/L, 19 (12.7%) patients had 150-450 U/L levels while as 11 (7.3%) patients had <150 U/L serum amylase levels. CT has been shown to yield an early overall detection rate of 90% with close to 100% sensitivity after 4 days for pancreatic gland necrosis. The correlation of urinary amylase with the CECT Severity Scoring in a patient of acute pancreatitis is still ambiguous.
Giuseppe Profiti, Pier Luigi Martelli and Rita Casadio*
Protein functional annotation requires time and effort, while sequencing technologies are fast and cheap. For this reason, the development of software tools aimed at predicting protein function from sequences can help in protein annotation. In this paper, we describe how to use our recently implemented Bologna Annotation Resource (BAR) version 3.0, a tool based on over 30 million protein sequences for protein structural and functional annotation. In BAR 3.0, sequences are arranged in a similarity graph and then clustered together when they share at least 40% sequence identity over 90% of sequence alignment, for a total of 1,361,773 clusters.
Protein sequences with known function transfer their annotation to other sequences in the same cluster after statistical validation. Sequences with unknown function and new sequences entering in a cluster inherit its statistically validated annotations.
The method well compares to other techniques in the Critical Assessment of protein Function Annotation algorithms (CAFA). The CAFA experiment tests the performances of different predictors on a dataset that accumulates annotations over time. BAR predictions have been submitted to all the instances of CAFA through the years (BAR Plus in CAFA, BAR++ in CAFA2 and BAR 3.0 in CAFA3). The benchmarking indicates that in the field improvement is still possible and that our BAR scores among the top performing methods.
This work focuses on how the tool can transfer statistically significant features to poorly annotated or new sequences derived from transcrptomics or proteomics experiments.
Josephina G Kuiper*, Patience Musingarimi, Christoph Tapprich, Fernie JA Penning-van Beest and Maren Gaudig
This study describes chemotherapy exposure, healthcare utilization, overall survival (OS) and progression-free survival (PFS) among patients diagnosed with chronic lymphoid leukemia (CLL). Newly diagnosed CLL patients who received chemotherapy were selected from the Eindhoven Cancer Registry between 1998-2011, linked on a patient-level to the PHARMO Database Network including data on in- and out-patient drug dispensings, hospitalizations and clinical laboratory measurements. Chemotherapy was classified in regimens of use based on chemotherapy combinations. OS and PFS were determined after diagnosis and after chemotherapy. Healthcare utilization was assessed in the year before diagnosis and in the year after chemotherapy.
In total, 125 CLL patients received chemotherapy: 52 patients (42%) started chemotherapy within 6 months and 73 patients (58%) started chemotherapy ≥6 months after diagnosis. Mean (±SD) age was 67(±10) years and 68% was male. About 50% had one treatment line and about 25% two lines of treatment. Chlorambucil was the most common type of first line chemotherapy. Prior diagnosis, 44% were hospitalized for any cause and 94% had at least one drug dispensing. After chemotherapy, this was 43% and 98%, respectively. One-year survival rate after diagnosis was 94%. Median PFS after first treatment line was 17 months for patients starting within 6 months and 27 months for patients starting ≥6 months after diagnosis. In conclusion, most CLL patients receiving chemotherapy were treated with chlorambucil. One-year after initial diagnosis, 94% were still alive. Median PFS after first line chemotherapy ranged from 17 to 27 months, depending on the timing of chemotherapy.
The linear no-threshold hypothesis (LNT)-the basis of radiation regulatory policy-extrapolates from observed high-dose harm to assumed low-dose harm, entailing that all ionizing radiation is harmful, by denying any biological response to damage and asserting cumulative lifetime harm, regardless of dose or dose rate.All aspects of LNT are demonstrably false. There are evolved biological responses that repair or remove radiogenic damage from low doses and dose rates, thereby averting acute harm and precluding the alleged cumulative damage. LNT and its offspring, the “as low as reasonably achievable” principle, do not err on the side of caution; neither is truly conservative. The public needs protection from radiophobia, rather than from low-dose radiation exposure. Neither radiation regulations nor medical practice should be based on LNT, but rather, at least as a first step, on a linear (down to a) threshold (LT) model.
Mark W Cornwall*, Carissa Lane, Jennifer Norwood, Sara Patterson and Daniel Strauss
<h2>Summary</h2><p>The Sit-to-Stand test (STST) involves comparing the change in a person’s non-weight-bearing and weight-bearing foot posture to quickly classify a person’s overall foot mobility. Despite the simplicity of the test, its reliability and validity has not been established. The purpose of this study is to determine the intra-rater and inter-rater reliability of the STST as well as its validity. Ninety-seven subjects with a mean age of 25 years (±3.7) participated in the study. Each subject’s foot posture from non-weight-bearing to weight-bearing was evaluated by two different raters. Each rater classified each subject’s change in foot posture as “Hypomobile”, “Normal” or “Hypermobile”. This same procedure was repeated approximately one week later without the raters being able to review what their original classification for that subject had been. The subjects also had their foot mobility quantified by measuring the height and width of their dorsal arch in both non-weight-bearing and weight-bearing. These quantitative measures of foot mobility were then classified as “Hypomobile”, “Normal”, or “Hypermobile” using quartiles. A series of Cohen’s Kappa coefficients were used to assess the amount of agreement between the visual classifications by each rater as well as the classification between the observational and objective classifications. The between-day Kappa coefficients ranged from 0.613 to 0.719 and the inter-rater Kappa coefficients ranged from 0.473 to 0.531. The Kappa coefficients between the visual and quantitative classifications ranged from 0.281 to 0.436. The STST should therefore be used with caution because of its moderate between-rater reliability and validity.</p>
Bronchiolitis obliterans (BO) is an infrequent clinical syndrome characterized by the chronic obstruction of small airways due to fibrosis [1]. Intravenous immunoglobulin (IVIG) could be used for treatment while underlying immune mechanisms in the pathogenesis of BO exist [2]. Here, we present two children with BO due to adenovirus infection whose complaints resolved after IVIG replacement.
The barium is often used in radiocontrast examinations of the digestive system because of mucosal absorption is limited. Massive barium aspiration is a rare complication, especially when there is no anatomic or neurological deficit. The depending on barium concentration can cause various lung effects.When the literature is reviewed, barium aspiration may be asymptomatic or lethal in massive amounts. Rarely, large amounts of barium sulphate are aspirated into the lung, there is no literature study how often this is happening.
We present a case of massive barium aspiration in this subject. The case is related to a patient’s diagnostic esophagography who complaints swallowing problems. The massive barium aspiration couldn’t notice because of the absence of acute symptoms and surgical operation of gastrointestinal tract which the patient had undergone previously. When the patient applied our Pediatric Chest Diseases Polyclinic after three months, as a result of the examinations and deep research it was understood that the case was about massive barium aspiration. The patient was directed to our center because there was a radiological appearance of bone density signs on chest X-ray. Such a complaint was not reported by the family neighter in his biography, nor was written in the epicrisis. We will share acute and chronic changes in the lungs, diagnosis and treatment approaches of this case. The infant who has ileostomy was previously operated because of necrotizing enterocolitis. And also still has severe gastro-esophageal reflux and under conservative and medical treatment, a possible fundoplication surgery is planning.
Objective: To report our experience of direct carotid puncture and its use in the management of a large and rapidly expanding cavernous aneurysm.
Methods: A patient with a cavernous aneurysm that measured 25mm in maximum diameter underwent treatment with flow diversion. The initial treatment strategy was parent vessel occlusion however she failed the balloon occlusion test at 3 minutes. Due to extremely tortuous vessels stable access via a common femoral artery approach was impossible to achieve. We present our strategy, the post-operative management and long term results.
Results: Using a direct carotid puncture three telescoped Pipeline embolisation devices were successfully deployed across the neck of the cavernous aneurysm without complication. The puncture site formed a stable platelet plug after direct compression with an ultrasound probe for 90 minutes with no post-operative complications either intracranially or at the neck puncture site. At 2 year follow-up the aneurysm is completely excluded from the circulation.
Conclusion: Direct carotid puncture can be used as access for intracranial interventional procedures even if patients are on dual anti-platelet medication.
Methods: A patient with a cavernous aneurysm that measured 25mm in maximum diameter underwent treatment with flow diversion. The initial treatment strategy was parent vessel occlusion however she failed the balloon occlusion test at 3 minutes. Due to extremely tortuous vessels stable access via a common femoral artery approach was impossible to achieve. We present our strategy, the post-operative management and long term results.
Water resources play an integral part in the life of a living being. The various water resources that are present on the earth’s surface are in the form of oceans, seas, lakes, rivers, ponds, waterfalls etc. Among these water resources Lakes and reservoirs are vital for people’s life, industrial activities and many other day to day activities. These water resources help in obtaining water for drinking after being treated. They also provide water for agriculture and industrial usage, fishery resource, flood control functions and many other activities. Due to the closed nature of lakes’, the waste material from sewage, agricultural effluents, domestic and industrial fields, gets accumulated around the surface of these water resources and once the water gets polluted, it gets strenuous to improve the quality of the water. In the study, the authors have examined different effective ways by which the quality of lake water can be improved.
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.
Amit Kumar Garg, Neha Agrawal* and Rajendra Kumar Tewari and Surendra Kumar Mishra
Statement of the problem: Anterior tooth fracture, as a result of traumatic injuries, frequently occurs in dentistry. This leads to necrosis of pulp and periapical pathology. The goal of endodontic and restorative dentistry is to retain natural teeth with maximum function and pleasing esthetics.
Purpose of the study: This study aimed at proper reconstruction of extensively damaged teeth through the procedure known as “Biological Restoration.”
Materials and methods: Biological post obtained through natural, extracted teeth from another individual represents a low-cost option and alternative technique for the morphofunctional recovery of damaged anterior teeth that provides highly functional and esthetic outcomes.
Conclusions: This case report refers to the esthetics and functional recovery of mandibular left lateral incisor after non-surgical healing of periradicular lesion.
Conclusions: This case report refers to the esthetics and functional recovery of mandibular left lateral incisor after non-surgical healing of periradicular lesion.
Materials and methods: Biological post obtained through natural, extracted teeth from another individual represents a low-cost option and alternative technique for the morphofunctional recovery of damaged anterior teeth that provides highly functional and esthetic outcomes.
Conclusions: This case report refers to the esthetics and functional recovery of mandibular left lateral incisor after non-surgical healing of periradicular lesion.
Materials and methods: Biological post obtained through natural, extracted teeth from another individual represents a low-cost option and alternative technique for the morphofunctional recovery of damaged anterior teeth that provides highly functional and esthetic outcomes.
A 60-year-old woman had central retinal artery occlusion (CRAO) presented to the ophthalmology department with a sudden, painless loss of vision. Her initial visual acuity was light perception and she treated with hyperbaric oxygen therapy (HBOT) 4 hours after the development of visual symptoms. Systemic risk factors were not found so she was diagnosed as having idiopathic CRAO. Her vision improved from light perception to 20/50 after the HBOT. Any complications such as neovascularization were not developed until the last follow up visit of 8th months.
The drugs of biological origins have attracted the attention of many pharmaceutical companies where it is essential to protect the heterogeneous nature and the optimal three dimensional structures of the different macromolecules. These molecules are used in both the investigation and therapy purposes, so their maximum activities should be maintained. This requires the designing of certain delivery formulations that suits the macromolecule nature, its target organ, the required dose and delivery route, and that’s why the biotech companies invest millions of dollars towards achieving that. The first main focal point of this article includes the recent developments in the formulation technologies for several biomacromolecule classes. The second focal point concentrates on the current considerations for optimizing their delivery for a maximum performance in the body.
Introduction: Burning mouth syndrome, oral sub mucous fibrosis, leukoplakia, etc are the different manifestations of a common disease as per the surmise of various authors. There is no known cause and no specific treatment. Attempt is made in this study to find a cause and if possible, a treatment.
Materials and methods: 38 such cases were taken up in this study. It was found, that the cardinal signs of paucibacillar indeterminate form of Hanseniasis, as per the definition of WHO, are present in all these cases. Also they are found to respond well to the anti-leprotic drugs prescribed by WHO for the Hanseniasis.
Conclusion: It is recommended for multicentre trial and further research on this score which would relieve the suffering millions of the world populations.
Breast cancer is a complex disease and one of the main causes of cancer-related mortality in women worldwide. In case of approximately 15% of all breast cancers, three markers i.e. estrogen receptors (ER), progesterone receptors (PR) and human epidermal growth factor receptors-2 (HER2) are not expressed, and is commonly termed as triple-negative breast cancer (TNBC). Particularly, TNBC is associated with a higher percentage of breast cancer related mortality, which is often aggressive and most frequently found with a BRCA1 mutation or increased basal marker expression. However, due to the limitations of chemotherapy and radiation based treatment; the current challenge is to establish a new strategy of diagnosis and treatment of TNBC. The deregulation of a number of microRNAs (miRNAs) in breast cancer has been widely reported. Therefore, this review is directed towards enhancing our understanding of the involvement of various miRNAs in the pathology of TNBC, their upregulations and downregulations and the effects on various factors. From recent studies a number of miRNAs are found to be related with TNBC, which have great potential to be used as a biomarker to determine the disease prognosis and predict the fate of disease. Again miRNA can be targeted to be applied as a therapeutic to provide a great benefit to the patients of TNBC by finding a new, safe, and effective treatment strategy.
Nilzete Liberato Bresolin*, Pedro Docusse Junior, Maria Beatriz Cacese Shiozawa, Marina Ratier de Brito Moreira and Natalia Galbiatti Silveira
Introduction: Acute tubulointerstitial nephritis (ATIN) is an acute kidney injury (AKI) resulting from damage to the tubulointerstitial tissue due to infection, trauma, or use of medication. It is clinically non-specific.
Case: A teenager with multiple trauma, hospitalised after lowering of level of conscience, and convulsion fits. While in the emergency ward, he received: midazolam, fentanyl and phenytoin. The cranial and abdominal CT scans were normal. He was stable with no signs of shock, trauma or infection; he developed oliguria and serum creatinine (Scr) 1.7mg/dL), 12 hours after the admission. After 36 hours, Scr levels were at 3.4mg/dL and urea at 55mg/dL. He had AKI according to pRIFLE (66.2% reduction in clearance). After other causes of AKI had been ruled out, the possibility of ATIN was raised; the phenytoin was suspended and pulse therapy, with methylprednisolone, was promptly initiated. After the first pulse, there was already a decline in the creatinine and urea readings; 48 hours later: Scr at 2.2mg/dL and urea at 86mg/dL. Thirty days after being discharged from hospital, the patient was in good health and had full restoration of kidney function.
Discussion: The singularity of this report relies on the rarity of ATIN secondary to the use of phenytoin and also in the importance of recognizing this aetiology as being one of the origins of AKI.
Conclusion: Early diagnosis allows the reversal of AKI through suppression of treatment with phenytoin and introduction of corticosteroid therapy, when necessary.
Pirabu Sakthivel*, Chirom Amit Singh, Smriti Panda, Suresh Chandra Sharma, Konki Malla Abhilash and Milind Sagar
We report an interesting case of a 21 year old male who presented with recurrent mucoepidermoid carcinoma of parotid with facial nerve involvement as facial tics. Intraoperatively, the tumour was noted to be firm, irregular and adherent to the underlying structures. The patient underwent extended total parotidectomy, division of buccal branch of facial nerve, selective neck dissection with cervical local rotational flap repair and post-operative radiotherapy. This presentation of Mucoepidermoid carcinoma with involvement of facial nerve as facial tics is one of the rare unique reported cases.
Mohammad M Rana, Muhammad Abdullah, Ferdinand L Shamalla and Shu Wei*
Agrobacterium rhizogenesATCC 15834 wild type strain was transformed with the binary vector pBI121 using the heat shock method. The transformed Agrobacterium was then tested for virulence through tobacco leaf explant transformation. Compared to the non-transformed Agrobacterium, the transformed Agrobacterium showed reduced virulence, producing significantly lower number of hairy roots in tobacco leaf explants. Although the transformed Agrobacterium showed reduced virulence, it was able to transfer the T-DNA of the binary vector into the plant genome, resulting in stable GUS expression in the generated hairy roots. This indicated that in addition to the transfer DNA (T-DNA) from its root inducing (Ri) plasmid, the transformed Agrobacterium is also capable of transferring the binary vector T-DNA and allowing the integration of a foreign gene. Results also showed that hairy root generation efficiency of the transformed Agrobacterium varied with the concentration of the selection agent (kanamycin). Hairy root generation efficiency (hairy roots·explant-1) progressively increased with decreasing concentrations of kanamycin; and the efficiency was highest in the absence of kanamycin. Generated hairy roots showed very strong to tiny GUS expression even those that grew under the highest concentration of the kanamycin (50 mg·L-1). This indicated that co-transformation and efficient transgene expression does not always occur.
The greater risk of hypernatremia in patients over 65 years old are associated with impaired mental status and physical disability which may result in impaired sensation to thirst, impaired ability to express thirst, and/or decrease access to water [1,2].
The neuromuscular disorders may be hereditary, autoimmune, and in some cases with unknown etiology. These diseases are characterized by progressive course, muscle weakness, and in an advanced stage with binding the patient to a wheelchair. This group includes a number of diseases, but from the dental perspective, the most interesting are muscular dystrophy, multiple sclerosis and myasthenia gravis. Neuromuscular disorders affect the oral cavity and the impact on oral hygiene procedures should be monitored with great attention.
It is estimated that even up to 30% of buildings worldwide may be the subject of complaints connected with the quality of indoor air. Potential sources of air pollution can be both organic and inorganic particles. This article focuses on biological air pollutants from living and dead biological sources, especially those connected with fungi. Fungi found in the indoor air of domestic dwellings in a large extent are similar in their species composition to those found on the outside of the building. Microorganisms enters into the buildings during the airing of rooms or through the different slots and can develop on the surfaces of various materials. Intensively develops in a poorly ventilated, damp and dusty environments. For this reason the exposure to the indoor air pollution might be stranger for inhabitants than the expose to the impurities of the outdoor air. Presence of fungi in domestic dwellings can be very danger because of most often is associated with allergic reactions, mycotoxins, volatile organic compounds or even with fungal infections.
Jigar Modi Ahmed Altamimi, Ashleigh Morrell, Hongyuan Chou, Janet Menzie, Andrew Weiss, Michael L Marshall, Andrew Li, Howard Prentice* and Jang-Yen Wu*
Stroke and neurodegenerative diseases including Alzheimer’s disease (AD) are responsible for a major proportion of mortalities in the elderly. We have previously investigated novel mechanism-based therapies of AEURA in cell culture models against viral infection and in glutamate excitotoxity. In our new studies, we propose that the homeopathic formula AEURA could serve as a potential therapeutic agent for stroke & for AD.In examining AEURA treatment of PC12 cells exposed to glutamate excitotoxicity, hypoxia /re-oxygenation injury and A-Beta toxicity. We demonstrated an increased survival rate in AEURA treated cells by comparison to control cells. In examining the therapeutic potential of AEURA in PC12 cells this homeopathic agent was found to be neuroprotective against either glutamate induced toxicity, hypoxia /re-oxygenation stress or cell stress resulting from viral infection (with either HSV-1 or rhinovirus). Our ongoing studies involve examining the neuroprotective potential AEURA in vivo using rodent models of stroke & AD.
Acute carbon monoxide (CO) poisoning is caused by the inhalation of large quantity of CO within short time leading to morbidity and mortality. In this study, a total of eighteen (18) rabbits were divided into three (3) groups of six (6) animals each. The first group first group was poisoned with CO and labelled carbon monoxide death (CD). The second group of animals was killed prior to exposure to CO and labelled disguised death (DD), while the third was the control group (CG). The vitreous humour samples were collected from all the animals using standard methodologies. The vitreous humour total protein and albumin were estimated while its globulin content and albumin/globulin ratio were derived mathematically. Pearson correlation analyses were used to establish relationships between vitreous protein profile components and the acute graded carbon monoxide concentrations. Results indicated a significant increase (P<0.05) in vitreous total protein and globulin of the studied groups. This observation was more pronounced in the CD group of animals. Therefore the marked elevation of vitreous total protein and globulin may serve as a useful tool in the confirmation of death due to carbon monoxide poisoning.
Mohsin Tariq*, Muhammad Noman, Temoor Ahmed, Amir Hameed, Natasha Manzoor and Marriam Zafar
Soil dwelling bacteria able to colonize plant roots and closely associated soil are referred to as rhizobacteria. A wide range of rhizobacteria has the ability to promote plant growth directly by producing phytohormone and nutrients; and indirectly by controlling plant pathogen.These beneficial bacteria are known as plant growth promoting rhizobacteria (PGPR). PGPR control phytopathogens by producing chemicals that could damage pathogen cells, removing pathogen specific nutrients from the environment, or inducing resistance against pathogen in plant body. Antagonistic bacteria specifically damage pathogens by producing lytic enzymes, antibiotics and bacteriocins; and excluding pathogen from plant environment by siderophores oriented iron chelation. This review highlights the antagonistic feature of PGPR. Application of antagonistic bacteria as biopesticides is an attractive alternate of chemical pesticides. Chemical pesticides are non-targeted and cause pollution during its synthesis as well as at the site of application. Antagonistic bacteria could be used as biopesticides and biofertilizers for better plant health and growth improvement.
García G, Agosta M, Valencia P, Mercedes E, Sarhane Y and Díaz-Lobato S*
Oxygen therapy is the main supportive treatment in hypoxemic respiratory failure and has traditionally been delivered using low and high flow devices. However, the maximal flow rates that these devices can deliver are limited because of the insufficient heat and humidity provided to the gas administered.Low flow devices such as the nasal cannula, conventional face mask and reservoir bag deliver a flow rate of up to 15 L/min by administering more variable oxygen fractions (FiO2), depending on the patient’s respiratory pattern, peak inspiratory flow and characteristics of the devices. Conventional high flow devices, such as venturi type masks, utilize a constant flow of oxygen through precisely sized ports, entraining the ambient air, using the Bernoulli principle, providing a more constant inspired oxygen fraction. However, they are less tolerated than nasal cannulas because they are less comfortable and the insufficient humidification and heating of the gas delivered [1].
In the last two decades, new devices have been developed to administer high humidified and heated flow through a nasal cannula (HFNC) that also allows the delivery of oxygen with a known FiO2 up to 100%. In the literature, this technique has also been called mini CPAP (continuous positive airway pressure), transnasal insufflation, high nasal flow ventilation, high flow oxygen therapy, and high flow nasal cannula oxygen therapy [2].
It is considered that high flow nasal cannula has certain benefits compared to those of oxygen therapy previously detailed. HFNC manages a flow of more than 30 L/min, which is able to surpass the peak inspiratory flow of the patient, being able to reach values between 60-80 L/min depending on the flow used. The gas source, which may be delivered by an air/oxygen blender, fans, or a flow generating turbine, is connected by an active humidifier to a nasal cannula and the FiO2 can be adjusted independently of the flow.
<h2>Abstract</h2><p>In recent years, the increasing number of patients with upper limb musculoskeletal disorders seeking timely, intensive, prolonged and task oriented hospital- and home- based physical rehabilitation, and the decreasing numbers of trained therapist to provide the needed care, have left a palpable gab. These have resulted in several preventable deformities with associated complications leading to social and economic burdens. Although the introduction of some robotic devices has addressed some of these concerns, the shortfalls from the use of these devices limit their effectiveness. The newly introduced hand rehabilitation board (Dominic’s Board) was prospectively evaluated in 82 patients with ULMDs of different etiologies to assess its therapeutic efficacy in rehabilitation of ULMDs. Additive, but complementary effect was observed when used along with conventional hospital-based therapy and at home, suggesting the effectiveness of this device in preventing or ameliorating the complications associated with ULMDs.</p>
Ospelnikova TP*, Gevorkyan OV, Mironova TV, Andreeva SA, Kolodyazhnaya LV and Ershov FI
The insufficiency of interferon production and the cytokine imbalance in patients with atopic dermatitis, especially in combination with persistent herpes virus infection, has been identified. The expediency of the use of interferon inducer Cycloferon in the treatment of chronic atopic dermatitis has been shown.
Depressive disorders are so frequent and disabling health conditions which have been inarguably accepted to be a public health concern [1]. Many drugs have been developed to treat depression, however the efficacy of the antidepressants are inadequate particularly for mild or moderate depression [2-4].It is also mentioned that when considering the trials about the treatment effect of the antidepressants, you should be careful about the results because of reflecting a small proportion of the society [4]. Despite the methodological issues related to the controversial results about the antidepressant efficacy, a recent review showed that the antidepressant effects of the drugs persist in a six month period [5,6].
Alterations in cardiac autonomic modulation of children and obese preadolescents have attracted the attention of researchers around the world. These alterations cause disorders in the cardiac autonomic control and can interfere in cardiac output and in the homeostatic actions that depends of the cardiovascular system action.
Laiyan Wu, Jirong Lan, Anping Yang, Yanxi Zhao, Songbo Wang and Junjiang Zhu*
Mesoporous graphitic carbon nitrides (mpg-CN) were synthesized by a templating method using Ludox (SiO2) as hard template and guanidine hydrochloride (GndCl) as precursor, and were used as metal-free photocatalysts for microcystin-LR (MC-LR) degradation in aqueous solution. By tuning the mass ratio of SiO2 to GndCl, mpg-CN with varied surface areas and condensation degrees were obtained. Catalytic results showed that sample prepared at mass ratio equals 0.4, i.e., mpg-CN(0.4), exhibits the best activity, with above 98% MC-LR conversion obtained at 120 min. Mechanism studies suggested that the reaction obeys the pseudo first-order equation and the produced superoxide anion radicals (•O2−) is the major reactive intermediates contributing to the reaction. Stability tests showed that no appreciable loss of activity is observed even the catalyst is recycled for five times, indicating that the material is stable in the reaction.
The present study was aimed to screen and quantify the phytochemicals by qualitative and quantitative analysis in methanol and aqueous leaf and stem extracts of Marsilea quadrifolia (L.). In qualitative analysis, the phytochemical compounds such as tannins, saponins, flavonoids, steroids, terpenoids, triterpenoids, alkaloids, carbohydrates, proteins, anthroquinones, phenolic compounds and phytosterol were screened. Among these phytocompounds tannins, saponins, flavonoids, steroids, alkaloids, carbohydrates, proteins and phenolic compounds were observed in methanol and aqueous leaf and stem extracts of M. quadrifolia. Anthroquinones were absent in both leaf and stem extracts of M. quadrifolia. The content of phenolic compounds 8.34±0.92 mg/g and 7.31±0.46 mg/g, flavonoids 7.46±0.64 mg/g and 6.45±0.68 mg/g, alkaloids 6.12±0.51 mg/g and 5.89±0.61 mg/g, tannins 6.58±0.72 mg/g and 6.07±0.56 mg/g and saponins 5.32±0.48 mg/g and 6.30±0.58 mg/g were determined in leaf and stem of M. quadrifolia, respectively. So, the present study confirmed that the presence of phytocompounds in leaf and stem of M. quadrifolia.
Children with cerebral palsy may have one or more of mental, psychomotor, visual, audio or speech problems. Not being a well-defined disease with clear boundaries, it is regarded as a set of conditions caused by various reasons. In this regard, children with CP have to depend on their families or caregivers and cope with physical, mental, social and economic problems due to their condition. Therefore, it turns out to be crucial to determine the needs of the family with children with CP so that the programs that will assist them during this process can be developed. The study further revealed that the parents of the children with cerebral palsy needed information about controlling their children’s behaviors and teaching them certain behaviors; they needed to talk to the teacher and/or therapist of the child; they needed support about making time for themselves; they needed community services about finding a care center or a nursery suitable for their children’s needs.
Roberto Carlos Burini*, Hugo Tadashi Kano, Mariana Santoro Nakagaki, Caroline das Neves Mendes Nunes and Franz Homero Paganini Burini
High blood pressure (HBP) is a strong, independent and etiologically relevant risk factor for cardiovascular and therefore, the leading cause of preventable deaths worldwide. Hypertension has high medical and social costs. Due to its many associated complications, the use of medical services create high costs with medications which represent almost half of the estimated direct expenses. Free distribution of more than 15 medications for HyPERtension and DIAbetes (HIPERDIA program) clearly shows the important role of drugs in the Brazilian Government’s effort to tackle these two diseases. Notwithstanding, the prevalence of HBP is rising in parallel with other NCDs. It is known that HBP results from environmental and genetic factors, and interactions among them. Our ancestors were often faced with survival stresses, including famine, water and sodium deprivation. As results of natural selection, the survival pressures drove our evolution to shape a thrifty genotype, which favored/promoted energy-saving and sodium/water preservation. However, with the switch to a sodium- and energy-rich diets and sedentary lifestyle, the thrifty genotype and ancient frugal alleles, are no longer advantageous, and may be maladaptive to disease phenotype, resulting in hypertension, obesity and insulin resistance syndrome. Low-grade chronic inflammation and oxidative stress would be the underlying mechanisms for these diseases. HBP is often associated with unhealthy lifestyles such as consumption of high fat and/or high-salt diets and physical inactivity. Therefore, alternatively to medicine drugs, lifestyle and behavioral modifications are stressed for the prevention, treatment, and control of hypertension. A lifestyle modification program (LSM) involving dietary counseling and regularly supervised physical activity (“Move for Health”) has been used for decades, in our group, for NCDs primary care. Retrospective (2006-2016) data from 1317 subjects have shown the top quartile of blood pressure(142.2/88.5mmHg) differing from the lower quartile (120.6/69.2mmHg) by being older, with lower schooling, lower income and, lower physical activity and aerobic capacity. Additionally, the P75 showed higher intake of CHO, saturated fat and sodium along with lower-diet quality score with a more processed foods. They showed higher body fatness and prevalence of metabolic syndrome along with higher pro-inflammatory and peroxidative activities and insulin resistance. In this free-demand sample, the HBP rate was 51.2% for SBP and 42.7% for DBP. The rate of undiagnosed HBP was 9.8% and only 1/3 of medicated patients were controlled for HBP. After 10 weeks of LSM the HBP normalization achieved 17.8% for SBP and 9.3% for DBP with a net effectiveness of 8.5% and 2.4%, respectively. The reduction of HBP by LSM was followed by increased aerobic conditioning and reduced intake of processed foods along with decreased values of BMI, abdominal fatness, insulin resistance, pro-inflammatory and peroxydative activities. Importantly, once applied nationwide this LSM would save HBP medication for 3.1 million of hypertensives at an economic saving costs of US$ 1.47 billion a year!
Nader Makki, David M Kline, Arun Kanmanthareddy, Hansie Mathelier, Satya Shreenivas and Scott M Lilly*
Background: Due to variations in hospital protocols and personnel availability, individuals with myocardial infarction admitted on the weekend may be less likely to receive invasive procedures, or may receive them with a greater latency than those admitted during the week. Whether or not this occurs, and translates into a difference in outcomes is not established.
Method: Using the Nationwide Inpatient Sample (2008-2011) database, we identified all patients admitted with a principle diagnosis of acute myocardial infarction. They were stratified by weekend or weekday admission. Baseline clinical characteristics, procedure utilization and latency to procedure were compared, and logistic regression models were constructed to assess the relationship between these variables and in-hospital mortality.
Results: Patient demographics and provider-related characteristics (hospital type, geography) were similar between weekend and weekday admission for myocardial infarction. Adjusted for covariates, we found that the odds of mortality for a weekend admission are 5% greater than for a weekday admission (OR: 1.05; 95% CI: 1.01, 1.09, p=0.009). For the utilization of an invasive procedure, we found that the odds of receiving a procedure for a weekend admission were 12% less than the odds for a weekday admission, adjusted for the other covariates (OR: 0.88; 95% CI: 0.86, 0.91, p<0.001). In addition, we found that the time to procedure was an average of 0.18 days (4.32 hours) longer for weekend admissions compared to weekday admissions (95% CI: 0.16, 0.20, p<0.001). However, we did not observe a significant difference in the overall length of stay for weekend and weekday admissions (0.004 days; 95% CI: -0.04, 0.05, p=0.87).
Conclusion: In a large and diverse subset of patients admitted with myocardial infarction, weekend admission was associated with fewer procedures, increased latency to those procedures, and a non-significant trend towards greater in adjusted in-hospital mortality.
Pourmehran O*, Rahimi-Gorji M, Tavana M, Gorji-Bandpy M and Ganji DD
In natural convection, the fluid motion occurs by natural means such as buoyancy. Heat transfer by natural convection happens in many physical problems and engineering applications such as geothermal systems, heat exchangers, petroleum reservoirs and nuclear waste repositories. These problems and phenomena are modeled by ordinary or partial differential equations. In most cases, experimental solutions cannot be applied to these problems, so these equations should be solved using special techniques. In this paper, natural convection of a non-Newtonian fluid flow between two vertical flat plates is investigated analytically and numerically. Collocation Method (CM) and fourth-order Runge -Kutta numerical method (NUM) are used to solve the present problem. These methods are powerful and convenient algorithms in finding the solutions for the equations. While these are capable of reducing the size of calculations. In order to compare with exact solution, velocity and temperature profiles are shown graphically. The obtained results are valid with significant accuracy.
A preliminary laboratory study was conducted using upflow anaerobic sludge blanket (UASB) reactor to investigate the potential of methane generation from brewery wastewater. Brewery wastewater from a local brewery company was collected and used in the experiments. The experiments were run for 15 days. The rate of methane production was about 5.32 L per kg of chemical oxygen demand (COD) removed per day. The pH reduction in the experimental reactor limited the ability of gas production and is likely the result of the temperature at which the experiments were conducted.
Sameera Singh Deo, Devinder Preet Singh* and Nitya Dogra
The rehabilitation of partially or completely edentulous patients with implant supported prostheses has been widely used, achieving high success rates. However, many studies consider the presence of bruxism as a contraindication for this treatment modality. The purpose of this study was to review the literature and identify risk factors in implant supported rehabilitation planning in subjects with bruxism.The rehabilitation of bruxers using implant supported prostheses, using implants with adequate length and diameter, as well as proper positioning, seems to be a reliable treatment with reduced risks of failure. Bruxism control through the use of a night guard by rigid occlusal stabilization appliance, relieved in the region of implants, is highly indicated. Although it is clear that implant supported rehabilitation of patients with bruxism requires adequate planning and follow-up, well-designed randomized controlled trials are needed to provide reliable evidence on the long-term success of this treatment modality.
Juliana Bassalobre Carvalho Borges, Debora Tazinaffo Bueno, Monique Fernandes Peres, Ana Paula Aparecida Mantuani, Andreia Maria Silva and Giovane Galdino*
<h2>Abstract</h2><p>Systemic arterial hypertension (SAH) is considered an important risk factor for the development of cardiovascular diseases. The aim of the present study was to verify the effects of a short cardiovascular rehabilitation program (CR) in hypertensive subjects. The clinical pilot study involved a sample composed of 11 hypertensive subjects. It was evaluated the weight, height, body mass index (BMI), waist and hip circumference, waist hip ratio, systolic blood pressure (SBP), diastolic blood pressure (DBP) and six-minute walk test (6-MWT) before and after CR. CR was performed twice a week for 60 minutes. The results shown that after CR occurred a reduction of waist circumference (99.86±8.7 to 95.2±8.6 cm, p=0.0002) and hip circumference (110.18±14.75 to 105.00±12.7 cm p=0.01) values. About the mean distance walked in the 6-MWT there was an increase after the CR program (335.9±123.5 m to 554.56±87.9 m, p=0.000). In conclusion, the results suggest that a short CR is an effective for the treatment of hypertensive subjects. After 16 CR sessions, functional and musculoskeletal capacity was improved, evaluated by 6-MWT. Furthermore, the short CR program decreased waist and hip circumferences, being an important option for these subjects. Although. There were no changes in baseline blood pressure levels.</p>
Previous studies suggest that diets with more eggs than is recommended may be used as part of a healthy diet in some countries. However, whether quail egg diets could form part of such diet has not been explored. The aim of the present study is to evaluate the effect of quail egg consumption on serum markers of atherogenesis and hematological parameters in healthy volunteers. Thirty adult subjects participated in this study after ascertaining their baseline health status. They were fed 3 eggs per day and 8hourlyfor 30 days. They were evaluated for serum levels of cholesterol sub-fractions, AIP and hematological parameters at days 0, 10 and 30 after the consumption of quail eggs. At day10, serum levels of cholesterol sub-fractions (TG, HDL-C and LDL-C) were not significantly (p>0.05) different from the corresponding values at baseline. Serum levels of VLDL-C and calculated AIP significantly (p<0.05) decreased compared to the levels at baseline. At day 30, serum levels of HDL-C, TG and VLDL-C significantly (p<0.05) increased, while LDL-C and AIP significantly decreased. Also, total RBC, HB, PCV, MCV, MCH and MCHC were not significantly different from the levels at baseline. At day 30, RBC, PCV and HB significantly (p<0.05) increased compared to the levels at baseline, while MCV, MCH and MCHC were not significantly (p>0.05) different from the baseline values.
Indeed, long-term consumption of quail egg may be associated with improvement in serum markers of atherogenesis and hematological parameters due to its varied nutrient constituents and their activities.
Clowning is a form of humour. It is an art form that invites play, interaction, and laughter. Clown Care is a programme in hospitals and medical centres involving visits from specially trained hospital clowns. Clowning helps patients to focus on something other than their illness. Olsson et al. and Spitzer suggested that clown care could create a warm climate, promote good interpersonal relationships, and relieve feelings of frustration, anxiety, or hostility.Hospital clowns work worldwide as a health humanization resort, providing interplay with patients, family and staff creating a positive emotional state that fosters affirmative environmental conditions. This type of activity varies greatly in terms of professionalism, accountability and artistic methods. Promotion of emotional and psychosocial well-being of patients transcends opportunities for oral health promotion activities in hospitals, schools and community. Previous research reports on clown training reflects attitude-building potential for the healthcare students provided that it is performed in a deep, essential, strict and continuous fashion in a facultative manner rather than mandatory allowing the student to build his own artistic, professional and personal path. Thus, the prospect of introducing training curriculum of this underrated non-technical skill for dental students in Indian dental education system needs to be harnessed.
Management of obstruction of the distal-pelvic ureters by minimally invasive procedures such as antigrade or retrograde double “J” stents has generally been unsatisfactory. Corrective surgical procedures mandate long hospitalization, hence high cost, and have a moderate incidence of complications.
Management of obstruction of the distal-pelvic ureters by minimally invasive procedures such as antigrade or retrograde double “J” stents has generally been unsatisfactory. Corrective surgical procedures mandate long hospitalization, hence high cost, and have a moderate incidence of complications.
Management of obstruction of the distal-pelvic ureters by minimally invasive
procedures such as antigrade or retrograde double “J” stents has generally been
unsatisfactory. Corrective surgical procedures mandate long hospitalization, hence
high cost, and have a moderate incidence of complications.Management of obstruction of the distal-pelvic ureters by minimally invasive
procedures such as antigrade or retrograde double “J” stents has generally been
unsatisfactory. Corrective surgical procedures mandate long hospitalization, hence
high cost, and have a moderate incidence of complications.
Environmental electromagnetic fields are nowadays available in all environments today. These areas affect the biological system. Controlled interactions with elecrtomagnetic fields can have positive effects when unrestricted interactions have negative effects.Uncontrolled exposure to low-frequency electromagnetic fields can cause adverse effects such as signal transduction in cells and tissues, cell membrane structure, ion channels, molecular interactions, DNA damage. But contrary to controlled exposure, it positively affects tissues. The most obvious example of this is seen in the bone and cartilaginous tissue. Repairing fractures and damage in bone and cartilage. This has been shown in many studies. Below is a summary of the relevant information.
Gabriela Mayrink, Paula Ramos Ballista, Laisa Kinderlly, Stella Araujo and Renato Marano*
The indications for impacted third molar extraction include the prevention of dental reabsorption on the adjacent tooth. Resorption can be classified as physiological (when deciduous teeth are exfoliated) or pathological (when caused by injury or irritation to the periodontal ligament). Many causes can trigger external root resorption (ERR), the most common cause of which is orthodontic forces.The most common cases of ERR involve impacted third molars which, due to the lack of space for their eruption, generate a greater chance of ERR on the distal portion of the second molar. This pathology is becoming progressively more frequent in clinical dental care. Periapical and panoramic radiographs are used to aid in diagnosis, as is cone beam computed tomography. In cone beam computed tomography scans, radiolucent areas with irregular gaps are detected; these gaps represent a significant loss of dental material. The objectives of this article were to report a case of second molar resorption triggered by an impacted third molar and to perform a review of the literature on the causes of external root resorption. Ideally, this information will aid dental clinicians (and orthodontists in particular) in understanding the features of this pathology so that they may recommend preventive third molar extraction when necessary.
Diego Abelardo Alvarez Hernandez*, Alberto Manuel Gonzalez Chavez and Alexia S Rivera
Introduction: Necrotizing Fasciitis (NF) is a rapidly progressing, severe suppurative infection of the superficial fascia and the sorrounding tissues that may lead to necrosis, septic shock and death if left untreated. Facial NF is rarely seen and symptoms may be non-specific at the onset and depend on the origin site and the stage of the disease, making it difficult for diagnosis.
Materials and Methods: A systematic review was done following the PRISMA guidance. PubMed database was searched for case reports published between January 2007 and March 2017. Full text articles were obtained and assesed for relevance. Data extraction was performed as an iterative process.
Results: A total of 24 articles, describing 29 adult patients with facial NF were included. Facial NF was more common in males. Skin trauma was the most frequent mechanism of lesion and diabetes mellitus was the most common associated systemic disorder. Periorbital area was the most affected area. In order of appereance, swelling and pain were the most common initial clinical manifestations. Group A Streptococcus was the most frequent microorganism isolated. Advanced airway management was needed in more than 50% of the cases and surgical management was done in 90% of the cases.
Conclusions: Practitioners should be aware of its existance, epidemiology, etiology, risk factors and initial clinical manifestations to develop a high index of suspicion, to order studies that may discard or confirm the diagnosis, and to offer prompt treatment to preserve patient’s life and reduce the disfigurement and disability that it may cause.
Mariusz Dyląg*, Emilia Flisowska, Patryk Bielecki, Maria Kozioł-Gałczynska and Weronika Jasinska
The authors describe the unusual case of subungual onychomycosis, due to fluconazole and itraconazole resistant Candida albicans after using the hybrid and acrylic lacquers and nail tips. The etiology of these atypical changes was supported by isolation of the fungus from the nail lesions, and its consistent identification by means of morphological and molecular diagnosis. In the presented case, topical treatment with ciclopirox 8% nail lacquer allow to fight the pathogenic fungus but did not restore the natural appearance of the nails.
tRNA-dependent amidotransferases (AdT) are essential enzymes for protein biosynthesis in many bacteria and in all archaea. As AdT is essential for a number of pathogenic bacteria, and it is absent from mammalian cytoplasm, it is considered as a putative target for novel inhibitors that could be lead compounds to develop a new class of antibiotics. Besides GatFAB of Saccharomyces cerevisiae mitochondria and GatAB of Plasmodium falciparum apicoplast, all reported AdT can be divided into two groups: heterodimeric GatDE and heterotrimeric GatCAB. The latter is required to catalyze the conversion of Glu-tRNAGln and/or Asp-tRNAAsn into Gln-tRNAGln and/or Asn-tRNAAsn in many pathogenic bacteria. Recently determined high resolution crystal structures of several GatCAB could be used to design new inhibitors. In this review, we highlight the essential role of AdT for the faithful translation of glutamine and/or asparagine codons, we describe important features of the crystal structures of several GatCAB as well as tRNA/AdT/aaRS complexes for the formation of Gln-tRNAAsn and Asn-tRNAAsn, we finally summarize discoveries of AdT inhibitors based on their analogy to glutamine, adesosine tripoliphosphate and 3’-end of tRNA.
The so-called “biotechnological revolution” is changing the structure of the Pharmacopoeia [1]. The space of biological products, previously limited to blood products and vaccines, grew from the introduction of first recombinant therapeutics in the 1980s until attaining a 25% by value of the pharmaceutical market. This share is expected to reach 50% in the coming years. More than 80 biotechnology drugs have entered the market in the last ten years. It is estimated that there are more than 900 biological products on development for more than 100 diseases [2].
Biopharmaceuticals have been used especially in the treatment of chronic diseases such as autoimmunities and cancer, which require long term treatments. Biologicals have an average cost 22 times higher than chemical drugs [3]. The appearance of effective but costly drugs for long treatments is contrary to the goal of gaining access to the best treatments and the goal of achieving wide population coverage. This conflict was already faced 30 years ago with synthetic drugs, and the solution was the introduction of generic drugs, at the moment when the patents of innovators expire.
Interferons are multifunctional cytokines widely used in clinical settings as an anti-viral drug. In addition, interferon’s exhibit anti-cancer and anti-bacterial effects. Nearly two thousand papers related to interferon are published each year, which illustrates the importance placed by researchers on the study of interferon. This review focuses on recent advances in the study of interferon, particularly in the areas of its mechanism of anti-cancer effect and signal transduction. We also describe the tumor resistance to interferon and the side-effect of interferon-based therapy, which leads to an expectation of future research of interferon.
Intraperitoneal vancomycin absorption is higher when there is peritoneal inflammation, but the absorption decreases with recovery from peritonitis. Consequently, intraperitoneal maintenance doses are ineffective, reducing the rate of cure.
Aim:To evaluate the outcome of Gram-positive peritonitis treated with intraperitoneal and subsequent intravenous vancomycin.
Methods: In April 1996, we initiated a protocol for treating peritonitis caused by Gram-positive organisms using a 2-g intraperitoneal loading dose of vancomycin followed by intravenous vancomycin at 1 g twice in 5 days for coagulase-negative Staphylococcus and at 1 g three times in 5 days for Staphylococcus aureus. We analyzed episodes of Gram-positive peritonitis (coagulase-negative and S. aureus) and the efficiency of the treatment protocol in 113 patients undergoing peritoneal dialysis between 1 April, 1996 and 3 August, 2016. There were 6090 patient-months and the mean treatment lasted 54±44 months. The outcomes were evaluated as (1) complete cure, (2) relapsing peritonitis, (3) catheter removal for refractory peritonitis, and (4) death.
Results: A total of 51 cases of coagulase-negative Staphylococcus peritonitis and 37 of S. aureus were seen in 46 of the 113 patients (40.7%). Of these, coagulase-negative Staphylococcus (92.15%) and 34 S. aureus peritonitis (91.89%) resolved.
Conclusion:The response to treatment was very satisfactory.
Lipomas are the most common type of soft tissue tumor occurring in the subcutaneous tissue. Rarely, lipomas present in the deep soft tissue such as intermuscular, intramuscular, and parosteal sites. When they occur within a skeletal muscle they are called intramuscular lipomas. Intramuscular lipomas may involve both children and adults. They are benign, nontender, deep located, circumscribed but unencapsulated lesions. Intramuscular lipomas account less than 1% of all lipomas. Most are located within a single muscle (solitary), while cases involving two or more muscles are very rare. They present with typical histological features. They may be divided into the infiltrative, the well-circumscribed and the mixed type. Differential diagnosis of the infiltrative type from liposarcoma is very difficult. Local recurrence may be evident if the surgical margin is not clear. They can occur in almost any anatomical site [1-15].
Intramuscular lipomas of the head may involve the tongue, which is one of the most commonly involved sites [16-24] or the tongue and the submandibular space [25]. They may also involve the cheek [26], the nose [27], the masseter [28] and the temporalis muscle [29,30]. In the eye the orbicularis oculi muscle and the eyelid [31], the superior oblique muscle [32], the superior rectus [33], the medial rectus in a child [34] have been involved.
Mirek S, Opprecht N*, Daisey A, Milojevitch E, Soudry- Faure A and Freysz M
Chest compression is the fundamental technique in cardiopulmonary resuscitation (CPR) in patients with cardiac arrest [1]. The quality and the early implementation of CPR are essential to improve the prognosis and the chances of restoring spontaneous circulation. In the literature, there are some articles about the poor quality of chest compression [2-4]. Therefore chest compression is as crucial as alerting the emergency services or early defibrillation in the survival chain. In accordance with the guidelines, chest compressions have to be performed continuously to improve the outcome [5]. However, the efficacy of manual chest compression diminishes over time with the fatigue of the provider (which appears within minutes of starting the procedure), and is impaired during transportation manoeuvres, which expose patients to unforeseen interruptions and a deterioration in the quality du massage in terms of power and rhythm. The efficacy of manual chest compression has been reported to fall by 20% per minute [6,7]. Mechanical chest compression overcome this problem of operator fatigue by ensuring constant efficacy in terms of both quality and quantity. Even though current data show no difference between manual chest compression and automated systems in terms of survival, haemodynamic studies in animal models have shown that mechanical techniques are more effective [8].
The principal aim of this study was to evaluate the hemodynamic impact (systolic, diastolic and mean arterial blood pressure) of the LUCAS™ active compression-decompression device (Medtronics® Jolife; Lund, Sweden) as the mechanical chest compression technique versus manual chest compression. The secondary aims were on the one hand to evaluate in a quantitative manner cardiac output and its evolution during mechanical and manual cardiopulmonary resuscitation and on the other hand to evaluate the correlation between cardiac output and other routinely-measured hemodynamic parameters, in particular the EtCO2.
The limits of classical equivalent computation based on time, dose, and fractionation (TDF) and linear quadratic models have been known for a long time. Medical physicists and physicians are required to provide fast and reliable interpretations regarding the delivered doses or any future prescriptions relating to treatment changes. In this letter, we propose an outline related to the different models usable for equivalent and biological doses that are likely to be the most appropriate. The used methodology is based on: the linear-quadratic-linear model of Astrahan, the repopulation effects of Dale, and the prediction of multi-fractionated treatments of Thames.
Lung cancer is the leading cause of cancer-related deaths worldwide, and almost accounts for 20% of these deaths, however, the cure rate is less than 10% [1]. Non-small cell lung cancer (NSCLC) accounts for approximately 85% of all cases of lung cancer [1], but fewer than 15% of individuals diagnosed with NSCLC can survive for more than 5 years, which poses a great threat to the patient’s life and health [2]. Recently, the incidence of lung cancer keeps dynamically growing, but more than 75% of patients at diagnosis has appeared local development or metastasis, missing the best period of surgery. Moreover, despite surgical treatment is the optimal choice for early-stage NSCLC patients, 30%-40% of patients with NSCLC develop tumor recurrence in a short time. Therefore, improving the prognosis of patients with lung cancer and predicting the long-term survival of patients is of particular importance [3]. At present, tumor and node metastasis (TNM) staging system, clinicopathological characteristics, visceral pleural invasion and marginal status are used to predict the disease progression and overall survival of NSCLC patients. There is no index which is stable, effective, reliable and less harmful to assess prognosis, predict recurrence risk and overall survival.
The genesis, progress and metastasis of NSCLC are not only related to the intrinsic characteristics of cancer cells but also to the cancer microenvironment. Systemic inflammation is a promoter of tumor genesis. Cumulative evidence has revealed that tumor-promoting inflammation contributes to cancer growth and progression by creating a tumor-promoting microenvironment, stimulates the proliferation of bronchial stem cells, and triggers the carcinogenesis of lung epithelial cell. Additionally, systematic inflammatory can not only cause tumor growth and promote tumor metastasis by activating type 2 T-assisted response, chemokines, vascular regeneration and others [4], but also responsible for reducing the effect of anti-cancer drugs and cancer-related symptoms including anorexia, cancerous pain, debilitation, cachexia [2]. In total, systematic inflammation has been shown to play an important impact on the pathogenesis and progression of NSCLC and is of great value to the aggravation and prognosis of NSCLC.
Aims and objectives: By reporting the use of therapeutic nursing interventions to facilitate the process of change in a depressive elderly caregiver, this paper seeks to underline the importance of fitting interventions to individual clients.
Background: In assisting families of chronic illness sufferers, it must be remembered that the perceptions and functions of both clients and families are determined by family members, and that changes, if any, are made by those clients and families, rather than by nurses. However, nurses do play an important role in facilitating the process of change.
Design: This is a case report.
Methods: A case study of a depressive elderly caregiver is used to examine the use of therapeutic nursing interventions to facilitate the process of change with problem analysis, case conceptualisation and specific skills employed documented.
Results: The change from one therapeutic approach (Cognitive-behavioural therapy) to another (Narrative Therapy) facilitates enlisting the caregiver’s unique strengths, resources and competence to overcome the difficulties and challenges identified during the process of change. In dealing with depression in family caregivers, nurses should not only be flexible but also remain sceptical in using different approaches, with heightened awareness of the client’s circumstances.
Several experimental studies performed since 1975, using smooth muscles richly innervated by sympathetic nerves to exclude the autonomic influence of adjusting reflex (rodent vas deferens), showed that L-type voltage-activated Ca2+ channels (VACC) blockers completely inhibited neurogenic contractions induced by electrical field stimulation (EFS) in high concentrations (>10-6 M), but paradoxically increased these EFS-contractions in low concentrations (<10-6 M), suggesting that other mechanisms than only autonomic adjusting reflex are involved in these paradoxical effects. In 2013, we showed that these paradoxical effects of L-type VACC blockers, named by us “calcium paradox” phenomenon, were potentiated by drugs which increase cytosolic cAMP concentration ([cAMP] c-enhancers), such as rolipram, IBMX and forskolin, indicating that this sympathetic hyperactivity drug-induced is due to interaction of the Ca2+/cAMP intracellular signaling pathways (Ca2+/cAMP interaction). Then, the pharmacological manipulation of this interaction produced by combination of the L-type VACC blockers used in the antihypertensive therapy, and [cAMP] c-enhancers used in the antidepressive therapy, could represent a potential cardiovascular risk for hypertensive patients due to sympathetic hyperactivity. Then, we discussed the role of Ca2+/cAMP interaction for antihypertensive pharmacotherapy.
Wolfgang Freund*, Frank Weber, Reinhard Meier and Stephan Klessinger
Background: Low back pain has recently been reported as the leading cause for disability worldwide. The diagnostic value of imaging has been estimated low. Led by own positive experience, however, we hypothesized that MRI can detect signs of facet joint pain.
Methods: 15 patients and 15 controls were retrospectively assessed by two readers. They compared de-identified T2 weighted lumbar spine MRI scans. Facet joint size, shape, angle, joint space signal and degeneration were rated. Pain aetiology was proven with the diagnostic gold standard of medial branch blocks.
Results: Facet joint angles and joint diameters were significantly larger in symptomatic patients, who also showed significantly higher grades of degeneration but no difference in joint space distances or shape or signal intensity.
The readers were able to correctly identify symptomatic patients with good interrater reliability (kappa 0.5, sensitivity and specificity 0.87-0.93), positive (LR+= 6.7-7.2) and negative likelihood ratios (LR-=0.15).
Conclusion: Contrary to recent publications, we could demonstrate differences between asymptomatic and symptomatic subjects showing the latter to have larger joints and more signs of degeneration.
One can conclude from the strong LR+ and LR- values that MRI is a useful investigation to rule in or rule out facet pain.
Marie-Eve Lamontagne, Kelly P Arbour-Nicitopoulos, Jennifer R Tomasone, Isabelle Cummings, Amy E Latimer-Cheung and François Routhier*
<h2>Abstract</h2><p><strong>Background:</strong> SCI Action Canada partnered with researchers to adapt an evidence-based leisure-time physical activity (LPTA) counselling service (Get-in-Motion (GIM). A satellite GIM service called Passez à l’action was established within a French-speaking context for persons with physical disabilities. An understanding of the determinants that influenced the implementation and functioning of the GIM service within the Adaptavie context are required to maximize the potential of other community-based LTPA services being successfully introduced in similar organizations.</p><p><strong>Purpose: </strong>The case study objectives are to: 1) describe the characteristics and implementation contexts of two leisure-time physical activity counselling services for Canadians with a physical disability and the adoption process that took place when the protocol was translated to a new context, and 2) elucidate, from the point of view of the service providers, the organizational determinants that could have facilitated and/or hindered the implementation and functioning of these services.</p><p><strong>Methods: </strong>Guided by the Consolidated Framework for Implementation Research, focus groups were held with the directors and staff of each service. Mixed-content and thematic analyses were then used to determine overarching themes.</p><p><strong>Results: </strong>Findings suggest that the presence of service innovators fosters ownership of the service and facilitates ongoing staff training and support. A thoughtful implementation plan should be included as a component of translation between contexts.</p><p><strong>Conclusions: </strong>Lessons learned and recommendations for future translation of similar evidence-based services to additional contexts are discussed.</p>
The recent introduction of the miniscrew in orthodontics revolutionized the clinical and biomechanical approach of anchoring. Used as direct or indirect anchoring, the orthodontic micro screws indications field is expanding due to their easy insertion, and their immediate loading ensuring an absolute anchoring.Our objective through this clinical case is to show the effectiveness of these miniscrews in the correction of the uncontrolled loss of anchoring.
Ilija Christo Ivanov*, Jan Dupej, Sarka Bejdova, Veronika Ciganova, Dagmar Strakova and Tatjana Dostalova
Objectives: The aim of the study was to develop a mathematical model for the visualization and evaluation of transversal palatal soft tissue changes; and to carry out a statistical evaluation of the changes in vertical and sagittal dimensions after rapid maxillary expansion treatment.
Material and Methods: 33 Caucasian children with posterior crossbite, 10 boys and 23 girls, aged 7 to 10 years (median 8 years 8 months) were treated with tooth-borne Haas type expander. Dental casts were digitalized by scanner and on the basis of quantitative mesh shape CPD-DCA analysis, coloured morphometrical maps were created. The statistical significance of individual vertex displacements was calculated by performing Hotelling’s T2 paired test. To determine the significance of the vertical and sagittal profile changes, the paired t-test and Wilcoxon signed rank test were carried out in 20 patients
Results: Visualization of the palatal soft tissue widening showed it to be greatest in the areas of the second deciduous and first permanent molars with maximum of 0.75 mm for each palatal side. Hotelling’s T2 paired test showed significant differences of p<0.01 in transversal width dimension. Cephalometric measurements of the changes to vertical and sagittal dimensions were statistically evaluated using the Wilcoxon and paired t-tests, and were shown to have insignificant values of p>0.05.
Conclusion: The expansion appliance in children resolved the crossbite and led to palatal widening, which was clearly visualized by creating mathematical morphometric models. The cephalometric measurements carried out did not reveal statistically significant relevance in changes to facial vertical or sagittal dimensions.
Fabio Dentale*, Ferdinando Reale, Angela Di Leo, Eugenio Pugliese Carratelli and Marina Monaco
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.
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%.
Objectives: Care of a person with schizophrenia involves multiple problems, possibly leading to burnout which is a culturally influenced phenomenon. The aim of this study was to investigate burnout and related factors in caregivers of outpatients with schizophrenia.
Methods: Subjects included in the study were 40 primary caregivers of outpatients with schizophrenia (15 males, 25 females) whom were assessed with the Maslach Burnout Inventory (MBI), the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI). Patients were also administered the Calgary Depression Scale (CDS). Also, sociodemographic information about patients and their caregivers were taken. The significance of differences between two groups was determined by Mann-Whitney U-test. The relationships between the variables were evaluated by Pearson correlation analysis.
Results: No significant difference was found in the MBI subscale scores in terms of caregivers gender, marital status, and education, being a family member, having enough information about the illness and taking support during caregiving. Emotional Exhaustion and Personal Accomplishment subscale scores of the caregivers were significantly different in terms of patients’ adaptation to treatment or not (respectively; p=0.010, p=0.030). The MBI-Emotional Exhaustion scores revealed significant positive correlations with the BDI and BAI total scores. Also, the MBI- Depersonalization scores and the BAI scores were positively correlated.
Conclusions: Burnout levels in caregivers of patients with schizophrenia were lower when compared with other cultures. Only treatment compliance predicted burnout, while other factors were excluded. Therefore, professionals have to help to patients primarily adapt to their treatment.
Martín Arnau B*, Medrano Caviedes R, Rofin Serra S, Caballero Mestres F and Trias Folch M
Morgagni hernia represents 2-4% of congenital diaphragmatic hernias. Only one-third of them are symptomatic, due to the hernia of abdominal viscera in the thoracic cavity, causing respiratory and digestive problems, some of them serious ones, such as intestinal obstruction. Acute presentation with incarceration of the contents is rare; there are only 7 cases described in the literature.
We are presenting a case of diaphragmatic hernia that began with obstruction of the colon and secondary ischemia, requiring emergency surgery in two phases: first surgery to control the damage, with an open right hemicolectomy, and then later surgery to repair the hernia and perform bowel transit reconstruction, with proper postoperative evolution and no evidence of relapse.
The treatment of Morgagni diaphragmatic hernia is surgical. Also in asymptomatic cases, due to the risk of incarceration, the most appropriate way to enter is abdominally, whether by way of laparotomy or laparoscopy, for the reduction of the contents of the hernia sac, the repair of the defect, as well as the performing of associated techniques on herniated viscera, as occurred in our case.
A complicated congenital hernia is an infrequent pathology, and there is little experience in handling it. Acute presentation requires a combined treatment of the abdominal symptoms and repair of the hernia defect. The carrying over of surgical techniques for damage control into non-traumatic surgery in the face of serious hemodynamic instability is a widespread, accepted practice with the benefits of reducing mortality in critical patients and at times allowing the avoidance of ostomies.
Fatih Oghan*, Muhammet Fatih Topuz and Onur Erdogan
Introduction: Primary infection with varicella-zoster virus (VZV) results in chickenpox, characterized by viremia with a diffuse rash and seeding of multiple sensory ganglia, where the virus establishes lifelong latency. Herpes zoster is caused by reactivation of latent VZV in cranial-nerve or dorsal-root ganglia, with spread of the virus along the sensory nerve to the dermatome. Both entities have a benign clinical course in immunocompetent and young individuals. Although Herpes zoster virüs may result in Ramsey Hunt sendrom, it may rarely cause peripheral facial paralysis in the course of varicella.
Case report: A 4-year-old girl patient was admitted to the ear, nose, and throat clinic with a complaint of a rash over the body with vesicles and pustules a few days. She had left peripheral facial palsy about 2 days ago. In a general clinical examination, a few macular lesions, probably residues of vesicles, and fluid-filled blisters and pustules were observed on the back, chest, abdomen, upper, and lower limbs. She had remarkable left peripheral facial palsy. Her facial palsy was assessed as a grade II using the House-Brackmann Score. Otoscopic examination was normal and otalgia and auricular vesicle was absent. 1 mg/kg/day prednisone and 30 mg/kg/day acyclovir therapy were given to the patient due to the peripheral facial nerve palsy involvement of the VZV infection. Complete remission was achieved at 1 month after treatment.
Conclusion: Varicella-zoster virus (VZV) is one of eight herpes viruses known to cause human infection and is distributed worldwide. While the results of bell palsy are good, facial paralysis results during viral infections are severe. Cranial nerve involvement secondary to viral infection should be followed closely. The current standard of care for treatment is acyclovir and prednisone. Thus early treatment can be started in the face of developing complications and possible mortality and morbidity can be prevented.
Suhail Amin Patigaroo*, Zubair Ahmad Lone, Quratul Ain Batool and Sajad Majid Qazi
Introduction: Carotid space is a deep neck space within the carotid sheath. .Mosher called carotid sheath as the Lincoln Highway of the neck. Abscess in this space is rare to be seen by young Ear, Nose and Throat (ENT) surgeons in this era of early diagnosis and good antibiotics. We are reporting a case of isolated carotid space abscess in a 20 year old male to familiarize young surgeons with this abscess.
Case report: A 20 year old young boy came to our Outpatient Department (OPD) with complaints of fever, painful neck swelling, progressive difficulty in swallowing from the last 7 days. Contrast Enhanced Computed Tomography (CECT) was done which revealed abscess located adjacent to carotid artery in the carotid sheath. Incision and drainage was done and carotid sheath was opened and pus drained .Patient was discharged after few days on oral antibiotics.
Conclusion: Carotid space abscesses are rarely seen in developed countries. Tender and fluctuating swelling over the carotid artery area points towards it. CECT is the investigation of choice. Needle aspiration should be avoided especially by less trained persons. Small abscesses may respond to intravenous antibiotics but when frank and large abscess is formed, incision and drainage is the treatment of choice.
Introduction: Several treatment options are available for the optimal treatment for orbital fractures, depending on aesthetic and functional results after orbital wall reconstruction.The objective of this study is to compare the effect and safety of large orbital floor fractures with titanium mesh combined with poly-L-lactic acid/polyglycolic acid copolymer implants (Lactosorb®) vs. autologous costochondral graft. A wide range of permanent and biodegradable materials have been used successfully for orbital floor reconstruction, however they present with disadvantages for reconstruction of large defects, even if combined.
Patients and Methods: A retrospective cohort study of patients from Estado de México, México, with access to ISSEMYM health care service, presenting with orbital floor fracture treated at Department of Plastic & Reconstructive Surgery/Maxillofacial Surgery at ISSEMYM Medical Center Toluca between January 2007 and July 2010. Age, sex, etiology, clinical findings, fracture pattern, and treatment modality (Titanium mesh with absorbable implant vs. costochondral graft) were considered. Predictor and outcome variables as complications, inpatient, trauma- surgery interval, surgical time and donor site pain are considered.
Results: Follow up of 21 patients (12 weeks) 17 male, 4 female, ages 22-63 was made. Enophthalmos, main objective of this study, was identified with statistical significance presenting 0% (n=0) post-op Group B patients and 30% (n=3) for Group A (p=0.049). Statistical significance was found referring to inpatient days between two groups being less for costochondral reconstruction patients (p=0.02). No pain in patients undergoing alloplastic surgery. An interesting result was that donor area analogue pain scale for costochondral graft was 2.9/10.
Conclusion: Surgical outcome and complications where evaluated comparing different materials for orbital floor reconstruction. Costochondral graft is a suitable choice when orbital reconstruction is indicated.
Antiphospholipid syndrome may present in various ways from cutaneous manifestation, obstetric complications, neurological manifestation, and cardiac manifestation to renal involvement. There are many cardiac complication of anti-phospholipid syndrome, among them are valvular dysfunction, pulmonary hypertension, myocardial infarction, intracardiac thrombi, and ventricular dysfunction [1]. The most common cardiac manifestation is valvular abnormalities ranging from 11.6-32% [2-5].
Cardiac thrombus is an important sequela of APLS. In general, the exact mechanism of intracardiac thrombus formation in APLS is unclear. Julio and Carmen suggested that the endocardial surface might be an important site for thrombus formation in patients with circulating aPL, because these antibodies, in the presence of other hemostatic defects, will abolish the balance between thrombosis and fibrinolysis, and might change the endocardial surface factors so that clot formation is promoted [6]. Coppock, et al. Speculated that an abnormal intracardiac blood flow pattern might contribute to thrombosis [7], and Kaplan, et al. hypothesized that diffuse ventricular dysfunction might predispose to the formation of intracardiac thrombus [8].
Intracardiac thrombosis is a potentially life threatening as it can cause pulmonary and systemic embolic events; however, it is treatable condition. 50% of APLS patients are at risk of developing recurrent embolic events [9], so there must be a delicate balance between this event as well as risk of bleeding from anticoagulation.
Other cardiac manifestations that has been reported to be associated with APLS are valvular lesions, pseudoinfective endocarditis, myocardial infarction, cardiomyopathy and pulmonary hypertension [10].
Valvular lesions has been reported in SLE and APLS patients. Recently; a prospective cross sectional study done showed that positive anticardiolipin, lupus anticoagulant and anti-beta 2 glycoprotein were associated with mitral valve regurgitation; thus the need to perform transthoracic echocardiogram for early detection and management plan even in asymptomatic patients [11]. APLS may also be presents with Libman-Sacks endocarditis which may occur with a prevalence of 11% in SLE. Recently, Kotkar reported on a APLS patient with pulmonary edema with Libman-Sacks endocarditis who required mitral valve replacement [12].
Myocardial infarction occurs in 5% of aPL positive patients [10]. The presence of LA and IgG anticardiolipin antibodies at medium or high titers helps to identify APLS patients at risk for thrombosis. A research done in Tel Aviv University among 214 patients showed that 6.9% with acute myocardial infarction has elevated antiphospholipid antibodies. Three out of 7 of them did not have risk factors of Ischaemic heart disease [13]. Young patients with vascular thrombosis and myocardial infarction with normal coronaries should be investigated for APLS [14].
Cardiomyopathy as a primary cause from APLS may be difficult to diagnose in a patient with multi-organ involvement. However, Antiphospholipid antibodies may be a useful marker. Leung et al reported that 4 out of 5 patients with isolated left ventricular dysfunction had +ve aPL. The presence of aPL were significantly associated with left ventricular dysfunction [15].
With regards to the management, aggressive treatment of all risk factors and liberal use of folic acid and vitamin B has been advocated. The use of hydroxychloroquine has been shown to have cardioprotective effect as it has suggested that it has anti-atherogenic effects [16,17]. Generally, the treatment for myocardial infarction, pulmonary hypertension and valvular disease are similar as those without APLS.
For APLS patients with thrombotic events, the duration of treatment is according to the patient’s clinical situation and the size, shape, and location of the thrombus. Lifelong warfarin may be an option in the presence of underlying cardiomyopathy which may predispose to further intracardiac thrombosis. A randomized clinical trial done comparing high intensity warfarin (INR 3.0-4.0) versus conventional antithrombotic therapy for the prevention of recurrent thrombosis in patients with antiphospholipid syndrome showed that high intensity warfarin was not superior and is associated with increased risk of minor hemorrhagic complications [18]. A current review states that for patients with definite APLS with first venous thrombotic event, prolonged use of anticoagulation to maintain target INR of 2.0-3.0 is recommended. For those with arterial thrombosis, proposed therapies include: anticoagulation with target INR 3.0-4.0; antiplatelet therapy alone; anticoagulation with target INR 2.0-3.0, or combination of antiplatelet or anticoagulation therapy with target INR 2.0-3.0 [19].
This manuscript illustrates the various cardiac presentations of APLS. The occurrence of thrombotic phenomena, especially in young patients without risk factors, should prompt further investigation towards APLS, i.e. aPL antibodies. Estimation of aPL in cardiological practice assumes considerable importance today.
Farzad Najafipour*, Farshad Najafipour, Mohammad Hassan Majlesi and Milad Darejeh
Introduction: Ankle sprain is a widespread impairment in sport groups; this impairment leads to an absence from the workplace. The ankle sprains incidence rates are induced by height, weight, BMI, physical fitness, level of match, classification of sport, and personal exposure to sport.
Methods: A longitudinal case-control study was executed to verify the outcome of risk factors for ankle sprain at a Military Male School between 2012 and 2013 of 4987 people at risk for ankle sprain, a total of 234 cadets sustained new ankle sprains during the study, 432 non-injured cadets randomly selected as the control group.
Results: Regarding to the total people at risk in our study the incidence rate was approximately 5/1000 ankle sprain-years. Cadets with ankle sprains had higher weight, BMI and higher scores in Army Physical Fitness test than the control group. Ankle sprain occurred most commonly during athletics (51.4%). Ankle sprain incidence rate did not significantly vary from different athletic competitions after controlling for athlete-exposure. Soccer and Ball Games had the highest ankle sprain incidence rate.
Conclusion: Higher weight, increased BMI, greater physical conditioning and athlete exposure to selected sports were all risk factors for ankle sprain.
Guilherme M. Cesar*, Chase M. Pfeifer and Judith M. Burnfield
<h2>Abstract</h2><p>Time-efficient screening of lower extremity biomechanics to identify potential injurious movement patterns is crucial within athletic medicine settings. When considering biomechanical risk factors for anterior cruciate ligament injuries, several screening tests have been used to assess dynamic knee valgus. Current methods involving 3-dimensional motion capture systems are considered gold standard for such assessment; however, these methods are time consuming and require expensive materials. This study investigated the use of 2-dimentional kinematic evaluation during a standardized vertical jump athletic assessment to screen for potential lower extremity risk of injury. 50 collegiate athletes, 25 male and 25 female, from various sports participated in the study. The vertical jump was chosen because it is a common performance evaluation test that is regularly performed several times a year, providing consistent opportunities for screening while not creating additional obligations for the student athletes. Results showed that the 2-dimentional evaluation method had strong correlations (P<0.0001) with the gold standard 3-dimensional evaluation, suggesting that an accelerated 2-dimentional screening process can be used as a first step to screen for potential injurious lower extremity movement patterns.</p>
Gabriele Cioni*, Rossella Marcucci, Rosanna Abbate and Giovanna D’Alessandri
Introduction: Lipoprotein (a) [Lp(a)] is a marker for cardiovascular disease, involved in pathogenesis and progression of atherosclerosis. In selected high-risk patients, lipoprotein-apheresis could optimize secondary prevention and improve prognosis.
Aim: We presented the case of a 49-year-old man with high lipoprotein (a) levels and recurrent cardiac adverse events, despite maximal pharmacological therapy.
Case report: Four years before the admission at our Centre, he presented an anterior STEMI, treated with angioplasty and implantation of a drug eluting stent on left anterior descending artery, at the age of 47 years, in September 2012; one month later, the patients presented a new episode of angina, and exams showed a critical stenosis in the right coronary artery, treated by angioplasty and implantation of drug eluting stent. Because of high Lp(a) plasma levels, patient was subsequently on regularly 7-10 day lipoprotein apheresis.
Results and discussion: A thrombophilic screening was performed, showing the simultaneous presence of heterozygous V Leiden mutation and prothrombin G20210A mutation. He referred to our Centre in order to optimize therapy; we performed an endothelial function assessment showing a severe dysfunctional pattern.
Because of these findings, we prescribed dual antiplatelet therapy, and we added omega-3 fatty acids and association with nicotinic acid/laropiprant. According with current guidelines, considering the high risk of bleeding, we preferred not to administer anticoagulant therapy. At 6-month and 1-year follow up the patient continued lipoprotein apheresis and was asymptomatic for other cardiovascular events.
Conclusions: The assessment for the eventual presence of thrombophilia might become a useful tool in clinical practice for high-risk selected patients.
Giuseppe Angelico*, Eliana Piombino, Giuseppe Broggi, Fabio Motta and Saveria Spadola
Rhabdomyosarcoma is a soft tissue pediatric sarcoma composed of cells which show morphological, immunohistochemical and ultrastructural evidence of skeletal muscle differentiation. To date four major subtypes have been recognized: embryonal, alveolar, spindle cell/sclerosing and pleomorphic.All these subtypes are defined, at least in part, by the presence of rhabdomyoblasts, i.e. cells with variable shape, densely eosinophilic cytoplasm with occasional cytoplasmic cross-striations and eccentric round nuclei. It must be remembered, however, that several benign and malignant pediatric tumours other than rhabdomyosarcoma may exhibit rhabdomyoblaststic and skeletal muscle differentiation. This review focuses on the most common malignant pediatric neoplasm that may exhibit rhabdomyoblastic differentiation, with an emphasis on the most important clinicopathological and differential diagnostic considerations.
Jolanta Floryszak-Wieczorek and Magdalena Arasimowicz-Jelonek*
In this study we proposed carbonic anhydrase (CA) asan important element of basal resistance during the potato (Solanum tuberosum L.)-Phytophthora infestans interaction.We found a different β-CAexpression pattern in incompatible vs. compatible systems correlated in time with CA enzyme activity.Resistant potato leaves supplied with dorzolamide (an inhibitor of carbonate CA activity) and challenged with the pathogen showed an elevated nitric oxide (NO) synthesis, which was the most evident during the early phase of NO burst (at 3 hpi) during hypersensitive response (HR). In vitro application of dorzolamide and effective inhibitors of NO synthesis confirmed the implication of CA activity in NO metabolism during potato defense. To clarify how suppression of CA carbonate activity translates into the complexity of NO-related responses leading to potato resistance or susceptibility to an oomycete pathogen we analysed expression of NPR, PR1, and PAL.
Taken together, pharmacological damping of CA activity revealed a functional link between CA and NO-dependent signaling in potato defense against P. infestans manifested by accelerated NO formation and a modified salicylic acid defense pathway. The dorzolamide-mediated effective responses for basal resistance also delayed symptoms of late blight in the susceptible potato cultivar, without overcoming HR formation in the resistant one.
<h2>Introduction</h2><p>Most patients with anterolateral ankle pain report some history of trauma as the precipitating event. In the majority of cases of anterolateral ankle pain with no history of trauma the cause is proliferative synovitis, especially in the area of the anteroinferior tibiofibular ligament [1,2]. Our case report is about a patient with anterolateral ankle pain and snapping, with no history of trauma, caused by an abnormal peroneal tertius muscle belly. We have found only one similar case reported in the literature [3]. That particular case was treated with arthroscopic resection, which requires specialist arthroscopic skills. In our case we have done an open resection, which can be safely performed by most surgeons.</p>
<h2>Abstract</h2><p><strong>Introduction:</strong>Acupuncture is a practice that has been used to treat multiple medical conditions for thousands of years and is one of the most popular alternative treatments applied in Western medical practice. Acupuncture is a modality that has significant potential for further integration into the treatment of sports medicine conditions.</p><p><strong>Methodology</strong>: The search strategy in this review included electronic databases-MEDLINE, Cochrane Library, PubMed, Web of Science, and Science Direct. Randomized controlled trials and systematic reviews were preferred for article inclusion, but other study types were included when the number or quality of evidence was limited.</p><p><strong>Results</strong>: Back pain, neck pain, shoulder pain, and knee pain related to OA tend to respond well to acupuncture treatment. There is evidence to support the use of acupuncture for the short-term treatment of plantar fasciitis, although long-term efficacy data is lacking. Acupuncture may be a useful treatment modality for epicondylitis and Achilles tendinopathy, but the current data is limited. While acupuncture may improve athletic performance and prevent Delayed-Onset Muscle Soreness (DOMS) symptoms, there is little current evidence to support this use.</p><p><strong>Conclusion</strong>: Further studies are needed to assess the usefulness of acupuncture in sports medicine. However, there is good evidence for the current use of acupuncture in treatment of multiple pain conditions.</p>
Arlene Silverio, Scott Briggs, Lisena Hasanaj, Jeffrey Hurd, Jr, Max Lahn, Liliana Serrano, Lucy Cobbs, Jenelle Raynowska, Rachel Nolan, Joel Birkemeier, Dennis Cardone, Steven L Galetta and Laura J. Balcer*
<h2>Abstract</h2><p>Identifying concussion and initiating removal from play is challenging for even the most diligent youth sports organizations. Empowering parents to implement removal from play protocols and sideline testing may be the most practical plan at community levels to protect young athletes. We developed paradigms for community-based youth sports teams that incorporated both standard concussion protocols and research investigations. The research studies were designed to determine how sideline tests of vision, cognition and balance augment the capacity for parents and other responsible adults to identify youth athletes with concussion in ice hockey, football, lacrosse and cheerleading. Research-based sideline tests were performed at pre-season baseline sessions and during the season at the time of injury or as soon as symptoms were recognized by trained volunteer parent team testers. The combination of standard concussion protocols and research studies were performed for 510 athletes, aged 5-17 years, over 2.5 years through 5 athletic seasons. To implement the protocols and studies, approximately 80 student volunteers and parents were educated and trained on early concussion recognition and on baseline and sideline test administration. Over 80% of parent-identified head injuries were physician-confirmed concussions. Of the sideline tests performed, over two-thirds were administered within 24 hours of injury; the rest were performed within an average of 2.6 days post-injury since some athletes had delayed development of symptoms. Removal from play guidelines and standard concussion evaluation protocols were maintained in the context of the sideline testing research investigations. Based on this observational study, parents of youth athletes can be successfully empowered to perform rapid sideline tests in the context of existing concussion protocols. Implementation of objective testing may improve concussion identification and shift the culture of advocacy and responsibility towards parent groups to promote safety of young athletes. Ongoing investigations will further examine the impact of these programs on concussion management in youth sports.</p>
Farahnaz Fallahian* and Seyed MohammadReza Hashemian*
Seizure is clinical manifestation of sudden disruption of the normal electrical activity of cortical neurons. The brain electrical activity is periodically disturbed, alteration in neural cell integrity, increase in firing impulses and spread to adjacent normal neurons result in temporary brain dysfunction with alterations in consciousness, behavior or motor function. It may be triggered by illness, infection, stress, stroke, brain tumor, or the underlying cause may not completely understand. Status epilepticus (SE) is a medical emergency and requires prompt diagnosis and treatment. Treatment includes general support measures, drugs to suppress epileptic activity and relieving the underlying condition. Refractory SE requires admission to an intensive care unit (ICU) to allow adequate monitoring and support of respiratory, metabolic and hemodynamic functions and cerebral electrical activity. For SE treatment, benzodiazepines are the first line antiepileptic agents, and if benzodiazepines fail to control seizures, Phenytoin is usually indicated; Phenobarbital or Valproate may also be considered. For refractory SE, Propofol and Thiopental represent first line agents after careful assessment of potential risks. In refractory SE, general anesthesia may be required. There is currently no unique consensus for definite treatment option of RSE. In this review, the management protocol of seizure, assessment, monitoring, and different alternative therapy would be discussed.
Siriporn Hirunpat*, Nat Wimolsiri and Nuttha Sanghan
Purpose: To determine the normal value of basal angle measured using the modified MR imaging technique in Thai population compared with the standard value obtained from the Western population.
Material and Methods: We retrospectively evaluated midline sagittal SE T1 weighted MR images in 200 adults and 50 children. The basal angle of the skull base was measured using the modified MR imaging technique described by Koenigsberg et al. The angle was formed by a line extending across the anterior cranial fossa to the tip of the dorsum sellae and another line drawn along the posterior margin of the clivus. The mean values of the basal angles among different age groups and sex were calculated and analyzed.
Results: The mean skull base angle of our adult population was 115° (range 100.5°-130°, SD=5.7) with an inter-observer agreement of 0.85, slightly smaller than the previous study from the USA which was 117°. There was no significant difference between the male and female groups. The mean skull base angle in our children population was 114.7° (range 102- 130.5°, SD=6.3) with an inter-observer agreement of 0.89, quite similar to the previous USA study which was 114°. There was no significant difference between adult and children.
Conclusion: The mean adult skull base angle measured using the modified MR imaging technique in Thai population was slightly smaller than the Western population, while the mean skull base angle of children was quite similar. The basal angle range of 103.6°-126.4° may be used as a guide for the potential range of normal skull base angles in Thai population and possibly also the Southeast Asian population.
Vinay V Umale, Kamlesh Singh, Aftab Azam, Madhvi Bhardwaj and Rohit Kulshrestha*
Aim: To evaluate sexual dimorphism in horizontal lip position in adults with different skeletal patterns.
Material and Methods: The sample comprised of 120 patients (Females 18 years and above, Males 21 years and above) with no history of previous orthodontic treatment or functional jaw orthopaedic treatment. They were divided into different groups based on the ANB angle and gender. Group I and II included 30 males and 30 females with skeletal class I malocclusion (ANB 0-4 degree). Group III and IV included 30 males and 30 females with skeletal class II malocclusion respectively (ANB above 4 degree).
Results: When comparison between males and females (Class I+Class II) was done S-line (p<0.001), B-line (p<0.001), E-line (p<0.001), Holdaways angle (p<0.001) and Merrifield angle (p<0.001) were found to be statistically significant. S-line (p<0.001), E-line (p<0.001) and Holdaways angle (p<0.001) were found to be statistically significant when comparison was done between males and females (Class I). When comparison was done between males and females (Class II) only Holdaways angle (p<0.001) showed a significant statistical difference.
Conclusion: Sexual dimorphism was found in various lip parameters. Significant amount of differences were found between Class I and Class II (male and female) subjects.
Objectives: The role of perioperative hemofiltration (HF) in adult patients with impaired renal function undergoing cardiac surgery is controversial. There are suggestions that it may be beneficial for high risk patients undergoing prolonged cardiopulmonary bypass (CPB) surgery. However, long term outcomes in coronary artery bypass graft (CABG) surgery patients have not been investigated.
Methods: To address this we retrospectively followed 7620 patients who underwent CABG between April 2001 and March 2006. Logistic regression was used to risk adjust in-hospital outcomes. Cox proportional hazards analysis was used to risk adjust Kaplan-Meier freedom from death curves. Outcomes were adjusted for American Heart Association and American College of College of Cardiology recommended variables.
Results: 113 patients had intraoperative HF, 38 had postoperative HF and control group of 7006 that had no HF. After adjusting for differences in case-mix, patients with preoperative kidney disease who received postoperative HF proportionately had significantly higher rates of hospital deaths as compared with intraoperative HF patients. In addition, 5-year follow-up risk-adjusted freedom from death indicated significant differences between intraoperative HF group and postoperative HF patients.
Conclusions: These findings support the hypothesis that after adjusting for differences in case mixes, the use of intraoperative hemofiltration may offer superior short term clinical outcomes and longer-term survival benefits for patients with preoperative kidney disease.
Wellington Luiz de Oliveira Da Rosa, Lucas Pradebon Brondani, Tiago Machado Da Silva, Evandro Piva and Adriana Fernandes Da Silva*
Background: A cracked tooth may be challenging for dentists because it may present with varied intensities, may be asymptomatic, and may still not be clinically visible. The transilumination method can facilitate diagnosis and ensure appropriate treatment in such cases. The aim of the present article wasto report a clinical case of an anterior cracked tooth with a nonesthetic class IV restoration.
Clinical considerations: A 22-year-old male patient with chief complaint of esthetics of upper front tooth reported a history of dental trauma. Transilumination with a dental curing light unit was used to examine the region. The tooth 11 was diagnosed with several cracks and a nonesthetic class IV restoration. For repair, the universal adhesive system Scotchbond Universal was applied without previous acid etching, followed by the application of Filtek Z350 of color type B2 (for body) above the old restoration, taking care to slightly overlap the fracture line with the composite and to not extend the composite until the incisal margin. Subsequently, a thin layer of Filtek Z350 of color type B2 (for enamel) was applied over the bevel until the incisal margin, and the tooth shape was carved.
Conclusion: This case report demonstrates simplified diagnosis of an anterior cracked tooth with transilumination; following repair, the esthetic quality of the restoration was considered satisfactory and approved by the patient.
Angelo Michele Carella*, Teresa Marinelli, Armando Melfitano, Michele Di Pumpo, Matteo Conte and Angelo Benvenuto
Ginseng extracts are often used as adaptogen to improve mental performances and well being, helping to overcome stress. Thus, in our times a lot of ginseng extracts are continuously produced and sold into commercial channels. Both Asian and Korean red ginseng (Panax ginseng) and American ginseng (Panax quinquefolius) are the most extensively used and researched.Both Panax ginseng and Panax quinquefolium contain different types of saponins, also known as ginsenosides, which are the substances that give ginseng medicinal properties. Human and animal studies showed that ginseng extracts can also have hypoglycemic effects. The mechanisms by which ginseng reduces blood glucose levels are unclear; some mechanisms have been proposed to explain its hypoglycemic effect, especially modulating effects on insulin sensitization and/or insulin secretion and regulating actions on digestion and intestinal absorption. We describe a case of hypoglycemia by ginseng in type 2 diabetic patient treated with oral hypoglycemic agents. Although, in order to provide better assessments of a sure anti-diabetic efficacy of ginseng, larger and longer randomized controlled clinical trials will be required, in our case we think that we have enough evidence to believe that the cause of hypoglycemia was ginseng. Obviously, this report should not be taken as a proof of the hypoglycemic effect of ginseng, nor it wants to be a suggestion to use ginseng in the treatment of diabetes; instead, it wants to be an alert for patients and clinicians to avoid hypoglycemia in daily clinical practice.
The objective of this study is to determine prevalence of alcohol-substance use among university students, and to investigate the correlation between the childhood abuse, suicide probability and anger expression styles in students who have drinking problems. A survey was carried out among randomly selected students from the Faculty of Education in Baskent University in Turkey. Study sample consists of 399 university students. Childhood Trauma Questionnaire (CTQ), Trait Anger and Anger Expressions Scales (T-Anger-Anger EX), and Suicide Probability Scale (SPS) were used. The CAGE questionnaire was applied to identify the problems of alcohol use. Probable presence of an alcohol use disorder is indicated by a score of 1+, whereas a score of 2+ was taken as the cut-off point for assessing presence of clinically significant alcohol use problems. Data were analyzed using with t test and multiple binary logistic regression. Of the whole sample 36.9% reported that they had ever tried drinking alcohol. The overall prevalence of alcohol use problems according to CAGE 1+ was 14.4% and CAGE 2+ was 7.3%. Sexual abuse and Anger-In were predictors of CAGE 1+, suicide probability was predictor of CAGE2+. Childhood trauma experiences especially, sexual abuse, suicide probability, trait anger, the anger expressed inside and outside were main factors to identify alcohol use problems. Professionals and parents must pay attention to childhood traumatic experiences, suicide and anger expression styles in youths with alcohol use problems.
Depression is a psychiatric disease resulting mainly by dysfunction of serotoninergic and monoaminergic neurotransmission in central nervous system (CNS). Due to the multifaceted nature of depression and our limited understanding on its etiology, depression is difficult to be treated with currently available pharmaceuticals. Then, new therapeutic strategies for depression have been proposed. Since 1975, several clinical studies have reported that L-type Ca2+ channel blockers (CCBs), used in anti-hypertensive therapy, produce increase of plasma catecholamine levels and tachycardia, typical symptoms of sympathetic hyperactivity. Despite these adverse effects of CCBs have been initially attributed to adjust reflex of arterial pressure, during almost four decades these enigmatic phenomena remained unclear. In 2013, we discovered that this paradoxical sympathetic hyperactivity produced by CCBs results from the increase of catecholamines release from sympathetic nerves, and adrenal chromaffin cells, due to its modulatory action on the interaction between intracellular signaling pathways mediated by Ca2+ and cAMP (Ca2+/cAMP signalling interaction). Then, the pharmacological modulation of this interaction by combined use of L-type CCBs, and cAMP-enhancer compounds, could be a more efficient (and safer) therapeutic strategy to produce increase of serotoninergic and monoaminergic neurotransmission in the CNS due to enhance of serotonin and monoamines release, thus attenuating clinical symptoms of depression in humans.
Jorge F Cameselle-Teijeiro*, Javier Valdes-Pons, Lucia Cameselle-Cortizo, Isaura Fernandez-Perez, MariaJose Lamas-Gonzalez, Sabela Iglesias-Faustino, Elena Figueiredo Alonso, María-Emilia Cortizo-Torres, María-Concepcion Agras-Suarez, Araceli Iglesias-Salgado, Marta Salgado-Costas, Susana Friande-Pereira and Fernando C Schmitt
A histopathological review preliminary of 429 patients diagnosed with tumours of the uterine corpus (TUC) cancer between 1984- 2010 in the Vigo University Hospital Complex (Spain) were evaluated prospectively for over 5 years. Of these 403 (93.9%) were epithelial tumours: 355 (82.7%) were adenocarcinomas of the endometrioid type, 5 (1.1%) mucinous adenocarcinoma, 10 (2.3%) serous adenocarcinoma, 17 (3.9%) clear cell carcinomas, 11 (2.5%) mixed adenocarcinoma, 4 (0.9%) undifferentiated carcinomas and 1 (0.2%) squamous cell carcinomas. A total 20 (4, 6%) were mesenchymal tumours: 4 (0.9%) endometrial stromal sarcoma, 7 (1.6%) Leiomyosarcoma, 9 (2%) Mixed endometrial stromal and smooth muscle tumour. A total 1 (0.2%) were mixed epithelial and mesenchymal tumours: (0.2%) Adenosarcoma 1. And 5 (1.1%) were Metastases from extragenital primary tumour (3 carcinomas of the breast, 1 stomach and 1 colon). The mean age at diagnosis from total series were 65, 4 years (range 28-101 years). Age was clearly related to histologic type: Endometrial stromal sarcoma 46.0 years, Leiomyosarcomas 57.1 years, Adenocarcinomas of the endometrioid type 65.4 years, Clear cell carcinomas 70.1 years and mixed endometrial stromal and smooth muscle tumours 71.2 years. Five-year disease-free survival rates for the entire group were: Endometrial stromal sarcoma 50%, Leiomyosarcomas 28.6%, Adenocarcinomas of the endometrioid type 83.7%, Clear cell carcinomas 64.7% and mixed endometrial stromal and smooth muscle tumours 44.4%. The 5-year disease-free survival rates of patients with Adenocarcinomas of the endometrioid type tumors were 91.4% for grade 1 tumors, 77.5% for grade 2, and 72.7% for grade 3.
In conclusion, we describe 5-year histological and disease-free survival data from a series of 429 patients with TUC, observing similar percentages to those described in the medical literature. The only difference we find with other published series is a slightly lower percentage of serous carcinomas (ESC) that the Western countries but similar to the 3% of all ESC in Japan. Our investigation is focus at the moment on construct genealogical trees for the possible identification of hereditary syndromes and to carry out germline mutation analysis.
Angela Jordao Camargo*, Mayara Cheade, Celso Martinelli and Plauto Christopher Aranha Watanabe
Ameloblastoma is the second most common odontogenic tumor being back only for the odontoma. An unusual case of recurrent peripheral ameloblastoma in the mandible from the site of previous occurrence, reducing oropharyngeal space due compression by lesion. Panoramic radiography not showed presence of lesion, except one step in left side of mandible angle. Multislice CT scans revealed presence of hypoattenuated image, well-defined, histopathological exam suggesting Ameloblastoma Follicular.
Antonacci F*, Belliato M Bortolotto C, Di Perna D, Dore R, Orlandoni G and D’Armini AM
This patient (male, 59 years old) underwent cardiac re-transplantation for chronic rejection. Prior to re-transplantation, the patient was in NYHA class IV, with a clear chest x ray. On 14th postoperative day, he presented hemoptysis. On chest x-ray, a left lower lobe opacity was seen. Therefore, a chest CT scan was done and it showed a round mass within a pulmonary cavity surrounded by airspace in proximity of the pulmonary artery. The radiologist strongly suspected a pulmonary lesion similar to an aspergillum’s disease. The radiological appearance together with the immunocompromised status of the patient made the diagnosis of aspergillosis possible. Considered the high risk of a devastating hemoptysis due to the aspergillum vascular invasiveness, a left lower lobectomy was performed. The following course was characterized by a difficult weaning from mechanical ventilation and the patient was discharged on 45th postoperative day post lobectomy. Surprisingly pathological examination showed an abscessual cavity in an area of pulmonary infarction.
We focused on aspergillosis in view of the above-mentioned aspects, nevertheless a differential diagnosis of pulmonary infarction could have been considered because of the prolonged bed rest and recent surgery. Lung lobectomy appeared to be the correct treatment since, both in case of aspergilloma and in case of pulmonary infarction, the left inferior lobe would have never recovered a normal function.
Micronodular thymoma is a rare subtype of thymoma with less than 20 cases published in the English literature. These tumours have been reported with thymoma or thymic cyst. The authors describe a new case of micronodular thymoma in a 68-year-old-patient which is well documented and particular by its cystic degeneration which hasn’t been described yet. Micronodular thymoma is a rare variant of thymoma with a challenging diagnosis. Clinicians must be aware of this entity in order not to confuse it with a thymic cyst.
Basic control theory equations are developed showing conventional exponential system response of refraction vs. time R (t) with a characteristic system time constant, in response to a step change of near work environmental conditions. Details from preliminary experimental design using reading glasses at the U.S. Naval Academy at Annapolis are discussed. The conclusion is that (+) add lenses, used as reading glasses during study, can prevent the development of myopia for college students in pilot training.
Ayena KD*, Santos KAM, Vonor K, Amedome KM, Wodome A, Strauss G, Nagbe YE, Koffi-Ametooyona A and Balo K
Aim: To compare the anatomical and functional outcomes of cataract surgery with manual small incision cataract surgery (MSICS) to those of extracapsular cataract extraction (ECCE) in Lome.
Patients and Methods: A prospective study involved two groups of patients who underwent ECCE (group 1) and MSICS (group 2) by the same surgeon in the same conditions in different periods. Complications and visual results to the 45th postoperative day were compared.
Results: At the 45th postoperative day, 60% of operated eyes of the ECCE group (G1) and 83.9% in the group of MSICS (G2) had uncorrected visual acuity greater than or equal to 3/10. Through the pinhole, these proportions increased to 73.3% for G1 and 92.2% for G2. Visual acuity was less than 1/10 in 4.4% for G1 and 1.1% for G2. The vitreous loss was observed in proportions of 3.8% for G1 and 3.3% for G2. During follow-up, the three main early postoperative complications were inflammation (13.9%), corneal edema (13.3%), and the pigment dispersion (7.2%) in G1 and corneal edema (9.4%), pigment dispersion (8.3%) and hypertonia (6.6%) in G 2.
Conclusion: Two cataract extraction techniques offer the same level of safety in intraoperative period. However, MSICS has certain advantages over the ECCE and would be an alternative technique in developing countries.
Aims: To present a further example showing an efficiency of a modeling method based on the theory of dynamic systems in pharmacokinetics.
Study design:The goals of the current study were twofold: to present (1) a further example showing efficiency of a modeling method based on the theory of dynamic systems in pharmacokinetics, an to perform (2) a next step in tutoring the use of computational and modeling tools from the theory of dynamic systems in pharmacokinetics.
The data available in the study by Plusquellec et al. published in the October Issue of the Journal Medical Engineering & Physics were used to exemplify the method considered here. For modeling purpose an advanced mathematical modeling method was employed. Modeling was performed using the computer program named CTDB described in the study by Dedík et al. published in September 2007 issue of the Journal Diabetes Research and Clinical Practice.
Main outcome: Modeling results revealed that computational and modeling tools from the theory of dynamic systems can be successfully used in the development of a mathematical model of such a complicated process as is a multiple sites discontinuous gastrointestinal absorption.
Carlos Alberto Kelencz*, Ingrid Solange Sepulveda Munoz, Paulo Rui de Oliveira, Bruno Mazziotti and Cesar Ferreira Amorim
Kinematic analysis and surface electromyography are tools being used as important methods to evaluate the human gait and to analyze different types of footwear aiming modifications and adaptations to the human locomotor system, especially of the feet. The aim of the present study was to analyze through electromyography (EMG) the muscles tibialis anterior (TA) and gastrocnemius lateralis (GL) and gastrocnemius medialis (GM) and to capture digital images of the human gait in four different footware situations, barefoot with tennis, platform shoes and high heels. Twenty healthy women with a mean age of 22.6 years took part in this experiment, which was performed on a treadmill at a speed of 3.8 m/s. The results showed that shoes that do not allow a normal movement of the tarsal bones caused changes in the trajectory of the gait, which promotes a greater muscular movement. This study concluded that shoes closer to a normal position and allow greater mobility of the feet, decrease muscular demands, which in everyday situations cause less localized muscular fatigue.
In the cardiovascular field, tachycardia and increment of catecholamine plasma levels (sympathetic hyperactivity) have been reported by hypertensive patients that use L-type Ca2+ channel blockers (CCBs) since 70´s. Our discovery of the involvement of interaction between the intracellular signalling pathways mediated by Ca2+ and cAMP (Ca2+/cAMP interaction) revealed that this phenomenon (sympathetic hyperactivity) was resulting of increase of transmitter release from sympathetic neurons stimulated by CCBs due to its interference on the Ca2+/cAMP interaction. In the neuroscience field, this discovery has produced new paths for the understanding of the cellular and molecular mechanisms involved in the pathogenesis of neurodegenerative diseases, such as Alzheimer´s and Parkinson’s diseases. In this way, novel journeys for the development of new pharmacological strategies more effective for the treatment of neurodegenerative diseases may be initiated.
Objective: The aim of the present study was to examine associations between secondary traumatic stress (ST), job burnout (BO) and several psychological variables such as world assumptions and locus of control in correctional psychologists.
Methods: This study utilized information provided by 87 currently prac¬ticing correctional mental health providers (psychologists) in the correctional settings across Russia in St.Petersburg, Belgorod, Vladimir, Kaluga, Ryazan, etc. The sample included 51 men, 36 women. The mean age of participants was 34.9±6.9 (ranging from 25 to 48 years). Participants reported working a mean of 6.23 ± 3.5 years (ranging from 3 months to 15 years) in a correc¬tional setting. Subjects were assessed with Maslach Burnout Inventory-Human Services Survey (MBI-HSS), Secondary Traumatic Stress Scale (STSS), World Assumption Scale (WAS) and Locus of Control (LC) Scale. Three sets of statistical analysis were provided: ANOVAs between- group comparisons with STS and BO as factors and Spearman correlation analyses.
Results: The results of our study reveal that burnout and secondary traumatic stress in correctional psychologists are significantly positively related and thus may be exacerbated by each other. BO is significantly negatively associated with WAS benevolence scale and the WAS self worth scale and STS is significantly negatively associated with WAS benevolence scale and the WAS meaningfulness scale. However, LC and its components are negatively associated with BO, but not with STS.
Conclusion: The main future direction of our research is to construct nonlinear model of burnout with STS, WA and LC components as predictors, identify its parameters and make its validation.
Modern-day enhancements in Enterprise Architectures (EA) has increased the interoperability issues in almost all domains; these issues are increasing day-by-day as organizations are spanning and information is being exchanged between different platforms. Command Control Computer Communication and Intelligence (C4I) complex systems are also facing the interoperability issues due to highly classified and sensitive information being exchanged. In this paper we have discussed the integration of different C4I applications running under heterogeneous platforms by allowing them to communicate using a secure and ciphered web based middleware named as Web Middleware (WMW). This middleware is a client-server based web adaptor to achieve clean, systematic, secure and reliable communication. The main feature among many is the simple HTTP browser based customization that do not require any specific or special add-ons and controls to be installed on the client machine. Architecture usage, and initialization of the WMW middleware is discussed with security and performance discussion.
Mohammad Hasanzadeh*, Nasrin Shadjou, Sattar Sadeghi, Ahad Mokhtarzadeh and Ayub karimzadeh
The main purpose of this report was to develop application of poly-dopamine-beta-cyclodextrin modified glassy carbon electrode (PDA-β-CD-GCE) towards electrooxidation and determination of L-Tryptophan (L-Trp) and also the evaluation its kinetic parameters. In continuation of our efforts to use PDA-β-CD-GCE for amino acids detection, our objective in the present work was to expand application of this sensor for the determination of L-Trp which is very sensitive.
Ameloblastoma is a benign odontogenic tumour that may have aggressive biological behavior with local recurrence and metastasis after the surgical resection. We report a case of cytology of recurrent ameloblastoma. The first tumour was diagnosed in the left mandible in 57-yers-old woman thirteen years ago. The patient was operated on, the tumour was enucleated, pathohistological diagnosis of ameloblastoma was put and DNA analysis by flow cytometry of the tumour was performed. DNA analysis showed that the tumour was diploid but proliferative. Two years after the operation, a new tumour appeared on the scar. Fine needle aspiration cytology with ultrasound guidance of the tumour was performed; cytological diagnosis of recurrent ameloblastoma was put and confirmed by pathohistology. Until now the patient is well without any new recurrent ameloblastoma.
Background: Prevalence of malnutrition in Chronic Kidney Disease (CKD) patients is due to their lower appetite level. Diabetic patients experience polyphagia. Hence it is necessary to understand the impact of diabetes on the nutritional status of CKD patient.
Aim: To compare the nutritious status between the CKD patients with and without diabetes.
Objectives: To find out the impact of diabetes on the nutritional status of CKD patients.
Method and Materials: A prospective random sampling method was adopted to select the subjects. Eighty CKD patients were divided equally into two groups. Tool which has been used to collect the data was SOAP format.
Results: While comparing BMI between group 1(CKD without diabetes) and group 2(CKD with diabetes) it was noticed that the percentage of normal nourished subjects in group 2 were greater than that of group1. About 63% and 25% of subjects with CKD in group1 had normal BMI and grade 1 undernourished respectively. In group 2, about 75% and 10% of patients had normal BMI and grade 1 over nourished respectively. About 80% of subjects in group 2 were on insulin treatment. About 88% of subjects in group1 were anorexic and about 55% and 25% of subjects in group 2 had polyphagia and normal appetite respectively. The difference in the energy and protein intake between the two groups was statistically significant at p<0.01 level.
Conclusions: It can be concluded from the above study that a better nutritional status was found in the CKD patients with Diabetes Mellitus (DM) than the CKD patients without DM which may be due to their normal appetite/ polyphagia, hence allowing a better food intake among group2 subjects. Weight gain in CKD with DM patients may be due to increase in fat mass which is subsequent to lipogenic effect of insulin.
Zvi H. Perry*, Udit Gibor, Shahar Atias, Solly Mizrahi, Alex Rosental and Boris Kirshtein
Introduction: A gastric outlet obstruction secondary to a gallstone ileus is known as Bouveret syndrome. Herein we present a case of an elderly woman with an impacted gallstone in duodenum and discuss its’ management.
Patient description: A 96-year-old woman was admitted to our department due to a gastric outlet obstruction. Initial gastroscopy revealed a gastric bezoar. An attempt for its extraction failed. She underwent a laparotomy in which a cholecystoduodenal fistula and a large impacted stone were found. Separation of the fistula, including closure of the duodenum side, cholecystectomy and removal of the obstructing gallstone were performed. Additional stones were found and retrieved during common bile duct (CBD) exploration. Surgery was finalized by duodenoplasty, closure and T-tube drainage of the CBD. Post-operative course was prolonged and uneventful.
Discussion and Conclusions: Bouveret syndrome is a rare cause of gastric outlet obstructions. In this case, unsuccessful endoscopic treatment necessitated surgery for removal of impacted gallstone in the duodenum.
Mushtaq Chalkoo*, Naseer Awan, Hilal Makhdoomi, Syed Shakeeb Arsalan and Waseem Raja
We present a review article on adrenal glands, with a special reference to their anatomy, physiology, evaluation, laparoscopic operative techniques with a short summary of review of literature.
Infectious bursal disease (IBD) considered as one of the major viral diseases threatening the poultry industry worldwide. The causative agent of the IBD is Infectious bursal disease virus (IBDV) which replicates in developing B lymphocytes in the bursa of Fabricius leading to its destruction and bursal inflammation. In this study, we investigated a technology to produce therapeutic recombinant antibodies against IBDV in bacteria by constructing a bacterial displayed recombinant scFv library from immunized chickens, followed by screening the scFv library by fluorescence activated cell sorting (FACS) with FITC-labeled VP2. Twelve VP2-binding scFv clones with unique sequences were obtained, with overall amino acid homology of 81.53%. The complementarity determining region (CDR) 3 in the heavy chain displayed the lowest homology, while the amino acid sequences in framework regions and CDR2 of both chains and CDR1 of the heavy chain are relatively conserved. Twelve VP2-binding scFv clones were expressed in E.coli and purified through denaturation and denaturation of inclusion bodies. Our ELISA results showed that all scFvs exhibited binding ability and specificity to VP2 and various IBDV strains. In addition, two scFvs showed significant neutralizing activity to IBDV (B-87 strain) as these scFvs inhibited cytopathic effect of chicken embryo fibroblast (DF1) caused by IBDV. In conclusion, our study provides a lead candidate for further development of therapeutic antibodies for IBDV infection.
The emergence and establishment of anthropological genetics as an interdisciplinary science is primarily, associated with the development of new genomic technologies. Precision genetic testing on the one hand, and the rapidly increasing number of genetic investigations on the other, have created a set of bioethical dilemmas for genetic and epidemiology research. Such research deals with persons who have the right to the protection of their personal information and confidentiality, and also concerns collective (village, region, ethnic group, state) consciousness, ethnic identity, and traditional culture, i.e., so called “ethnic pride”. In this regard, taking into consideration the results of ongoing field research, we make some recommendations for better management of relationships with individuals and communities and the preparation of questionnaires and informed consent forms that will facilitate similar research projects, especially in such an ethnically, linguistically and culturally diverse region such as the Caucasus.
Growing evidence supports the hypothesis that endothelial cell-derived microparticles (MPs) might contribute to the pathogenesis of cardiovascular (CV) disease. Endothelial cell-derived MPs play a pivotal role in the regulation of the endogenous repair system, thrombosis, coagulation, inflammation, immunity and metabolic memory phenomenon. There is evidence that the MPs are secreted actively accompanied to other regulatory molecules. All these actively synthetizing and secreting factors include proteins, adhesion and intercellular signal molecules, peptides, lipids, free DNAs, microRNAs, and even microparticles (MPs) are defined as cellular secretome. The proteomic profile of secretome is under tightly control of genetic and epigenetic mechanisms, which may altered a secretion of the proteins involved into MPs’ organization. Finally, this may contribute the modification of MP’s after their secretion and throughout transfer to the target cells. As a result, communicative ability of endothelial cell-derived MPs may sufficiently worse. Subsequently, cross talk between some components of secretome might modulate delivering cargos of MPs and their regenerative and proliferative capabilities via intercellular signaling networks. The aim of the review is to discuss the effect of various components of secretome on MP-dependent effects on endothelium.
Hrishikesh Upadhyaya*, Lutfa Begum, Bishal Dey, P K Nath, and S K Panda
Calcium phosphates are of great interest in medicine, biology, agriculture and materials sciences. The present study evaluates the effect of calcium phosphates nanoparticles on biochemical changes in rice. Nanoparticles increased the growth rate and affect the physiology of the plant. Calcium phosphate nanoparticles may help in the formulation of new nano growth promoter and nano-fertilizers for agricultural use. Therefore, it could potentially help in reduction of the quantity of fertilizer applied to crops and contributing to precision farming as it reduces fertilizer wastage and in turn environmental pollution due to agricultural malpractices. However, detail physiological and molecular understanding of its impact on rice crop plant is needed in future to validate its prospective application in agriculture.
Hani Ayyash*, Michael O Ogundele, Ruth Wisbey, Emma Weisblatt, Lorraine Cuff and Venkat Reddy
ADHD is the most common neurodevelopmental disorder in children and adolescents with prevalence ranging between 5% and 12% in developed countries. There is ample evidence that carefully structured enhanced behavioural parenting programmes are useful in the management of ADHD.
We assessed the outcome of an ADHD group parenting training programme (APEG) offered between 2014 and 2015 by the Peterborough Neurodevelopmental Service (NDS) in improving the knowledge and skills of carers using a pre-/post-training intervention study.
APEG follows a Parent Advisor Model, consisting of a 6-session programme of evidence-based parenting training.
A total of 27 parents completed the 53 pre- and post-course questionnaires. The knowledge and understanding of the parents increased significantly about all aspects of ADHD diagnosis and management in response to all the 5 questions. The difference between the scores of 0 to 3 and 4 or 5 pre- and post-intervention was statistically significant (chi square 239, df 1, p value <0.01).
The study suggests that provision of a psychosocial intervention programme for parents of ADHD children through the APEG parenting training proved to be effective in significantly improving the level of knowledge and understanding of parents regarding several aspects of ADHD diagnosis, symptom identification and behaviour control.
Nuclear Medicine is an integral part of modern healthcare. The use of radioactive nuclides tagged biomolecules, evaluating their distribution in human bodies by SPECT or PET systems, provides longitudinal sets of volumetric and quantitative images that can be used to diagnose a wide range of disease and/or assess response to disease specific treatments [1].
Nuclear Medicine therapy, also before known as radio-metabolic, consists in replacing cited diagnostic nuclides with alternative radionuclides that emit a “curative” type of radiations such as beta- or alpha-particles [2].
The eventual presence of a contemporary gamma emission by the nuclide utilized also allows the execution of scintigraphic investigations after its administration, useful for monitoring the distribution of the radio-pharmaceutical in the body and make the most of the time a predictive estimation of the dose received from the target compared to the administered activity [3].
The eventual presence of a contemporary gamma emission by the nuclide utilized also allows the execution of scintigraphic investigations after its administration, useful for monitoring the distribution of the radio-pharmaceutical in the body and make the most of the time a predictive estimation of the dose received from the target compared to the administered activity [3].
Akanksha Gupta, Sangeeta Singh Malik, Swati Gupta and Ravi Prakash SM*
Osteoma is a benign osteogenic tumor arising from the proliferation of cancellous or compact bone. In the facial bones, both central and peripheral osteomas have been described in the literature. Peripheral type of osteoma is the most common variant in the mandible, which occurs on the cortical bone surface. We present a case of a fourteen year old boy who had swelling on right and left parasymphyseal region. Radiographs revealed radiopacity having onion-peel appearance and histopathology gave the final diagnosis of osteoma. Periosteal reaction giving rise to onion peel appearance on the radiograph has been reported in Ewing sarcoma, Garre’s osteomyelitis and infantile cortical hyperostosis in the literature but our case shows that similar appearance can be there in osteoma as well.
Mario Lombardi, Paolo Severi, Andrea Mazza, Maria Grazia Bendini, Elisa Caldarone, Massimo Armeni, Stefania DEmidio and Massimo Leggio*
Hypertension is a complex disorder involving multiple organ systems and the primarily modifiable risk factor for heart disease, which is the leading cause of death among both men and women in the World. Although both men and women develop hypertension, distinct gender differences in the incidence and severity of hypertension are well established where men have a higher incidence of hypertension compared with women of the same age until the sixth decade of life [1,2]. Despite gender differences in human hypertension, the treatment guidelines do not differ by gender [3]. Even if the causes of hypertension are complex and are related to genetic factors, lifestyle, diet structure, and environmental factors including air pollution [4], coupled with the potential determinants of hypertension, sex differences in hypertension-which exist in human populations-are attributed to both biological and behavioural factors. The biological factors include sex hormones, chromosomal differences, and other biological sex differences that are protective against hypertension in women. These factors become prominent in adolescence and persist through adulthood until women reach menopause. Behavioural risk factors for hypertension include high body mass index, smoking, and low physical activity.
<h2>Abstract</h2><p><strong>Background:</strong> Literature on ACL injury is limited when assessing for the presence and interaction of multiple risk factors simultaneously. Identifying risk factor interaction may increase the impact of prevention programmes to target ACL injury reduction. The aim of this study was to retrospectively assess ACL injured female athletes to identify which modifiable and non-modifiable risk factors were present at the time of injury.</p><p><strong>Method</strong>: Seventeen female athletes who had sustained a non-contact ACL injury were interviewed retrospectively to assess for the presence of reported risk factors for ACL injury.</p><p><strong>Result</strong>: This retrospective analysis ACL injury cases highlighted a number of factors which were present with high frequency across this group of cases. All had non-contact ACL injury occurring during cutting or landing, which suggests a predisposing deficit in neuromuscular control. This poor neuromuscular control could be exacerbated by the presence of fatigue identified within the cohort. This poor control could be further influenced by the fact a majority of athletes had another significant injury in the 12 weeks prior to ACL injury. The restriction to training could have either decreased fatigue resistance, or potentially changed their movement pattern because of the method of injury management undertaken.</p><p><strong>Conclusion</strong>: This case series provides insight into the interaction of risk factors for ACL injury in sportswomen, with the presence of another injury disrupting training, decreasing the athletes work capacity and fatigue resistance, being compounded perceived or actually elevated levels of fatigue, leading to the potential for abhorrent movement patterns and increased injury risk.</p>
Gabriele Cioni*, Francesca Cesari, Rossella Marcucci, Anna Maria Gori, Lucia Mannini, Agatina Alessandrello Liotta, Elena Sticchi, Ilaria Romagnuolo, Rosanna Abbate, Giovanna D’Alessandri
Introduction: Endothelial progenitor cells (EPC) are involved in vascular repair and proliferation, contributing to the long-term outcomes of apheretic treatment. Aim of this study was to investigate the relationships between endothelial function, assessed by levels of bone marrow-derived progenitor cells and endothelial response to hyperaemia, and clinical and biohumoral parameters in high vascular risk patients before, immediately after, 24-hours and 72 hours after a single lipid apheresis procedure.
Material and Methods: We evaluated lipid profile, endothelial function and endothelial progenitor cells before (T0), immediately after (T1), 24h after (T2) and 72h after (T3) a lipoprotein apheresis procedure, in 8 consecutive patients [Sex: 62.5% M; Age; 63.29(12), mean, (range) years] with a personal history of acute coronary syndrome, symptomatic peripheral arterial disease and elevated plasma levels of lipoprotein (a) [Lp(a)]. Patients were on regularly weekly or biweekly lipoprotein apheresis, and they were treated with the FDA-approved Heparin-induced Extracorporeal LDL Precipitation (H.E.L.P.) (Plasmat Futura, B.Braun, Melsungen, Germany) technique. PAT values were expressed as the natural logarithm (Ln-RHI, normal values≥0.4) of the reactive hyperaemia index (RHI), which is the parameter automatically calculated by the device.
Results: We found a reduction in the natural logarithm of reactive hyperaemia index (Ln-RHI), assessed immediately after the procedure (0.57±0.21 vs 0.72± 0.29); difference between T2 and T0 was statistically significant (0.43±0.24 vs 0.72±0.29; p=0.006). Reduction in Ln-RHI values was documented in all patients, two subjects showing a Ln-RHI<0.4 at T1, and four at T2. At T3, PAT values were increased significantly (0.91±0.18) in comparison to T1 and T2, showing a median value higher than at T0. Cd34+/Kdr+ and Cd133+/Kdr+ showed a minimum increase in median values at T1, and a higher increase at T2, in comparison to baseline. Differences in Cd34+/133+/Kdr+ values at different times were not statistically significant. A significant reduction in circulating endothelial cells (CEC) count at T2 in comparison to T0 was found (12.00±8.85 vs 23.86±12.39; p=0.024).
Discussion: At 24h and 72h after procedures, we found an improvement in endothelial function, expressed by an increase in PAT values and EPC levels, and by a reduction in CEC.
Material and Methods: We evaluated lipid profile, endothelial function and endothelial progenitor cells before (T0), immediately after (T1), 24h after (T2) and 72h after (T3) a lipoprotein apheresis procedure, in 8 consecutive patients [Sex: 62.5% M; Age; 63.29(12), mean, (range) years] with a personal history of acute coronary syndrome, symptomatic peripheral arterial disease and elevated plasma levels of lipoprotein (a) [Lp(a)]. Patients were on regularly weekly or biweekly lipoprotein apheresis, and they were treated with the FDA-approved Heparin-induced Extracorporeal LDL Precipitation (H.E.L.P.) (Plasmat Futura, B.Braun, Melsungen, Germany) technique. PAT values were expressed as the natural logarithm (Ln-RHI, normal values≥0.4) of the reactive hyperaemia index (RHI), which is the parameter automatically calculated by the device.
Anoikis resistance (AR) is a favorable attribute exhibited by cancer cells for metastasis. Carcinoma associated Fibroblasts (CAFs) plays a crucial role in AR in various cancers. It was proved in array of studies in different cancers that there was definite interrelationship between CAFs and AR. But its role in OSCC is ambiguous. It is the need of the time to reveal the correlation of CAF and oral squamous cell carcinoma (OSCC) in relation with anoikis. Molecular pathways which affects the AR via CAFs in various cancers has been highlighted in this communication. Divulging the importance of CAF in cancer will aid in designing customized novel chemoprevention therapy and thus will help in enhancing the prognosis of patient in OSCC.
Carlos Alberto Sanchez Salguero and Alvaro Isidro Sanchez Chacon
Introduction:Forty-six per cent children have allergic rhinoconjunctivitis (Allergologica 2005).
Working hypothesis:Ocular topical cyclosporine improves the quality of life for these patients.
Material, methods, design:2-year prospective study (2015-16), 40 patients with topical corticosteroids without improvement, followed 20 and 20 switched to corticosteroids cyclosporine 0.05%. Interview with Quality of Life Questionnaire in Children with rhinoconjunctivitis (PRQLQ) before and at the end of treatment. Mean age of 10.3 years with 60% male-40% female. Treatments were applied from January to March. There were 15 questions divided into two blocks. Children responded using a card with responses rated from zero (not bothered at all) to 6 (quite upset).
Results: Before the 100% reported that, the itching was very bothersome. In the group of 40 children, 80% showed symptoms of epiphora and 60% showed symptoms of ocular inflammation. 100% complained of significant discomfort in rubbing their eyes, 30% did not like to take medications. Headaches affected 20%. 100% stated that they cannot play normally. 80% showed decreased concentration in class.
Continuing with corticosteroids did not show statistically significant changes.
Patients with cyclosporine improved the results by 3 points, with decreased itching, tearing, swelling, pain, eye rubbing, medication and headaches. In the 2nd questionnaire there was limited variation in the results related to fatigue, malaise, and irritability but with substantially improved balance of sleep, insomnia and concentration at school.
Conclusion: Cyclosporine A is a cyclic polypeptide calcineurin inhibitor developed from the fungus Tolypocladium inflatum. The first dilution was 2% but it is currently used at a dilution of 0.05% and recent publications suggest nanosuspensions. Our study showed improvement in parameters related to symptoms, especially itching and lower improvement of psychological aspects, this achieves a better quality of life for children and more willingness to adhere to the treatment.
Alessandro Bistolfi, Jessica Zanovello, Elisa Lioce, Lorenzo Morino, Raul Cerlon, Alessandro Aprato* and Giuseppe Massazza
Despite its high incidence and the great development of literature, there is still controversy about the optimal management of Achilles tendon rupture. The several techniques proposed to treat acute ruptures can essentially be classified into: conservative management (cast immobilization or functional bracing), open repair, minimally invasive technique and percutaneous repair with or without augmentation. Although chronic ruptures represent a different chapter, the ideal treatment seems to be surgical too (debridement, local tissue transfer, augmentation and synthetic grafts). In this paper we reviewed the literature on acute injuries.
Michel Bertani, Denise Soares*, Everton Rocha and Leandro Machado
Background: The foot is an important and complex structure that provides support, balance and propulsion to locomotion, thus, its proper care can help to have a better life quality avoiding pain. The medial longitudinal arch is an important structure that is related to injury risks when it shows some impairment. The purpose of this study was to characterize the foot arch index in people in relation to age and gender.
Methods: The sample was composed of a total of 122 subjects, 79 healthy young subjects (40 women and 39 men) and 43 healthy elderly subjects (32 women and 11 men). Ten seconds of standing barefoot plantar pressure was measure through Tekscan F-Scan device, and the data processing, filtering, and arch index (AI) calculation were performed using MATLAB™ 7.0.
Findings: The elderly group presented a lower arch (AI-0.23) than the young group (AI-0.13) (p=0.000); young female and male groups show similar AI, while the elderly female group showed lower arch (AI-0.23) than the elderly male group (AI-0.18) (p=0.033).
Interpretation: The foot arch has a trend to be lower with aging, and even lower within elderly female subjects, probably due to some decrease within plantar muscle’s stiffness, that in turn may be related to lower physical activity and footwear choices.
Findings: The elderly group presented a lower arch (AI-0.23) than the young group (AI-0.13) (p=0.000); young female and male groups show similar AI, while the elderly female group showed lower arch (AI-0.23) than the elderly male group (AI-0.18) (p=0.033).
Akanksha Satyavanshi, Monalisa Pattnaik and Patitapaban Mohanty*
Introduction: A reduction in physical activity due to spinal cord injury leads to deconditioning and increased dependency. Manual wheelchair propulsion is a straining form of ambulation and propulsion is based on the use of upper extremities, which are usually capable of producing less force with less efficiency. Theraband can be an exercise mode, which resembles wheelchair activity. Mat exercises are also given for strengthening of upper limb muscles in persons with paraplegia. The aim of this study is to compare effects of both elastic resistance strength training and strengthening by mat activity of upper limb muscles on wheelchair propulsion efficiency in persons with paraplegia.
Materials and Method: The selected subjects were randomly assigned into Theraband and Mat exercise groups with 15 subjects each. Theraband group received theraband strengthening of wheelchair propulsion muscles, whereas mat activity group received mat strengthening of wheelchair propulsion muscles. Total duration of treatment was 5 days per week for 5 weeks.
Results: Results of the study showed both mat exercise and theraband groups showed significant improvement in wheelchair 15 meter sprint test and wheelchair propulsion for 50 meters in paraplegics due to spinal cord injury. However, theraband group showed significantly more improvement.
Conclusion: The study revealed that theraband exercises for improving upper limb strength for wheelchair propulsion is superior to strengthening through mat exercise.
A 21-y-old recreationally active male lacking the last 30° of elbow extension from a fractured and dislocated elbow sustained while wakeboarding came to our clinic November of 2015. A regimen was applied of 20-minutes of pulsed shortwave diathermy (PSWD) treatments delivered at 100 watts to heat the affected tissue prior to approximately 40°C followed by 10 minutes of joint mobilizations.This was followed by application of an ice pack to the area for 30 minutes. Measurements and treatments were given on Nov 3,5 and 10. The changes in AROM extension were as follows: Nov 3, from 30° to 20°; Nov 5, from 24° to 10°; Nov 10, from 10° to 0°. Over the course of the treatment the PSWD/ joint mobilizations improved extension AROM of the elbow 30° (full AROM) in just 3 treatments. There was also no post-treatment pain.
Camila Fonseca de Oliveira*, Denise Paschoal Soares, Michel Christian Bertani, Leandro Jose Rodrigues Machado and Joao Paulo Vila-Boas
Coactivation of agonist and antagonist muscles participates in the regulation of joint stiffness and postural instability. Alterations on muscle activity have been revealed as an important falling risk factor. It is unclear the effects, and age-related differences, of a prolonged demanding task on the muscular coactivation levels.We compared muscle activation amplitude and coactivation of the vastus medialis, biceps femoris, tibialis anterior, and gastrocnemius medialis from surface EMG in 16 young adults (age 21-33) and 8 elderly adults (age 66-72) while fast-walking at 70% of their maximum heart rate. Overall, the elderly demonstrated higher coactivation indexes than the young individuals. Ankle coactivation decreased in the first half of the swing phase, while coactivation at the knee increased in the latter half of the swing phase in our elders. Alterations of muscle activation and coactivation on the knee and ankle were more prominent close to landing and in the swing phase. Our results suggest that these alterations may suggest potential concerns with respect to the risk of falls.
Ndao SCT, Gaye ND*, Dioum M, Ngaide AA, Mingou JS, Ndiaye MB, Diao M and Ba SA
Introduction: Coronary disease accounts for 75% of diabetic mortality. Coronary angiography reveals lesions that are often diffuse, staggered and multi-truncated. The objective of this study was to determine the indications and results of coronary angiography in diabetic patients.
Method: This is a cross-sectional, descriptive and analytical study which took place from May 2013 to July 2015 at the cardiology clinic of the Aristide Le Dantec hospital. We have included all diabetics who have benefited from coronary angiography by studying clinical and paraclinical data, particularly coronary angiography ones.
Results: During this period, 400 patients had coronary angiography, including 45 diabetics, a hospital prevalence of 11.25%. The average age of our patients was 62.27 y/o with extremes of 44 and 85 y/o. The sex ratio was 1.6 in favor of men. Diabete was revealed in 42 patients. Almost all patients were type II diabetics (44 patients) since 9.94 years in average. The associated cardiovascular risk factors were hypertension 66.7% and dyslipidemia 49.6%. Only 4 patients had typical chest pain. The electrocardiogram was abnormal in 84.4% of cases with 26 cases of SCA ST +. Coronary angiography was abnormal in 37 patients with significant stenosis in 30 patients. A single-truncular lesion was found in 14 cases, 8 had bi-truncular and other 8 had tri-truncular one. The anterior interventricular artery and the segment II of the right coronary were the most affected branches. Concerning the management, 14 patients had angioplasty with an active stent, 8 patients had medical treatment alone and 9 patients had coronary artery bypass surgery. Accidents occured for 4 patients, two of whom had arterial spasm, one of a vagal discomfort and another had an occlusion of the circumflex that led to the implantation of a stent.
Conclusion: Diabetes is accompanied by progressive coronary atherosclerosis, which has an adverse effect on patients' prognosis. Tri-truncal affection and indications for coronary artery bypass surgery are common.
Dioum M*, Aw F, Masmoudi K, Gaye ND, Sarr SA, Ndao SCT, Mingou J, Ngaide AA, Diack B, Bodian M, Ndiaye MB, Diao M and Ba SA
Introduction: Coronary angioplasty is a safe therapeutic method for coronary disease. However, its major obstacles remain the occurrence of stent thrombosis (ST) and in-stent restenosis (ISR). The aim of this study was to evaluate the short-term and medium-term results of coronary angioplasty patients in the cardiology department of Aristide Le Dantec hospital in Dakar.
Methodology: It was a longitudinal, descriptive and analytical study over a period of 12 months (April 2014 to April 2015) with a follow-up at 6 months. Was included any patient who had a coronary angioplasty with stent placement.
Results: Thirty-eight patients had been included with a male predominance and a sex ratio of 5.32. The average age was 57.94 years. Cardiovascular risk factors were mainly smoking (57.9%) and coronary heredity (42.1%), followed by hypertension (39.5%) and diabete (34.2%). The indications for angioplasty were acute coronary syndromes TS(+) and TS(-) respectively (50%) and (23.7%) and stable angina (26.3%). The right femoral approach was almost exclusive (97.4%). Coronary angiography revealed a predominance of anterior interventricular affection (84.2%). Type B lesions were the most frequent (68.4%). The single-truncal valve affection was predominant (76.3%). Direct stenting accounted for 63.2% of procedures. Twenty-one bare stents (55.3%) and 17 active stents (44.7%) were implanted. The results were excellent (94.7%). One case of acute stent thrombosis was noted. Echocardiography of dobutamine stress during follow-up was positive in 04 patients (12.5%). The control coronary angiography performed in two patients revealed an ISR. The predictive factors for restenosis were dominated by a deterioration in the segmental kinetics (p=0.009), in the diastolic function (p=0.002), the systolic function (p=0.003), a high post angioplasty troponin (p=0.004), the presence of calcifications (p=0.004) and a high SYNTAX score (p=0.021).
Conclusion: According to these results, Angioplasty is an effective therapy for coronary disease. However, a correct intake of double platelet antiaggregants and clinical and non-invasive screening are required for follow-up to avoid stent thrombosis or restenosis.
Quadricuspid aortic valve (QAV) is rare congenital malformation of the aortic valve with estimated prevalence of 0.013% to 0.043% [1-4]. QAV is most commonly associated with aortic insufficiency (AI), which is found in almost 75% of cases [5].QAV can also be associated with other cardiac defects such as ventricular or atrial septal defects, patent ductus arteriosus, subaortic fibromuscular stenosis, malformation of the mitral valve, and coronary anomalies [3]. Up to 40% of all patients with QAV undergo aortic valve replacement surgery most commonly due to progressive AI in 88% of case [2,3,6]. Here we report a case from our institution of a woman with QAV with severe AI and anomalous origin of the right coronary artery.
A 73-year-old male underwent cardiologic evaluation for an incidental electrocardiographic finding of left bundle branch block (LBBB). He was asymptomatic and had no relevant cardiac history. Physical examination and transthoracic echocardiogram revealed no abnormalities.
12-lead Holter ECG showed constant sinus rhythm, preserved AV conduction (PR at the upper normal limit) and no brady/tachyarrhythmias. Complete LBBB was observed during prolonged phases of the recording, but occasionally it was intermittent (Figure 1). What is the most likely mechanism of the intermittent LBBB showed in this figure?
Shijie Liu, Jawahar L Mehta, Yubo Fan, Xiaoyan Deng and Zufeng Ding*
Background: Flow-dependent concentration polarization of native LDL is important in the localization of atherogenesis. However, ox-LDL plays a more important role than n-LDL in atherogenesis by inducing cell proliferation and apoptosis. We hypothesized that concentration polarization of ox-LDL may adversely affect vascular beds due to its toxicity to endothelial cell (EC) lining.
Methods: Using a parallel-plate flow chamber technique, we studied water filtration rate and wall concentration of ox-LDLs EC monolayers cultured on permeable or non-permeable membranes. ECs cultured on permeable and non-permeable membranes were examined in terms of cell viability, ox-LDL uptake, LOX-1 expression and cell apoptosis (Cytochrome c and Bcl-2 expression). We observed that the wall concentration of ox-LDL was about 16% higher in the permeable group than in the permeable group (P<0.05). Cell proliferation (MTT assay) increased in response to low concentration of ox-LDL (1-5 μg/ml), and fell drastically in response to higher concentration; all these changes were more pronounced in the permeable group than in the non-permeable group. The uptake of ox-LDL and LOX-1 expression by ECs were also significantly higher in the permeable group than in the non-permeable group of cultured cells.
Conclusions: These observations suggest that concentration polarization of ox-LDL occurs in an artery that is permeable to water, and ox-LDL concentration polarization can enhance ox-LDL accumulation into the arterial wall and accelerate EC proliferation at low concentrations and apoptosis at high concentrations, possibly via LOX-1 expression.
Myocardial coronary bridging [1], encasement [2], and mid-LAD rigid straightening [3-5] appears to be epiphenomenon of takotsubo syndrome [6], rather than causing the disease. Typical takotsubo syndrome usually lasts only a few weeks, but chronic takotsubo cardiomyopathy is reported [7].
In a series of meanwhile 10 cases rigid straightening of the mid-portion of the left anterior descending coronary artery without lumen reduction mid-ventricular or basal ballooning was reported, or both basal and mid-ventricular ballooning in one case [4]. In all these patients wrap-around (recurrent segment) phenomenon of the left anterior descending coronary artery was not present. The abnormalities of the left anterior descending coronary artery are due to myocardial bridging without lumen reduction of the LAD, only seen in computed tomography [3]. When stress or in some cases happiness appears myocardial ballooning can appear, lasts 2-4 weeks and disappear with a recurrence rate of nearly 10% despite beta blocking agents [8].
Primary cutaneous lymphomas (PCLs) are the second most common group of extranodal non-Hodgkin lymphomas (NHL) with an estimated annual incidence of 1/100.000. Interferons (IFNs) are used in mono or combination therapy for cutaneous lymphomas especially for cutaneous T-cell lymphomas (CTCL) for years. IFN-α is the most widely-used type for cutaneous lymphomas. IFN-α has been shown to be a highly active agent in CTCL with response rates ranging from 40% to 80%. In this review, the current information about PCLs and IFNs treatment is summarized.
Omkolsoum M Alhaddad, Maha M Elsabaawy*, Khalid A Gameel, Marwa Elfauomy, Olfat Hendy and Eman A Rewisha
Hepatitis A virus (HAV) infection is the commonest form of acute viral hepatitis all over the world. Complicated HAV cases had been reported with evolving presentations. This is a report of three cases of non-fulminant HAV infections annotating rare non hepatic sequalae.
Purpose: Accurate patient positioning is crucial in radiation therapy. To fully benefit from the preciseness of proton therapy, image guided patient positioning and verification system is typically utilized in proton therapy. The purpose of this study is to evaluate the inter-observer variability of image alignment using a commercially available patient positioning and verification system in proton therapy.
Methods: The VeriSuite patient positioning and verification system (MedCom GmbH, Darmstadt, Germany) provides a six degrees of freedom correction vector by registering two orthogonal x-ray images to digitally reconstructed radiograph (DRR) images that are rendered in real time from the planning computed tomography (CT) images. Six cases of various disease sites, including brain, head & neck, lung, prostate, pelvis, and bladder, were used in this study. For each case, the planning CT images and a daily orthogonal x-ray portal image pair were loaded into the VeriSuite system. The same set of x-ray images and CT images for each case were reviewed and aligned separately by each of the 10 radiation therapist, following the clinical procedure for the corresponding disease site. The resulting correction vectors were then recorded and analyzed.
Results: Our study shows that the inter-observer variation (One standard deviation) in image alignment using the VeriSuite system ranged from 1.2 to 2.0 mm for translational correction and from 0.6 to 1.3 degrees for rotational correction for the six cases. The use of fiducial markers for prostate patient alignment achieved the least inter-observer variation while the bladder case produced the largest.
Conclusions: Inter-observer variation in image alignment could be relatively large, depending on the complexity of patient anatomy, image alignment approach, and user experience and software limitations. Automatic registration and fiducial markers could potentially be used to align patient more accurately and consistently. To ensure adequate tumor coverage in proton therapy, inter-observer variability in patient alignment should be carefully evaluated and accounted for in patient setup uncertainty analysis and treatment planning margin determination.
Marzia Cottini*, Amedeo Pergolini, Giordano Zampi, Vitaliano Buffa, Paolo Giuseppe Pino, Federico Ranocchi, Riccardo Gherli, De Marco Marina, Carlo Contento*, Myriam Lo Presti, Francesco Musumeci
Despite the background of advances in cardiac surgery procedures for higher risk population, the postoperative complication has already been a challenge for cardiac surgeon and Heart-Team. Future perspectives to exceed this challenge could be periodically patient’s follow up and advance diagnostic workup. We describe the diagnosis of a large sub mitral left Ventricle Pseudoaneurysm that was identified in a 59-year-old woman 17 years after she underwent aortic and mitral valve replacement for rheumatic valvular disease.
Background: Early and effective identification of childhood neurodevelopmental disorders remains a critical task of all pediatric healthcare professionals, which is critical to the well-being of children and their families.
Methods: A retrospective review of medical records of all preschool children referred to a Child Development Centre (CDC) in North-West England, over a six-month period between Sept 2014 and Feb 2015 was conducted. The local multi-professional approach to the clinical assessment and management of preschool children was described and the published literature on this topic was reviewed.
Results: Twenty four different categories of professionals spanning the whole range of primary, secondary, and tertiary healthcare, social care and educational services were involved in the management of the patients. The largest group of professionals was the primary healthcare specialists. The ten different primary care professionals managed an average of 42% of the patients.
The secondary healthcare providers were involved in the care of an average of 17%, tertiary care providers 10%, educational specialists 25% and social care professionals were involved with 5% of all the patients.
The commonest diagnostic disorders were Speech/Language delay (56%), Global developmental delay (33%), Behavior difficulties (26%), Social communication concerns (21%) and Autistic spectrum disorder (19%).
Conclusion: The high number and specialties of various healthcare professionals at all levels of care indicates the high social and economic investment required in managing the affected preschool children in the region. Childhood neurodevelopmental disorders in the preschool age represents a high level of public health significance.
Mohamed Elsafi, Mona. M. Gouda, Mohamed. S. Badawi*, Abouzeid. A. Thabet, Ahmed. M. El Khatib, Mahmoud. I. Abbas and Kholud. S. Almugren
In gamma-ray spectrometry, the analysis of the environmental radioactivity samples (soil, sediment and ash of a living organism) needs to know the linear attenuation coefficient of the sample matrix. This coefficient is required to calculate the self-absorption correction factor through the sample bulk.In addition, these parameters are very important because the unidentified samples can be different in the composition and density from the reference liquid sources which are usually used for efficiency calibration in the radioactive monitoring process. The present work is essentially concerned to introduce a mathematical method to calculate the linear attenuation coefficient without using any collimator. This method was based mainly on the calculations of the effective solid angle subtended by the source-to-the detector configurations, the efficiency transfer technique and the average path lengths through the samples itself. The method can be used as a tool for the calculation of the linear attenuation coefficient of unidentified materials with good facility to use it in the calibration process of γ-ray detectors, particularly in the study of soil samples. The results are compared with the data from NIST-XCOM to show how much the results are in close agreement and to give the validity of the approach.
Ahmed. M. El Khatib, Mohamed. S. Badawi*, Mohamed. A. Elzaher, Mona. M. Gouda, Abouzeid. A. Thabet, Mahmoud. I. Abbas and Kholud. S. Almugren
Determination of the detector efficiency using volumetric cylindrical sources is very important in various scientific and industrial fields, especially in the field of quantitative analysis. To calculate the absolute activity of any sample, the full-energy peak efficiency (FEPE) of the detector is needed.By applying the efficiency transfer method, the FEPE of the detector would be determined easily without using the standard sources. This approach depends on two main factors. The first one, is the reference efficiency of the reference source, which is determined experimentally, and the second one, is the calculation of the effective solid angle ratio between the sample and the reference source geometries. This work introduces an empirical formula for calculating the second factor for using two different sizes of NaI(Tl) detectors. The validity of this empirical formula was successfully demonstrated by comparing the calculating values with the experimental values.
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.
Taurodontism is a rare dental anomaly presented with an aberration of teeth that lacks the constriction at the level of the cemento-enamel junction (CEJ). It is characterized by elongated pulp chambers and apical displacement of bifurcation or trifurcation of the roots, forming a rectangular shape. Whilst, it appears most frequently as an isolated anomaly, its association with several syndromes and abnormalities has also been reported in the literature. Although permanent molars are most commonly affected, this anomaly could also be seen in deciduous dentition, unilaterally or bilaterally, and in any combination of teeth or quadrants. These morphological anomalies pose various challenges to the dentist during their endodontic treatment. Modern diagnostic tools such as Cone beam computed tomography (CBCT), loupes and Dental operating microscopes (DOM) help in achieving better treatment outcome in such cases. The presented article elaborates diagnosis and successful management of 2 rare cases of taurodontism in permanent molars.
Fernanda Velluzzi, Massimiliano Pau, Andrea Loviselli, Raffaele Milia, Daniela Lai, Daniele Concu, Gianmarco Angius, Abdallah Raweh, Andrea Fois and Alberto Concu*
We utilized the training impulses method to numerically quantify the volume of physical exercise to be prescribed to postmenopausal obese women in such a way of obtain the best possible improvement of their health-related quality of life.Nine women (57±4 years, 89±2 kg, 157±9 cm) carried out 3-months of exercise training (3 session/week each lasting 80 min) under the supervision of skilled operators which indirectly calculated the volume of physical exercise by assessing heart rate values while patient exercised and making sure that the workload corresponded to 50-60% of their maximum oxygen uptake. Before and after training anthropometric, functional and biomechanical variables were assessed. After training patients shoved statistically signifi cant (P<0.05) reduction in body mass (-2%) and body mass index (-4%), waist circumference (-4%), total (-6%) and LDL (-26%) serum cholesterol and glycaemia (-8%), diastolic arterial blood pressure (-14%), and oxygen cost (-14%) at the maximum workload during incremental cardiopulmonary test, the sway area from unipedal stance (right leg) of 20 s on a pressure platform (-49%), while increased both free fat body mass percentage (+3%) and space covered during the six minute walk test (+11%). It was concluded that, when an exercise protocol is carried out by postmenopausal obese women and the volume of exercise is instrumentally controlled by experienced operators, it could result in an effective benefi t on the quality of life of these patients since they ameliorate some critical anthropometric and functional parameters.
Mohamed Yasser Kharma*, Mohamed Sadek Alalwani and Manal Fouad Amer
Oral cancer has a tendency to be detected at late stage which is detrimental to the patients because of its high mortality and morbidity rates (survival rate 15-50% [1]). The incidence of oral cancer worldwide is approximately 3% of all malignancies, thus creating a significant worldwide health problem [2]. The most common form of oral cancer is squamous cell carcinoma (SCC), which accounts for 96% of all cancers of the oral cavity [3]. Oral squamous cell carcinoma (OSCC) and oropharyngeal and pharyngeal SCC is the sixth most common malignancy in the world today [4]. Oral cancer has a mean survival rate of five years, which is much lower than other cancers [5]. Early detection will allow oral cancer to be 90% curable and less cost effective for treatment [6].
Early detection of oral cancer is therefore important to reduce the incidence of mortality of fatal disease. Methods that are available for early detection involves being knowledgeable in oral cancer’s etiology, methods for detecting and examination which require for the clinician to follow the advancement of the methods of detection. Competent, well-educated oral health care providers are needed to provide proper oral cancer screening examinations, for early oral, head, and neck cancer detection. The detection rate of OSCC screening is only 0.12% [7]. Therefore, we focused on the important of advanced screening and detecting methods for early diagnosis of oral premalignant and malignant lesions.
Tobacco use and alcohol consumption are regarded as the main risk factors for oral squamous cell carcinoma (OSCC) table 1, while human papilloma virus (HPV) infection is emerging as the leading risk factor in cancers of the oropharynx. One study of 143 patients found HPV-16 present in 16.8% of head and neck squamous cell carcinomas [8].
The main method for evaluation of healing processes of the jaws in oral and maxillofacial surgery are radiological diagnostics. Quantitative description is possible by measuring the relative bone density, which puts the mean grey value of a certain area in relation to the surrounding bone tissue. In this research the intra- and interindividual variability is determined for this method and a standard operation procedure is elaborated.
Therefore ten panoramic radiographs of typical surgical indications in oral a maxillofacial surgery were analyzed by three different members of the workgroup, five times each. The measurements were analyzed with descriptive and comparative statistical methods.
The mean coefficient of variation was 2.972% ± 2.361%. The measurements of defect regions were more consistent (2.252% ± 1.928%) than the measurements of surrounding bone (3.691% ± 2.626%). The analysis of variance did not show a statistically significant influence of the different raters to the measurements (ANOVA, Pr>F = 0.9462).
Following the standard operation procedure this method seems to be an easy, cheap and close to practice way to visualize healing process of the jaws. Especially in the mandibula, but also in the maxilla with special reconsideration of the sinus-region, it seems to be suitable.
Asa Engstrom*, Maria Johansson, Mia Mattsson and Ulrica Stromback
Background: Intensive care patients are often in need of sedation to endure being intubated. Light sedation is increasingly common since it has been proved to offer benefits such as faster recovery to patients.
Aim: The aim of this study was to describe critical care nurses’ experiences of nursing patients lightly sedated with dexmedetomidine.
Research Methodology: Qualitative personal interviews were conducted during 2015 with 10 critical care nurses in Sweden. Interview transcripts were analysed using inductive qualitative thematic analysis.
Results: Light sedation of the patient facilitated communication and interaction with him or her, and the relationship between the patient and his or her family members. Dexmedetomidine was described as a fairly new drug, and the critical care nurses stated that they needed more knowledge about it and about sedation scales in order to learn more about the drug’s mechanism of action and its potential side effects on patients.
Conclusion: It is important to critical care nurses to learn more about dexmedetomidine and about sedation scales to assess levels of sedation, as light sedation has been shown to benefit the patient as opposed to deep sedation that can increase recovery time.
Cristian Merchan*, Ryan Morgan, John Papadopoulos and David Fridman
The widespread availability of non-traditional dietary supplements and pharmacologically active substances via the Internet continues to introduce mechanisms for inadvertent toxidromes not commonly seen. Consumers are virtually unrestricted in their ability to acquire products purporting augmentation of normal physiology for the purposes of enhancement, recreation, and/or potential abuse. The safety profiles at standard or toxic doses remain largely unknown for many agents that can be purchased electronically. We report a case of mixed toxicity related to phenibut and fosaracetam, both of which are readily available for consumer purchase from online retailers. Written and verbal consent was obtained for this case presentation.
Objective: We evaluated the 30-day outcomes of early (≤ 14 days) or delayed (15 days to three months) carotid revascularization (CR) performed in patients who presented acute brain infarction secondary to internal carotid artery (ICA) stenosis.
Methods: We included all patients with a recent cerebral infarction from July 2010 to June 2014 who underwent CR in our center within three months after the onset of symptoms for ICA stenosis. Data were retrospectively collected. Two groups were identifi ed: Group A included patients who underwent early CR within the first fourteen days after symptom onset, and Group B, patients who underwent delayed CR, from the fifteenth day up to the third month after symptom onset. Death, stroke and major adverse cardiac events (MACE) were analyzed.
Results: Seventy-one patients underwent CR (73.2% men, with a median age of 71). Nineteen patients underwent early CR and 52 underwent delayed CR. The mean interval from initial examination to surgery was 9.5 days (range, 3-14 days) in Group A and 42 days (range, 15-92 days) in Group B. No complication occurred in Group A within the 30 postoperative days. In Group B, no MACE or death was observed and two patients presented with post-operative stroke (3.8%).
Conclusion: This retrospective study confi rmed the satisfactory outcomes of early CR after acute brain infarct. Accurate clinical and radiological selection of patients prevents early neurological complications.
Objective: The aim of the study was to determine the compliance to infection control of various dental laboratories in Durban.
Study design: This was a qualitative survey.
Setting: Dental laboratories in Durban area, South Africa.
Subject: Registered laboratory technicians.
Study methodology: Convenient random sampling method was used.
Results: There was poor compliance to infection control procedures by most dental laboratories. Majority, 66.67%, of the dental laboratories relied on dental clinics for disinfection of dental impressions; therefore, they did not disinfect the impressions. On the other hand, only 33.33% carried out disinfection of dental impressions on their own. A high number (53.3%) of the respondents had disinfection areas within their dental laboratories, 6.7% had no disinfection areas while 40% depended upon dental clinics for all disinfections. About 60% of the dental technicians had valid vaccinations against Hepatitis B Virus while 40% had no vaccination against HBV.
Conclusion: The results of this study indicated that there was substantial nonconformity to infection control measure in all dental laboratories. There should be comprehensive inspection of dental laboratories prior to licensing and thereafter by the South African Dental Technician Council’s inspectors to ensure that all dental laboratories comply with the various infection control measures.
Conclusion: The results of this study indicated that there was substantial nonconformity to infection control measure in all dental laboratories. There should be comprehensive inspection of dental laboratories prior to licensing and thereafter by the South African Dental Technician Council’s inspectors to ensure that all dental laboratories comply with the various infection control measures.
Maaz Zuhayra, Marlies Marx, Ulrich Karwacik, Yi Zhao and Ulf Lützen*
Introduction: Radioiodine therapy is a standard procedure in thyroid autonomy treatment. Discrepancies in the visual comparisons of the scintigraphies prepared for this purpose using Tc-99m-O4- and I-131 have been known for years.In this study a new method is used to calculate and perform a quantitative comparison of both uptakes using subtraction analysis and 3D imaging. The results and their causes are discussed together with practice-relevant conclusions for better clinical results.
Material and Methods: The new method was used in 38 patients with thyroid autonomies for the subtraction analysis of standardized pretherapeutic and intratherapeutic scintigraphies. The parametric distribution of activity was calculated absolutely and as a percentage and displayed three-dimensionally. These results were compared with the visual assessment of the different scintigraphies by the experts. Inclusion criteria were pretherapeutic and intratherapeutic hyperthyroidism without medication affecting the thyroid. The time difference between acquiring the scintigraphies was 28 days maximum.
Results: Activity distribution was visually discrepant in 39.5% of cases. 60.5% displayed comparable uptake. The calculated values showed reversed results after applying the new method. The results using our method show a higher rate of calculated discrepancies compared with visual analysis.
Conclusion: Accurate functional imaging of the thyroid is next to further aspects very important in establishing the diagnosis and deciding about the therapy activity for thyroid treatment. In combination with clinical symptoms and laboratory values, Tc-99m-O4 - scintigram can be used for an orientated, preliminary assessment of functional disorders of the thyroid. But because of the higher rate of found discrepancies, the solely use of Tc-99m-O4 - scintigram is not always capable for exact and reliable diagnosis. The known reason for this is most probably due to the different biokinetics of both radiopharmaceuticals, which can be imaged more sensitively with this method. Consequently, a scintigram should be performed in the pretherapeutic radioiodine uptake test. Despite higher costs and radiation exposure, alternatively, pretherapeutic use of other diagnostic iodine isotopes like I-123 or -124 should be discussed, because they could overcome the limitation of the different biokinetics. Following this approach the preliminary assessment using Tc-99m-O4 - scintigraphy can be precised and double checked to improve diagnostic confi dence and treatment results for a better outcome of the patients.
Results: Activity distribution was visually discrepant in 39.5% of cases. 60.5% displayed comparable uptake. The calculated values showed reversed results after applying the new method. The results using our method show a higher rate of calculated discrepancies compared with visual analysis.
Christodoulos E Papadopoulos*, Dimitrios G Zioutas, Panagiotis Charalambidis, Aristi Boulbou, Konstantinos Triantafyllou, Konstantinos Baltoumas, Haralambos I. Karvounis and Vassilios Vassilikos
Background: Left atrial volume (LAV) has been established as a sensitive marker of left ventricular (LV) diastolic function and as an independent predictor of mortality in patients with acute myocardial infarction (AMI). LA remodeling and its determinants in the setting of AMI have not been much studied.
Methods: We studied 53 patients with anterior AMI and a relatively preserved LV systolic function, who underwent complete reperfusion and received guidelines guided antiremodeling drug management. LA and LV remodeling were assessed using 2D echocardiography at baseline and 6 months. LAV indexed for BSA (LAVi) was used as the index of LA size and further LA remodeling.
Results: LAVi increased signifi cantly at 6 months compared to baseline [28.1 (23.0-34.5) vs 24.4 (19.5- 31.6) ml/m2, p=0.002] following LV end diastolic-volume index change [56.8 (47.6-63.9) vs 49.5 (42.0-58.4) ml/m2, p=0.0003]. Other standard LV diastolic function indices did not show any signifi cant change. Univariateanalysis showed a strong positive correlation of LAVi change with BNP levels at discharge, LV mass index and LV volumes indices change, throughout the follow up period. Multivariate regression analysis revealed that BNP plasma levels was the most important independent predictor of LA remodeling (b-coef.=0.630, p=0.001).
Conclusions: Despite current antiremodeling strategies in patients with AMI, LA remodeling is frequently asssociated with LV remodeling. Additionally LAVi change in the mid-term reflects better than standard echocardiographic indices LV diastolic filling impairment.
Gesualdo M Zucco*, Andrea Carletti and Richard J Stevenson
<h2>Abstract</h2><p>Concussion occurs with some frequency in a variety of sports. Any trauma to the brain can also result in temporary or chronic olfactory dysfunction. The relationship between sports concussion and olfactory dysfunction is not well studied, nor do we know whether only more severe injuries result in smell impairments.Three sports players who had previously experienced either a moderate or severe concussion were compared to matched controls. Only the player with a previous severe concussion had a current olfactory impairment. We tentatively suggest that the distinction between moderate and severe concussion may represent a possible cut-off between the presence and absence of olfactory impairment in sports players.</p>
Yasuhiro Homma, Arnaud Dubory, Jacques Pariat, Damien Potage, Charles Henri Flouzat Lachaniette, Nathalie Chevallier, Helene Rouard and Philippe Hernigou*
When Total Hip Arthroplasty (THA) is required in a patient with developmental dysplasia of the hip (DDH), bone deficiency in the acetabular roof often remains a problem. The iliac crest (IC) has long been the preferred source of autograft material, but graft harvest is associated with frequent complications and pain. Autologous bone graft can also be obtained from the femoral head (FH) for reconstruction of the acetabulum in hip arthroplasty. However, in certain challenging clinical scenarios, incorporation of the femoral head autograft appears less successful than the iliac crest autograft. The difference in potential for proliferation and osteoblastic differentiation between the two sites has still not been evaluated; therefore, it is not known how to compensate for this difference when it is present. We designed this study to evaluate the number of mesenchymal stem cells (MSCs) in both the iliac crest and femoral head of the same patient. We also determined the best operating room procedure for loading the femoral head with MSCs to achieve equivalent numbers of MSCs as in the IC. Twenty patients (8 men and 16 women) undergoing THA for DDH were enrolled in the study. The mean age was 55.5 years (range 41–65 years). Bone marrow aspirates were obtained from three depths within the femoral head and the aspirates were quantified relative to matched iliac crest aspirates that were obtained from the same patient at the same time. The cell count, progenitor cell concentration (cells/mL marrow), and progenitor cell prevalence (progenitor cells/million nucleated cells) were calculated.
Aspirates of FH marrow demonstrated less concentrations of mononuclear cells compared with matched controls from the iliac crest. Progenitor cell concentrations were consistently lower in FH aspirates compared to matched controls from the iliac crest (p = 0.05). The concentration of osteogenic progenitor cells was, on average, 40% lower in the FH aspirates than in the paired iliac crest samples (p = 0.05). However, with bone marrow aspirated from the iliac crest, we were able to load the femoral head autograft with sufficient MSCs to obtain the same number as present in an iliac crest. With concentrated bone marrow from the IC, supercharging the femoral autograft with MSCs to numbers above that present in the IC was possible in the operating room, and the number of MSCs supercharged in the femoral head was predictable.
Based on these findings we suggest that FH graft supercharged with BM-MSCs from the IC is comparable to IC graft for osseous graft supplementation especially in THA for patients with DDH.
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