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Some Problems of Vaccination Campaigns in Developing Countries
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Quality Improvement in Clinical Laboratories: A Six Sigma Concept
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C-C Chemokine Receptor Seven (CCR7): Coming of Age In Vaccines
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Herd Immunity Conferred By Hepatitis B Vaccination Increases the Protection Efficacy against Hepatitis B Virus Infection
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Is Normal Knee Biomechanics Reproduced by Modern Total Knee Arthroplasty Designs? The Role of Fluoroscopy
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Model Based vs. Rule Based Designs in Phase I Dose Finding Clinical Trials
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Cultural Adaptation for Common Orthopedic Disorders Pathology and Presentations With Focus on Middle Eastern and Asian Patients
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Tumor Necrosis Factor Inhibitors May Improve Glycemic Control in Patients Rheumatoid Arthritis and Concomitant Type 2 Diabetes Mellitus
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A Rare Cause of Shoulder Pain: Ganglion Cyst of the Acromioclavicular Joint
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Innovations in Microbial Biodiscovery, Targeting Silent Metabolism and New Chemical Diversity
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Dendritic Cell Maturation is a Critical Step in Dendritic Cell Vaccine Preparation for Cancer Therapy
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The QuickDASH in the Assessment of Rheumatoid Arthritis Disease Activity
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Innovation of Wound and Burn Care Dressings from Traditional to Nonwoven Polymeric Scaffolds
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Invasive Moderately-Differentiated Mucinous Adenocarcinoma Incidentally Identified in Perforated Acute Diverticulitis With Abscess Formation
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Distribution and Conduct of Clinical Trials Involving Music Therapy: Registered Clinical Trials in the Lost 15 Years
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Abstract [+]
Objective: This study aimed to conduct an evaluation of music therapy clinical trials
worldwide, to understand what trials have been conducted and to show the chronological
changes. Additionally, we sought to clarify issues related to providing clinical trial registration
information.
Methods: We searched the International Clinical Trials Registry Platform (ICTRP) database for
“music therapy,” and identified the disease target for each article found.
Results: A total of 150 clinical trial studies were found in the ICTRP using the term “music
therapy.” In these trials, music therapy was used for improvement of social functioning in
schizophrenia and/or serious mental disorders, anxiety and depressive symptoms, and cancer
symptoms. Twenty-five clinical trials were actively recruiting. Sixteen of the 25 trials were
registered in the United States at ClinicalTrials.gov, of which 9 trials were conducted in the US.
Seven trials were conducted in other countries such as Spain, Taiwan, and China.
Conclusion: A search for music therapy clinical trials retrieved 150 trials from the ICTRP, and
the number of clinical trial registrations has increased yearly. Music therapy is widely used in
patients with various diseases, including Alzheimer’s disease, anxiety, and arthritic pain and
has the potential to improve certain disease outcomes, but there is not enough evidence to
substantiate its efficacy. It is important to enlighten researchers and pharmaceutical companies
on the proper management of the quality of such clinical trial information, as this is an important
issue.
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Cell Derived Virus-Like Particles (VLP) in Future Vaccine Development
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The Swan Song of a Pathologist: “Why Do I Love Thee, Pathology? Let Me Count the Ways….”
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Fluorinated Lipids Conjugated to Peptide Antigens do not Induce Immune Responses Against Cervical Cancer
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Recent Advances in Adenovirus-Vectored Vaccines Development
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Hair Loss and Chemotherapy: An Overview about What You Need To Know
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Clinical Investigations on Medical Devices, after the New European Regulation (2017/745)
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Cluster Randomized Controlled Trials: A Quick Update on Concepts and Types
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Immunobiology of Anticancer Virotherapy With Newcastle Disease Virus in Cancer Patients
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Education and Health System Collaboration are Indispensable in Vaccination Coverage
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Training of Future Surgeons in Minimally Invasive Surgery Needs Intensification: A Multicentre Study
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The Concept of Developing a Plasmodium vivax Malarial Vaccine with a Focus on its Pre-erythrocytic Stage
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New Ideas on Limitations to VO2max: Five Major Determinants for VO2max
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A Case Report on Vogt-Koyanagi-Harada Disease Seen at a Tertiary Hospital in the Philippines
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Don’t Shun the Shunt: Surgical Portosystemic Shunts in the Era of TIPS and Liver Transplantation
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Hair as a Specimen to Determine the Concentration of Cortisol Levels in Individuals that have Performed Physical Activity
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Cranial and Spinal Subdural Hygroma Following Lumbar Epidural for Labour Analgesia
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Abstract [+]
Intracranial hygroma is a rare and probably missed complication of epidural analgesia secondary to accidental dural breech. The patient presented had a presumed spinal cerebrospinal fluid leak with symptoms of intracranial hypotension. Unusually the patient had both an intracranial subdural hygroma and rarely reported extensive spinal intradural (extra-arachnoid) collection following a lumbar epidural, administered in labour. Given the potential for progression to symptomatic neurological deficits, anesthetists should consider subdural hygroma when encountering patients with features of intracranial hypotension, or altered neurology following epidural. Pathophysiology, imaging and management are discussed.
Keywords
Subdural hygroma; Epidural; Dural puncture.
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Pediatric and Neonatal Malnutrition: A Collaborative, Family-Centered Approach Improves Outcomes
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Glucocorticoid Induced Hypothalamic-Pituitary Axis Alterations Associated with Hypogonadotropic Hypogonadism
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Fractional CO2 Laser Treatment for Vaginal Rejuvenation in Post-Menopausal Indian Women
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Determinants of Canine Rabies in Morocco: How to Make Pertinent Deductions for Control?
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Alleviating Impact of Taurine on Renal Lipid Peroxidation and Oxidative Stress in Lambda-Cyhalothrin Exposed Rat
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Prevalaence of Anaemia among Preganant Women Attending 82 Division Nigerian Army Hospitals, Enugu
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Compliance with Tobacco Control Policies and Global Youth Tobacco Survey: A Cross-Sectional Comparison between GYTS 2000 and 2015 in Maharashtra, India
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Actinic Lichen Nitidus with Dermoscopic Features, and Response to Hydroxychloroquine
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The Effectiveness of Transcutaneous Electrical Nerve Stimulation Versus Carbamazepine in Trigeminal Neuralgia: A Randomized Controlled Trial
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Alternative Effective Management of the Musculoskeletal Pain
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“The Moustache Sign”: A Common Morphological Characteristic in Cardiovascular Disease Treatment
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Bilateral Staged Primary Total Knee Arthroplasty: Are Patients Less Pleased with their Second Side?
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The Causes of Marginal Discrepancy of Fixed Dental Prostheses: A Cross-Sectional Study
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Challenges Facing Pediatric Dentistry Diplomates and the American Board of Pediatric Dentistry: Setting the Bar for Minimal Competency vs. Excellence
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A Decision Support System is Needed for Rapid Triage of Chest Pain Patients Using High Sensitivity Troponin Testing-Based Algorithms
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Consensus Meeting on International Standards for Oral Whole Cell Killed Cholera Vaccines, 17-18 May 2018, Seoul, Republic of Korea
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A Cycle of Altered Proteasome and Reactive Oxygen Species Production in Renal Proximal Tubular Cells
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Anesthetic Considerations in Bilateral Congenital Anophthalmia: A Rare Clinical Entity
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Abstract [+]
Congenital anomalies planned for ocular surgeries range from the rare to atypical to common. Many of this rare ophthalmopathy are associated with clinical syndromes and have important anesthetic implications. Not only is it important to know the syndrome we are dealing with, but it’s also the more important to understand the systems that are involved, the extent of involvement, potential anesthetic complications, right from the cerebrovascular, cardiovascular, endocrine, metabolic, neuromuscular, genitourinary systems to airway. Understanding these aspects becomes more important in rare clinical scenarios as it helps to plan the case, anticipate and treat the complications. Congenital anophthalmia is one of the rare conditions with an incidence of <3/1000 with microphthalmia reported in up to 11% of blind children, hence we report a rare case of bilateral congenital anophthalmia planned for excision of right ocular swelling.
Keywords
Ophthalmopathies; Congenital anophthalmia; Microophthalmia; Ocular surgery.
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Hardware Causing Hard Times: Use of the SuperNO2VA™ Nasal PAP Device to Address Airway Challenges Caused by Eroding Mandibular Hardware
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Abstract [+]
Background
Maintenance of the airway and adequate ventilation are essential for the anesthetized patient and may be compromised in patients with pan-facial trauma, abnormal dentition, abnormal mandibular space, or presence of dental hardware. We present an unusual case of a patient with a lack of natural mandibular structure and exposed mechanical hardware with fistula complicating intubation and ventilation prior to surgery.
Case Presentation
A 35-year-old male with a history of a self-inflicted gunshot to the left submandibular region approximately 6 years prior was scheduled for urgent mandibular hardware removal, closure of left facial fistula, and removal of several teeth. Pre-oxygenation and ventilation were complicated by extruding hardware and eroded skin, causing interference with a conventional facemask seal. The patient was pre-oxygenated using the SuperNO2VA™ nasal mask with which an adequate seal was achieved without use of a nasal trumpet and with a modified grip. Tracheal intubation via oral video laryngoscopy was successful, and the case proceeded uneventfully.
Conclusion
Adequate ventilation and airway maintenance can be difficult to achieve in patients with abnormal facial structure or mandibular mechanical hardware using conventional methods. The SuperNO2VA™ nasal mask can address airway issues for these patients peri-operatively.
Keywords
Anesthesiology; Airway management; Difficult airway; Airway devices; Difficult intubation; Ventilation; Oxygenation; Facial trauma; Mask ventilation.
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Pneumocephalus Caused by an Epidural Ozone Injection for Treatment of Disc Prolapse
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Abstract [+]
Pneumocephalus is a complication seen either after head trauma or post-neurosurgical procedure. It can be life-threatening if it turns into tension pneumocephalus. The presence of intracranial air indicates the presence of an open communication of cerebrospinal fluid. Air enters dura matter even without connection. Thin air flows upstream along the cerebrospinal fluid (CSF) pathway. Herein, we report a case of pneumocephalus in a 62-year-old female after epidural injection of Bupivacaine and Ozone for the treatment of a prolapsed disc. She was shifted to our hospital post-epidural injection for the management of severe headache. Though it is a rare complication, keeping this in mind will help to quickly diagnose, if need arises.
Keywords
Pneumocephalus; Head trauma; CT; Thunderclap headache.
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The Prognostic Value of PD-L1 Expression in Triple-Negative Breast Cancer: A Cohort Study and Systematic Literature Review
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Changes on Electrocardiographic Patterns and Associated Factors among Chronic Obstructive Pulmonary Disease Patients
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A Pilot Study on the Effect of Massage on Stress among Female Japanese University Students
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Antihyperglycemic Mechanisms of Allium sativum, Citrus sinensis and Persea americana Extracts: Effects on Inhibition of Digestive Enzymes, Glucose Adsorption and Absorption on Yeast Cells and Psoas Muscles
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Abstract [+]
Mechanisms by which some plants with antihyperglycemic effects reduce postprandial hyperglycemiaare not fully elucidated. This study was designed to investigate some action mechanisms of extracts from stem bark of Citrus sinensis, seeds of Persea americana and bulbs of Allium sativum including in vitro inhibition of α-amylase and invertase; glucophagic capacity, absorption capacity on yeast cells and psoas tissues.
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Compliance with Highly Active Antiretroviral Therapy (HAART) does not Prevent Human Papilloma Virus (HPV)- Related Cancers in Women Infected with Human Immunodeficiency Virus (HIV)
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Abstract [+]
Introduction
Cancer is one of the leading causes of death in people with human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS), due to behavioral choices and overlapping risk factors.Aim
The purpose of this report is to determine the long-term incidence of human papilloma virus (HPV)-associated cancer in women with pre-invasive cervical neoplasia, and compliance with medication and cancer screening recommendations.Methods
HIV-infected women diagnosed with pre-invasive cervical neoplasia and an HPV-associated malignancy between 1995-2008 were identified. Data collected includes: demographics, HIV treatment/response, malignancy treatment/response, other healthcare utilization, use of health navigators, and compliance.Results
Seventy-one subjects were identified with HIV infection, cervical dysplasia, and at least ten years’ follow-up. 17/71 (24%) were identified with an HPV-related malignancy. The mean age of those diagnosed with HPV-related malignancy was 39-years. Malignancies included: Cervix-9, Vulva-7, Anal-4, Vagina-3, Uretha/Bladder-2, Oropharyngeal-3. Eight also had in-situ neoplasms: Cervix-4, Vulva-3, Oropharyngeal-1. Four subjects had 3 separate malignancies, and two others had 2 malignancies. Compliance with HAART correlated strongly with immunocompetence, response to therapy, use of patient navigators, and survival. Sixty out of saventy one (84.5%) subjects underwent screening mammography, 57/71 (80.3%) underwent colonoscopy, and 67/71 (94.3%) underwent pap smear testing. Compliance with screening compared favorably with the general population, and overall survival was similar.Discussion and Conclusion
The long-term incidence and mortality from cancer in women with HIV and cervical dysplasia appears to be comparable to that seen in the general population, with the possible exception of oropharyngeal cancers. Compliance with cancer screening recommendations appears to be higher than in the general population. This suggests that structured primary care programs for HIV-infected women are effective in prevention/early diagnosis of cancer. Standardized screening programs for oropharyngeal cancers should be considered in this population.Keywords
Human immunodeficiency virus (HIV); Cancer; Human papilloma virus(HPV); Women; AIDS;
Highly active anti-retroviral therapy (HAART).
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Hysteroscopy Versus Laparoscopy in the Management of Isthmocele: A Review of the Literature
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Abstract [+]
Objective
Isthmocele is a pouch defect of the anterior uterine wall, detected at the site of the previous cesarean scar. It can be asymptomatic or cause abnormal uterine bleeding, pelvic discomfort and difficulty conceiving. The main objective of this review is to highlight the hysteroscopic and laparoscopic approaches in the management of this disorder.Main Findings
During the hysteroscopic approach, the superior and inferior edges or just the superior edge of the defect are resected, removing the fibrotic tissue and allowing renewal of the continuous canal between the cervix and the uterine cavity. Whereas, the laparoscopic approach consists of direct visualization and removal of the defect followed by re-approximation of the myometrium. Both methods lead to significant improvement in symptoms and fertility.Conclusion
While hysteroscopy is a quick non-morbid procedure that allows concurrent removal of other uterine pathology, laparoscopy is characterized by improved visualization and decreased risk of complications with defects less than 3mm as well as the possible correction of uterine retroversion. Definitely, randomized controlled trials are required in this field for better guidance of the diagnosis and management.Keywords
Isthmocele; Uterine niche; Cesarean scar defect; Cesarean scar syndrome; Hysteroscopy; Laparoscopy.
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Changes in Blood Bone Metabolism Markers with Oat Bran Consumption and Brisk Walking Exercise in Middle Age Hypercholesterolemic Women
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Abstract [+]
Purpose
To investigate the additional beneficial effects of combined oat bran consumption and brisk walking exercise compared to oat bran consumption alone on bone metabolism markers in 40 to 50 years-old hypercholesterolemic women.Methods
Thirty-three hypercholesterolemic women participants aged 40 to 50-years-old were recruited and were assigned into three groups, with eleven participants per group (n=11): sedentary without oat bran consumption control (C), oat bran consumption alone (Ob), and combined oat bran consumption and brisk walking exercise (ObEx) groups. Participants in the ObEx group performed brisk walking exercise sessions 30 minutes per session, 3 sessions per week for 6 weeks. Participants in the Ob group and ObEx group consumed 18 g of oat bran powder, 7 days per week for 6 weeks. Participants’ anthropometry and blood bone metabolism markers were measured at pre- and post-tests.Results
There were no significant main effects of time (p>0.05) in serum total calcium, serum phosphorus and serum C-terminal telopeptide of type 1 collagen (1CTP) (bone resorption marker) concentrations in all the groups. However, significantly (p<0.05) increase in serum alkaline phosphatase (bone formation marker) concentration was observed in Ob group and ObEx group respectively.Conclusion
The present observations did not show large difference in the beneficial effects of combined oat bran consumption and brisk walking compared to oat bran consumption alone on bone metabolism markers. Future studies with longer duration may be needed to elicit greater effects of combined oat bran consumption and brisk walking than oat bran consumption alone on bone metabolism markers in middle age hypercholesterolemic women.Keywords
Bone metabolism; Brisk walking; Hypercholesterolemic; Oat bran consumption; Middle age women.
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The Effectiveness of Inferior Turbinoplasty in Children with Nasal Obstruction
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Abstract [+]
Objective
To evaluate the effectiveness of medial flap inferior turbinoplasty for the treatment of nasal obstruction in children.Patients and Methods
This study was conducted at the ear nose throat (ENT) Department at Minia University Hospital, Minia, Egypt which include 40 children with bilateral nasal obstruction due to bilateral hypertrophied inferior turbinates that did not respond to medical treatment for 3 successive months in the form of (systemic antihistamines, systemic and local decongestant drugs and local corticosteroid spray) who attended the ENT outpatient clinic. All patients were subjected to turbinate reduction through medial flap inferior turbinoplasty.Results
Forty patients with bilateral hypertrophied inferior turbinates were assessed. Ninety days after surgery, 90% of patients transformed from severe or moderate degrees of nasal obstruction “pre-operatively” to mild degree or completely with no nasal obstruction; 80% of patients had grade I improvement in nasal obstruction and 14 patients had only grade II improvement; only
10% of patients had crustation.Conclusion
Medial flap inferior turbinoplasty is safe and effective in the treatment of nasal obstruction in children with almost no complications was recorded.Keywords
Inferior turbinate hypertrophy; Inferior turbinoplasty; Nasal obstruction; Children.
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Coexistence of Tuberculosis and Metastatic Undifferentiated Carcinoma of Nasopharynx in Cervical Lymph Node
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Abstract [+]
The coexistence of a head and neck cancer and a lymph node tuberculosis is rarely described. The problem is essentially diagnostic. We report the case of a patient with cervical lymphadenopathy and non suspect swelliing of nasopharynx. Histopathological study of lymph node reveled an association of a tubercular adenitis and a metastasis of a squamous cell carcinoma.
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Changes in Estimated Glomerular Filtration Rate, Biochemical and Hematological Profile of Workers in Spray Painting Industry: A Cross-Sectional Study
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Abstract [+]
Introduction
There is a global increase in occupational exposure to solvents, some of which are suspected to cause acute or chronic toxic nephropathies in humans. However, limited studies have been done to evaluate the systemic effects of exposure to some of the commonly used solvents such as paints.
Aim
The aim of the present study was to assess the effect of chronic exposure to paint fumes on renal and hepatic functions of industrial spray painters. Methodology In this cross-sectional study, 49 occupationally exposed male industrial spray painters who had served for greater than 5 years were evaluated for changes in renal, hepatic and hematological indices using standard instruments and results were compared with levels in the unexposed (sex and age-matched) participants.
Results
Significant changes in markers of renal, hepatic and hematological functions were observed in the exposed compared with unexposed participants including significant decrease in estimated glomerular filtration rate (eGFR) and serum levels of potassium (K+) and chloride (Cl-), and significant increases in serum levels of creatinine (Cr), sodium (Na+), urea (Ur) and uric acid (UA) in the exposed compared to levels in the unexposed group. Abnormal serum levels of hepatic enzymes (AST, ALT and ALP) and hematological indices (PCV, total-RBC, nuetrophils, basophils, monocytes and lymphocytes) were also observed in the exposed compared to levels in the unexposed participants.
Conclusion
Prolonged exposure to paint fumes may be associated with a significant risk for hepato-renal dysfunction and hematotoxicity. Preventive measures should include limiting exposure and using antioxidant medications.
Keywords
Spray painting; Toxicity; Workers; Kidney; Liver; Blood cells.
Abbreviations ALT: Alanine transaminase; ALP: Alkaline phosphatase; AST: Aspartate transaminase; eGFR: Estimated glomerular fitration rate; C-G: Cockroft-Gault; MDRD: Modification of diet in renal disease; Na+/K+/ATPase: Sodium potassium adenosine triphosphatase; PH: Hydrogen Concentration; PCV: Packed cell volume; RBC: Red blood cells; ROS: Reactive oxygen species; UA: Uric acid; Ur: Urea.
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Loss of Pancreatic β-cell Secretory Function During Disease Progression in Type 2 Diabetes Mellitus – A Small Cross-Sectional Study
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Abstract [+]
Introduction: Overt type 2 diabetes mellitus (T2DM) is a chronic progressive disease which is produced by the collusion of three metabolic defects-increased hepatic glucose production, impaired pancreatic β-cell insulin secretion and decreased insulin action. The measurement of plasma glucose 2 hours post-ingestion of 75 g of glucose during the oral glucose tolerance test (OGTT) may be used to classify individuals as normal glucose tolerant (NGT), impaired glucose tolerant, T2DM and T2DM with pancreatic β-cell failure.
Objectives: This study was undertaken primarily to show the importance of assessing the pancreatic β-cell function especially during the care of the diabetic patient.
Methods: A standard 75 g glucose tolerance test (OGTT) was administered to four groups of 8 subjects (4 male, 4 female). Blood was drawn every 15 minutes for 2 hours for the measurement of glucose, insulin and C-peptide and the measurement of the area under the curve (AUC(0→2)) over the 2-hour period.
Results: American Diabetes Association (ADA) criteria were used to classify the subjects. The normal glucose tolerant (NGT), had 2 h glucose 111±11 mg/dL, those with impaired glucose tolerance (IGT) had 2 h glucose 160±13 mg/dL. The 2 h glucose for the T2DM group was 258±27 mg/dL and those for the T2DM-PE group was 260±42 mg/dL. The AUC(0→2) for NGT group were 254±40 mg/dL/h, 112±61 μU/mL/h and 10.2±4.6 ng/ml/h for glucose, insulin and C-peptide, respectively. The AUC(0→2) for the IGT group were 394±32 mg/dL/h, 160±48 μU/mL/h and 19.8±7.7 ng/ml/h for glucose, insulin and C-peptide, respectively. The AUC(0→2) for the T2DM group were 474±62 mg/dL/h, 194±40 μU/mL/h and 13.4±4.7 ng/mL/h for glucose and insulin, and C-peptide, respectively. The AUC(0→2) for the T2DM-PE group were 481±80 mg/dL/h, 51±29 μU/mL/h and 7.2±2.8 ng/mL/h for glucose, insulin and C-peptide, respectively. There was no significant difference between the diabetic groups with respect to the glucose AUC(0→2) but a significant difference existed in the insulin AUC(0→2), (p<0.0001) mirrored by the fasting plasma insulin levels (30±8 μU/mL vs 14+8 μU/mL, for T2DM and T2DM-PE, respectively, p<0.0005). Although there was about a 300% increase in fasting insulin between the IGT and T2DM groups, the corresponding fasting C-peptide levels were only about 15%. This is probably due to differences in hepatic and renal functions in those two groups, the processes that control insulin and C-peptide levels in the body. Conclusion: Although measurement of blood glucose appears adequate in the diagnosis of the diabetes, it seems that plasma insulin/C-peptide measurements could guide physicians in their choice of medications for the treatment of diabetic patients, especially when the pancreas begins to fail. To that end, larger studies are warranted to study the effects of hypoglycemic agents on hepatic insulin extraction and renal C-peptide excretion to ascertain the reliability of the plasma insulin and C-peptide levels. Keywords Type 2 diabetes mellitus; Pancreatic β-cells; Oral glucose tolerance test; Pancreatic exhaustion.
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Exploring the Everyday Lived Experience of African American People Living with HIV/AIDS (PLWH) in the Rural South
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Abstract [+]
Aims/Objectives
Despite previous findings attesting to the syndemic nature of human immunodeficiency virus (HIV), chronic disease and mental illness coordination of these issues remains a significant barrier to initiating and maintaining the delivery of mental and physical health care to persons living with HIV (PLWH). These inequities are even greater when applied to rural settings, particularly in areas that are medically underserved. To date, there is scarce research regarding the lived experiences of African American PLWH
in rural settings. Constructivist grounded theory was used to analyze this qualitative data set. These discourses provide a rich narrative regarding effective systems of care, the context in which these processes take place and related constraints or limitations of the current systems.Methods
In-depth interviews with 24 African American PLWH both inside (N=20) and outside (N=4) of care in rural Northwestern Virginia were conducted. Rural African American PLWH were queried about their perceptions of the provision of HIV health care services, barriers to linkages to care, retention of PLWH in care, and recommendations for improving HIV health care services for rural PLWH.
Results
Participants offered insights on the linkages to health and mental health care consistent with the pattern recommended by the cascade of care (i.e. pre-screening, testing, refer to treatment, treatment and sustain treatment). Participants identified contextual factors, including traumatic events, medication (side effects), other chronic health issues, issues with the current health and mental health system, stigma, and lack of social support. We highlight PLWH’s recommendations for linking rural PLWH into care and sustaining that care.
Conclusion
We discuss the implications of these findings for programmatic development in the rural context.
Keywords
Rural African Americans living with HIV; Barriers to HIV health care; Rural South; HIV lived experience.
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Early Onset, But Late Diagnosis of a Rare Disease
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Abstract [+]
One of the most common sphingolipidosis, Gaucher disease (GD) remains rare till date. A case report of a 56-year-old patient diagnosed with GD is presented herein. Her sister was known to have Gaucher disease. Her personal medical record consisted of splenectomy, anemia, recurrent infections, and bone lesions at a young age. Taking into consideration her personal and familial history, the clinical and paraclinical examinations, she was diagnosed with Gaucher disease which was confirmed with enzyme and gene testing. Upon introduction of specific enzyme replacement treatment for Gaucher patients,much evidence demonstrated the substantial improvement of hematological and visceral parameters. However, it has been observed that the bone tissue does not respond equally to the treatment.
Learning Points
• The physician should always investigate the splenomegaly of unknown etiology before deciding to do a splenectomy
• Bone lesions in Gaucher disease are sometimes irreversible, hence the importance of early diagnosis of this rare disease
Keywords
Gaucher disease; Bone lesion; Splenomeagly.
Acronyms
GD: Gaucher disease; Hb: Hemoglobin; MRI: Magnetic resonance imaging; ERT: Enzyme replacement therapy.
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Outcomes of Vocal Fold Immobility After Pediatric Cardiovascular Surgery
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Abstract [+]
Objectives
Cardiovascular surgery is increasingly performed in children for congenital malformations of the heart and great vessels. Observed as vocal fold immobility, recurrent laryngeal nerve injury is a well-described complication. As overall outcomes improve and patients live longer, the sequelae of vocal fold immobility amplify insignificance. Families are often unaware of the longterm issues related to vocal fold immobility especially with regard to need for alternative alimentation routes. We report on the incidence of use of feeding tubes, the timing of vocal fold function return and need for additional aerodigestive interventions.
Methods
We reviewed 65 patients <2-years who underwent cardiovascular surgery at a tertiary center from 2008-2013 and were diagnosed post-operatively with vocal fold immobility by fiberoptic examination. Results Patent ductus arteriosus and hypoplastic left heart syndrome were the most common of the cardiovascular anomalies included. The majority (92%) had unilateral left immobility. Recovery of motion was observed in 29% ranging from 1-month to 3-years. Hypoplastic left heart syndrome had a significant negative correlation with recovery. Forty-six percent required gastrostomy tube placement either to supplement their oral intake or to completely meet their nutritional needs. Forty-eight percent required subsequent aerodigestive surgery including direct laryngoscopy/bronchoscopy (22%), tracheostomy (8%) and vocal fold injection (5%). Conclusion Counseling of families and primary care providers regarding the impact of pediatric vocal fold immobility after cardiac surgery should include the high potential requirement for supplemental alimentation as well as the need for feeding and speech therapy. Longitudinal otolaryngology and speech pathology care is imperative with vocal fold immobility since the majority of these patients do not experience functional recovery and may require further interventions over time. Keywords Vocal cord paralysis; Pediatric cardiovascular surgery; Pediatric aerodigestive disorders; Voice; Swallow; Gastrostomy.
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Physico-Chemical, Surface and Thermal Properties of Date Palm Pollen as a Novel Nutritive Ingredient
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Abstract [+]
Background
Date palm pollen (DPP) is a natural product well-known in folk medicine in the Arab world. It is used to improve the fertility of human beings and studies have tested this activity on rabbits and rats. In the region of Sfax from Tunisia, a huge quantity of DPP could be discarded. Taking into account of the richness of this typical product of different components and of the trend of producing food supplements that could be sold at medium price comparing with the existing product, DPP was analyzed on the basis of physical and chemical properties in order to promote its use as a techno-functional ingredient in the agri-food and pharmaceutical field.
Results
X-ray diffraction showed that DPP is characterized by an amorphous structure which leads to better techno-functional properties while stored in a water-air-tight container. Findings proved that DPP is capable to reduce the surface tension. Collected data from thermal analysis proved that DPP is thermally stable during storage and in different food systems.
Conclusion
The present study demonstrated that DPP could be used in the agri-food and pharmaceutical field. The obtained results help to define the suitable storage conditions of DPP and to predict its behavior when used as an ingredient. DPP can be used as a whole in food formulations or after extracting protein which is the main responsible agent for surfactant property. DPP proteins might be used as a food supplement in commercial sports nutrition products that can be sold at medium prices compared to some existing products.
Keywords
Date palm pollen; Physico-chemical; Morphology; Surface; Thermal.
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Why do HIV PrEP Patients Become Lost-to-Care and How Can We Improve PrEP Retention?
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Abstract [+]
Objectives
To assess reasons for patients being lost-to-care (LTC) at an urban health center (Philadelphia, PA, USA) that provides access to oral tenofovir/emtricitabine(TDF/FTC) as pre- exposure prophylaxis(PrEP) to patients ages 13-30 years through a drop-in model of care.
Methods
Ninety-nine patients were identified as LTC based on not visiting a clinician in ≥4 months during the period April 2016-January 2017. Patients were contacted by phone/email to participate in a voluntary telephone survey regarding reasons for falling out of care. Results were analyzed descriptively.
Results
Of the 99 patients preliminarily identified as LTC, 19 completed the survey. Reason(s) for becoming LTC included: 47%(9) relocation, 11%(2) transportation difficulties to/from clinic, 26%(5) financial/insurance problems, 5%(1) perceived medication side effects, 16%(3) trouble remembering to attend appointments regularly, 5%(1) difficulty with daily medication adherence, and 0% social stigma. Furthermore, 21%(4) remain at high-risk of HIV/STI acquisition after becoming LTC. The main study limitations are selection bias and small sample size, where the small sample size did not allow for statistical significance.
Conclusion
While the major cause for becoming LTC was relocation, these findings suggest 37% of LTC incidences may be preventable with additional/up-front support. Because 21% of LTC patients remain at high-risk of HIV/STI acquisition, proactive re-engagement initiatives are potentially useful.
Keywords
HIV/AIDS; Pre-exposure prophylaxis; Retention and care; Socioeconomic factors; Adolescent Health; Lesbian/Gay/Bisexual/Transgender Persons.
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Latest Results from Immunotherapy Clinical Trials in Triple Negative Breast Cancer
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Abstract [+]
Cancer immunotherapy has evolved enormously in the recent years with better understanding of immune reactions, immune microenvironment and immunosurveillance. Breast cancer is characterized by large heterogeneity, a fact which rather complicated the development and the approval of novel therapeutic options in comparison to the majority of other solid tumors since each subtype has required a unique scientific approach and different targets and goals. Triple negative breast cancer (TNBC) is considered the most aggressive of the breast cancer subtypes with limited treatment options and worse outcome compared to others. This article summarizes some of the early clinical studies and the recently presented phase III clinical study of immunotherapy checkpoint inhibitors in this difficult setting.
Keywords: Cancer; Immunotherapy; Triple negative breast cancer (TNBC); Breast cancer.
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Transcatheter Arterial Embolization in Postpartum Hemorrhage: A Case Report
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Background
Postpartum haemorrhage is the leading cause of maternal mortality and morbidity. The significant impact of postpartum haemorrhage (PPH) on maternal mortality can be reduced if timely measures are implemented. Transcatheter arterial embolisation (TAE) is an alternative therapeutic strategy for PPH.
Case report
We report a case of postpartum haemorrhage which was managed by transcatheter arterial embolization in lieu of hysterectomy to preserve fertility and menstruation in a 27-year-old patient.
Conclusion
The critical role of obstetrician, anaesthesiologist and interventional radiologist as a team, improve the quality of care and patient safety.
Keywords
Postpartum hemorrhage (PPH); Peripartum hysterectomy; Transarterial embolisation.
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A Novel Hospital-Based Mass Casualty Decontamination Facility for Hazardous Material Disasters
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Since the Sarin incident in the subways of Tokyo in 1995, there has been an unprecedented increase in the use of chemical agents on civilian populations internationally. This scourge of chemical terrorism has been relentless worldwide and is likely to continue to be a public health issue that needs to be addressed by the relevant authorities as part of national disaster preparedness and response. One aspect of chemical disasters involves the need for mass decontamination of chemically-contaminated casualties from the scene. The traditional role of hazardous materials civil defence experts in providing such decontamination of victims in the pre-hospital setting is limited by many factors. The presence of congestion in densely populated areas in a highly built up environment of modern-day cities, compounds the timeliness of putting up cordons and crowd control and hence delays the prompt set up of such mobile decontamination facilities close to the incident site. The expected side effect is an almost instantaneous influx of contaminated casualties to the nearest hospital in such situations, which drives the need for public hospitals to be ultimately capable of performing mass casualty decontamination as part of hazardous materials disaster preparedness. This review presents an innovatively designed rapidly deployable hospital-based decontamination facility that has served a tertiary care hospital in Singapore for the last 2 decades in being prepared for managing mass casualties arriving from a chemical disaster in a timely manner.
Keywords
Decontamination; Chemical incident; Industrial disasters; Toxic industrial chemicals; Hazardous materials preparedness; Disaster contingency plans; Emergency preparedness.
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In Need of Care but Providers of Care: Grandparents Giving Fulltime Care to their Grandchildren in Rural Uganda
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Background
In most African countries, the elderly face challenges that affect their health and wellbeing and are more pronounced because of the systemic factors of inadequate health care, food insecurity and the general care. Increasing population of the elderly persons in Uganda is raising concern than ever before. The purpose of this paper to ascertain care available to the rural elderly persons and their role as carers for their grandchildren and implications on their wellbeing.
Methods
This was a qualitative study conducted among the rural elderly aged 60 years and above in eight purposively selected district that included Lira, Nebbi, Kampala, Luwero, Pallisa, Jinja, Mbarara, and Ntungamo. The study sample consisted of 101 elderly person from whom in-depth interviews were conducted. Data was analysed using qualitative thematic content analysis.
Results
Rural elderly in Uganda face a lot of constraints that include access to healthcare and information, poor economic status, food insecurity and poor nutrition, and poor accommodation and housing conditions. Two broader themes emerged inductively from the analysis that include care available for the rural elderly and providing care to grandchildren. These themes generated several subthemes. Taking care of grandchildren crippled the elderly and reduced the economic benefits. That said some rural elderly were happy and felt fulfilled to care of the grandchildren despite the lack of resources.
Conclusion
The rural elderly in Uganda are living in doleful conditions with limited care and support. They need care but are the providers of care to the grandchildren. They are frails and may not afford to provide adequate care. They care for grandchildren many of whom are orphans and vulnerable yet they themselves need care. It is important the government and the community re-enforce this care not to put strain on elderly. The rural elderly unique challenges necessitates special targeting and mobilization of resources at the household, local, district and national levels.
Keywords
Grandparents; Care; Orphans; Grandchildren; Skip-generation; Uganda.
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Neoantigen: A New Hope for Effective Cancer Immunotherapy
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Uptake of the BI-RADS Ultrasound Characterization of Breast Masses: Perceptions among Staff at Mulago National Referral Hospital, Uganda
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Abstract [+]
Introduction
The Breast Imaging-Reporting and Data System (BI-RADS) is a classification system aimed at standardizing risk assessment during breast ultrasound to ensure patient safety. BI-RADS is currently used in Uganda so as to standardize breast ultrasound reporting and enhance patient management.
Objective
This study aimed at exploring staff perceptions towards the use of the BI-RADS ultrasound characterization of breast masses.
Methodology
It was an exploratory qualitative study that involved staff who perform breast ultrasound at Mulago Hospital in Uganda. Focus group discussions and individual interviews were conducted.
Findings
All staff used the BI-RADS system, however, some of them had a negative attitude towards BI-RADS. The three major themes that emerged were: standardization of breast ultrasound reporting for patient safety; need for more Continuous Professional Development (CPD) and challenges with the BI-RADS system.
Conclusion
The study demonstrated that the staff generally had positive perceptions and attitude of the BI-RADS system and felt that it was an efficient system for ensuring patient safety and further reduce mortality from breast cancer.
Keywords
Breast imaging-reporting and data system (BI-RADS); Breast; Ultrasound; Staff perceptions.
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Preconception Care: Existing Knowledge in Karnataka, India and Need for an Intervention
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Background
Preconception care improves pregnancy outcomes. The aim of preconception care is to identify situation in which the parents particularly mother or the fetus may be in any additional health risk, and to take steps to minimize the risk before pregnancy is possible. But the concept of preconception care is not as popular as in western countries comparing to India where the number of maternal and newborn morbidity and mortality is high.
Objectives
To assess the level of knowledge among married women on preconception care by structured knowledge questionnaire; determine the effectiveness of informational booklet in terms of gain in knowledge scores; find the association between pre-test knowledge score and selected variables like age, education, occupation, type of family and parity.
Materials and methods
The study was carried out among married women between the age group of 18-35 residing in a selected village of Udupi District, Karnataka, India. An evaluative approach with one group pre-test and post-test design was used. Frequency, percentage, paired t-test and Chi-square test were used to analyze the data.
Results
Majority (55%) of the women had poor knowledge and 45% women had average knowledge in pre-test. In the post-test 57% of women had good knowledge and 43% had average knowledge. Mean difference between the pre-test and post-test knowledge score was 7.92, p<0.001 which showed an improvement in knowledge scores among women. An association was found between educational status and knowledge among women which can be inferred that the level of knowledge is dependent on the level of education.
Conclusion
Majority of the married women had poor knowledge on preconception care and an informational booklet on preconception care is an effective intervention in improving the knowledge.
Keywords
Preconception care; Married women; Information booklet; Knowledge level.
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The Use of Single-Cell Transcriptomics’ to Detect Cellular Transition through Notch Signaling and Receptor Expression in Differentiated Kidney Collecting Tubule Cells in Adult Mice: A Review
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Transcriptomics has allowed for a better understanding of disease, and the sequencing of individual genes is becoming a leading approach to discovering novel germ lines. A newly defined cell type, described as transitional cells, was characterized based on their expression of key marker genes that define principle cells (PC) and intercalated cells (IC). Gene expression patterns suggested that a Notch signaling pathway was activated during the transition from IC to PC. An experimental model studying the transition in an inducible transgenic mouse demonstrated that Notch signaling and receptor expression is sufficient to drive cell transition in differentiated adult kidney collecting tubule. The identification of novel cell lines allows for a more accurate diagnosis of kidney disease and precise staging of disease. Molecular profiling and precision therapy will continue to revolutionize the field of medicine and warrants further exploration.
Keywords
Transcriptomics; Kidney disease; Principle cell; Intercalated cell; Notch signaling; Gene sequencing.
Abbreviations
PC: Principle cell; IC: Intercalated cell, DNA: Deoxyribonucleic acid; RNA: Ribonucleic acid; mRNA: Messenger ribonucleic acid.
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A Case of Pleomorphic Adenoma Metastasising to Contralateral Supraclavicular Lymph Node
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Introduction
Pleomorphic adenomas are the most common benign parotid tumours in all populations. Management always consists of a curative superficial parotidectomy. However, rare cases described, in which these histological benign tumors metastasize to distant sites. We present an example of a recurrent parotid pleomorphic adenoma with a contralateral supraclavicular lymph node metastasis after several surgical interventions.
Case report
In this case, we reported reported a case of 29-years male with extensive metastasis in submandibular, submental and also very rarely seen contralateral supraclavicular lymph node metastasis. Parotidectomy with preservation of facial nerve and radiotherapy was given to the patient since the lesions were very aggressive.
Conclusion
The patient had several surgical interventions, so it is essential to do meticulous resection in the first surgery to prevent local recurrence and distant metastasis.
Keywords
Pleomorphic adenoma; Metastasizing pleomorphic adenoma; Salivary gland benign neoplasia.
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Efficacy and Safety of Clarithromycin, Lenalidomide and Dexamethasone (Bird) Therapy for Japanese Patients with Relapsed or Refractory Multiple Myeloma
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Object
It is difficult for the elderly, those with complications, and those who live in remote areas to visit the hospital, and as a result, there are limits on the drugs they are able to use. It is therefore effective to prescribe such patients oral medications that have few adverse effects and in regimens that require few hospital visits. Clarithromycin can induce cell death by autophagy and it has a direct antitumor effect. There have been reports of the outcomes of Lenalidomide and Dexamethasone therapy with Clarithromycin which is administered orally and is safe on multiple myeloma. However, in Japan, there have been few studies. Here, we report on Clarithromycin, Lenalidomide and Dexamethasone therapy in our hospital.
Method
We analyzed 7 patients with relapsed refractory or refractory multiple myeloma who were treated at this hospital between January 2012 and December 2014. The Clarithromycin, Lenalidomide and Dexamethasone therapy were administered in a 28-day cycle as follows: Clarithromycin 400 mg/day for 28-days, Lenalidomide 15 mg/day for 21-days, and Dexamethasone was administered in a dose of 20 mg once per week. The response criteria used were standard International Myeloma Working Group (IMWG) Uniform Response Criteria. and adverse events were graded according to the national cancer institute-common terminology criteria for adverse events (NCI-CTCAE) Ver. 4. Statistical analysis was performed using Easy R (EZR).
Result
The response to Clarithromycin, Lenalidomide and Dexamethasone therapy were selective catalytic reduction (sCR) in 2 patients, CR in 1 patient, per rectum (PR) in 3 patients, and standard deviation (SD) in 1 patient. Response rates of PR or better were observed in 86% of the patients. Duration of response was median 316-days (range, 160-522-days). Median oculus sinister (OS) period was 1,907 days. Median OS following discontinuation of the study was 1,385 days. Hematological adverse events were G1-2 anemia in 3 patients and G3-4 anemia in 1 patient. G1-2 thrombocytopenia was observed in 1 patient and G3-4 thrombocytopenia was observed in 1 patient. Leukopenia of G1-2 was observed in 6 patients but G3 was not observed. Non-hematological adverse events were G1-2 liver disorder in 6 patients, G1-2 skin rash in 3 patients, and G1-2 constipation in 2 patients. G4 adverse events were fainting and duodenal ulcer in 1 patient each.
Conclusion
Clarithromycin, Lenalidomide and Dexamethasone can be safely and effectively administered in the relapsed refractory multiple myeloma
Keywords
Multiple myeloma; Bird; Clarithromycin, lethal dose (Ld).
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Role of Sound Enhancer Device in Teleconsultation
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Abstract [+]
Aim
To study the role of sound enhancer device in teleconsultation.
Methods
This study was conducted in the plastic surgery department in a tertiary care centre in the month of May-June 2019. A sound enhancer device was used with mobile phone for videoconferencing as form of teleconsultation by plastic surgery trainees in operation theatre and outpatient department. At the end of the study feedbacks were taken from the trainees.
Results
It was found that on using the sound enhancer device, the sound quality improved and it was helpful in the teleconsultation sessions using videoconferencing.
Conclusion
The use of sound enhancer is a simple, cost-effective, innovative method of using a simple technology to aid in utilisation of teleconsultation facilities in a very non-sophisticated way.
Keywords
Sound enhancer device; Teleconsultation; Telemedicine.
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Malignant Restenosis and Progression of Disease in Psoriatic Patients Undergoing Coronary Interventions: Is it the Koebner’s Phenomena to Blame?
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Severe psoriasis is associated with an enhanced risk of cardiovascular (CV) diseases. The potential impact of psoriasis on the prognosis following coronary revascularization (percutaneous coronary intervention (PCI) or surgical) is not well studied and sparse data available in literature points towards a grim long-term prognosis. The following two cases highlight this phenomenon. We also discuss the plausible reasons responsible for the poor prognosis and propose some possible mechanisms for the same.
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Ovine Network between Fatteners and Breeders in Middle Atlas of Morocco: Where to Act to Prevent the Spread of Epidemics?
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Abstract [+]
Objective
This cartographic and analytical study, using the social network analysis method, aims to characterize sheep mobility from breeders producing lambs in the Middle Atlas Mountains to the fattening centers, passing through livestock markets in order to describe the exchange network, to identify the main mobility hubs and to secure the production of fattening lambs by improving the efficiency of the epidemiological surveillance system for “peste des petits ruminants” (PPR) in lambs producers of the Middle Atlas in Morocco.
Design
Descriptive cross-sectional study within the framework of active epidemiological surveillance. It was carried out at a regional level, for mapping the movements of sheep and to analyze the network of exchange relating to this species by the Social Network Analysis (SNA) method in the middle atlas massif and in the zone of sheep fatteners to guide epidemiological surveillance efforts. A total of 807 breeders producing lambs, sheep fatteners and traders were surveyed, including 54 fatteners in fattening workshops (sampling fraction of 48.6%), 150 breeders and traders in livestock markets of Middle Atlas and 603 producing lamb breeders of this massif (sampling fraction at the massif level of 6.64%).
Results
The study revealed a very strong commercial relationship between middle Atlas breeders and fattening zone breeders whose longrange outflows mainly converge towards urban consumption centers. The major strategic livestock markets of the middle Atlas proved to be key points in the articulation of the flows, as was the commune gathering the fatteners. Centrality indicators were used to identify the main trade hubs that contribute to the spread of diseases and to quantify their importance in the influence of sheep movement, while network cohesion parameters have shown that network is vulnerable to the spread of epidemics.
Conclusion
The results of this survey revealed the main commercial hubs at the Middle Atlas level and at the level of the province of fatteners, which represent a great risk of spreading sheep diseases over long distances rather quickly in event of an epizootic, but also representing the ability to control the spread through the control of the movement of animals at their level.
Keywords
Ovine network; Epizotic of (Peste des Petits Ruminants); Mapping; Social network analysis; Hub; Betweenness; Degree; Strong component; Cutpoint.
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Self-Adjuvanting Peptide Vaccines Against Cervical Cancer
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Abstract [+]
Background
Cervical cancer is a common cause of cancer-related deaths in women worldwide, with a fatality rate second only to breast cancer. Human papillomaviruses (HPVs) are the main causative agents of cervical cancer, and are therefore obvious targets for vaccine development. Although two prophylactic HPV vaccines have been commercialized, therapeutic vaccines against HPVs have not been developed yet. Current vaccine technologies emphasize the power of small particles in targeting immune cells, and particles of 20-50 nm have been reported to induce optimal immune responses against a variety of pathogens and cancers.
Methods
We synthesized new nanoparticle-based vaccines against cervical cancer by using antigenic 8Qmin peptide epitope derived from HPV-16 E7 protein, a hydrophilic poly-(L-glutamic acid) (PGA) linker, and an 8-arm poly (tert-butyl acrylate) dendrimer-based delivery system (D8).
Results
Four different peptides containing 8Qmin and PGA of different lengths were successfully synthesized with high yield and purity. These were then conjugated to alkyne-functionalized D8 by copper-catalyzed alkyne-azide cycloaddition “click” reaction. The conjugates self-assembled into nanoparticles, with decreased particle size corresponding to a greater number of Glu units. The four vaccine candidates were tested in C57 black 6 (C57BL/6) mice bearing well-established (7-day-old) tumors to examine their therapeutic effects.
Conclusion
Interestingly, only one conjugate delayed tumor growth, and montanide adjuvanted antigen, used as a positive control, failed to demonstrate any therapeutic effect.
Keywords
Peptide-based subunit vaccine; Human papillomavirus; Polyglutamic acid; Therapeutic cancer vaccine; Polymer-peptide conjugate; Self-adjuvanting; Cervical cancer.
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Prothrombin Complex Concentrates in Post-traumatic Hemorrhage: A Review
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Prothrombin complex concentrates (PCC) has long been used to reverse vitamin K antagonists (VKA)-induced coagulopathy rapidly and safely. However, its use in trauma-induced coagulopathy (TIC) in patients not using VKA drugs is yet to be elucidated. This article is a narrative review and analysis of the most recent literature to analyse consequences, and intended effects associated with this treatment modality in TIC. Utilization of PCC was addressed in the literature data found by searches of databases. The indications, efficacy and outcomes associated with the use of the product were reviewed in the articles. Some studies point out promising results with respect to PCC use to overcome the VKA-related coagulopathy in victims of trauma. PCC may be a viable option for resuscitation in emergency and critical care in the management of severe hemodynamic deterioration induced by trauma, despite contradictory findings in the literature.
Keywords
Blood coagulation factor; Trauma; Hemorrhagic shock; Exsanguinating hemorrhage.
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Addressing the Model Minority Myth from a Cognitive Perspective
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Exploring the Association between Demographic Factors and Breast Cancer Diagnosis at a Holistic Breast Imaging Clinic in Cairo, Egypt
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Background
Breast cancer is among the most common cancers affecting women worldwide, including Egypt. Age is a well-known determinant of breast cancer risk; however, more data is needed to better understand the importance of age on incidence of breast cancer in the Middle East. Being overweight or obese are also known risk factors—especially for post-menopausal women–however, these data are not available for women in developing countries.
Purpose
The purpose of this study was to qualitatively explore the association between age, breast density, and demographic factors of breast cancer patients, across a spectrum of radiological breast diagnoses at a large Breast Imaging Clinic in Cairo, Egypt.
Materials and Methods
We explored the association between age, demographic factors, and Breast cancer incidence among 6,711 women undergoing mammographic screening over a consecutive period of 6-years. Data was collected from March 2007 until March 2013 and extracted
from an electronic data base system.
Results
A total of 6,711 participants were included in this study. The median age of all patients was 46.1. Mean body mass index (BMI) of 28.5, where 34% of the patients were overweight and 32.4% were obese. Older women were more likely to be obese compared to younger women (38.4% vs 18.1%, p<0.001). Older females were more likely to have less dense breasts (ACR: A) compared to younger females (18.1% vs 8.7%, p<0.001). Women older than 40 had a higher confirmed number of breast cancer diagnoses compared with the younger age group (10.7% vs 3.5%, p<0.001). Women with breast cancer were more obese (p<0.001), had denser breasts (p<0.001), were post-menopausal (p=0.002), and more likely to be Muslim (p=0.0021). In the multivariate analysis, aforementioned factors were significant predictors for confirmed diagnosis.
Conclusion
To our knowledge this is the largest study to examine the association of radiological breast assessments on breast cancer incidence, obesity and demographic factors in Egypt. Although data shows the global burden of breast cancer is shifting to the developing world and affecting younger women at alarming rates, our data demonstrated a very low occurrence of breast cancer in both age groups.
Keywords
Breast cancer; Breast radiological diagnoses; Phenotypic variations; Breast imaging-reporting and data system (BI-RADS).
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Clinical Research: The Future of Medicine Stuck in the Digital Past
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Call Me Anything but Thoughtless or Misguided in IBD Management
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Morbidity and Mortality Associated with Development of Hypogammaglobulinemia after Rituximab
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Abstract [+]
Objective
Low-levels of gamma globulin are associated with a risk of infection, and complications of hypogammaglobulinemia are often observed in hematologic malignancies. In chronic lymphocytic leukemia (CLL), IgG≤600 mg/dL is reportedly associated with higher risks of infection. The objective was to determine the risks of hypogammaglobulinemia and infection in malignant lymphomas for which rituximab that targets B-cells is used.
Methods
A retrospective analysis of data from medical records of patients with malignant lymphomas treated with rituximab-containing therapy at our hospital between April 2014 and March 2016 was performed to assess the risks of infections through an evaluation of IgG levels and hospitalizations for and deaths due to infections in patients hospitalized with infections during this period.
Results
From April 2014 to March 2016, 128 patients with malignant lymphomas received rituximab-containing therapy at our hospital, and 94 (61%) of these patients had IgG levels measured. These 94 patients were included in the analysis. The histological types were as follows: 30 had follicular lymphoma (FL), 17 had indolent non-Hodgkin’s lymphoma (iNHL), 42 had diffuse large B-cell lymphoma (DLBCL), and 5 had mantle cell lymphoma (MCL). The mean minimum immunoglobulin G (IgG) level in patients hospitalized for infection was 546 mg/dL and was 628 mg/dL in those not hospitalized (p=0.6). Although a significant difference was not observed, IgG levels tended to be low in hospitalized patients with infection. In addition, there were 4 patients with mean IgG levels that were 600 mg/dL or less in the 6-months immediately prior to hospitalization. Among these 2 died of infection.
Conclusion
Low-levels of gamma globulin are associated with a risk of mortality due to infections in malignant lymphomas.
Keywords
Hypogammaglobulinemia; Malignant lymphoma; Rituximab.
Abbreviations
CLL: Chronic lymphocytic leukemia; FL: Follicular lymphoma; iNHL: Indolent non-Hodgkin’s lymphoma; DLBCL: Diffuse large B-cell lymphoma; MCL: Mantle cell lymphoma; FN: Febrile neutropenia.
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Do You Still Use Topical Antibiotics after Intravitreal Injections?
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Abstract [+]
Nowadays intravitreal drug injection is the most frequent treatment for retinal diseases. Despite widely use endophthalmitis is already most feared complication of every intravitreal injection in each patient. In clinical setting topical antibiotics have been widely used as a precaution to prevent endophthalmitis however recent published evidence showed it to be unnecessary. Furthermore repeated use of topical antibiotics might give rise to antibiotic resistance in conjunctival flora and thus more aggressive endophthalmitis. Strict asepsis has been awarded as the main rule for endophthalmitis prophylaxis intravitreal injection.
Keywords
Intravitreal injection; Steroid; Anti-vascular endothelial growth factor (VEGF); Topical antibiotic; Enodphthalmitis; Antibiotic resistance.
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The Relationship between Socioeconomic Status and Adherence to Antihypertensive Treatment Regimen in a Metropolitan Community Sample of Hypertensive African Americans in New York
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Abstract [+]
Introduction
Low socioeconomic status (SES) is one of the strongest predictors of morbidity and premature mortality worldwide, as well being associated with large increases in cardiovascular disease in both men and women. Uncontrolled hypertension contributes to cardiovascular disparity. Non-adherence to antihypertensive regimens worsens the cardiovascular burden and further widens the health disparity gap. A hierarchical multiple regression study of multiple factors impacting adherence among urban residents in a New York metropolitan region found socioeconomic factors as the strongest factors impacting adherence in this cardiovascular high-risk population..
Methods
Secondary analysis of data of a cross-sectional, correlation design study of a dissertation study, with each of the SES variables analyzed against adherence and self-efficacy variables.
Results
Overall, only three SES variables (years with the same provider, work status and income) were significantly related to adherence and/or self-efficacy. Years with the same provider was related to adherence with correlation of rs=0.16 (p=0.048), and to self-efficacy rs=2.0 (p=0.016). Work status was related to adherence with difference in adherence scores between retired and unemployed subjects (KS=38.6, p=0.013 with Bonferroni adjustment; means=3.7 and 3.3, respectively). Work status was not related to selfefficacy scores. Income level was significantly related to the self-efficacy scores, but not the adherence scores. Difference noted between earners<$10,000/year and >$80,000/year (KS=-44.2, p=0.037, with Bonferroni adjustment; means=3.06 and 3.51, respectively).
Discussion
Low socioeconomic status and non-adherence to antihypertensive regimens remain important factors which worsen cardiovascular health and widen health disparity health gaps. This is evident among the cardiovascular high-risk persons of African descent including those residing in the New York metropolitan regions. Self-efficacy is implicated as a mediating variable between income and adherence. The inverse relationship between fulltime work status and adherence was no longer noted. Further investigation on the associations between income, full time status and adherence among young, hypertensive Blacks/African Americans; as well as self-efficacy mediating effects on income and adherence is recommended.
Keywords
Socioeconomic status or poverty or low income; Adherence or compliance; Hypertension treatment or hypertension therapy; Blacks or African Americans.
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Unilateral Surgical Amputation of Horn Due to Suppurative Sinusitis in Cow
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Abstract [+]
Dehorning or disbudding is the process of removing or stopping the growth of the horns and horn producing tissues after the horns have formed from the bud by different methods which can match to the size of the horn and age. The present case report is aimed to describe and document the surgical procedures, techniques of unilateral horn amputation and its outcome on six years old local breed cow that was referred to the veterinary teaching hospital (VTH), Addis Ababa University from nearby; Hiddi Veterinary Clinic. History stipulated as the cow was treated several times with antibiotics but didn’t respond as the condition was getting worse. Based on the history and clinical findings, the case was diagnosed as suppurative frontal sinusitis. After aseptic preparation of the surgical site, stabilizing the animal and locally desensitizing the incision area; an elliptical skin incision with a distance of approximately (~1 cm wide) around the base of a right horn was performed for successful removal of the corium. Then, skin edge was opposed to assist the skin contraction by using the silk 2-0 size in cross mattress suture pattern. Then the area was properly bandaged with elastic bandages and properly secured to the normal horn and admitted home. Finally, with regular dressing, bandaging and lavaging of the dehorned site, the cow was successfully recovered after two months.
Keywords
Cow; Dehorning; Horn Injury.
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Building Resilience in Children to Prevent Social Aggression: The Principles of Behavioral Sciences
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Abstract [+]
Most anti-bullying programs today are punitive. They rely heavily on schools enforcing procedures based on reporting, investigating, punishing, and labeling bullies. This paper challenges the notion that bullying behavior can be regulated effectively by legislative bodies and policymakers. Schools are communal ecosystems featuring unique social norms and behaviors. For example, in school, a student reporting a classmate to authorities may be labeled a ‘snitch’ because ‘tattling’ violates accepted social norms. Furthermore, the current legal definitions of bullying are confusing and complicated. In many cases, even trained lawyers have difficulty identifying acts of bullying. We suggest, the better approach to preventing bullying in schools, even the workplace, is to ground interventions using psychological frameworks to strengthen children’s social and emotional competence. We contend that social development models provide the psychological frameworks society needs to develop emotionally stable children and
adults while providing them with the internal fortitude to bounce back effectively from adverse situations like bullying.
Keywords
Bullying prevention; Social-emotional learning (SEL); Social development; Emotional strength; Social aggression; Anti-bullying; Self-awareness; Social-emotional competence; Power imbalance; Intentional; Columbine; Intervention.
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Therapeutic Modalities: Best Practices to Protecting Patients from Harm During Treatment
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Abstract [+]
Healthcare providers and clinicians such as athletic trainers and physical therapists utilize therapeutic modalities to administer treatment to patients in the clinical setting. It is the responsibility of these healthcare providers to ensure the safe use of therapeutic modalities during treatment sessions, as well as effective delivery of treatment. Thermal-heat, ultrasound, cryotherapy and electrostimulation treatments have the potential for causing harm to patients. Proper care and maintenance of modalities can minimize the risk to patients and avoid legal issues for physical therapists and athletic trainers. This article will explore some of the legal issues, case studies and reports as well as providing information on what healthcare providers can do to protect patients.
Keywords
Risk management; Negligence; Malpractice; Best practices; Injury prevention; Athletic Trainer; Physical Therapists; Accreditation.
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The Relationship between Pre-Season Testing Performance and Playing Time among NCAA Division II Men’s Soccer Athletes Over a Competitive Season: A Pilot Analysis
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Abstract [+]
Aim
The purpose of this study was to investigate the relationships between pre-season testing performance and playing time within a Division II men’s soccer team over a competitive season.
Methods
Data was collected from pre-season athletic performance testing data for 13 male National Collegiate Athletic Association (NCAA) Division II men’s soccer players (age=20±1.5-years; height=180±6 cm; weight=75±7 kg), and was analyzed to determine if relationships existed between physical performance tests (countermovement jump height, peak anaerobic power in watts derived from jump height], change-of-direction performance (505-agility, modified T-test), linear speed (10 m and 30 m sprint intervals), and aerobic fitness (20 m multi-stage fitness test), and playing time over a collegiate season were provided by the University’s coaching staff and retrospectively analyzed.
Results
A Pearson’s moment correlations correlation revealed significant (p<0.05) moderate relationships between playing time and 10 m speed (r=-0.569) only.
Discussion
These results suggest that linear speed, in particular acceleration over short distance, could be a key characteristic that has some influence on playing time for Division II men’s soccer players.
Conclusion
Pre-season testing of soccer players is commonly used to assess athletic potential. Minimal research has investigated the associations between these tests and playing time over the course of a collegiate season.
Keywords
Aerobic capacity; Power; Speed; Agility; National Collegiate Athletic Association (NCAA).
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Complications Related to Implants Used in Anterior Bleb Forming Glaucoma Surgery: A Systematic Review of the Literature
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Abstract [+]
Purpose
To make an account of published implant-related complications (IRC) by a systematic review of the literature.
Methods
A systematic search of Pubmed and Scopus databases and Google Scholar engine was performed with selection criteria to detect papers on IRC. We excluded unrelated papers and reviewed selected ones. We considered papers that did not explicitly state about occurrence or not occurrence of IRC as non-IRC reporting. Main outcome measures were the number of papers reporting on complications, IRC, and types of IRC.
Results
After the search, selection, and addition, we studied 109 papers. Incidence of IRC was 4.5%, half required explantation. While 26 implant studies found IRCs (23%), 13 case reports on surgical complications, 8 (61.5%) of them reported IRC. Frequent complications were conjunctival erosion, blockage of the tube, migration to anterior chamber or damage to surrounding tissues.
Conclusion
Most papers did not report on IRC. Length or nature of studies may skew finding IRC. The incidence of IRC was 4.5%. Hard and sharp implants carry a greater risk of IRC and explantation.
Keywords
Implant-related complications (IRC); Glaucoma surgery; Anterior bleb forming.
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A Study to Explore the Impact of Endometriosis in the United Kingdom: A Qualitative Content Analysis
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Abstract [+]
Objective
To gain insight into the areas that impact women with endometriosis.
Design
A qualitative content analysis of an online survey.
Setting
Online questionnaire via Endometriosis UK.
Population
Women diagnosed with endometriosis of any age range.
Methods
Free-text online questionnaire through Endometriosis UK completed by women. Results were analysed using NVivo version 9, qualitative analysis software. The software creates links between common words (codes), and these links allow data to be placed in nodes (called themes) which are then developed into categories. Content analysis was used to understand this data.
Main outcome measures
Impact of endometriosis on women’s lives.
Results
In total, 1872 questionnaires were returned but not everyone was able to identify ten separate features that affected them. As such, 1872 women provided at least one area that affected them, 1800 provided two areas, 1770 provided three areas and 1600 provided four areas. The results show that the main areas of concern for these women were pain (53%), heavy menstrual bleeding (11%), low mood (8%) and the perceived lack of understanding displayed by other people (7%). Other important factors were fertility concerns, impact on employment, problems with the medical team and uncertainty. These then impacted on their daily life whereby some women felt “guilty” for not ‘being a normal mother’. A key term that resonated was that endometriosis is an “invisible disease”.
Conclusion
This analysis provides us with insight into the complex psycho-social factors that interact with bio-physical symptoms. Further research is required in sub-population groups such as teenagers and ethnic minority women to explore any differences in impact and how care can be guided accordingly.
Keywords
Endometriosis; Impact; Qualitative methods; Quantitative methods; Online survey.
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Sirtuin Inhibitor as a Novel Cell Cycle Checkpoint and Regulator of the TP53-MDM2 Pathway in Uveal Melanoma
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Abstract [+]
Purpose
The liver is the most common site of uveal melanoma (UM) metastasis with approximately 50% of UM patients being affected. With no proven therapies that mitigate metastases the mortality rate is 85% within the first year after detection of the liver disease. In this study, we provide a mechanistic understanding of the de-regulation of the TP53-MDM2 pathway in UM, which plays a central role in tumor biology.
Methods
We investigated the TP53-MDM2 signaling pathway in the microenvironment of liver metastases taken from both a murine orthotopic xenograft and post-mortem metastatic UM human liver. These findings were studied in-depth using both primary and metastatic UM cell lines treated with the MDM2 antagonist Nutlin-3a and the sirtuin inhibitor and transcriptional activator of TP53, Tenovin-6.
Results
De-regulation of the TP53-MDM2 signaling pathway is specific to the liver microenvironment, providing a survival mechanism for UM metastases. Tenovin-6, not Nutlin-3a, reduced UM cell survival by increasing the percentage of cell death and reducing the percentage of proliferating cells. Tenovin-6 increased acetylation of p53, reduced ubiquitination of the protein, and acted as a cell cycle regulator.
Conclusion
Our findings suggest that in patients with metastatic UM de-regulation of TP53-MDM2 signaling pathway promotes growth of the liver metastases and provides pre-clinical information on the potential of targeting of the TP53-MDM2 signaling pathway via Tenovin-6.
Keywords
Uveal melanoma; Ocular tumors; Nutlin-3a; Tenovin-6; TP53; MDM2.
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Role of Bactiguard Infection Technology in Preventing Catheter-Associated Urinary Tract Infections
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Abstract [+]
To study the role of bactiguard infection technology (BIP) in preventing Catheter-associated urinary tract infections. This study was conducted in a tertiary care centre in the Department of Plastic Surgery, JIPMER, Pondicherry, India in the month of August 2019. The study subject was a 55-year-old gentleman with Fournier’s gangrene and type 2 diabetes mellitus (DM). The Foley’s catheter with BIP technology was used and its role in preventing urinary tract infections (UTI) was studied over a period of 10-days. During the period of the catheter use in our subject, patient did not develop features of urinary tract infections. BIP technology is claimed to be effective in preventing Catheter-associated urinary tract infections but further studies in more individuals is required to validate the same.
Keywords
Bactiguard infection technology (BIP); Catheter associated urinary tract infection (CAUTI); Biofilm.
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Pulmonary Artery Hypertension in Children Living with Sickle Cell Anaemia
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Abstract [+]
Pulmonary artery hypertension (PAH) ultimately leads to straining of the right ventricle and increases the risk of heart failure in affected patients. Its clinical presentation is similar to that of many other diseases thus delaying the diagnosis until the disease is far advanced. It remains one of the leading causes of death in adults with sickle cell anaemia (SCA) worldwide. It confers a high risk of death with two-year mortality rates as high as 40-50% even at modest elevation of pulmonary artery pressure. Median survival age after detection of the disease is said to be 25.6-months. Early detection of elevated pulmonary artery pressure in childhood and appropriate intervention by optimization of anti-haemolytic therapy may prevent the progression of this complication. The current writes up is a review of literatures on pulmonary artery hypertension among children with sickle cell anaemia. This will give information which will aid early diagnosis and treatment of pulmonary artery hypertension among children with sickle cell anaemia. This will ultimately improve the quality of life of children with sickle cell anaemia and reduce morbidity and mortality from the disease in adults and children living with sickle cell anaemia.
Keywords
Sickle cell anaemia; Pulmonary artery hypertension; Children.
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Diagnosis and Cure: Intellectual Honesty is the Basis of All Science
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Remote Consent Clinical Research
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Abstract [+]
Recruitment in clinical research trials can be challenging in trials that are time-sensitive and/or are rare disease and critical care trials. One of the hurdles for recruitment in these types of clinical trials is due to the consent process, and the need to have consent of the patient within a certain timeframe, or the patient unable to consent for themselves. This paper will discuss the usage of the utilization of remote consent options for these trials.
Keywords
Recruitment; e-consent; Remote consent; Clinical trials; Rare disease; Time-sensitive.
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Product Development and Quality Evaluation of Biscuit and Ready-to-Eat Snack from Cowpea-wheat Flour Blends
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Abstract [+]
Aim
The research was conducted with the aim to develop biscuit and ready-to-eat snack product from cowpea flour incorporated with wheat flour.
Methods
The wheat and cowpea flour blends were prepared in five blending ratios including B1 (90:10), B2 (40:60), B3 (65:35), B4 (78:22), and B5 (53:47); respectively. The D-optimal mixture design software was used for flour blend formulation. Biscuit and extrudate products from cowpea and wheat blends were analyzed. Quality characteristics parameter used for value-added products includes physical, functional, proximate, mineral and microbial quality. Furthermore, bioactive components and sensory quality evaluation were also investigated. The biscuit samples were prepared at a baking temperature of 205 °C for 10-minutes holding time. The extrudate samples were also manufactured at feed moisture (18 and 21%), barrel temperature (100, 110 and 120 °C) and screw speed (175 and 220 rpm).
Results
The result for crude protein analysis of biscuit (B3) and extrudate (Ex-3) samples was revealed that 15.972±0.125, and 15.915±0.251; respectively. The result for microbial quality analysis of biscuit (B3) and extrudate (Ex-3) samples was also shown as aerobic bacteria count of 44×10-5, 42×10-5 and yeast and mold (un-detected); respectively. The highest overall sensory evaluation of biscuit (B3) and extrudate (Ex-3) samples score were found 7.6 and 7.14; respectively.
Conclusion
Based on quality evaluation parameters, 35% cowpea flour with 65% of wheat flour blending ratio reveled sensor acceptable for biscuit production and manufacturing of ready-to-eat snack.
Keywords
Biscuit; Cowpea; D-optimal mixture; Extrudate products; Wheat.
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Despite 50 Years of Knowledge of Actual Versus Perceived Risk, Public Fear Persists of Contaminated Foods
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Multiple Tumoral Calcinosis in a Hemodialysis Patient
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Abstract [+]
Pseudotumoral calcinosis is a rare condition characterized by periarticular calcium deposition. It preferentially affects large joints such as the hip, shoulder and elbow. It is a severe complication of chronic renal failure. We report a case of secondary pseudotumoral calcinosis in a chronic hemodialysis patient.
Keywords
Tumoral calcinosis; Chronicrenal failure; Hemodialysis.
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What IBD Physicians Can Learn from Major League Baseball Managers
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The Evolving Field of Stereotactic Body Radiation Therapy in Pancreatic Cancer
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Abstract [+]
Pancreatic cancer remains a devastating disease with dismal outcomes despite the development of novel chemotherapeutic regimens and radiation techniques. Stereotactic body radiation therapy (SBRT) offers an advantage both in image guidance and radiation dose delivery to direct ablative doses to tumors with acceptable toxicity compared to conventional techniques. Recent literature is clustered with data pertaining to SBRT in patients with resectable, borderline resectable and locally advanced pancreatic tumors. We here present a summary of the current data and highlight the limitations and potential for future growth. Further clinical study in the form of multi-institutional trials is warranted to establish the role of SBRT in combination with new chemotherapeutic agents as well as a non-invasive alternative to surgery.
Keywords
Pancreatic neoplasms; Pancreas cancer; Radiosurgery; Stereotactic; Stereotactic body radiation therapy (SBRT); Radiation; Radiotherapy.
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Muscle Cell Function and the Effects of Hyperbaric Oxygen Therapy
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Abstract [+]
There are different processes via which a muscle cell can utilize oxygen to make energy that will sustain activity. The type of activity and duration of activity will determine what energy system is used to sustain the activity being done. Aerobic metabolism uses oxygen to sustain the energy demand. Oxygen is obtained from the air we breathe, and then transported to the cells though the myoglobin. Although ambient air only contains 21% oxygen, it is enough to sustain life and energy needs. But what if the muscle cell could instead receive 100% oxygen? The delivery method would be via hyperbaric oxygen therapy (HBO) which supplies oxygen at 100% concentration under a minimum of 1 atmospheric pressure. Atmospheric pressure will affect the outcomes of consuming 100% oxygen. Research supports positive findings on oxygen therapy under pressure and muscle cell recovery but much research still needs to be investigated. One research study revealed detrimental effects of 100% oxygen breathed in consistently for days resulting in comorbidities that did not exist prior to experiment. HBO can pose some risks but if it is applied in a controlled manner, HBO can be a safe option to enhance cellular recovery and cell function.
Keywords
Oxygen; Hyperbaric oxygen therapy; Muscle recovery; Muscle cells; Pure oxygen.
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Circulating Tumor Cells: Beyond Isolation and Detection
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Abstract [+]
Circulating tumor cells (CTCs) are the precursors to metastases and increased numbers of CTCs in the peripheral circulation have been shown to correlate with decreased progression-free and overall survival. Although the current clinical utility has been focused on the prognostic significance, other clinical applications are being explored, such as determining if a patient is a candidate for treatment, determining the efficacy of treatment, evaluation for resistance to therapy, prediction of metastatic site, or as an early predictor of metastases. Current methodologies are based on quantifying CTCs and include technologies based on physical, immunological, and molecular techniques. However, these have limitations, of which most of them do not have the ability to perform morphological evaluation. Using morphological evaluation, CTCs in body fluids could be used for primary diagnosis in the setting of cancer of unknown primary (CUP) or in initial or early diagnostic scenarios. Additionally, cytological specimens have been shown to be useful for ancillary testing in patients when surgical resection specimens or biopsies are not available. Evaluation of CTCs should incorporate histological, immunehistochemical, and molecular characterization to enable clinicians to obtain the comprehensive diagnostic, prognostic and therapeutic information necessary to provide appropriate personalized care to cancer patients.
Keywords
Circulating tumor cell (CTC); Circulating; Tumor cell; Cancer; Isolation; Detection; Metastasis; Prognosis.
Abbreviations
CTC: Circulating tumor cell; RT-PCR: Reverse transcriptase-polymerase chain reaction; EMT: Epithelial-mesenchymal transition; MET: Mesenchymal-epithelial transition; TRAIL: Tumor necrosis factor-related apoptosis-inducing ligand; CEA: Carcinoembryonic antigen; CUP: Cancer of unknown primary; CAP: College of American Pathologists; AMP: Association for Molecular Pathology; ASCO: American Society of Clinical Oncology.
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An Urgent Request for Evidence-Based Mental Health Intervention Research in Low-Income and Middle-Income Countries
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Exploring the Notion of Performance in Branch Sales Managers: A Narrative Approach
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Abstract [+]
Aim
The purpose of this study was to identify factors that affect the performance of branch sales managers (BSM) of a private bank in India. It also aimed to identify factors that differentiate high performing BSMs from the rest.
Methods
A phenomenological methodology known as narrative analysis was used to uncover the lived experiences of Branch sales managers. Open-ended semi-structured interviews were conducted with 50 Branch sales managers situated across the Northern, Western and Southern Regions of India who were pre-classified in two pools of talent–high performers and average performers based on their performance ratings.
Results
Results yielded two distinguishing profiles of high and average performing BSMs known as ‘Bulls’, and ‘Bears’ respectively. Ramifications of individual’s personality, family structure and education profile, birth order, educational and vocational choices, influence of their past work experience, etc., were found to contribute to distinct patters of wok behavior and thereby performance.
Conclusion
Sales organizations will need to hire both “Bull I/Bull II” and “Bears” as each brings a different work ethos that is critical for high and consistent performance within the sales function. Organizations will need to create specific performance levers to engage the “Bull I/Bull II” and “Bears”.
Keywords
Bears; Bull I; Bull II; Sales performance; Sloths.
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Challenges Ahead for Advanced Training Programs in Pediatric Dentistry in the Area of Sedation for Pediatric Dentists and the Commission on Dental Accreditation
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Robot Assisted Comprehensive Surgical Staging for Endometrial Cancer: A Validation Study
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Abstract [+]
Objective
The study sought to evaluate the historical surgical-pathological trends in Gynecologic Oncology Group (GOG) 33 in a cohort of patients who underwent robot-assisted staging of uterine carcinomas.
Materials and Methods
This is a retrospective study from June 2016 through December 2018 at Catholic Health Services Hospitals in Long Island (CHSLI), NY, USA. All patients underwent robotic surgical staging with hysterectomy, bilateral salpingo-oophorectomy, and pelvic and para-aortic lymphadenectomy. Fifty patients were included, and patients were separated into cohorts with endometrioid or non-endometrioid histology for analysis. Patients were staged using the International Federation of Gynecology and Obstetrics (FIGO) 2009 classification.
Results
For all patients undergoing surgical staging, the rate of pelvic and para-aortic nodal metastases occurred at 10% and 8%, respectively. Sixty percent of the grade 1 endometrioid tumors had less than 50% myometrial invasion. No patients had positive paraaortic lymph nodes in the absence of pelvic node involvement. High-risk histologies were associated with nodal disease thirteen percent of the time. A correlation between increasing depth of invasion and positive lymph nodes was demonstrated. Increasing grade of tumors was correlated with the frequency of nodal metastasis. Intraperitoneal spread was highly correlated to metastatic lymph nodes. Deep invasion was positively correlated with nodal disease.
Conclusion
The results of this study validate the trends previously known from GOG 33 in a population undergoing robot-assisted surgical staging for uterine carcinomas.
Keywords
Gynecologic Oncology Group (GOG) 33; Robotic; Surgery; Uterine cancer; Lymph nodes; Trends.
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Non-Surgical Sterilization Methods in Male Animals: A Review
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Abstract [+]
Non-surgical sterilization technique in animals is an ancient practice and dates back to 7000 BC. Surgical castration in animals has been applied for centuries to control the animal population, advance genetic selection, improve calmness of aggressive animals and mainly to ensure and selectively provide high-quality meat production for human consumption. An ideal method of castration should cause permanent block to spermatogenesis and inhibit androgenetic enzymes with low-cost of treatment and doesn’t affect the welfare of the animal. Even if operative methods are the main methods of castration, hormonal castration and chemical castration are also an alternative and equivalent method of sterilization. Over the past years, non-surgical sterilization has found application in male dogs, cats, monkeys, goats, bulls, hamsters and rabbits. Calcium chloride, lactic acid, sodium chloride, chlorhexidine, formalin, zinc tannate, zinc gluconate, glycerol, glucose, ethanol and silver nitrate are commonly used in chemical
castration. After intratesticular application, degeneration of seminiferous tubules and Leydig cells, decrease in testosterone and sperm production, testicular atrophy is observed. In this review, the approaches of chemical castration were mentioned in different male animals.
Keywords
Male animal; Non-surgical sterilization; Castration; Chemicals; Testicle.
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