letter to the editor
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
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
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.
To study the role of sound enhancer device in teleconsultation.
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.
It was found that on using the sound enhancer device, the sound quality improved and it was helpful in the teleconsultation sessions using videoconferencing.
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.
Sound enhancer device; Teleconsultation; Telemedicine.
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.
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).
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.
Interestingly, only one conjugate delayed tumor growth, and montanide adjuvanted antigen, used as a positive control, failed to demonstrate any therapeutic effect.
Peptide-based subunit vaccine; Human papillomavirus; Polyglutamic acid; Therapeutic cancer vaccine; Polymer-peptide conjugate; Self-adjuvanting; Cervical cancer.
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.
Bactiguard infection technology (BIP); Catheter associated urinary tract infection (CAUTI); Biofilm.
opposite to the editorial
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.
Recruitment; e-consent; Remote consent; Clinical trials; Rare disease; Time-sensitive.
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.
Circulating tumor cell (CTC); Circulating; Tumor cell; Cancer; Isolation; Detection; Metastasis; Prognosis.
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.
Absorbable threads represent one of the most exciting breakthroughs in aesthetic medicine. The innovative composition of absorbable poly-L-lactic acid (PLLA)/caprolactone (PCL) threads enriched with hyaluronic acid (HA) has triggered the interest of aesthetic practitioners.
To compare the aesthetic outcomes of armouring procedures with absorbable PLLA/PCL threads versus the same procedure performed with PLLA/PCL/HA threads (APTOS, Tbilisi, Georgia threads).
Materials and Methods
Eight patients underwent thread insertion in the face (PLLA/PCL threads on one side and PLLA/PCL/HA threads on the other). Aesthetic outcome was determined subjectively by the patient after 7 days using a 5-point rating questionnaire. Wrinkles were evaluated objectively using 3D photosystem software after 7, 30, and 90 days.
Seven days after treatment there was significantly less pain, less swelling, less burning and a faster reduction of skin irregularities on the side treated with HA-enriched threads (all p<0.05). The side of the face treated with HA-enriched threads also demonstrated faster and more obvious improvement of wrinkles.
Absorbable PLLA/PCL threads have a reliable reputation for oval correction of the face and long-lasting biostimulation. The new HA-enriched threads shorten the post-procedure downtime, accelerate rejuvenation and provide more significant patient satisfaction.
Absorbable thread; Thread lifting; HA-enriched threads; Aesthetics.
The Lactobacillus is an industrially-important group of probiotic organisms that plays an important role in human health by inhibiting harmful and pathogenic bacterial growth, boosting immune function, and increasing resistance to infection. The aim of this study was to identify the probiotic bacteria Lactobacillus based on their phenotypic features and genotypic features. This study also shows the importance of probiotic bacterium, and the effects of their antibiotic resistance to human.
Six different brands were cultured on man, rogosa and sharpe (MRS) agar. The identity of the culture was based on the characteristics of the strains of Lactobacillus spp. which was characterized using their phenotypic features (cell morphology, Gram’s staining tests which are specific for Lactobacillus genus). The bacterial deoxyribonucleic acid (DNA) was extracted by two different methods, boiled cell method and cetyl trimethylammonium bromide (CTAB) method. Furthermore, the extracted DNA yields were compared to determine which gives the best yield. The bacterial genus was detected with using genus specific primers, specific to the Lactobacillus. All the isolates were further subjected to antibiotic resistance test using disc diffusion method against a total of 4 antibiotics (Erythromycin, Tetracycline, Vancomycin and Ampicillin) and the antibiotic resistant genes of tet(M) & erm(B), were analyzed by polymerase chain reaction (PCR).
Five isolates out of six samples (A to E) were found to exhibit multiple resistance against some of the most commonly used antibiotics. The isolates showed resistance toward tetracycline, erythromycin & vancomycin. Besides that, the isolates displayed a low-level of resistance toward ampicillin.
This study proves that antibiotic resistance is present in different species of probiotic strains, which may pose a food safety concern.
Lactobacillus; Probiotics; Antibiotics; Tetracycline; Vancomycin; Erythromycin; Ampicillin; Antibiotic resistance.
Deoxyribonucleic acid (DNA) microarrays are collections of DNA probes arranged on a base pair and the latest commercialized molecular diagnostic technologies that offer high throughput results, more sensitive and require less time. It is the most reliable and widely accepted tool facilitating the simultaneous identification of thousands of genetic elements even a single gene. Microarrays are powerful new tools for the investigation of global changes in gene expression profiles in cells and tissues. The different types of DNA microarray or DNA chip devices and systems are described along with their methods of fabrication and their use. The DNA microarrays assembly process is automatized and further miniaturized. DNA microarrays are used in the search of various specific genes or in gene polymorphism and expression analysis. They will be widely used to investigate the expression of various genes connected with various diseases in order to find the causes of these diseases and to enable their accurate treatment. Generally, microarray analysis is not only applied for gene expression studies, but also used in immunology, genotyping, diagnostics and sequence analysis. Additionally, microarray technology being developed and applied to new areas of proteomics, cancer research, and cellular analysis.
Application, DNA, Microarray, Principle.
The American diet is nutrient-poor and rich in unhealthy compounds like sodium, sugar, and saturated fats. Whether food has an effect on appearance has not been fully elucidated. The purpose of this prospective, single-armed study was to evaluate the impact of consuming two nutrient-dense functional foods, which are low in salt, sugar, and saturated fats, on hair, skin, and fingernail health.
Both subjective (self-reported questionnaires and photographs) and objective (i.e., salivary pH and skin hydration) tests were used to evaluate appearance. Weekly compliance with nutrient-dense foods, body weight, and quality of life assessment were also recorded.
Participants(n=28) consumed most of the nutrient-dense foods and remained weight stable, which was the goal of the study to exclude the effect of changes in body weight on appearance. Neither objective measurement of appearance showed significant improvements. Subjective measurements using questionnaires specific to hair, skin, and fingernails improved significantly over the 8-week study. Rating of photographs that the participants took of themselves improved significantly over the 8-weeks. These included reduced redness, decreased pore size, and better skin color. Using an acne-rating scale, a significant improvement was observed at week 8 compared to baseline. The quality of life parameters improved significantly including feeling of well-being, feeling full, having more energy, sleeping better, having less stress, and being more focused.
Inclusion of two nutrient-rich, functional foods in the diet improved the appearance of hair, skin, and fingernails. These foods were well-received and easy-to-prepare, leading to excellent compliance with the dietary protocol.
Appearance; Diet; Functional foods; Nutrient-dense foods; Hair; Skin; Nails.
This case documents the treatment of a middle-aged woman with chronic, unresponsive adhesive capsulitis (frozen shoulder) using manipulation, active release therapy, and electronic acupuncture. She had not responded to typical physical therapy but did respond to active release therapy along with adjunctive manipulation and acupuncture. In our course of treatment we wanted to see if we could significantly improve pain-free range of motion and normal; function without using invasive treatments like surgery and manipulation under anesthesia. Over a course of five weeks, using a soft tissue manipulation technique known as active release technique along with electrified acupuncture and home exercises, we were able to increase her range of motion to near normal and her function to normal. She was not forced to miss any work because of the treatment and can now do all the things she needs to do for work.
Frozen shoulder; Adhesive capsulitis; Manipulation; Active release therapy; Non-invasive treatment.
To evaluate the immunogenicity of a recombinant protein D from Haemophilus Influenzae (Hi) and the functional activities of the induced protein D antibodies in a mouse model.
Female Balb/c mice were immunised subcutaneously with recombinant protein D in the presence or absence of adjuvants and the serum immunoglobulin G (IgG) response to protein D was assessed by ELISA. The functional activity of the immune sera was evaluated in vitro using bactericidal assay against typeable Hi serotype b (Hib) and non-typeable Hi (NTHi) clinical isolates and in vivo using an infant rat bacteraemia model and a Hib clinical isolate.
A dose-dependent IgG response was induced in mice immunised with the recombinant protein D and this response was further increased by the adjuvants used [CPG, AlPO4 and Al(OH)3], with the latter showing the greatest effect on the antibody response. Immune sera were very effective in bactericidal assay against several Hib and NTHi clinical isolates, with a higher serum bactericidal titre against the NTHi than against the Hib isolates. This is possibly due to the lower expression of protein D on the Hib isolates used in our study, compared to the NTHi isolates. In addition, anti-protein D antibodies were partially protective in vivo infant rat bacteraemia model against a challenge with Hib Eagan strain.
Our results suggest that recombinant protein D is a good vaccine candidate against Hi and should be given in combination with other vaccine candidates to ensure complete protection against Hib and NTHi.
Haemophilus influenzae (Hi); Haemophilus influenzae serotype b bacteraemia; Rats.
This case report presents the diagnosis of superior mesenteric artery and nutcracker syndromes in a previously fit and well 14-year-old girl. Although these two entities usually occur in isolation, despite their related aetiology, our patient was a rare example of their occurrence together. In this case the duodenal compression of superior mesenteric artery syndrome caused intractable vomiting leading to weight loss, and her nutcracker syndrome caused severe left-sided abdominal pain and microscopic haematuria without renal compromise. Management of the superior mesenteric artery syndrome can be conservative by increasing the weight of the child which leads to improvement of retroperitoneal fat and hence the angle of the artery. The weight can be improved either by enteral feeds or parenteral nutrition. This conservative management initially helped but not in the long-term as the child started losing weight again. The next step in management is surgery (duodenojejunostomy – if the conservative management fails), which the child went through, remarkably improving their symptoms.
Unique difficulties and challenges can arise for rare diseases and orphan disease indications within a clinical trial. Some of the challenges encountered by trials that are working on rare diseases can include recruitment and enrollment. One of the explanations for the challenges that are encountered in rare disease trials is because of the trial design of study, where the investigational product is being compared to the placebo. This review paper discusses the usage of placebo and when other options could be taken into consideration while creating the protocol, specifically with consideration to rare disease studies. It is essential for the investigators and those designing the protocol to consider alternative options from the standard randomized controlled trial. The aim of this paper is to review alternative trial design options. The trial designs discussed in this review paper include crossover trials, single arm studies and historical data, and n-of-1 trials.
Recruitment; Enrollment; Placebo controlled; Clinical trials; Rare disease; Crossover trials; Single arm study;
Historical data; n-of-1 trials.
Perniosis or chilblain pernio is an inflammatory skin disease, typically located on acral skin surfaces secondary to prolonged exposure to cold temperatures and damp conditions. This disorder can appear as an idiopathic dermatosis, usually in young women, but occasionally it is associated with diseases such as anorexia, intestinal lymphoma, chronic myelomonocytic leukemia, monoclonal gammopathies, cryoproteinaemia, viral infections, as well as connective tissue diseases, especially lupus, picture that is known as chilblain lupus. We present a case of perniosis associated with Systemic Lupus Erythematosus and review the literature.
Chilblain lupus; Perniosis; Chilblain pernio; Rare cutaneous; Myelomonocytic leukemia; Systemic Lupus Erythematosus.
Everyday all of us use rechargeable solutions either its smartphones, televisions, or any other electronic devices. Faster streaming of these electronic devices to other external devices may be facilitated through wireless connectivity. Wireless streaming demands much more battery backup. With advancement of hearing aid technology many features exists in hearing aids which may facilitate better spectral information, improved speech understanding in presence of background noise and thus improving communication and quality of life of the users. The use of these advanced features often requires continuous uninterrupted power supply. Traditional disposable hearing aid batteries cannot be assured of their performance due to their inopportune time discharge. Recently rechargeable solutions in hearing aids have been discovered that can support long-lasting wireless streaming. Modern day rechargeable batteries are expected to be easy to charge which can last for longer duration with more reliability and durability. Rechargeable as a feature is added on over and boon. Rechargeable battery solutions based on its various benefits may support as boon for environment, hearing aid users and professionals (better counseling and more satisfied users). The aim of this article is to highlight the awareness of these different rechargeable solutions for the users and professionals. In addition mentioning in brief the superiority of Lithium ion battery which is widely accepted in rechargeable hearing aids.
Rechargeable hearing aids; Wireless streaming; Batteries for hearing aids; Li-ion batteries.
Bone grafting is a surgical procedure that replaces missing bone through transferring bone cells from a donor to the recipient site and the graft could be from a patient’s own body, an artificial, synthetic, or natural substitute. Bone grafts and bone graft substitutes are indicated for a variety of orthopedic abnormalities such as comminuted fractures (due to car accidents, falling from a height or gunshot injury), delayed unions, non-unions, arthrodesis, osteomyelitis and congenital diseases (rickets, abnormal bone development) and are used to provide structural support and enhance bone healing. Autogenous, allogeneic, and artificial bone grafts are common types and sources of grafts and the advancement of allografts, synthetic bone grafts, and new operative techniques may have influenced the use of bone grafts in recent years. Osteogenesis, osteoinduction, osteoconduction, mechanical supports are the four basic mechanisms of bone grafting and help bone tissue to regenerate completely. A bone graft can be harvested from the iliac crest, proximal tibia, proximal humerus, proximal femur, ribs, and sternum. An ideal bone graft substitutes should be biologically inert, readily available, must possess osteogenic, osteoinductive and osteoconductive properties, provide mechanical support, easily adaptable in terms of size, shape, length and substituted by the host bone. Bone banks are the source of bone grafts and implants and necessary for providing biological material for a series of orthopedic procedures. Bone grafts and implants can be selected as per clinical problems, the equipment available and the preference of the surgeon. A search for an ideal bone graft is on and may continue time to time.
Application; Bone; Bone graft; Bone replacement; Bone bank; Principle.
To describe our myositis cohort in-depth.
From January 2006 to December 2018, all newly diagnosed myositis patients were retrospectively enrolled in the study. We performed a subtype reclassification using the 2017 EULAR/ACR criteria, following the example of the EuroMyositis registry. Disease activity and damage were measured by the newest standardized assessment-tools for clinical studies. Comparisons between myositis subgroups were conducted using Fisher’s exact test.
We enrolled 32 patients (25 were female): six patients with dermatomyositis, six with polymyositis, eleven with overlap myositis, six with antisynthetase syndrome, one with autoimmune necrotizing myopathy, one with juvenile antisynthetase syndrome and one with juvenile dermatomyositis. The overall median follow-up period was 23-months (9-44.75). Interstitial lung disease (ILD) was most frequently seen in patients with antisynthetase syndrome. Patients with overlap myositis were more likely to have polyarthritis mimicking rheumatoid arthritis, reduced capillary density in the nail fold capillaroscopy and Raynaud syndrome. Ovarian cancer during the follow-up period occurred in two patients (one with polymyositis and one with dermatomyositis). Myositis-related death was reported in two patients: acute respiratory failure in autoimmune necrotizing myopathy and dysphagia-related complications in polymyositis. Cyclophosphamide, methotrexate and rituximab demonstrated a significant steroid-sparing effect. In 22 of 32 patients, the myositis subgroup classifications made on the basis of our opinion and the new EULAR/ACR classification criteria were different, showing strong disagreement, especially in the subtype polymyositis.
Our analysis highlights the heterogeneity in myositis subgroups and shows the steroid-sparing effect of cyclophosphamide, methotrexate and rituximab.
Myositis; Idiopathic inflammatory myopathy; Dermatomyositis; Antisynthetase syndrome; Overlap myositis; Rituximab.
CCP: Cyclic Citrullinated Peptide; CK: Creatine kinase; CYC: Cyclophosphamide; IIM: Idiopathic Inflammatory Myopathy; ILD: Interstitial lung disease; IMACS: International Myositis Assessment and Clinical Studies Group; MDI: Myositis Damage Index; MMT8: Manual muscle test 8; MTX: Methotrexate; MYOACT: MYOsitis disease ACTivity; RTX: Rituximab; TIF-1γ: Transcriptional factor-1γ.
It was previously reported that diethylnitrosamine (DEN) enhanced liver cancer progression in ATT-MYC mouse model of liver cancer. Radiogenomics is a new tool in advanced science technology that gives information on tumor biology, non-tumor surrounding tissue, the degree of tumor size and presence of necrosis of cells especially with joined micro computed tomography – positron emission tomographys (CT/PETs).
To evaluate the correlation of gene expression and non-invasive microPET information of the liver tumors at different points of the stage of growth.
Exon array expression of the liver of ATT-MYC mice treated with DEN or butylated hydroxytoluene (BHT) compared to control non-transgenic mice were analyzed by array track and the current data were also compared to microarray expression of liver tumor of ATT-MYC mice.
The expression of genes responsible for glucose transport such as glut1, 3, 4, hk1, slc1a5, slc1a1, slc1a4, slc1a2, gp6c and gpc-1-3-4 were up-regulated significantly in DEN-treated transgenic mice immediately after end of treatment (p≤0.05), while glut2 (fold change 0.9503, p-value 0.4385) and hk2 (fold change 3.0589, p-value 0.0565) genes were increased not significantly immediately after end of treatment. Additionally, at 4.5-months of observation after the end of treatment slc1a5, slc38a2, glut1, glut4 and gpc3-4 genes had a significant fold change in liver tumor tissue in DEN treated mice when compared to BHT or control transgenic or non-transgenic one. While hk1, 2, slc5a1, slc1a4, glut2, glut3, g6pc and gpc-1 genes were increased non-significantly in the liver of treated mice when compared to control group at 4.5-months of observation after the end of treatment. Notably, c-myc, hif-1 and aldoa glycolytic genes were expressed significantly both time points of 4 and 8.5-months while ldhb, hk-2 and PKM2 were increased non-significantly in DEN treatment when compared to BHT/control non-transgenic animals.
There is a definitive correlation between genes responsible for glucose transport and 18F-Fluorodeoxyglucose (FDG) uptake in the early and advanced degree of liver carcinogenesis. This study of glucose pathway in Hepatocellular carcinoma (HCC) at different stages of early and advanced one is the potential for therapeutic anticancer therapy.
18-FFluorodeoxyglucose (FDG); MicroPET; Exon array expression; Hepatocellular carcinoma (HCC); Att-myc transgenic mice; Diethylnitrosamine (DEN), Butylated hydroxytoluene (BHT); Glucose metabolism.
Cutaneous polyarteritis nodosa is a rarer variant of classic polyarteritis nodosa with unknown etiopathogenesis. It presents with skin, articular and nervous involvement, after systemic involvement is ruled out. This work reports the case of a 41-year-old male patient diagnosed with cutaneous polyarteritis nodosa with skin lesions, polyarthralgia and sensory axonal polyneuropathy.
Skin; Polyarteritis; Vasculitis; Biopsy; Immunofluorescence; Histology.
India is a vast country with limited human resources. People living in remote areas often have limited access to healthcare facilities. To address this need and to increase healthcare awareness, health camps have been established. These camps are often supervised by junior physicians. Telemedicine, and in particular use of a digital stethoscope may provide better diagnosis and better consultation to the patient by senior physicians located remotely. This article highlights the clinical use of a digital stethoscope in such a health camp.
Health camp; Telemedicine; Digital stethoscope.
Patient centricity has led to the idea that drugs should answer medical needs not only defined by the medical bodies but relevant for the patients themselves. This implies that the diversity of the patients should be represented in clinical trials. Disparities in representation of diverse populations in clinical trials have been well-documented for several pathologies like arterial hypertension, diabetes but also in oncology. Today, Caucasian patients included in clinical trials represent at least 75% of the clinical trials population even in pathologies where minorities are largely more affected than Caucasians. Filling the gap in diversity is an important matter to ensure ethics, good practices, regulatory compliance, patient safety and scientific validity. To achieve their recruitment goals and being patient centric, sponsors and investigational sites need to pay attention of this problem and put in place specific strategies. Mistrust of patients of minority groups toward clinical research is one of the main barriers along with lack of access to clinical trials (low awareness, communication barriers, distance to investigational sites). Adapted communication, community-based strategies are some of the useful strategies directed to the patients. Investigators may not encounter diverse populations in their area or may not be aware of unconscious bias when identifying patients suitable for a clinical trial. Looking for referrals and raising awareness of the risk of bias with training on culturally sounded approaches could help investigators to recruit more diverse populations. Lack of awareness and costs may prevent sponsors to focus on diversity but ethics, benefits of data acquisition and patient centricity should be enough motivators to modify this trend. Patients, investigators and sponsors have their own barriers to tackle the lack of diversity in clinical trials. The cultural background of all stakeholders is an important factor in those barriers. Only multidisciplinary approaches including human sciences would help to define patient recruitment strategies that would mitigate the current lack of diversity.
Clinical trials; Patient recruitment; Diversity, Minorities.
The coronavirus disease-2019 (COVID-19) emergency has clearly shown the need to discover, test and produce a new vaccine but also in general the fragility of the current chain of clinical trials. Through this emergency, is it possible to look at the current clinical trial processes with new eyes? Is it possible to seize the opportunity for change and to have confidence in the possibility of their improvement? In this short article the authors wanted to give an optimistic answer to this question by pushing on the possibilities of innovation nowadays.
Clinical trials; Innovation; Covid-19; Digital transformation.
Hackensack Meridian Health, a large New Jersey network comprised of 17 hospitals, a medical school, and 200 ambulatory care centers, executes a large research program with approximately 1000 active human subjects studies. With the arrival of the coronavirus disease-2019 (COVID-19) pandemic, the Office of Research Administration was confronted with a series of challenges. These included minimizing face-to-face contact among research participants and staff, allocating limited resources to handle the influx of COVID-19 related proposals, providing human subjects protection training to the physicians and staff who were needed to run the clinical trials, adjusting bio-repository activities to meet the increased demand for samples, and disseminating all of the new regulatory and operational information to the thousands of researchers in the network. The network’s success in modifying its research program quickly and effectively to adapt to the changing landscape can be attributed, in large part, to the centralized nature of the research administration.
Research administration; COVID-19; Network.
Although the negative pressure wound therapy (NPWT) is a time tested method of wound preparation, the role of NPWT with instillation and dwell time (NPWTi-d) in decreasing the downtime of wound preparation needs to be evaluated.
The objective of this study is assess the role of NPWTi-d in wound bed preparation.
Materials and Methods This study was conducted in a tertiary care center, after getting informed consent and ethical clearance. NPWTi-d was done on a 36-years-old female with no known co-morbidities admitted with infected raw area over the right below knee amputation stump and exposed bone who was not responding well to conventional wound dressing. NPWT was applied with the help of sterile polyurethane sponge and two tubes. The antimicrobial solution used was ionic silver solution, just enough to wet the sponge completely and up to the point when the transparent occlusive covering begins to lift. Negative pressure was applied at 125 mmHg. The wound was bathed with ionic silver solution and it was allowed to stay in the wound for 10-minutes, after every 2-hours of negative pressure application. This was continued for 1-week. The dressing was opened at the end of 1-week, wound irrigated with normal saline, exudate swabs for culture taken and debrided, following which fresh NPWTi-d was applied. This was repeated for the next 3-weeks.
By the end of third week, the wound became clean, fully covered with healthy granulation and the wound bed was ready to undergo the definitive wound cover procedure.
Negative pressure wound therapy (NPWT); Negative pressure wound therapy with instillation dwell time (NPWTi-d); Ionic silver solution; Wound bed preparation; Amputation stump.
Liposomes have been used for drug delivery since their discovery 60-years-ago. The advantages they provide as carriers have been recognised and exploited to improve the delivery of numerous drugs and eliminate harmful side-effects. Liposomal delivery has been tested for anticancer drugs, anti-tuberculosis drugs, variety of vaccines, just to list a few.
We developed a series of liposomal formulations with the addition of cholesterol and polyethylene glycol. The uptake of these formulations by human epithelial prostate cancer (PC-3) cells and mouse macrophages was examined and analysed by flow cytometry and confocal microscopy.
Among the liposomes tested, small anionic liposome vesicles (≤200 nm) prepared with egg phosphatidylglycerol as the main lipid were most effectively taken up by PC-3 cells and macrophages.
We produced a liposome formulation that can be used as a model system for the delivery of drugs and vaccines.
Liposomes; Drug delivery; Vaccines delivery; Egg phosphatidylglycerol; Polyethylene glycol.
The current study examined the impact of a non-governmental organization’s academic tutoring and mentoring program on the social-emotional learning (SEL) and subjective well-being of 240 marginalized young women.
One-hundred-fifty-nine currently enrolled 7-12th grade students with a mean age of 16.39, SD=1.55; 40 students who were enrolled in college with a mean age of 20.25, SD=1.57, and 25 who had graduated from college with a mean age of 22.48, SD=2.16 and their leaders participated.
All participants completed in a survey that assessed the degree of participants’ locus of control, expectations of success (self-efficacy), current goals and career-related aspirations and their satisfaction with their relationships and life in general. Twenty-one of the participants and all leaders also were interviewed.
Regression analyses revealed that both the participants’ self-management and the leader’s locus of control were significant predictors of the participants’ internal locus of control. Congruent with interview findings, latent structural equation analysis revealed that three manifest variables of social-emotional learning, “self-management”, “social awareness”, and “self-efficacy” had direct positive effects on participants’ subjective well-being (i.e., their satisfaction with life and relationships).
Culturally sensitive approaches to mentoring and training are needed and helpful. Future research should be carried out to mitigate design limitations and further the current study’s addition to the body of research on social-emotional learning and well-being.
Self-management; Self-efficacy; Social awareness; Social-emotional learning (SEL); Internal locus of control; Life satisfaction; Relationship satisfaction; Subjective well-being (SWB).
Patients with maxillary Kennedy Class I are frequent visitors to the dental office, the missing of posterior teeth makes the control of the movement of removable partial dentures difficult due to the axis of rotation and the different resiliencies between the supporting structures. The use of implants in association to the conventional metal frame denture provides favorable long-term stability and retention, good clinical outcomes in terms of occurrence of complications and maintenance. In this clinical case, a patient with a maxillary Kennedy Class I was rehabilitated using a 3 implants to support metallic removable partial denture. A three dimensional (3D) surgical guide was used for the well-placement of the strategic implants and ball attachments were tightened as connectors between implant and denture. The patient was satisfied after 4-years of follow-up and reported good occlusal stability, esthetic and functional satisfaction.
Dental implant; Distal extension removable partial denture; Kennedy Class I; Attachment denture.
Fluid overload is a major contributor to mortality in critically ill patients but is difficult to estimate clinically. Bioimpedance has been used to estimate fluid volumes with three different methods of analysis:1. single-frequency; 2. multi-frequency; 3. bioimpedance spectroscopy. The aim of this study is to assess the accuracy of different types of bioimpedance analysis in detecting changes in fluid volumes.
Prospective observational study, in end-stage renal disease patients requiring dialysis, in a tertiary care center. During hemodialysis, we assessed the correlation between change in estimated total body water volumes, as measured by all three methods of bioimpedance, and fluid volumes removed, as measured by changes in body weight.
Twenty-four pediatric and adult patients were included in the study (median age 42.4 years) with a total of 30 study assessments performed. There was a weak correlation between change in body weight and change in estimated total body water volumes (R=0.15, 0.41, and 0.38, respectively). In the Bland-Altman analysis, the mean biases along with their associated 95% confidence limits of agreement were -0.23 L (-4.1 to 3.5 L) for single-frequency; -1.1 L (-4.1 to 1.9 L) for multi-frequency; and -0.6 L (-6.1 to 4.8 L) for bioimpedance spectroscopy.
In this study of end-stage renal disease patients requiring dialysis, the accuracy of bioimpedance measurement to evaluate fluid changes was poor, regardless of bioimpedance modality.
Body composition/physiology; Body fluid/physiology; Electric impedance; Extracellular fluid/metabolism; Renal dialysis.
In the realm of competitive athletics, numerous variables have been examined for predictive utility with respect to player selection/development and outcomes on the field. Notwithstanding important advances, the current predictors only account for a modest amount of variance in outcomes of relevance in the National Football League (NFL).
The primary objective of this study was to investigate the predictive validity of a new measure of athletic intelligence, the Athletic Intelligence Quotient (AIQ), which is based on the empirically supported Cattell-Horn-Carroll (CHC) Theory of Intelligence. The predictive validity of the AIQ was determined in relation to performance metrics from 146 NFL players across several seasons.
Hierarchical regression analyses indicate that specific AIQ factors accounted for a statistically significant increase in the explanation of variance beyond the current level of evaluation for several performance metrics (e.g., career approximate value; sacks, tackles, rushing yards). Further, specific factors of the AIQ are related to position specific statistics, offering the possibility that performance prediction can be focused in for the specific skills required by a given position.
Given the recent impact of analytics in professional sports, and the significant findings noted in the current investigation, the authors discuss the potential importance of the AIQ in the selection and coaching processes.
Diabetes mellitus (DM) is a chronic debilitating condition affecting people worldwide and diabetic foot ulcers are also a common problem. The treatment of diabetic ulcers requires a multimodal approach. Adjuvant low-level laser therapy (LLLT) may be useful in lesions with protracted healing course but the evidence is still limited. In this study, we share our experience regarding the use of low-level laser therapy as an adjuvant treatment modality in a patient with diabetic foot ulcer.
Low-level laser therapy; Diabetic ulcer.
The study was conducted to determine the prevalence of hydatidosis, to identify the association between expected risk factors and occurrence of the disease, to investigate economic importance and to evaluate fertility and viability of the hydatid cyst in cattle slaughtered at the abattoir.
Materials and Methods
A cross-sectional study, which involves both ante-mortem and post-mortem examination, was conducted at Nekemte municipal abattoir from November 2015 to March 2016.
A total of 355 local cattle breed was randomly sampled and examined for the presence of hydatid cysts in the organs of the animals using the standard meat inspection procedures, 66 (18.6%) animals were found harboring hydatid cysts. Statistical analysis showed that there was a significant difference (p<0.05) between the prevalence of bovine hydatidosis in all risk factors with exception of sex of the animals. Among 207 hydatid cysts recorded, 93 (44.92%) were from lungs, 65 (31.40%) from livers, 4 (1.93%) from heart, 3 (1.44%) from kidney, 1 (0.48%) from spleen and 41 (19.8%) were in two organs from lung and liver. Fifty-seven (57) of these 207 cysts were randomly selected and subjected to fertility and viability test which revealed 19 (33.33%) as fertile, 25 (43.86 %) sterile and 13 (22.81%) calcified. Viability test proved 7 (12.28%) of 19 fertile cysts as viable and 12 (21.05%) of 19 fertile cysts as non-viable. Viability of cysts in different organs revealed that 5 (16.1%) and 2 (10%) of cysts from lungs and liver, respectively. The estimated financial loss during the study period both due to condemnation of organs and an in direct carcass weight loss from hydatidosis was 2,190,143.52 ETB.
The results of this study revealed that bovine hydatidosis was an economically important disease of cattle which need serious attention for prevention and control actions in and around Nekemte. Hence, establishment of well-equipped standardized abattoirs, prohibition of backyard slaughter, creation of public awareness, deworming and control of stray dogs are of paramount importance.
Abattoir; Cattle; Economic loss; Hydatidosis; Nekemte; Prevalence.
Esophageal replacement (ER) is indicated in patients with long gap esophageal atresia (LGEA) or failure of the primary anastomosis. Also, severe caustic or peptic strictures, resistant to conservative treatment with medication and dilations, may require an ER. Numerous techniques with different organs and routes have been described, all with satisfactory results.
Our objective is to describe the experience obtained with partial gastric pull-up according to the Schärli principles (SGPA).
Materials and Methods
Medical records of patients who required a SGPA between October 1995 to June 2018 were reviewed. The analysis was observational, longitudinal, retro-prospective and descriptive. Epidemiological data, surgical aspects and postoperative complications of the patients were considered.
Seventy ER were performed with SGPA. The indication was esophageal atresia (EA) in 58 cases (44 long gap and 14 failure of the anastomosis), 10 caustic strictures, one peptic stricture resistant to conservative treatment and the other due to a retained foreign body. The age of the ER was on average 2-years and 9-months. The route was: posterior mediastinal (35), retrosternal (29) and transpleural (6); without a thoracic approach in 59 patients. The duration of the procedure was 4.7-hours on average. There were 13 cases of intraoperative complications, 8 cases of pneumothorax, 5 bleeding injuries (3 in the spleen, 1 liver and 1 cervical), and one injury to the cervical trachea. Anastomotic dehiscence was observed in 37 patients (52%), which closed spontaneously after an average of 17.8-days in all except one patient. Thirty-one patients (44%) developed anastomotic stenosis, requiring redo anastomosis in 6 cases; 37% developed dumping and 23% gastroesophageal reflux disease. There were 3 deaths (4.2%): all in EA patients with associated malformations, following a morbid postoperative period with infectious complications in intensive care at 10-days, 7 and 8-months after ER. Follow-up was an average of 8-years. All 67 living patients are currently tolerating oral feeding.
In our experience with ER using SGPA, we observed a high incidence of complications, generating a longer post-operative evolution and with greater morbidity than that described in other techniques. Given these results, we changed our strategy to complete gastric transposition, in order to reduce morbidity and improve the evolution of this complex group of patients.
Esophageal replacement; Partial gastric pull-up; Esophageal atresia; Caustic stricture.
The 2008 Physical Activity Guidelines recommend that the more than 53 million people living with a physical disability in the United States to participate in regular physical activities consisting of both aerobic and anaerobic components, if possible. Also, if individuals with physical disabilities are unable to meet the recommended physical activity guidelines, they are encouraged to do as much as their physical disability permits. Despite the recommended guidelines, several individuals with physical disabilities do not participate in regular physical activities. Prior research suggests that several societal and structural barriers in sport and exercise environments often negatively affect individuals with physical disabilities. Thus, it is essential for family members, healthcare practitioners, rehabilitation/recreational teams, and community leaders to encourage individuals with physical disabilities to conquer barriers that restrict participation.
Necrotizing fasciitis is a soft tissue bacterial infection that spreads rapidly resulting in the destruction of muscles, skin, and underlying tissue. Necrotizing fasciitis is defined as a fast and progressive inflammatory infection of the fascia leading to secondary necrosis of the subcutaneous tissue moving along the facial plane. Fournier gangrene is a type of necrotizing fasciitis involving the scrotum and perineal area. Patients suffering from acute necrotizing fasciitis require an effective regimen which includes surgical removal of devitalized tissues, systemic antimicrobials and mitigating underlying systemic disease processes. The burden of treating wounds following surgical debridement, on the other hand, can be challenging especially in the third world where resources are scarce resulting in suboptimal wound coverage and function. At primary care level we had the opportunity of using natural honey in 5 patients with non-healing wounds in either the lower limb or scrotum due to acute necrotizing fasciitis. This natural noninvasive approach offers a cost-effective and efficacious alternative to dermatotraction, skin grafting and negative pressure wound therapy. In these patients, the use of natural honey led to the restoration of the appearance and function of the fasciotomy wound especially in patients with co-morbidities or those refusing skin grafting due to cost, religious factors, etc. The authors present the clinical results followed by a discussion on the therapeutic properties of natural honey. This case series demonstrates the efficacy of topical raw honey as a catalyst for speeding the healing process by secondary intention thereby offering a safe and efficacious
alternative for managing various wounds resulting from acute necrotizing fasciitis.
Natural honey; Necrotizing fasciitis; Primary care; Wounds.
Equitable access to safe abortion is part of the corpus of human rights. Providing women with access to safe abortion means protection and realization of one of their fundamental human rights. However, around the world, even nowadays, women face not only legal obstacles, but as well stigmatization and conviction against fulfillment of the right to abortion. In North Macedonia there a multiple type of barriers and large inequalities related to the accessibility and availability of reproductive healthcare
services. Women with low socio-economic status are mostly affected. The need for contraception has not been met and reproductive healthcare services are unevenly distributed across the country.
Laws; Abortion; Safe; Women’s sexual and reproductive rights; Healthcare services.
Connected care is defined as the “real-time, electronic communication between a patient and a provider, including telehealth, remote patient monitoring, and secure email communication between clinicians and their patients” (Alliance of Connected Care). Connected care can create a high-value interaction strategy with patients when it makes thoughtful use of commercially available digital health technologies with demonstrated both clinical and economic effectiveness. Karantis360™, is a home sensor technology that enables real-time tracking, data analytics and predictive care for personal (at home) care powered by IBM Watson Health. IndividuALLyticsTM is a telemedicine platform driven by a patent-pending an N-of-1 analytical engine and related digital dashboards that provides individual, patient level evaluation of treatment response. The underlying technology combines disparate digital health technology data with the best evidence-base guidelines with N-of-1 methodology. The output allows for creation of personalized treatments empirically tested at the patient level over time (aka over the course of care). When aggregated both within and across persons,
the time-ordered data can build predictive pathways of behavior and ensure the relevant care and medical treatments are in place to support effective medical and self-management of chronic illness. This case-series report describes the implementation of a joint home sensor technology (big data) and an N-of-1 analytic engine (small data) with three elderly consented volunteer customers-patients of Karantis360™. Each person underwent successive, 2-week behavioral change treatment phases to determine usability, utility regarding medical and self-management and any proximal effects on health risks.
Telemedicine; Small data; n-of-1; Internet of things; Chronic conditions; Self-management; Predictive analytics.
A 30-year-old woman was admitted to the emergency department one and half hours after severe bupropion extended-release intoxication, estimated to be between 18 and 36 g. She initially presented with seizures and later developed signs of cardiotoxicity with persisting sustained ventricular tachycardia. Despite multiple defibrillation attempts and the administration of sodium bicarbonate,
calcium gluconate and magnesium, restoration of sinus rhythm was found unsuccessful. In another attempt to treat this refractory ventricular tachycardia lidocaine was given followed by deterioration to asystole. During cardiopulmonary resuscitation (CPR), the quality of chest compression was assessed and optimised using transoesophageal echocardiography. Eventually venoarterial extracorporeal membrane oxygenation (VA-ECMO) was needed to achieve hemodynamic stability. In this case report we discuss the successful use of VA-ECMO after bupropion intoxication, which has only been reported in 3 other cases but should be considered as one of the treatment options in severe overdose cases. Also, the rare complication of asystole after lidocaine administration and the value of transoesophageal echocardiography during CPR will be discussed.
Bupropion; Intoxication; Extracorporeal membrane oxygenation; TEE guided resuscitation; Antiarrhythmic therapy.
Existing research has addressed the importance of community integration (CI) and its benefits of dwelling in a community but has yet to address the methods and efficiency of improving these activities among older people. Thus, it is vital to understand how healthcare workers can integrate the benefits of CI among older people, especially with the use of occupational therapists (OTs). The latter are actively working to improve ageing individuals mobility within the community.
This study aims to identify Malaysian OTs’ perspectives on CI’s and its implication on older people.
Occupational therapist from different states of Malaysia participated in a semi-structured interview, through a virtual medium (Zoom Cloud Meetings). The interview guide encapsulated the theory of critical incident technique (CIT).
Thematic content analysis, over fourteen participants from 13 states of Malaysia, provided insights into CI’s barriers for older people in Malaysia. The findings revealed that multifaceted factors from an individual, organisational and socio-environmental perspective limit older people’s active CI engagement.
South-East Asia hierarchal and collectivist culture play a significant role in influencing all factors of CI. OTs must understand and incorporate appropriate cultural norms during CI practice development for the older population in Malaysia.
Occupational therapist; Critical incident technique; Older people; Community integration; Qualitative study; Societal norms; Cultural norms.
Telogen effluvium (TE) and its acute form (aTE) are two of the commonest occurrences in a trichology clinic, with patients claiming excessive hair shedding. ATE can occur in people of any age and ethnicity and is considered to be a quite common condition in either sex even if women are more likely to have a lowered quality of life and restricted social contacts as compared to men as a result of hair loss. Brittle nail syndrome (BNS) is a common condition affecting up to 20% of the population, especially women over 50 years of age. Nails affected by BNS appear ragged, thin, and dull. The clinical features of BNS include horizontal splits within the nail plate (onychoschizia) and increased longitudinal ridging or splitting (onychorrhexis). In BNS oral supplementation, trace elements and amino acids (especially L-Cystine) have been reported to be useful to ameliorate the nail plate condition.
We hypothesized that a nutritional approach, with nutrients of which the composition is close to the human keratin, could be effective to decrease hair loss during telogen effluvium and to improve brittle nails condition. At this purpose, a clinical study was designed to investigate the efficacy of a natural keratin hydrolysate obtained from a non-human source (feathers) on both aTE and BNS.
The in vivo effects of a natural keratin hydrolysate, Kera-Diet® (KD) upon human hair and nails condition was tested in a randomized, double-blind, parallel-group, benchmark (BE) and placebo (PL) controlled study involving 60 women during 90 days. In all subjects, Anagen/Telogen hair, hair volume and density, pull test, global photography, hair and nails brightness, and nail plate
growth were measured at baseline and after 45 and 90 days of products use. A self-assessment test was carried out at the end of the study.
With the KD treatment group, hair density, percentage of hair in anagen phase, hair and nails brightness, and nails growth were significantly increased compared to PL treatment group. Interestingly, with this same group, the diagnosis of aTE by pull testing was negative from 45 days. The efficacy of KD was equal to or greater than PL treatment group.
In this study, we demonstrated that daily oral administration of 1000 mg during 3 months of a natural extensively keratin hydrolysate, Kera-Diet®, associated to trace elements and specific vitamins was effective to improve both hair and nails condition. Furthermore, it demonstrates the role of nutrients in both aTE and BNS.
Keratin hydrolysate; Oral supplementation; Telogen effluvium; Hair growth; Brittle nail syndrome; Onychoschizia; Clinical study.
Present study was conducted with a theme to develop yoghurt spread from goat milk owing to its therapeutic significance and ameliorate nutritional value and quality of the finished product via supplementation of chia seed oil.
Four treatments (T0, T1, T2 and T3) possessing varying concentrations of chia seed oil (0, 2, 4 and 6%) were formulated and the first was opted as control. Samples were evaluated on 0th, 10th and 20th day for physicochemical (pH, acidity, TSS, total protein, fat), microbiological (total plate count) and sensory acceptance.
Significant changes (increasing or decreasing trends) were perceived in all physicochemical parameters as the storage span progressed however minute differences were observed among different treatments except moisture content which varied significantly among different formulations. Total microbial count also increased with increase in storage days however decreased with increase
in concentration of chia seed oil. Sensorial attributes particularly product acceptability was considerably reduced at the end of storage period.
Generally, addition of chia seed oil at different concentration to yoghurt spread improves the sensory properties and overall acceptability, extends the shelf life and enhances nutrition values. Goat milk is preferable to cow milk owing to essential nutrients it provides to infants and substantial therapeutic significance.
Yoghurt spread; Goat milk; Chia seed oil; Qualitative valorization; Shelf life.
Paediatric urolithiasis is an emerging disease in developing nations especially in India, but a rarer entity compared to its adult counterpart. There is significant geographic variation in the incidence of urolithiasis within India itself. Given the changing dynamics of the disease, this study evaluated paediatric urolithiasis patients in a non-endemic region in South India.
This is a retrospective study of children and adolescents diagnosed with urolithiasis from January 2009 to December 2019 in a single tertiary care centre in South India. The purpose of this study was to investigate and identify the demographic and clinical characteristics, aetiology, management, clearance rates after surgical intervention and disease recurrence of paediatric stone disease
in a non-endemic region in South India.
We evaluated 29 patients which included a total of 97 hospital admissions. Predominantly the study population consisted of males (80.0%), with a mean age of symptom onset of 9.44±5.53-years. All patients were metabolically evaluated, 16 patients (55.2%) had metabolic abnormalities and the most common abnormality was hypocitraturia (37.5%). Spontaneous elimination rate was 6.9% and clearance rates for surgical procedures ranged from 72% to 100%. Recurrent stones were seen in 37.9%. No patient developed chronic kidney disease or mortality due to stone disease within the evaluation period of this study.
Paediatric urolithiasis is an emerging disease in India. There is a high prevalence of metabolic abnormalities in paediatric stone disease which supports the need for metabolic evaluation in all cases. There is more similarity of our study with western literature than the available Indian data which may be due to the lifestyle changes, significant geographic variation within India itself between
endemic and non-endemic regions or changing epidemiology of paediatric stone disease per se.
Paediatrics; Urolithiasis; Urinary tract infection (UTI).
Acute antibody-mediated rejection (aAMR) can negatively impact renal allografts outcomes. To date, there has not been a consistent therapeutic approach to manage aAMR. The aim of the study is to evaluate the tolerance and efficacy of an institutional protocol of methylprednisolone, intravenous gamma globulin (IVIG), rituximab, and bortezomib used to treat aAMR in pediatric renal transplant recipients (pRTRs).
A retrospective chart review was performed on 10 pediatric renal transplant recipients (pRTRs) who were diagnosed with aAMR on a renal biopsy performed between January 2014 and November 2015.
Over the study period, 9.5% of pRTRs had aAMR. Sixty percent of whom had concurrent acute cellular rejection (ACR). Renal allografts survival was 100% during the the first post-aAMR. At the time of diagnosis of aAMR, estimated glomerular filtration rate (eGFR) had decreased by 42% (mean at baseline eGFR=67.2±19.5 mL/min/1.73 m2 vs mean at aAMR eGFR=38.9±14.2 mL/min/1.73 m2; p=0.002). At 1-year post rejection, eGFR had increased by 26% as compared eGFR at the time of rejection (mean eGFR=49.0±13.2 mL/min/1.73 m2; p=0.006). Immuno-dominant donor-specific anti-HLA antibody titers (iDSAs) class I and class II decreased by 69% and 15% at 6-month follow-up visit. No serious opportunistic infections nor malignancy were reported in our subjects.
Our study suggests that our protocol improved kidney function with 100% graft survival at 1-year post aAMR episode. The percentage decline in iDSAs class I titers was more significant than class II. Furthermore, our treatment protocol was well-tolerated with no life threatening complications.
Acute antibody-mediated rejection (aAMR); Intravenous gamma globulin (IVIG); Pediatric renal transplant recipients (pRTRs).
Surrogacy has existed since ancient times. Depending on the way of creating an embryo, two types of surrogacy differ, traditional and gestational. When it comes to monetary compensation, two types of surrogacy exist, altruistic and commercialized. A lot of questions come to light such as: Is the altruistic surrogacy a humane gesture for all contracted parties? What if the mother changes her mind? Do the babies born of surrogacy mothers have rights? In North Macedonia, surrogacy was introduced for
the first time in 2014 in the amended Law on Biomedicine and Assisted Fertilization. It was a novelty having in mind that in the Law of 2008 the surrogacy as a practice was outlawed. The amended law applies the term gestational mother and provides a
liberal stance, but many provisions are unclear.
Laws; Gestational carrier; Commercialization; Altruism; Child rights; Health consequences.
The purpose of the research was to build a scale of quality of working life, in telemarketers of a call center company in Downtown of Lima, with a sample of 700 telemarketers.
The methodology was obtained through a non-probabilistic convenience sampling, the validity was carried out through the judgment of 10 experts and the indices were obtained using the V. of Aiken p>0.80 and the Binomial test p<0.05 in 29 questions.
The construct validity was obtained through confirmatory factor analysis, to explain the quality of working life composed of five dimensions according to Maslow’s theory.
In the results, the Kaiser Meyer Olkin (KMO) measurement test yielded a value of 0.930, which means that it is greater than>0.80 over the number of observations for the base of respondents (700), for the test of Bartlett’s sphericity. is not significant
(p<0.05), which means a correlation between the variables, in the total variance explained indicates that the instrument has five factors that explain 54.982% of the total variance, it tells us that the test is acceptable, whose factorial the loads ranged between 0.4 and 0.8 respectively. The reliability by internal consistency with a value of 0.919.
The relevance of the theoretical model to explain the quality of working life composed of five dimensions according to Maslow’s theory was verified, showing adequate adjustment indices: X2/gl=4.920 and 4.711, CFI=0.835 and 0.90, RMSEA=0.075 and
0.073, except TLI=0.805 and 0.815 that did not show an adequate value.
Quality of work life; Quality-of-life; Design; Validation; Psychometry.
Objective: Technology is rapidly shifting our day-to-day existence, education, social relationships, health care and business. Psychiatric leaders have slowly explored telepsychiatric services – but few have an approach to technology in general–due to
competing clinical, educational and research demands. Technology has typically been added on, rather than integrated, to institutional functions.
Method: This narrative review used a literature search of Medline, PsycNET, PsycINFO, Embase, Cochrane, SpringerLink, Scopus, ABI/Inform, Business Source Complete, and Web of Science, using subject headings and keywords along with a manual search of reference lists of articles published by November 2020. The keywords explored four areas: 1) business; 2) service delivery; 3) system change; and 4) technology. Articles were reviewed by title/abstract, full text review and review of references. They were included if they discussed integration of technology into health care and compared literature from medicine/health, psychiatry/behavioral health, business, technology, leadership and health care administration. The goal was to explore how medicine/psychiatry has integrated technology compared to business, and apply business approaches to health care and training.
Results: From a total of 2,710 potential references, two authors found 327 eligible for full text review and found 69 papers directly relevant to the concepts. Business and medicine/psychiatry have similarities/differences from both historical and contemporary views. Many health care systems and companies lack a strategic plan for technology and focus only on short-term due to administrative demands. Clinical informatics is a rapidly expanding area and would be central to this process. It has started to facilitate patient-centered care as defined by quality, affordable, and timely health care. While in principle information systems use integrative approaches, electronic health records, electronic means of communications with patients and staff, behavioral health indicators and related digital advances are often added to existing systems rather than integrated. Effective businesses use integrative approaches to share domain knowledge and streamline practices to link information technology (IT) with research and development, production, financing and marketing management. A case example highlights the IT strategy and business leaders’ comments in shifting to straight through processing (STP) from the banking industry for investments. It also exemplifies a model of shared IT-business understanding, which improves performance via efficiency, quality of data/information processing/integration and managerial teamwork.
Conclusion: When it is integrated into health care service delivery workflow, evaluated and quality improved, IT facilitates the translation of strategic planning into organizational change. Incremental versus strategically innovative approaches to technological integration for care, education and administration are considered. Successful implementation requires a needs and impact assessment for patients, staff, clinicians and leaders across all levels of the organization. Benefits to the mission, limited disruptions of core operational workflow and reasonable costs reduce the likelihood of failure.
Health care; Business; Information technology; Shared; Leadership; Understanding; Straight through processing.
Pain is the distress feeling, most commonly encountered in diseases, which accompanies from an early age and it is one of the important aspects of determining the level of well-being of animals. Pain is more complex in animals and it can rather difficult to determine the seriousness and impact of painful events. Hence, we have to identify the signs of pain in animals consistent with indirect markers which involve behavioral, physiological, and at last clinical responses. Moreover, specifically, the behavioral changes related to pain will be together with the overall signs also species-specific and hardly recognizable especially for an inexperienced observer seemingly unimportant which makes pain assessment even more complicated. The veterinarians have an ethical responsibility to assist in alleviate the animal pain. Although most veterinarians accept the actual fact that animals feel pain, still, post-operative pain relief isn’t a routine practice in veterinary hospitals and clinics today the feeling and assessment of pain are subjective. The assessment of pain and also the documentation of the effectiveness of any interventions are fundamental principles of successful pain management. The most important aim is pain management while efforts are made to spot and treat the underlying disease and to reinforce healing and recovery. Adequate management of acute pain may additionally prevent the event of chronic pain.
Animal; Pain assessment; Pain; Pain management.
Glomus tympanicum is a tumor classified as a paraganglioma. We report a case of a 66-year-old female with two middle ear pathologies: an incidental finding of a glomus tympanicum during stapedotomy surgery for otosclerosis.
Glomus tympanicum; Otosclerosis; Paraganglioma; Stapedotomy.
The present study investigated the effects of cypermethrin exposure on humoral and cellular immune response in rat and its attenuation by zinc and alpha-lipoic acid.
Cypermethrin at the dose levels of 40 mg and 80 mg/kg body weight were orally administered and pre-treatment of zinc (227 mg/L in drinking water) and alpha-lipoic acid (35 mg/kg body wt.) were done. Total leukocyte and differential leukocyte counts (DLC), phagocytic index, serum nitric oxide (NO) activity, total immunoglobulin concentration, quantitative hemolysis, proliferation assay of blood mononuclear cells were estimated and histological examination of spleen was accomplished.
Total white blood cell (WBC) count and percentage of lymphocyte, serum nitric oxide activity (p<0.001) and quantitative hemolysis were increased significantly increased whereas neutrophil %, total serum immunoglobulin, and blood mononuclear cell proliferation (p<0.001) and the phagocytic function of peritoneal macrophages were significantly reduced in cypermethrin treated rats compared to control group rats at a dose-dependent manner. Zinc and alpha-lipoic acid pre-treatment reversed the results.
From the findings it can be concluded that the co-administration of zinc and alpha-lipoic acid significantly attenuated the immunotoxic effects in cypermethrin exposed rat.
Cypermethrin; Zinc and alpha-lipoic acid; Total serum immunoglobulin; Blood mononuclear cell proliferation; Phagocytic index.
This qualitative study investigated the psychological effects on 21 U.S. high school students during the coronavirus disease 2019 (COVID-19) pandemic.
The study aimed to identify and assess the pandemic’s effect on the mental health of these students.
To determine the stress and anxiety students faced during the pandemic, an online survey used five open-ended questions that focused on awareness of the pandemic surrounding the major themes of insight, stress, anxiety, social support, and adapted coping strategies. NVivo software analyzed the raw data. Colaizzi’s descriptive phenomenological analysis method converted the quantitative results into a visual/verbal form. Based on the analysis, the researcher identified the pandemic’s effects on students’ mental health and well-being.
All 21 participants responded to each of the five questions. Of the participants, 72% demonstrated a negative outlook on their future. Seventy percent (70%) of the participants felt that COVID-19 hurt their social life because of safety precautions, such has social distancing. Even though schools and their faculty tried to keep students engaged and active, 64% of the participants found it challenging to be physically distanced from friends and teachers while learning from home. Of the students, 62% worried about missing out on sports and activities canceled due to the pandemic. 63.14% of the students felt the pandemic stressed
them to the point that fear and anxiety overwhelmed them with many questions about the future.
This study’s results may help create programs that better meet students’ mental and social needs.
COVID-19; Pandemic; High school; College students; Mental health; Stress; Anxiety; Coping strategies; Depression.
We describe herein the case of a 72-year-old woman with persistent and symptomatic sore or painful tongue (SPT) treated using PF-MOUTH GELTM (PF-Gel; Daiichi-Sangyo, Osaka, Japan), which includes 30% fucoidan and 0.75% sword bean. PF-MOUTH GELTM was applied to the tongue and kept in place for 3-min. Application was performed twice a day (morning and evening) for 3-months, and resulted in marked improvement of symptomatic sore or painful tongue. Because only one case was reported in this study, clinical trials are required to confirm the efficacy and safety of topical PF-MOUTH GELTM for the treatment of symptomatic sore or painful tongue.
Tongue; Fucoidan; Inflammation; Treatment; Gel.
The main objective of the present study was to do the comparative study of clove oil and clove extract on the oral micro-biota causing dental caries and also to assess the antifungal activity.
Materials and Methods
The antimicrobial activity of clove oil and clove extract was assessed against Halobacterium sp., Lactobacillus sp., Pseudomonas sp., Micrococcus sp. and Streptococcus mutans (major causative bacteria of dental plaque) by the paper disc diffusion method. For each extract
three replicate trials were conducted against each organism. The antifungal activity of clove oil and extract was also assessed against seven fungal species (Aspergillus niger, A. fumigatus, Aspergillus sp., Alternaria sp., Rhizomucor sp., Rhizopus sp. and Penicillium sp.)
by agar disc diffusion method.
Both clove oil and clove extract was found to exhibit broad spectrum of antibacterial activity inhibiting all the ten test bacterial species involved in dental caries. Clove oil produced maximum inhibition zone of diameter (IZD) against the major causative bacteria of dental plaque as compared to clove extract, thereby, showing that clove oil possesses strong bactericidal activity against oral pathogens. The highest inhibition zone of diameter was observed by clove oil as compared to clove extract against the test fungal species
The clove oil has the potential to be used as a natural antibacterial agent for oral pathogens.
Syzygiumaromaticum; Clove extract; Clove oil; Antimicrobial; Oral pathogens.
Traumatic cervical are injuries are very common due to high motility of cervical spine and its vulnerability to traumatic injuries. Optimal time for stabilizing the patients with traumatic spinal fractures remains controversial. It is almost due to different outcomes in various studies and the lack of consensus about it. Here we explain an ultra–early cord decompression that led to complete recovery of a patient with severe cervical cord injury.
The patient was a 27-year-old gymnast woman with a recent history of spinal cord injury caused by high jumping with head back and neck hyperextension presented within 2-hours of trauma. As a critical case and lack of advanced radiologic equipment, only cervical spinal radiographs were used for decision-making within the first 3 hours of injury to save the patient’s cord function by surgical decompression.
Many studies have proposed different intervention times for achieving the optimal result; however, we present an ultra-early surgery (within 3-hours of injury), conducted in a context of limited medical facilities. This case revealed an excellent result after 12-months follow-up.
Cervical spine; Early decompression; Surgery; Trauma.
Access site vascular complications remain a recognised complication following transcatheter aortic valve implantation (TAVI). Suture-based vascular closure devices (VCDs) such as ProGlide® (Abbott Vascular Inc., Santa Clara, CA, USA) are widely used in order to achieve rapid haemostasis. The MANTATM (Essential Medical Inc., Malvern, PA, USA) is a collagen plug-based VCD which can be used as an alternative to traditional suture-based devices, but is significantly more expensive per-unit. We compare the efficacy, safety and total cost associated with the use of the MANTATM and ProGlide® VCDs.
This retrospective study included all consecutive patients who underwent transfemoral (TF) TAVI between November 2017-June 2018. The primary endpoints were primary access site-related VARC-2 vascular complications, VARC-2 bleeding and the overall per-patient cost incorporating treatment for complications or use of additional VCDs.
A total of 136 patients were included in this study; 86 in the ProGlide® group and 50 in the MANTATM group. Baseline characteristics of the two groups were well-matched. Three patients in the ProGlide® group required surgical repair compared to none in the MANTATM group. However, no significant differences were observed with respect to overall primary access site-related VARC-2 vascular complications (10.5% vs. 10%; p=0.93) or VARC-2 bleeding (9.3% vs. 4.0%; p=0.25). There was no significant difference in the mean cost per patient when taking into consideration the use of additional VCDs and treatments for vascular complications (£568.79 vs. £599.95; p=0.90).
The use of the MANTATM VCD following TF TAVI is cost-neutral compared to ProGlide® VCDs, whilst being associated with no increase in VARC-2 vascular or bleeding complications.
Transcatheter valve interventions; Vascular complications; Vascular closure devices (VCD).
Cardiovascular disease (CVD) is the leading cause of death globally, with Blacks in the United States (U.S.) disproportionately affected. Healthcare access and utilization have been reported as risk factors for poorer cardiovascular health among several U.S.
Aims and Objectives
The purpose of this systematic literature review was to examine the results of existing studies reporting on cardiovascular health and healthcare utilization by African-born compared to U. S. -born Blacks.
A systematic literature review was conducted using keywords and medical subject headings (MESHs) in the PUBMED, Web of Science and CINAHL electronic databases. Exclusion and inclusion criteria determined articles to be reviewed for eligibility and methodological soundness. A pooled analysis was performed on all studies.
Only seven studies met inclusion criteria. Four compared U. S. -born with African-born Blacks residing in the United States, while three compared U. S. -born Blacks with Blacks residing elsewhere. None of the studies examined the associations between healthcare utilization and cardiovascular health for these populations.
The results of this review indicate a need to examine the impact of healthcare utilization for increasing awareness, prevention and treatment of CVD in Blacks who reside in the United States regardless of their nativity.
Cardiovascular health; African-born Blacks; U.S-born blacks; Healthcare utilization.
CVD: Cardiovascular disease; US: United States; MESHs: Medical subject headings; sBP: Systolic blood pressure; dBP: Diastolic blood pressure; BMI: Body mass index; BP: Blood pressure.
With physicians and patients fearful of coronavirus disease 2019 (COVID-19), this has a profound impact on the working and personal life and living style of individuals. In United States (U.S.), around 10.7% reported perceiving severe thoughts of hurting themselves and contemplating suicide as a reaction. There is a 3-4 times rise in the incidence of mental well-being disorders in the past year relative to the year prior as reported in the article in US. It was also confirmed that salivary glands of throats had affected by coronavirus and many patients infected have developed dysgeusia and anosmia which are also happened to be found in patients taking angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers, thus pointing out the role of ACE receptors for entry of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Reducing technologic use and addiction would be feasible by adequate sleep and preventing during work hours through reducing task triggering anxiety-related use of mobile phones. Consuming plenty of Vitamin C can protect against such viral infections. Study have also shown that sufficient vitamin D supplementation could boost humoral and cellular immune responses and reduce intestinal leakiness among COVID-19 infected population.
COVID-19; SARS-CoV-2; Dental; Stress; HPA.
The most common neurologic disorder is migraines. Migraine is defined as throbbing headaches that can be associated with auras. The headaches are episodic and can be debilitating in quality. Migraines can be triggered by emotional stress, lack of sleep, bright lights, loud noise, certain foods, and other environmental factors. The most effective way of preventing migraines is to avoid these triggers. A migraine can begin with prodromes or warning signs such as loss of vision, loss of motor reflexes or sensation. In this review, the types of migraine, signs and symptoms, pathways leading up to auras, and detailed pathophysiology will be discussed. The pathophysiology of a migraine consists of three different mechanisms: 1) cortical spreading depression, 2) the trigemino vascular system, and 3) sensitization. Three different treatment methods for a migraine will be discussed: 1) pharmacological, 2) non-pharmacological and 3) lifestyle modifications. Lifestyle modifications include eating a healthy diet, exercising, and maintaining proper sleep hygiene. Pharmacological treatments can be preventative or abortive. The latest migraine treatment of calcitonin gene-related peptide (CGRP) antagonist use will be discussed in this review and compared to other treatments such as nonsteroidal anti-inflammatory drugs (NSAIDs), anticonvulsants, and Triptans. Future research methods to prevent and better treat migraine headaches are considered a hot topic in medicine and these novel methods will be discussed.
Migraine treatment; CGRP antagonists; Neuromodulation; Nerve stimulation; Trigeminal activation; Cortical spreading depression.
The thyroid cancer in Pakistan is accountable for 1.2% cases of all cancers. Earlier information from Pakistan showed papillary thyroid carcinoma (PTC) to comprise 57-89% of all thyroid malignancies As per World Health Organization (WHO), papillary microcarcinoma of thyroid (PMCT) is a small area of malignant transformation measuring up to 1 cm or less being defined by WHO, that is currently being diagnosed more often than the past. Albeit small, they have the capability of metastasizing to regional lymph node and may disappear after metastasis.
To evaluate the prevalence of PMCT in benign multinodular goiter in thyroidectomy specimens.
The study was performed in Histopathology Laboratory of Peshawar Medical College, where 32 specimens of multinodular goitre (MNG) patients were received from its affiliated hospitals. The patients’ details were obtained from the hospital records. The specimens were closely examined for the presence of suspicious foci both grossly and microscopically. Results obtained were
recorded and data was analyzed statistically.
All the 32 specimens of the patients were thyroids. The results show a predominance of female patients in surgically resected MNGs with a relatively low incidence of neoplastic transformation. Our study reported two cases of PMCT and both were from different age groups, one was below 25-years and the other was 48-years. Patients mean age was 38.63-years with a SD±12.95-years. The size and weight of the samples varied. The mean of weight was 206.31±304.50 grams, which is due to the reason that many outliers were noted in weight category.
In thyroid excisions the weight of the excised specimen holds much great importance in determination/diagnosis of the disease. The risk of malignancy is higher in MNG compare to solitary nodules. The prevalence of PMCT (6.25%) are higher in smaller nodules is compare to PTC (3.12%). Furthermore, the fact that our both PMCTs occurred in total thyroidectomy specimens cautions us for their prudent assessment both in gross and histopathological levels.
Papillary microcarcinoma thyroid; Multinodular goiter; Thyroidectomy.
This commentary presents a point of view on how the arrival of electronic health records (EHR) in the United States (U.S.) has changed physicians’ practice. EHR implementation has pros and cons. EHR systems have been a great asset during the
pandemic and help with efficiency, safety, and cost reduction. Despite their benefits, healthcare providers and organizations still face challenges, including usability and interoperability across systems, contributing to physicians’ burnout. Can physicians adopt new technologies and adapt to current challenges? Is it the right time for physicians to stop being observers and become active
participants in the process of healthcare innovation and implementation?
Physician; EHR; Implementation; Physicians’ burnout.
Background: Community engagement has proved effective in increasing access to healthcare including health insurance, in developed and developing countries.
Aim: The study aims at designing and testing the effectiveness of engaging the community in awareness-raising and increment of health insurance coverage.
Methods: The study was a social interventional community-based study, conducted in A-Duiem Administrative Unit, A-Duiem Locality, Sudan. Baseline data on enrollment in health insurance was collected from 800 heads of households, whereas data on knowledge and attitudes about health insurance was collected from 420 heads of non-insured households using a standardized questionnaire. Strategies to scaleup health insurance through community engagement was collected from community leaders, local authorities, and health insurance policymakers through in-depth interviews and focus group discussions. The community promotion package of health insurance was implemented for one year and post-intervention data were collected from 420 heads of households. Quantitative data were analyzed using SPSS version 20. Statistical significance was set at p<0.05 when the confidence interval was 95%. Qualitative data was analyzed manually using the thematic approach.
Results: The study showed significant improvement in the knowledge of the heads of the non-insured households about health insurance after the intervention; knowledge about the enrollment process and service’s package has increased from 34.4% to 61.8% and from 55.8% to 84.7% respectively (p-value 0.0001 in both). The health insurance coverage increased by 17.3% with a significant difference and p-value at 0.0001.
Conclusion: The study concluded that community members have a considerable role in awareness-raising and scaling up of health insurance coverage if they are properly organized, trained, monitored, and supervised. The insufficient commitment of local officials in the unit was a challenge to address during further testing and expansion of the experience.
Health insurance; Population coverage; Knowledge; Attitudes; Community engagement; Intervention; Sudan.
Sudden cardiac arrest continues to have a high mortality rate. Out of hospital cardiac arrest (OHCA) has a poor outcome compared to those occurring in a healthcare setup due to lack of awareness and appropriate resources. The most common rhythm abnormality in out of hospital cardiac arrest is ventricular fibrillation which requires early defibrillation, ideally on the location.
A 19-years male was witnessed by lay bystanders to have become unresponsive following contact with an electric lighting pole on the road median in Chandigarh. A passer-by medical resident detected no pulse and initiated chest compression. Since there was no immediate return of spontaneous circulation and aetiology suggested a defibrillate rhythm. The patient was taken in the car
and rushed to a tertiary care centre, 10-minutes away. Cardiopulmonary resuscitation (CPR) was interrupted during transport for lack of adequate personnel. Ventricular Fibrillation was noted and shock was delivered along with inotropes. Around 26-minutes into the resuscitation, the patient had the return of spontaneous circulation. After post-cardiac arrest care in intensive care unit (ICU), he was extubated and discharged home in 1-week with full neurological recovery.
Recovery of full neurologic function could be explained by the alternating presence of stable and unstable cardiac rhythms and in part at least brought about by immediate attempts at resuscitation. The report seeks to review these aspects of emergency care besides highlighting the need for both immediate and accurate emergency medical services such as lay responder training, public
access defibrillation and responsive transport systems for such patients.
Sudden cardiac arrest; Out of hospital cardiac arrest; Ventricular fibrillation; Early defibrillation; Electrical injury.
Background and Goal of Study
Chronic post-operative pain (CPOP) is an increasing public health issue considering its impact on the patients quality of life and and the associated costs for the healthcare system. The incidence of CPOP can be as high as 75%, depending on the surgical procedure and other factors. Lidocaine is a local anesthetic with anti-inflammatory, analgesic and antihyperalgesic properties. Several studies have shown its use in controlling acute post-operative pain when used intravenously. The goal of this study was to define the role of intravenous lidocaine in preventing CPOP.
Materials and Methods
The PubMed database was searched from 2006 and 2019 with the keywords: “Chronic post-operative pain” or “Chronic post-surgical pain” or “Chronic pain” and “Intravenous lidocaine”. Adequate papers for the purpose of this study were selected.
Results and Discussion
Three randomized controlled trials that met criteria were obtained: two on breast surgery and the other on open nephrectomy. All trials used intravenous lidocaine during surgery, suspending the infusion up to the first 24-hours of the post-operative period. All three of them showed a significant decrease on the incidence of CPOP. There was a 20-fold decrease six months after breast
Intravenous lidocaine seems to decrease the incidence of CPOP however, there is limited evidence. More trials are necessary to define the efficacy and safety of intravenous lidocaine. A generally accepted definition of CPOP is needed.
Chronic pain; Chronic post-operative pain; Chronic post-surgical pain; Intravenous lidocaine.
The purpose of this study was to 1) compare the body composition values of an active group of breast cancer survivors (BCS) determined by dual X-ray absorptiometry (DXA) and anthropometry, and 2) compare the bone mineral density of the upper thoracic region to assess the effect of tumor burden on bone health.
Design and Methods
Forty (n=40) breast cancer survivors from a local competitive Dragon Boat Team were measured as part of team assessments. ANOVA with Dunn’s post-hoc testing was used to compare results of DXA, body density, and body composition estimated from anthropometry. Bland-Altman testing and correlational analysis were calculated.
Percentage of fat measure by DXA was significantly higher than values used to estimate body fat from skinfold measures or from body density equations (DXA 41.1±6.0% vs. 3-site skinfolds 28.8±4.9%, 4-site skinfolds, 22.1±4.1%, skinfold and body density, 31.8±9.4%, respectively, p<0.05). Post-hoc testing revealed that all values were significantly different and the strongest correlation
with DXA was skinfolds at three sites was r=0.81. Regional (upper thoracic) bone mineral density was not significantly different based on tumor side diagnosis (breast cancer diagnosis side versus healthy, 0.971±0.198 vs. 0.988±0.190 gm*cc-1). Anthropometry and bilateral bone mineral density characteristics are presented to serve as a comparative sample of BCS for future studies.
As body composition is an important factor in long-term cancer survivorship, we found the use of skinfold measures inadequate to accurately determine percentage of fat in this group of active female BCS. As a result, recommendations aimed at achieving an ideal body composition based solely on anthropometry would have grossly underestimated fat mass, which may lead to overall clinically poorer outcomes.
Breast cancer; Body composition; Percentage fat; Bone mineral density.
Retroperitoneal cysts are rare; they are divided into neoplastic and non-neoplastic cyst. Incidences are 1 in 5750 to 1 in 250,000. They are often asymptomatic. Lymphangioma are benign cyst whereas 95% of them are found in the neck and axilla only 1% is in the abdomen. This is a case report describing the course of management for a 30-year-old male who presented to our outpatient
clinic with abdominal discomfort due to retroperitoneal cyst.
Retroperitoneal Cyst; Ultrasound; Histopathology.
Neurological disorders are a ubiquitous part of our lives, and with innovative technological advancements there are increasing numbers of people being diagnosed with a variety of conditions. While these advances uncover the underlying pathological process, the requisite need to manage a patient’s condition necessitates renewed vigour in the realm of key therapeutics. This case study looks at a patient with a rare neurological condition, transverse myelitis (TM), and a complication that many spinal cord injury patients suffer, autonomic dysreflexia (AD). However, what makes this case unique is when the patient was administered with immediate-release Tapentadol, a synthetic opioid, the patient suffered more frequent and prolonged attacks of AD. The exploration
of the functional anatomy of TM as it applies to this case is highlighted, and how the role of Tapentadol was a causative agent in increasing the patient’s AD.
Spinal cord injury; Transverse myelitis; Pharmacokinetics; Opioids.
TM: Transverse myelitis; CNS: Central nervous system; AD: Autonomic dysreflexia; VAS: Visual analogue scale; MET: Medical emergency team.
Erectile dysfunction (ED) is a significant and common medical problem. Currently, there are several treatment available options for patients with ED, both non-invasive and invasive like phosphodiesterase 5 inhibitors, intra-cavernosal injections (BIMIX,TRIMIX), intraurethral prostaglandin E1 pellets, vacuum erection devices and insertion of a penile prosthesis. Most of these options are
invasive, which can be troublesome for patients, and also have side-effect profiles. Pulsed-electro magnetic stimulation therapy (PLMST) has gained interest in the field of sexual medicine. In the given case author presented a successful effect of in a case of erectile dysfunction.
Erectile dysfunction; Electromagnetic stimulation therapy; Latest treatment; Non-invasive treatment;
Erection hardness scale (EGS).
Culling is defined as the departure of cows from the herd because of sale, slaughter, salvage, or death. Culling is an important cost for dairy farms. At the same time, culling is a way to increase herd productivity and profitability, as keeping diseased and unproductive cows might result in lower herd milk production and deteriorated reproduction. In order to maximize profitability, the proportion of voluntary culling (selling for dairy purposes or culling due to low production) should be highest among the total culling rate. Previous studies indicate an ascending trend in the proportion of involuntary culling. This observational study used registry data of all cows from herds with ≥5 cow-years in 2016-2017.
This study was conducted to assess the reason for culling a dairy cow and its association with age at culling in and around Mekelle using a structured questioner format and direct observation. Visits were performed to each farm to collect data directly from owners or animal attendants and using direct observation.
Materials and Methods
The cross-sectional study was conducted in and around Mekelle city dairy farm from November, 2016 to April, 2017.
The most common causes of culling were disease and economic reasons. The most common causes of voluntary culling were economic reasons (17.39), low milk yield (20.29%), and aging (8.70%). The common causes of involuntary culling were diseases (34.78%), injury (7.25%), and infertility (5.80%). In this study rates of culling increased with parity. The highest rate of culling was
in animals between parity 2 and 5, increased from (14.49%) to (21.74%) and slightly decreased from parity 6 to 7, i.e. (13.04)% to (8.70)%, respectively. The highest rates of culling were between 3 and 5-years, (17.39)% and (23.19)%, respectively.
This study indicated animals were culled at premature age because of involuntary culling, which is economically not feasible, diseases were the most common causes of involuntary culling and voluntary culling was the most type of culling in dairy cattle farms and animals mostly culled for decreased production and economic reasons.
Culling; Dairy cattle; Milk yield; Parity.
Cestode infestations in animals are the most important parasite of livestock and humans because most of these parasites are zoonotic causing cysticercosis and hydatidosis in man and it causes economic and production losses in livestock. Diagnosis of Taenia Spp by microscopic observation lack sensitivity and specificity and detection by enzyme-linked immunosorbent assay (ELISA)
technique form cross-reaction. The molecular diagnostic can be best to detect in adult and larval stage in definitive and intermediate host based on the amplification of deoxyribonucleic acid (DNA) of target gene with the primer using a different technique of polymerase chain reaction (PCR) such as multiplex PCR. Conventional PCR, real-time PCR, nested PCR, and PCR-restriction
fragment length polymorphism (RFLP) are highly sensitive for the diagnosis of cestode and metacestode. Those diagnoses are used for differentiation of Taenia species and differentiation of Taenia and Echinococcus species. As compared to other diagnostic techniques most molecular methods have higher sensitivity and specificity but due to the relatively higher cost, few are commercially
available. Most of the molecular diagnostic tests developed to date are generally applicable for laboratory research purposes. The developments in the genomic and proteomic analysis should be used for further understanding of parasite-animal host interaction to find additional targets for diagnosis.
Cestode; Molecular test; Metacestode; Veterinary importance.
Bp: Base pair; DNA: Deoxyribonucleic acid; ELISA: Enzyme-linked immunosorbent assay; gDNA: Genomic DNA; AMP: Loop-mediated isothermal amplification; NAD: Nicotinamide adenine dinucleotide; NADH: reduced form of NAD; PCR-REA: Polymerase chain reaction restriction enzyme analysis; PCR: Polymerase chain reaction; RFLP: Restriction fragment length polymorphism; rRNA: Ribosomal ribonucleic acid; REA: Restriction enzyme analysis; SSCP: Single-strand conformation polymorphism.
This study was devised to be conducted to determine the prevalence and identify the major gastrointestinal nematode parasites based on fecal examination.
A cross-sectional study was carried out to determine the prevalence and associated factors with ovine gastrointestinal nematode infestation by fecal examination of 384 sheep from Wayu Tuka and Diga district, Eastern Oromia regional state.
Out of the total 384 sampled sheep, 169 (44.0%) had been infected with gastrointestinal nematode parasite. Haemonchus species were the most frequently (20.8%) recovered nematode eggs followed by Trichostrongylus (13.0%) and Nematodirus (10.2%). There was no significant difference (p>0.05) in prevalence between age groups and sex. Sheep with poor body condition had a significantly
higher prevalence of gastrointestinal nematode parasite (p<0.05) than those sheep in moderate or good body condition. There was no significant association between the gastrointestinal nematode infection in animals of different ages and sex groups.
The study shows that the gastrointestinal nematode parasite was a major important health problem and impact on the production of sheep in the study area. Therefore, a detailed study should be conducted to identify the parasite at the species level and special consideration should be taken on the management of sheep in poor body condition to reduce the burden of gastrointestinal nematodes.
Diga; Eastern Wollega; Gastrointestinal nematodes; Prevalence; Sheep; Wayu Tuka.
Dogs and cats are belonging to canine and feline family respectively. The liver is the largest gland in the body and is located in the cranial abdomen between 3rd and 4th ribs in dogs and cats. This review is mainly focused on: to understand the anatomy and physiology of liver, the liver diseases pathophysiology, to diagnose the liver diseases, managemental and ameliorative methods of liver diseases. The dual blood supply to the liver is hepatic artery and portal vein. The function of liver includes the regulation of digestion and metabolism, the synthesis of hormones and proteins, immune response and filtering of toxins from the blood stream. Any problem that affects the liver is liver disease. Inflammation of liver is hepatitis. Hepatitis caused by infectious, non-infectious, auto-immune and reactive. It can be acute and chronic. The most encountered liver diseases in dogs and cats are hepticlipidosis, cholangiohepatitis, portosystemicshunt, cholelithiasis, choledocholithiasis, cholecystitis, pneumobilia and hepatic neoplsia. The clinical symptoms of liver diseases include jaundice, hepatic encephalopathy, gastro intestinal disorders and nonspecific signs include polyuria/polydipisia. The liver disease diagnosed based on history, liver function tests, medical imaging. The latest imaging procedures are endoscopic retrograde cholagio pancreatography (ERCP) and computed tomography (CT). For confirmatory diagnosis liver biopsy and histopathological interpretation is required. Therefore, based on diagnosis appropriate treatment should be selected: bile stasis is treated urodeoxycholic acid (URDA), fluid therapy include sugar and salt solution for
replacement fluid loss, gastrointestinal protectors include ranitidine, cimitidine and lactulose, albumin to treat hypoalbuminimia, antioxidant for scavenging free radicals include vitamin E, Selenium, S-adenosyl-L-methionine (SAMe), diuretic fursimid for treatment of ascites and supplementation low protein diets. This laparoscopic technique for removal of gallstones and endoscopic retrograde cholagiopancreatography (ERCP) to treat gall stones on bile ducts and to widen the slipped ducts and liver transplantation for cirrhotic dogs and cats. Early accurate diagnosis and managing any predisposing factors that affects the health of dogs and cats are important for controlling the liver diseases.
Canine; Feline; Liver disease; Hepatitis; Hepatocyte; Kuppfer cells.
The substance abuse subtle screening inventory (SASSI) has been used successfully in correctional treatment settings and correctional screening since 1988. These screenings include outpatient evaluations of offenders within community settings, as well as assessments of incarcerated individuals within federal, state, city, and county correctional facilities. One key element towards reducing recidivism and reoffending, is that individuals receive treatment for substance use disorders (SUD’s) while in the correctional
system. While SUD is not the only contributing factor to criminality, it does significantly increase the likelihood of legal infraction and violations, placing these individuals at a higher risk of re-offending. Thus, identifying SUD as early as possible helps provide tailored treatment to those who need it, while simultaneously reducing the risk of future legal difficulties. Now in
its fourth iteration (SASSI-4), this article discusses the SASSI screening tools’ utility with criminal offenders and serving clinical needs, and reviews a case study of a young male’s clinical evaluation while incarcerated.
For this case study, we reviewed the SASSI-4 screening results of a 24-year-old male whom we will call “Bryon”. Bryon was in his 4th week of detention at a local mid-western jail in the United States. He was arrested after turning himself in for a prior domestic violence offense committed while under the influence of alcohol and for which he had fled the state. Bryon had one prior arrest (for receiving stolen property, which he subsequently traded for drugs). The intake counselor conducting Bryon’s assessment had been meeting with him at the jail for several weeks. The court was particularly interested in determining the level of risk that Bryon would again flee the area.
This case presents us with a good example of the value of early identification of substance use disorder, and potential problems in criminal justice settings. Bryon’s SASSI results clearly demonstrate a well-established pattern of substance misuse that will require relatively intensive intervention. Therefore, he may be a solid candidate for diversion into an alcohol and drug treatment program as a way of reducing the risk of future offenses.
Subtle SUD screening; The SASSI Institute; Criminal offenders; Corrections; Recidivism; Alcohol and drug screening.
Sexually transmitted infections (STIs) and unwanted pregnancies affect adolescent females annually. This study’s objective was to determine factors leading to disproportionate risk of STIs and unplanned pregnancies utilizing a survey to compare a presumed high-risk urban female population with an age-matched expected low-risk urban female population.
Adolescent women ages 18-24 were surveyed during 2017 utilizing a qualtrics survey. The survey was given at a local urban university and participating students received research credit. The survey was also given at an urban Emergency Department (ED) using an iPad to participants during their visit. The main outcomes measured were STI and unplanned pregnancy rates.
The ED cohort had higher rates of chlamydia (52% vs 5%), gonorrhea (20% vs 0%), trichomoniasis (30% vs 2%), pregnancy (60% vs 2%), and perceived themselves to be a higher-risk for pregnancy (3.4 vs 1.9) than the University cohort. They were younger the first time they had vaginal sex (15.6 vs 16.3-years), though median age of first oral sex was similar between groups. The ED cohort
was older (21.4-years-old vs 19.1-years-old) and more likely to be non-white (64% vs 6%). There were no differences between the cohorts in regard to educational background and sexual orientation. After adjustments were made, the University cohort was more likely to use condoms and had a lower rate of lifetime partners.
Young, urban females use condoms and birth control less frequently and have more male partners than an age-matched university population.
Young; Urban; Females; STI; Sexual behavior.
Environmental toxicants have become a major source of health hazards to humans, thereby negatively impacting the health and overall well-being of exposed individuals. Among these environmental toxicants, heavy metals stand out as the major cause of tissue pathologies and threaten an individual’s health status. One such heavy metal is cadmium (CD) whose exposure has been linked to various tissue toxicities including nervous, respiratory, reproductive, cardiovascular, hepatic and renal tissues. Cadmium is a non-biodegradable heavy metallic which possesses a long half of lifestyles and comfortably accumulates inside the tissues in which it produces tissue toxicities main to tissue disorder. The present study was aimed to determine the amelioration capabilities of Vitamin C, E and Zinc from the harmful effects of CD in Wistar rats.
The Wistar strain male albino rats weighing 225±10 g were administered with CD along co-administered with Vitamin C, E and Zinc, individually and also in combinations. After the completion of 45-days of experimentation, certain specific enzymatic parameters were assayed in plasma serum to assess the impact of CD and protective effect of Vitamin C, E and Zinc.
Soon after the co-administration of CD along with Vitamin C, E and Zinc, either individually and in combinations, Body weights, liver weight and histo-somatic index (HSI) of liver and certain specific enzymes of plasma including aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), γ-glutamyl transferase (GGT), lactate dehydrogenase (LDH), creatinine, glucose and urea were monitored. All the parameters monitored showed a significant (p<0.05) increase during CD administration except ALP. All the parameters selected in the present study were shown to be significantly (p<0.05) reversed due to co-administration of Vitamin C, E and Zinc either individually or in combination, due to the protective effect from CD toxicity
in wistar rats.
Our results demonstrate that co-administration of Vitamin C, E and Zinc ably protects the toxicity of CD in Wistar rats significantly.
Cadmium; Wistar rats; Oxidative stress.
Cancer of the cervix is a common cause of malignancy. Its association with systemic lupus erythematosus (SLE) is debatable.
Early detection of cervical pre-neoplastic lesion in SLE patients.
A case control study was performed on 64 SLE group and 64 control group using a colposcopy, pap smear and histopathological examination.
This study revealed that preneoplastic and neoplastic lesions of the cervix were higher in the SLE group.
Systemic lupus erythematosus (SLE); Cancer; Cervix; Low grade squamous intra-epithelial lesions; High grade squamous-intraepithelial lesions; Cervical; Intraepithelial neoplasia; Squamous cell carcinoma.
ASCUS: Atypical squamous cells of undetermined significance; LGSIL: Low grade squamous intra-epithelial lesions; HGSIL: High grade squamous-intra-epithelial lesions; CIN: Cervical intraepithelial neoplasia; SQCC: Squamous cell carcinoma; SLE: Systemic lupus erythematosus.
Lower Urinary tract symptoms are common in patients with multiple sclerosis (MS) and have a negative influence on the quality of life (QoL). Detrusor overactivity is the most frequent symptom. Lifestyle modifications are the first therapeutic line followed by oral medication in patients with storage dysfunction. When these drugs are ineffective or intolerable, botulinum toxin bladder injection is an alternative treatment. The aim of this work is to evaluate the effectiveness and the impact on QoL of patients with MS and refractory or intolerant to oral therapy overactive bladder (OAB) after botulinum toxin type A bladder injection.
Materials and Methods
Retrospective study with six-months follow-up of patients with MS diagnosis and a refractory or intolerable to oral drugs OAB treated with botulinum toxin injections. All patients completed urological evaluation and a QoL questionnaire prior to the injection, 3 and 6-months after. Evaluation of the urodynamics tests prior and 3-months post injection was made.
Sixteen patients were treated. The QoL questionnaire showed progressive improvement 3 and 6-months after the injection. There was decrease in the number of daily voids urination and in the urinary incontinence episodes. There was an upgrade in the bladder capacity from 191 to 338 ml average (p 0.0004) and 75% evidenced disappearance of detrusor overactivity (p 0.0005). Thirteen (13) patients (81.25%) made spontaneous urination with post-voiding residue <100 ml after injection. Three (3) episodes of urinary tract infection were evidenced.
Botulinum toxin generates a positive impact on the QoL of patients with neurogenic OAB with MS.
Pinna swelling that is angiolymphoid hyperplasia is a benign lesion that needs to be discussed. Most of the time it affects the face in that preauricular area involved, where it appears as a tiny erythematous lesion. Here we reported a case of a 24-years female patient who presented to us at the hospital with left ear pinna swelling for 7-years.
Pinna; Swelling; Angiolymphoid; Hyperplasia; Eosinophilia.
Diabetes mellitus (DM) is associated with altered white blood cell (WBC) and glycated hemoglobin dysfunction.
In this study, we were aimed to compare the status of hemoglobin, glycated hemoglobin and WBC level between diabetic and nondiabetic patient’s group.
This study was conducted in the medicine department of Women’s Medical College and Hospital, Sylhet, Bangladesh. The number of participants was 142. All the patients enrolled were informed verbally about the study and written consent was taken from each patient. Ethical permission was obtained from the institute. All of the tests were performed according to the procedure adopted in the hospital for routine uses. Among the participants, 71 (male 47, female 24) were diagnosed as type-2 diabetics (T2DM) and the other was non-diabetes (male 32 and female 39).
During this study, diabetic patients showed increased hemoglobin (Hb) and WBC level in diabetic blood than non-diabetic one. It has been supported by the study that, HbA1c is remarkably greater than that of New Delhi metallo-β-lactamase 1 (NDM-1) patients. So, our assumptions could be concluded as; diabetes mellitus is an inflammatory condition itself, which may play role in increased HbA1c and WBC count.
Therefore, elevated WBC count is independently associated with worsening of glucose metabolism and HbA1c may ameliorate the chronic low-grade inflammation such as type-2 diabetics (T2DM).
Diabetes; Blood parameters; White blood cell (WBC); Glycated hemoglobin; Hemoglobin.
Academic stress is a mental distress originated from the anticipated frustration associated with academic failure. Whereas, emotional intelligence (EI) is a characteristic of an individual that determines the degree, and intensity with which they are able to understand and accept one’s own emotions as well as that of others.
Aim and Objective
The broad aim of the present study was to investigate an empirical-based examination of the relationship among academic stress and EI in high school students. The objectives of the study were to ascertain if there exist any gender, family structure and single child differences between academic stress and EI.
This study is based on a quantitative analysis of the data. To collect validated data, purposive sampling was taken from varied streams and family structure of the age group 16 to 18-years; with no gender disparity. Student Academic Stress Scale (SASS) and emotional intelligence test (EIT) were used in this research. The data obtained was further validated through statistical techniques of correlation and analysis of variance (ANOVA) methods.
The results showed an inverse correlation between EI and academic stress in high school students. The study also revealed single child and family structure factors are associated with the level of EI and showed an impact on academic stress of high school students.
Academic stress; Emotional intelligence; High school students; Family structure.
During a state of trauma, such as injury or surgery, the body’s nutritional needs are expected to increase. The body enters a higher metabolic state and requires more energy, the immune system is weakened due to stress, and persistent inflammation delays full return to normal function. Surgical nutritional interventions have demonstrated that targeted nutrition can enhance outcomes in
acute patients and chronic conditions. This paper reviews the state of the clinical evidence on nutrition as a remedy for improving musculoskeletal and surgical patient outcomes.
Nutrition; Orthopedics; Cosmetic; Surgery; Outcomes; Supplementation; Healing; Recovery.
The hindlimb suspended (HLS) rat model has been used in land-based research to evaluate effects of simulated microgravity. Previous research demonstrated that 2-4 weeks of HLS reduced vasoconstrictive responses of aortic, mesenteric, and femoral arterial rings to phenylephrine (PHE) while acute exposure to hyperoxia amplified constrictive responses to PHE. The purpose of this study was to determine if hyperbaric oxygen treatment (HBO) during HLS would reverse the attenuation of the vasoconstrictive response.
Five-month-old male Sprague Dawley rats were randomly divided into aging controls (AC), AC-HBO, HLS, and HLS-HBO. Groups receiving HBO (AC-HBO; HLS-HBO) were placed in a cage that was fitted for the animal hyperbaric chamber to maintain HLS. HBO groups received 24 treatments, once a day, 6 d/week using a wound care protocol. The chamber was flushed with 100% oxygen, compressed over 10 min to 2.5 atmospheres absolute (ATA) (22.5 psig), a 90-minute treatment, then a 10 min decompression. After 28 d of HLS, animals were sacrificed under isoflurane anesthesia and thoracic aorta segments isolated. Relaxation of aortic rings was measured in response to acetylcholine (ACh) and sodium nitroprusside (SNP) after pre-constriction with PHE (3×10-7). Constriction of aortic rings was also determined in response to increasing concentrations of PHE. All drugs were administered cumulatively in vessel baths at 10-10-10-4 M. Data were analyzed using four-parameter (i.e., minimum, maximum, EC50, slope) nonlinear regression, and groups compared using 2×2 ANOVA with HBO and HLS as main effects.
Responses to ACh and SNP were not affected by HLS or HBO. However, in response to PHE, there was a decrease in maximum vasoconstriction in HLS compared to controls (44.7±7.3% vs 82.4±6.0%, respectively, p≤0.05) and in HBO compared to controls (48.5±6.5% vs 78.6±6.8%, p≤0.05).
These results indicate that PHE-induced constriction of thoracic aorta is decreased after HLS. HBO did not reverse HLS-induced reductions in contractile responses; instead, HBO independently reduced PHE-stimulated constriction of aortic segments. This suggests that HBO may be useful in conditions where constriction is enhanced, such as diabetes.
Hyperbaric oxygen; Vascular reactivity; Hindlimb suspension.
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.
Subdural hygroma; Epidural; Dural puncture.
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.
Ophthalmopathies; Congenital anophthalmia; Microophthalmia; Ocular surgery.
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.
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.
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.
Anesthesiology; Airway management; Difficult airway; Airway devices; Difficult intubation; Ventilation; Oxygenation; Facial trauma; Mask ventilation.
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.
Pneumocephalus; Head trauma; CT; Thunderclap headache.
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.
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.
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.
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.
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.
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.
Type 2 diabetes mellitus; Pancreatic β-cells; Oral glucose tolerance test; Pancreatic exhaustion.
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.
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.
The critical role of obstetrician, anaesthesiologist and interventional radiologist as a team, improve the quality of care and patient safety.
Postpartum hemorrhage (PPH); Peripartum hysterectomy; Transarterial embolisation.
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.
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.
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.
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.
Grandparents; Care; Orphans; Grandchildren; Skip-generation; Uganda.
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.
Transcriptomics; Kidney disease; Principle cell; Intercalated cell; Notch signaling; Gene sequencing.
PC: Principle cell; IC: Intercalated cell, DNA: Deoxyribonucleic acid; RNA: Ribonucleic acid; mRNA: Messenger ribonucleic acid.
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.
Pancreatic neoplasms; Pancreas cancer; Radiosurgery; Stereotactic; Stereotactic body radiation therapy (SBRT); Radiation; Radiotherapy.
To compare the degree of bacteria dissemination using two currently available operating room (OR) personnel warming devices. The “off-label” use of 3MTM’s Bair HuggerTM vs. a fairly new device, worn around the torso and under a scrub warm-up jacket or surgical gown, the OPERATIONHEATJAC® transformer only (TRO) powered by a transformer and controlled by a 4-level controller, and best for anesthesia providers and perfusionists.
Initially, staff members in scrubs sat in a room for 3 and 6-hours with agar plates placed in various positions throughout the room. Then staff members sat in the same room under the same conditions for 3 and 6-hours, and placed the hose from 3M’s Bair Hugger under their scrubs. Agar plates were positioned in the room in the same positions as in the control. Then staff members sat in the same room under the same conditions for 3 and 6-hours, wearing the OPERATIONHEATJAC® TRO over their scrub shirt and under a scrub warm-up jacket. Agar plates were again positioned in the room in the same positions as in the control. Bacteria colony counts were compared.
The bacteria colony counts were 43.78% and 46.18% higher at 3 and 6-hours respectively from placement of the hose from 3MTM’s Bair HuggerTM under scrubs vs. the control. There was no significant difference in bacteria colony counts with using the OPERATIONHEATJAC® TRO vs. the control.
ORs are maintained cold, mostly for surgeon comfort. In an attempt to keep comfortable in this environment, peripheral OR staff opt for the “off-label” use of 3M’s Bair Hugger hose placed under scrubs. An increased spread of bacteria throughout the OR can result from this practice. Currently, there are now safer OR personnel warming devices available. In addition, this paper reviews the significance and benefits of keeping staff warm and comfortable.
Warming devices; OPERATIONHEATJAC®; surgical site infections (SSIs); Operating room (OR); Temperature.
Melorheostosis is a rare skeletal dysplasia, and to date there are no reports of this condition in Australia. This is a case of a lady who presented with dull arm pain with a pathognomonic radiological findings. The plain radiographs obtained of the limb demonstrated a characteristic candle wax appearance in a monomelic distribution. The natural history, presentation, and management are discussed in detail.
Melorheostosis; Skeletal dysplasia; Central Australia.
Survival rates for pancreatic cancer (PC) remain dismal. Current standard of care treatment regimens provide transient clinical benefit but eventually chemoresistance develops leading to poor outcomes. PC is a relatively chemoresistant tumor and one of the explanations for this is attributed to desmoplasia that impedes drug delivery. Based on this, stromal modifying agent such as Pegvorhyaluronidase alfa (PEGPH20) was developed and investigated in phase I-III studies. Although phase I-II studies showed promising results in patients with high hyaluronic acid (HA) expressing tumors, the phase III HALO 301 study failed to miss it’s primary endpoint and further development of PEHPH20 is halted. This failure implies that targeting desmoplasia alone is not sufficient and other intrinsic factors such as lack of significant neoantigens, low tumor mutational burden, and epithelial to mesenchymal transition may be at play. It is also important to consider that although the tumor stroma may be a physical barrier hampering drug delivery, it may also have protective effects in restraining tumor growth and progression. Further studies in molecular biology to better characterize the complex interaction between the microenvironment and cancer cells are warranted.
Pegvorhyaluronidase alfa (PEGPH20); Desmoplasia; Pancreatic cancer; Chemoresistance; HALO.
Survival rates for pancreatic cancer remain dismal. Current standard of care treatment regimens provide transient clinical benefit but eventually chemoresistance develops. Tumors deficient in deoxyribonucleic acid (DNA) damage repair mechanisms such as BRCA mutants show better responses to platinum based agents, however, such tumors can utilize the poly(adenosine diphosphate [ADP]–ribose) polymerase (PARP) pathway as a salvage mechanism. Therefore, inhibition of PARP pathway could lead to tumor destruction and synthetic lethality in presence of BRCA mutation. Various PARP inhibitors have been approved for treatment of patients with germline or somatic BRCA mutant breast and ovarian cancer. This provides basis of using PARP inhibitors in patients with pancreatic cancer that harbor BRCA mutation. A recent phase III Pancreas Cancer Olaparib Ongoing (POLO) study showed impressive results with near doubling of progression free survival compared to placebo (7.4 vs 3.8 months). These results highlight the importance of germline testing for all patients with pancreatic cancer and inclusion of additional deficiencies in homologous recombination repair (ATM and PALB2) including BRCA variants of uncertain significance should be further explored.
Pancreatic cancer; Chemoresistance; DNA damage repair; Synthetic lethality; BRCA1/2; Germline mutations; Genomics.
Differentiating between cystic lesions of pituitary gland may be challenging. Usual differentials are cystic pituitary adenoma (cPA) and Rathke’s cleft cyst (RCC). Diagnostic certainty of magnetic resonance imaging (MRI) is limited in the absence of usual suggestive features. Furthermore, RCC can co-exist with approximately 2% of pituitary adenomas. Over time, these cystic lesions may remain static, resolve spontaneously, or result in symptomatology relating to mass effect and/or hormonal disruption. In cases of an asymptomatic lesion being found incidentally, little is known about how it may progress, raising question whether to proceed with surgical management or follow-up. We a present case of a spontaneously resolving pituitary cystic lesion with imaging features more suggestive of cPA than RCC, for which watchful waiting proved a successful treatment strategy. The current case serves as a reminder that small cystic lesions can be followed-up with spontaneous resolution and should be offered active treatment only when clinically required.
Pituitary gland; Pituitary cystic lesion; Cystic pituitary adenoma (cPA); Magnetic resonance imaging (MRI).
Gemcitabine is the backbone of systemic treatment of locally advanced and metastatic intrahepatic cholangiocarcinoma. In recent literature, gemcitabine has been linked to various pulmonary side effects.
We report a case of an 82-year-old male who developed acute pulmonary hypertension after receiving one cycle of gemcitabine for metastatic cholangiocarcinoma. His symptoms began with fatigue associated with shortness of breath and cough that worsened despite dose reduction. He developed new onset bilateral pulmonary effusions and an echocardiogram revealed findings consistent with pulmonary hypertension. A computed tomography (CT) angiogram was negative for pulmonary thromboembolism. Although he was promptly treated with diuretics and steroids, the patient could not tolerate any further therapy.
Gemcitabine-induced pulmonary hypertension is rare and can be challenging to diagnose, as it remains a diagnosis of exclusion. However, physicians should be vigilant of new pulmonary symptoms, as delayed treatment can cause significant patient morbidity and mortality.
Cholangiocarcinoma; Gemcitabine; Pulmonary hypertension.
CT: Computed Tomography; PE: Pulmonary Thromboembolism; GIPT: Gemcitabine-Induced Pulmonary Toxicity.
Functional disorders of the digestive tract are a common occurrence in the doctor’s office. In addition to functional dyspepsia, 35% of dyspepsia are unresolved dyspepsia, which are a symptom of the early stage of pancreatic exocrine insufficiency.
Based on clinical experience, we can suspect and detect chronic pancreatic insufficiency at an early stage, which is the aim of this paper.
To demonstrate the efficacy of enzyme replacement therapy in the early stage of pancreatic exocrine insufficiency using the case report of the patient.
Results confirms significance and effectiveness of creon as an enzyme replacement therapy in the treatment of malabsorption and maldigestion.
Creon (pancreatin) showed great effect in the treatment of dyspepsia and anorexia nervosa, body mass index (BMI) for 30 days increased from 15.9 to 17.4, which leads us to the conclusion that unrecognized chronic pancreatic insufficiency can be expected in long-term dyspepsia.
Chronic pancreatic insufficiency; Enzyme; Body mass index (BMI); Digestive tract.
To compare the effectiveness of 5 different skin moisturizers using JELL-O® as a model for the human skin.
In this study five different moisturizers (Equate®, Burt’s Bees®, Suave®, Aveeno® and Vaseline®) were applied to equivalent samples of JELL-O®. Observations were made over a 12-day period and data was collected at 15 different time intervals. The primary outcome was the height (cm) and weight (g) of the JELL-O® sample at each time interval. The study was an ex vivo experiment conducted in a home laboratory. No Institutional Review Board (IRB) approval was required since the research does not involve living organisms.
Overall, the JELL-O® sample that had the Vaseline® applied on it had the lowest loss of height and weight. The height stayed at 100% of its original value and the weight only decreased to 97.2% of the original value by the end of the observation period. In contrast, the sample which had Suave® applied to the surface its height and weight decrease the most (42% and 28% respectively). The other moisturizers had effects intermediate between these two extremes.
Based on this ex vivo head to head study using JELL-O® as a model for the human skin the 5 moisturizers examined had widely differing levels of effectiveness with Vaseline® appearing to be the most protective against evaporative losses and Suave® appearing to be the least.
Moisturizers; Dry skin; Different moisturizers; Skin lotions; Vaseline® effectiveness.
We herein present a case report of a 60-year-old male patient diagnosed with squamous-melanocytic tumour (SMT) in his anal region, comprised of two intermingled different phenotypic lesions. This dual tumour is quite uncommon and could potentially be challenging on both diagnose and also management. It is the first case reported on this location, moreover, the lack of consensus for these lesions makes it difficult to classify them. We reviewed the literature of similar SMT’s and discussed its histogenesis. As they are rare, their biological behavior and potential metastasis remain unclear. Therefore, close follow-up is advised.
Combined neoplasia; Squamous-melanocytic tumour; Uncertain; Anal canal.
The study was aimed to assess the results of treatment for fracture-dislocations of the proximal humerus (PH) within different time frames for optimizing treatment tactics.
Patients and Methods
This retrospective cohort study evaluated clinical outcomes of 25 patients with fracture-dislocations of the PH (15 patients were analyzed for short- and medium-term results, and 10 – for long-term results). The follow-up period ranged from 1 to 9-years. All patients underwent: clinical examination, constant score assessment and shoulder X-ray examination. Clinical, radiological and statistical methods were used for analysis.
Assessment of the degree of initial displacement of tubercles and its impact on the results of treatment showed that significantly better results were obtained in case of displacement no more than 10 mm (p=0.041). Patients with displacement no more than 10 mm had an average score of 68.0±16.1 points (Mean=69.5), while those with displacement of the tubercle(s) exceeding 10 mm had an average score of 49.5±19.5 points (Mean=44). Analysis of the results of treatment showed that the delay in restoring normal anatomy of the PH or avoiding surgical interventions at all led to functional disorders of the shoulder joint. It was also demonstrated that neither patients, nor doctors were satisfied with the outcomes of the unipolar shoulder replacement (USR). Based on the results of the study, we proposed an algorithm for determining the tactics of surgical treatment in cases when a fracture-dislocation of the PH with complete dislocation of the fragment involving the articular surface of the humeral head is diagnosed.
The present study demonstrated some factors affecting the outcomes of treatment for fracture-dislocations of the PH. Current approaches for endoprosthesis replacement in these cases remain debatable and require further investigation.
Trauma; Fracture; Shoulder joint; Fracture-dislocation of the proximal humerus.
Bystanders are an integral part of an emergency scene. Their presence on site makes them the immediate potential responders, who can provide life-saving assistance as well as various rescue actions. Research has shown that bystanders are willing to and are capable of helping, especially (but not limited to) when a leader emerges, as the help is rooted in a collective action. In this article, we suggest a new framework for understanding the effectiveness of bystanders help, based on the evolving social process between bystanders and first responders. As we show, the transition from no help, at the very first moment right after the emergency has occurred, to an effective coordinated response where first responders and bystanders act together, goes through engagement of bystanders. Further, first responders should acknowledge the social organization of bystanders, utilize and leverage it in order to optimize their efforts. This framework has important insights for policy makers when managing emergency and disaster situations with limited resources.
Bystanders; First responders; Mass casualty incident; Help; Emergency; Cardio-pulmonary resuscitation (CPR).
This essay has emerged through my research engagements with life history as a research method in anthropology. It is based on the life events of a woman artist. The past few decades have brought an explosion of cultural criticisms and also explorations of women’s creative expressions across cultures. Some of the queries addressed are, how do external forces shape the creativity of female artists. Also, how do creative women respond to such forces? Creative women, then, have a unique relationship to their cultural contexts, as well as to the creative genre to which they respond. This essay also delves into myths related to insanity and women. It discusses creativity, as a mode of engagement with rigid social structures.
Life history; Women; Creativity; Body psyche; Insanity; Myths; Anthropology.
Presenting in her late twenties, this case report examines a G6P2 patient at 11-weeks gestation that was diagnosed with a blighted ovum, as well as the subsequent outcome and methods of additional management. A blighted ovum refers to a fertilized egg that does not develop, despite the formation of a gestational sac. The most common cause of a blighted ovum is of genetic origin. Trisomies account for most first trimester miscarriages, while consanguineous marriages result in recurrent miscarriages due to a blighted ovum. Additionally, a higher percentage of deoxyribonucleic acid (DNA) damage in sperm carries a higher rate of miscarriage. Nutritional factors that may lead to a blighted ovum include low-levels of copper, prostaglandin E2, and anti-oxidative enzymes. High body mass index (BMI), especially in women with a BMI≥30 kg/m2 has been shown to be linked to a blighted ovum. Globally, it has been shown that a blighted ovum is a serious adverse event related to vaccination against dengue fever.
This case report illustrates a challenging case of worsening heart failure in a previously well-compensated patient with unclear etiology. Further workup revealed the patient’s cardiac resynchronization therapy-defibrillator (CRT-D) left ventricle (LV) lead was losing capture during positional changes. This case demonstrates the importance of device optimization, as well as electrocardiogram (ECG) monitoring to elucidate possible causes of acute systolic heart failure.
Cardiac resynchronization; cardiac resynchronization therapy (CRT); Systolic heart failure; Lead positioning;
Advanced heart failure.
brief research report
Previous literature has reported ill-effect of ototoxic drug on hearing and balance. Present study investigated awareness among medical doctors for the same.
A total of 55-medical doctors of multiple specialties from Assam, India participated in the present study. A total of 14 questions with Likert Scale based scoring pattern were framed and validated for the present study.
Outcome of the present study showed high awareness percentage about side effect ototoxic drugs was obtained, which was a satisfying outcome.
While low audiological referral and consultation awareness was identified as an area of concern.
Ototoxicity; Doctors; Assam; Awareness.
Low serum bicarbonate, with or without an elevated anion gap, can indicate metabolic acidosis. High anion gap metabolic acidosis is due to the unmeasured anions. Hypertriglyceridemia can also be associated with spuriously low serum bicarbonate levels due to lab interference. We present a 44-year-old woman who presented with anion gap metabolic acidosis in the presence of severe hypertriglyceridemia.
Hypertriglyceridemia; Acid-base disorders; Low serum bicarbonate; Metabolic acidosis.
Understanding the importance of training young people, this study sought to explore the early experience of pre-service teachers in their computational practices in terms of the difficulties they faced and the strategies they used while learning how to program. Based on convenience sampling, four participants were recruited from an undergraduate course focusing on computer science education in K-12. The literature on novice programmers’ difficulties and their strategies was used to establish the conceptual background for this study. We collected four semi-structured interviews with pre-service teachers, a total of five hour-long classroom observations, and 19 class activities (archival data). After conducting a content analysis, findings showed four categories in which pre-service teachers face difficulties: (a) understanding the computational concepts (semantic); (b) using the concepts inappropriately (syntax); (c) developing a program (algorithmic thinking), and (d) identifying problems (debugging). We also found five categories in which pre-service teachers overcome their difficulties: planning, using resources, seeking support, guessing and checking, and looking for visual assistance. This study emphasized that pre-service teachers encounter several difficulties in learning computational concepts through programming languages, which should be considered in pre-service teacher education.
Computational Thinking; Computer science education; Pre-service teachers; Problem solving strategies.
Traditionally, ciliary body destruction has been used to treat uncontrolled intraocular pressure (IOP) following maximally tolerable medical therapy. This is due to the large number of complications seen with this procedure. However, recently a new technique of sub-threshold laser or micropulse laser, is able to provide selective destruction of the ciliary body in a controlled manner. This avoids most of the complications seen with other modalities. We have performed a small case descriptive pilot study to assess the effectiveness of micropulse transscleral cyclophotocoagulation (MP-TSCPC) in lowering IOP.
This pilot study was conducted on four patients in the age range 55-70-years with intractable glaucoma. Two patients had primary angle closure glaucoma, one-each had steroid-induced glaucoma and neovascular glaucoma. Mean baseline IOP was 32±2.4 mmHg. Mean number of glaucoma medications were 2.5±1.5. All patients underwent 180° MP-TSCPC. Absolute success was defined as IOP<20 mmHg without acetazolamide.
Following the procedure the patients were followed-up at days 1,7,30 and 90. At the last follow-up of the study, mean IOP was 18.2±1.2 mmHg in all four patients. Mild anterior chamber inflammation was the only complication noted. Mean number of glaucoma medications reduced to 1.5±1.0 following the procedure. Thus, absolute success was achieved in all patients.
This small pilot study validates other studies which show effectiveness of MP-TSCPC as an efficient and safe procedure to lower IOP. This procedure can be used over a wide variety of cases, though the indications for such procedures are still evolving. More extensive and long-term studies will clarify the position of this procedure in our glaucoma management practices.
Glaucoma; Micropulse laser; Cyclophotocoagulation.
Aim: Obesity is increasing globally by leaps and bounds and thus the incidence of type 2 diabetes mellitus (T2DM) along with it so much so that the term diabesity had to be coined. Earlier we had reviewed how to treat the both together and the role of empagliflozin to improve cardiovascular outcome trials (CVOT). Similarly T2DM and hypertension are pathophysiologically-related diseases which co-exist with a broader complex of metabolic diseases which co-exist possessing similar set of risk factors. Hence it is important to consider which antihypertensives are suitable that possess a positive effect on metabolic factors in cases of T2DM who require an antihypertensive.
Method: A systematic review was carried out using the PubMed search engine with the MeSH terms: “T2DM”; “essential hypertension; “cardiovascular (CV)”; “Complications of diabetes mellitus (DM) and antihypertensive”; “Antihypertensive preferred in T2DM subjects”; “Renin-angiotensin–aldosterone system inhibitors”; “Angiotensin converting enzyme inhibitors (ACEi)”; “Angiotensin receptor blockers (ARBs)”; “Dihydropyridine calcium channel blocker”; “β2 blockers”; “Diuretics”.
Discussion: Most diabetes mellitus (DM) subjects need a minimum of two antihypertensive drugs, combining a renin-angiotensinaldosterone system (RAS) inhibitor with a dihydropyridine calcium channel blocker seems to be the most indicated approach. But not all dihydropyridine calcium channel blockers have equivalent effects on metabolic parameters. Hence manidipine that causes positive effect on insulin resistance (IR) seems to be an effective option. We have reviewed how manidipine is superior to amlodipine with regards to improving IR, not seen with amlodipine, along with not causing excessive sympathetic nervous system (SNS) activation, pulse pressure and ankle edema or to much lesser extent than amlodipine. Therefore, manidipine needs to be the first addition to RAS inhibitors in case of DM’s having hypertension of the dihydropyridines calcium channel blockers. Further good blood pressure (BP) control been correlated with good CVs outcomes.
Conclusion: A RAS inhibitor is the first line of choice of drugs in a subject with T2DM who needs to be treated with empagliflozin for better CVOT outcome, and when a 2nd drug has to be added it is manidipine that is preferred over amlodipine. Plant products are proving to be having a lot of beneficial effects in DM, obesity and hypertension. Thus need for developing agents from plants will prove to be more cost effective in these chronic diseases where compliance is difficult to achieve with the use of common antiDM drugs and antihypertensives with the cost factor along with their side effects.
Type 2 diabetes mellitus (T2DM); Diabesity; Antihypertensives; Renin-angiotensin-aldosterone system (RAS) inhibitor; Dihydropyridines calcium channel blockers; Plant products.
Malrotation of the gut is rare in adults. We discuss the case of a 30-year-old primiparous woman who presented to the acute gynecology ward at 19-weeks’ gestation with ongoing nausea and vomiting throughout pregnancy. She attended on a number of occasions with the same symptoms and was trialed on a number of different antiemetics. Initial biochemical investigations were unremarkable, however, the patient started to develop signs of ‘abdominal obstruction’. A magnetic resonance image (MRI) of the pelvis showed evidence of duodenal obstruction secondary to malrotation which may be secondary to a fibrous (Ladd’s) band. She was treated laparoscopically via a Ladd procedure and had an uneventful recovery. Interestingly, the patient presented again in her second pregnancy with very similar symptoms and underwent another Ladd procedure, but via a laparotomy. This is an interesting, rare and unusual case of nausea and vomiting in pregnancy.
Ladd bands; Pregnancy; Nausea; Vomiting; Hyperemesis; Volvulus.
Due to contamination, open fractures are considered to be dangerous and thereby require proper management. Through a systematic review and meta-analysis, this study compares the literature on pre-debridement and post-debridement cultures derived from such fracture sites.
Data for this review was collected through various online sources such as dataBASE (EMBASE), medical literature analysis and retrieval system online (MEDLINE) and different citations provided the relevant data.
Twenty articles were included. The desired timing to examine the debridement was six hours post-injury (according to the six-hour rule). Antibiotics including ampicillin, penicillin, cefazolin, cefuroxime, and flucloxacillin were used in some patients. The use of Ancef I as an antibiotic during the starting hours of fracture helps to reduce the chances of infection in 1.4% of the infected patients. The infection rate was 3% in pre-debridement culture, while a 2% infection rate was found in post debridement culture. Gram-negative bacteria were responsible for pre-debridement infection, while gram-positive bacteria were responsible for post-debridement.
The pre-debridement infection rates are reduced as compared to post-debridement when treatment is initiated within a strict time interval and limited to the specific use of antibiotics. Treatment of gram-negative bacteria helps to reduce the bulk of infectious material and thereby reduces the infection rate.
Open fractures; Debridement; Pre-debridement; Post-debridement; Meta- analysis; Systematic review.
Statins are widely used in the management or inhibition of several processes that lead to the development of cardiovascular diseases. Increased statin therapy has been related to the induction of type II diabetes (DM), a state which predisposes to cardiovascular disease (CVD). Statins are well-known to possess anti-inflammatory properties and the ability to disrupt de novo biosynthesis of cholesterol and lipid homeostasis has been implicated in the induction of inflammatory responses within pancreatic β-cells. Inhibition of β-hydroxy β-methyl glutaryl-CoA (HMG-CoA) results an increased level of low-density lipoproteins (LDL) receptors. Increased LDL receptor numbers will replenish exhausted intracellular supplies, resulting in higher levels of intracellular cholesterol. Therefore, stimulating immunological response and inflammatory reactions, disrupt the functional integrity of the β-cell via oxidation of the plasma-derived low-density lipoprotein. Despite the pleiotropic effects of statins on the pancreatic β-cell, they have also been reported to affect a number of other cell types associated with the development of diabetes. Inhibition of the biosynthesis of isoprenoid by statins has been associated with the down-stream regulation of glucose transporter (GLUT 4) in adipose tissues, which facilitates the uptake of glucose. This effect resulted in increasing resistance to insulin in the liver, muscle, and adipose tissue. Adiponectin, a plasma protein released by adipocytes, alters fatty acids and carbohydrate metabolism both in the muscle cells and liver. This process indirectly influences resistance to insulin by the attendant decrease in hepatic gluconeogenesis and to upregulate muscular β-oxidation and glucose uptake.
The aim of this prospective study is clinical and ultrasonographic evaluation of the pelvic floor in primiparous women after normal vaginal delivery with episiotomy and without episiotomy.
This is a cross-section study of primiparous women with a history of delivery at Tanta University Hospital from August 2018 to August 2019. The sample power was calculated based on avulsion (major and minor) in two groups (vaginal delivery with episiotomy and without episiotomy) of total forty-primiparous women with an interval after delivery (20 cases after normal vaginal delivery with episiotomy and 20 cases after normal vaginal delivery without episiotomy).
Twenty-four hours of delivery there was a highly significant difference between group A (with episiotomy) and group B (without episiotomy) regarding to ultrasound abnormalities, degree of tear, blood loss, hemoglobin concentration and clinical findings, while no difference regarding levator ani weakness. Two months later from delivery there was no significant difference between group A and group B regarding to ultrasound abnormalities and levator ani weakness while there was a difference between the two groups in regarding with clinical findings.
Normal vaginal delivery without episiotomy in primiparous women is better than normal vaginal delivery with episiotomy as there is no perineal tenderness, no dyspareunia. Low incidence of urinary, rectal incontinence, tear and perineal infection.
Clinical and ultrasonography; Primiparous; Normal vaginal delivery; Episiotomy.
Current image reconstruction techniques in computed tomography (CT) such as filtered back-projection (FBP) and iterative reconstruction (IR) have limited use in low-dose CT imaging due to poor image quality and reconstruction times not fit for clinical implementation. Hence, with the increasing need for radiation dose reductions in CT, the use of artificial intelligence (AI) in image reconstruction has been an area of growing interest.
The aim of this review is to examine the use of AI in CT image reconstruction and its effectiveness in enabling further dose reductions through improvements in image quality of low-dose CT images.
A review of the literature from 2016 to 2020 was conducted using the databases Scopus, Ovid MEDLINE, and PubMed. A subsequent search of several well-known journals was performed to obtain additional information. After careful assessment, articles were excluded if they were not obtainable from the databases or not available in English.
This review found that deep learning-based algorithms demonstrate promising results in improving the image quality of low-dose images through noise suppression, artefact reduction, and structure preservation in addition to optimising IR methods.
In conclusion, with the two AI-based CT systems currently in clinical use showing favourable benefits, it is expected that AI algorithms will continue to proliferate and enable significant dose reductions in CT imaging.
Computed tomography (CT); Artificial Intelligence (AI); Image reconstruction (IN); Machine learning (ML); Deep learning (DL); Dose reduction.
AI: Artificial intelligence; CT: Computed tomography; ML: Machine learning; DL: Deep learning; FBP: Filtered back-projection; IR: Iterative reconstruction; MBIR: Model-based iterative reconstruction; LDCT: Low-dose computed tomography; FDA: U.S Food and Drug Administration; ANN: Artificial neural network; DNN: Deep neural network; CNN: Convolutional neural network; CNR: Contrast-to-noise ratio; SNR: Signal-to-noise ratio.
Agenesis of the thyroid isthmus is a rare entity with a incidence rate of 0.5 and 10%. Thyroid isthmus agenesis could be associated with ectopic thyroid tissue or agenesis of the thyroid lobes. We discuss a case of a multinodular goitre which presented with morphological variations which was not detected on ultrasonography of the neck.
Thyroid; Head and neck; Isthmus.
The prevalence of softball injuries in young pitchers is increasing with more injuries in the upper extremity in the beginning of the season.
Calculate the forces generated during the pitching motion of female youth pitchers at four main areas: the stride, hips, shoulder, and wrist for 2 groups. R1: u1≠u2.
Pilot study, Cross-sectional design.
Level of Evidence
This study included a total of 15 female youth fastpitch softball pitchers (mean age, 14.33-years; mean weight, 59.01 kg) recruited to participate during the Fall Softball League (2014). Divided into two groups: 270° hip rotation group vs. a projected 360° hip rotation group.
A paired sample t-test showed that the 2 groups (270° hip rotation and projected 360° hip rotation) were strongly and positively correlated (r=0.993, p<0.001). There was a significant average difference between 270° hip rotation and the projected 360° hip rotation forces (t14=12.996, p<0.001). On average, the projected 360° hip rotation forces were 580.68 N higher than 270° hip rotation forces (95% CI [676.51, 484.84].
The Current Method (CM) of pitching clearly uses the shoulder as the driving force of the pitch, as pitchers created 467.96 N of force at the shoulder. Pitchers who used 270° hip rotation produced an average of 147.33 N at the hip while these same individuals can create an average of 589.30 N with full hip rotation.
Pitchers using the CM of pitching generated an average of 468 N of force at the shoulder. Identifying interruptions in the kinetic chain is the key to reducing injuries. This is accomplished by creating the ideal kinetic chain and teaching it through a certified pitching coach program. Once identified, interruptions can be modified and changed through exercises to strengthen and improve the kinetic chain.
Softball injury prevention; Fastpitch softball; Windmill pitch; Female youth pitchers; Windmill biomechanics.
The aim of this study was to assess challenges and current practices in implementation of coaching manuals in selected Addis Ababa city, Ethiopia youth handball coaching program.
The study was employed a descriptive survey research method. Ten sample youth projects were selected, from twenty-four youth handball projects using stratified and purposive sampling technique. Thus, the samples of this study were 50 players, 10 coaches and 32 sport administrative officials. The data was collected through questionnaire and observation checklist and thus, analyzed using both quantitative and qualitative methods by describing statements and frequency counts and percentages.
The findings of the study indicated that, lack of coordination work among the concerned stakeholders, due to financial scarcity; unavailability of adequate training materials and equipment, and the selection of trainees conducted just randomly without clearly stated criteria. Lack of suitable and standardized handball courts in the area and less emphasis given to maintain even the existing ones, the existed manual was not well designed and modified based on the trainee’s age level since similar manual for both sex. Due to monitoring were limited to certain sport expertise, here were no concerned bodies in charge of finding immediate solutions to the problem that were faced by the coaches and trainees. Furthermore, due to lack of awareness of communities, trainee families did not support the training program.
This kind of implementations revealed that was exposed to failure to solve the confronted challenges. Therefore, attention must be paid to the availability of sport infrastructures and qualified human resources should be employed. In addition, special attention must be given to acquiring and developing resource material such as manuals and coaching kits, which may assist in improving knowledge and advancing the technical skills of sport experts and coaches.
Handball; Program; Trainee; Coaching manual; Challenges; Coach; Implementation.
Proteinuria is a common incidental finding that physicians face in the inpatient and outpatient setting. Proteinuria may represent a benign pathology in asymptomatic patients, or it can be a sign of significant renal or systemic disease. The latter is usually associated with persistent proteinuria or other clinical findings such as renal failure. This article will focus on the mechanisms, causes and diagnostic approach of proteinuria. Proteinuria is a common incidental finding that physicians face in the inpatient and outpatient setting. Proteinuria may represent a benign pathology in asymptomatic patients, or it can be a sign of significant renal or systemic disease. The latter is usually associated with persistent proteinuria or other clinical findings such as renal failure. This article will focus on the mechanisms, causes and diagnostic approach of proteinuria.
Proteinuria; Glomerular; Tubular; Nephritic; Nephrotic.
Giant cell myocarditis is a rare condition first described in 1905. It has a reported incidence range from 0.007% to 0.051%. It affects female and male individuals, equally, and usually occurs in young and middle-aged persons. The underlying aetiology of giant cell myocarditis is unknown but it is thought to be mediated by T-lymphocytes. Diagnosis is made via histological examination of myocardial tissue and is characterized by a mixed inflammatory cell infiltrate with multinucleated giant cells and cardiomyocyte necrosis, predominantly affecting the ventricles. The following report describes a rare case of giant cell myocarditis in a 71-year-old man with a history of hypertension and heart failure, who died while waiting to be seen in the emergency department. Autopsy findings revealed an enlarged, dilated heart with histologic features in keeping with giant cell myocarditis, along with features of heart failure. Diagnosis of giant cell myocarditis is less common in the elderly age group, possibly due to a less severe disease process in this age group and it may be misdiagnosed because older individuals may have other cardiovascular diseases (CVDs).
Myocarditis; Giant cell myocarditis; Autopsy; Elderly, Cardiovascular.
The objective of the present study was to examine the influence of social self-concept and physical self-worth on global self-esteem in college athletes compared to their non-competing peers. It was hypothesized that the unique contribution of each variable on self-esteem would be markedly different between the groups.
In a population of 146 undergraduate students, regression analyses revealed significant relationships between the domain-specific self-perceptions and global self-esteem in both groups. It was determined, however, that athletes and non-athletes differed in the distribution of variance explained by the variables. Specifically, the variance in self-esteem in athletes was attributed exclusively to physical self-worth while non-athletes revealed unique contributions from both social self-concept as well as physical self-worth.
Results and Conclusion
The results of the present study may be meaningful from the perspective of athletic identity and retirement from sport. Further investigation is warranted, both qualitatively and quantitatively, that may assist in developing strategies to ease the transition from participating athlete to non-competitive participation. An additional area of interest may be in examining the relationship between the domain-specific self-perceptions and psychological risk for, and impact of, athletic injury.
Self-esteem; Athletes; Social self-concept; Physical self-worth; Non-athletes.
Photobiomodulation is a non-invasive treatment modality acting at different biological levels through the non-thermal transfer of photons to the living matter via a photoelectric effect, inducing photochemical reactions in treated cells. The objectives of this article is to review the literature on Photobiomodulation, its different fields of application and mechanisms of action, for establishing a comprehensive summary of evidence. The search strategy initially run searches in scientific databases MEDLINE,
PubMed, EMBASE and Cochrane registries from 1990 up to March 2020, with entries Photobiomodulation, LLLT-LEDT, PDT, Photobiology, Cytochrome c Oxidase. Selection criteria was based on preferably inclusion of randomized clinical trials (RCTs), systematic reviews (SR) and studies providing qualitative and quantitative data with the best consistency, in a field where heterogeneity of light parameters is often a difficulty to comparison of findings. Publised expert opinions were also considered. A total of 80 publications were reviewed out of a thousand obtained from databases, among which were retained 9 RCTs, 6 systematic reviews, 3 meta-analysis and 2 case-reports. Differences were found in treatment parameters as wavelength, dosage, energy output, treatment length, performances of light-sources, quantity of diodes and single power of these, which may explain the paucity of high-level body of evidence in Cochrane databases. However, numerous state-of-the- art researches are also found, led by dedicated research teams paving the way to standardized methods of evaluation and comprehension of light-biological-tissues interaction and optimization of outcomes in a promising field.
PhotoBioModulation; Low-Level-Laser-Therapy (LLLT); Light emitting diodes (LED); Biophotons-mitochondria; Adenosine-triphosphate (ATP); Inflammation-pain-skin rejuvenation; Photo dynamic therapy