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Quality Improvement in Clinical Laboratories: A Six Sigma Concept
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Is Normal Knee Biomechanics Reproduced by Modern Total Knee Arthroplasty Designs? The Role of Fluoroscopy
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Cultural Adaptation for Common Orthopedic Disorders Pathology and Presentations With Focus on Middle Eastern and Asian Patients
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Tumor Necrosis Factor Inhibitors May Improve Glycemic Control in Patients Rheumatoid Arthritis and Concomitant Type 2 Diabetes Mellitus
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A Rare Cause of Shoulder Pain: Ganglion Cyst of the Acromioclavicular Joint
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The QuickDASH in the Assessment of Rheumatoid Arthritis Disease Activity
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Innovation of Wound and Burn Care Dressings from Traditional to Nonwoven Polymeric Scaffolds
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Invasive Moderately-Differentiated Mucinous Adenocarcinoma Incidentally Identified in Perforated Acute Diverticulitis With Abscess Formation
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The Swan Song of a Pathologist: “Why Do I Love Thee, Pathology? Let Me Count the Ways….”
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Glucocorticoid Induced Hypothalamic-Pituitary Axis Alterations Associated with Hypogonadotropic Hypogonadism
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Alternative Effective Management of the Musculoskeletal Pain
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The Prognostic Value of PD-L1 Expression in Triple-Negative Breast Cancer: A Cohort Study and Systematic Literature Review
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Diagnosis and Cure: Intellectual Honesty is the Basis of All Science
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Circulating Tumor Cells: Beyond Isolation and Detection
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Abstract [+]
Circulating tumor cells (CTCs) are the precursors to metastases and increased numbers of CTCs in the peripheral circulation have been shown to correlate with decreased progression-free and overall survival. Although the current clinical utility has been focused on the prognostic significance, other clinical applications are being explored, such as determining if a patient is a candidate for treatment, determining the efficacy of treatment, evaluation for resistance to therapy, prediction of metastatic site, or as an early predictor of metastases. Current methodologies are based on quantifying CTCs and include technologies based on physical, immunological, and molecular techniques. However, these have limitations, of which most of them do not have the ability to perform morphological evaluation. Using morphological evaluation, CTCs in body fluids could be used for primary diagnosis in the setting of cancer of unknown primary (CUP) or in initial or early diagnostic scenarios. Additionally, cytological specimens have been shown to be useful for ancillary testing in patients when surgical resection specimens or biopsies are not available. Evaluation of CTCs should incorporate histological, immunehistochemical, and molecular characterization to enable clinicians to obtain the comprehensive diagnostic, prognostic and therapeutic information necessary to provide appropriate personalized care to cancer patients.
Keywords
Circulating tumor cell (CTC); Circulating; Tumor cell; Cancer; Isolation; Detection; Metastasis; Prognosis.
Abbreviations
CTC: Circulating tumor cell; RT-PCR: Reverse transcriptase-polymerase chain reaction; EMT: Epithelial-mesenchymal transition; MET: Mesenchymal-epithelial transition; TRAIL: Tumor necrosis factor-related apoptosis-inducing ligand; CEA: Carcinoembryonic antigen; CUP: Cancer of unknown primary; CAP: College of American Pathologists; AMP: Association for Molecular Pathology; ASCO: American Society of Clinical Oncology.
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Principles and Applications of Deoxyribonucleic Acid Microarray: A Review
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Abstract [+]
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.
Keywords
Application, DNA, Microarray, Principle.
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Non-Invasive Treatment for Adhesive Capsulitis Not Helped by Physical Therapy: A Case Study in Manipulative Medicine
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Abstract [+]
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.
Keywords
Frozen shoulder; Adhesive capsulitis; Manipulation; Active release therapy; Non-invasive treatment.
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A Rare Cutaneous Manifestation of the Systemic Erythematosus Lupus: The Chilblain Lupus – A Clinical Case
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Abstract [+]
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.
Keywords
Chilblain lupus; Perniosis; Chilblain pernio; Rare cutaneous; Myelomonocytic leukemia; Systemic Lupus Erythematosus.
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Bone Grafting, Its Principle and Application: A Review
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Abstract [+]
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.
Keywords
Application; Bone; Bone graft; Bone replacement; Bone bank; Principle.
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An In-Depth Analysis of Our Myositis Cohort Following the Example of the EuroMyositis Registry
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Abstract [+]
Background
To describe our myositis cohort in-depth.
Methods
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.
Results
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.
Conclusion
Our analysis highlights the heterogeneity in myositis subgroups and shows the steroid-sparing effect of cyclophosphamide, methotrexate and rituximab.
Keywords
Myositis; Idiopathic inflammatory myopathy; Dermatomyositis; Antisynthetase syndrome; Overlap myositis; Rituximab.
Abbreviations
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.
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Cutaneous Polyarteritis Nodosa in Adult Patient
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Abstract [+]
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.
Keywords
Skin; Polyarteritis; Vasculitis; Biopsy; Immunofluorescence; Histology.
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Autopsy Data to Refine Healthcare Quality: A Fresh Perspective
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Papillary Microcarcinoma of Thyroid in Resected Benign Multinodular Goiters Shows Correlation with Weight of the Specimen
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Abstract [+]
Introduction
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.
Objective
To evaluate the prevalence of PMCT in benign multinodular goiter in thyroidectomy specimens.
Materials
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.
Results
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.
Conclusion
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.
Keywords
Papillary microcarcinoma thyroid; Multinodular goiter; Thyroidectomy.
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Intranasal Delivery of Liposomes-Based Lipopeptide Hookworm Vaccine Diminished its Ability to Protect Mice Against Hookworm Challenge
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Abstract [+]
Background
Hookworm infection is particularly problematic for middle- to low-income countries. While treatment methods are currently available, vaccination may be the ideal intervention, as it could offer cost-effective long-term protection against infection and reinfection.
Methods
Previously established lipopeptide-based vaccine formulations, proven to be effective in an oral application, were adapted for an intranasal administration using a predicted B-cell peptide epitope derived from the hookworm Necator americanus aspartic protease-1 (Na-APR-1) protein and a universal T-helper epitope attached to two lipid moieties, Pam2Cys or lipid core peptide (LCP). The lipopeptides were encapsulated into liposomes or self-assembled into nanoparticles. The intranasal vaccine candidates were evaluated in a rodent hookworm challenge model.
Results
The vaccine candidates were formulated to optimal sizes and charges for uptake by immune cells. However, no significant serum antibody response was elicited, and no protection was demonstrated following hookworm challenge.
Conclusion
In contrast to the previously reported effective oral immunization, intranasal delivery of lipopeptide-based vaccine failed to trigger significant antibody responses in mice against hookworm and had no effect on parasite numbers following challenge infection.
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An Evaluation of the Measures to Reduce the Impact of Human Immunodeficiency Virus Infection and Acquired Immune Deficiency Syndrome in Zimbabwe and Report on the Achievements Made to Date
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Abstract [+]
The impact of human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) on individuals, communities and organisations is a major bone of resentment the world over. Human capital planning (HCP) focuses on helping managers set the direction for an organisation in regard to its future. Human Resources needs but lamentably this is made difficult because of the HIV/AIDS pandemic which among other devastating effects is short life expectancy which leads to high turnover within organisations. To reduce this catastrophe, a collaborative effort has been made by International organisations, the government and the private sector to provide measures to fight the impact of HIV/AIDS. These measures have been largely effective and include initiatives such as obtaining. Political support by leaders, engaging multiple economic sectors, educating the youth on HIV/AIDS, fighting stigmatization, enhancing poverty and improving free counselling interventions just but to mention a few. The achievements brought by these measures to date in Zimbabwe include reduction of workplace discrimination against HIV/AIDS infected people, formation of the National AIDS Control Programme by the Ministry of Health in 1987 and implementation of a mandatory 3% AIDS levy to support HIV prevention.
Keywords
Antiretroviral; Discrimination; Poverty; Sexually transmitted infection; Stigma; Zimbabwe.
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Coronavirus Disease-2019 Conspiracy Theories are Alive and Breathing on the Internet
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Transient Myopic Shift and Coronavirus Disease-2019: A Case Report
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Abstract [+]
Since the emergence of coronavirus disease-2019 (COVID-19) and its declaration as a global pandemic, multiple ophthalmic manifestations secondary to this infection have been reported, ranging from conjunctivitis to more serious and vision impairing manifestations. In this case report, we present a case of transient myopic shift observed after COVID-19 infection, in an ophthalmology specialty hospital in Beirut, Lebanon, with a discussion of the possible causes based on literature review.
Keywords
COVID-19; SARS-COV-2; Pandemic.
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Systemic Lupus Erythematosus as a Risk Factor for Cervical Cancer and its Precursor Conditions: Assessment Using Pap Smear and Histopathology
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Abstract [+]
Background
Cancer of the cervix is a common cause of malignancy. Its association with systemic lupus erythematosus (SLE) is debatable.
Objective
Early detection of cervical pre-neoplastic lesion in SLE patients.
Method
A case control study was performed on 64 SLE group and 64 control group using a colposcopy, pap smear and histopathological examination.
Conclusion
This study revealed that preneoplastic and neoplastic lesions of the cervix were higher in the SLE group.
Keywords
Systemic lupus erythematosus (SLE); Cancer; Cervix; Low grade squamous intra-epithelial lesions; High grade squamous-intraepithelial lesions; Cervical; Intraepithelial neoplasia; Squamous cell carcinoma.
Abbreviations
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.
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The Prevalence of Pathologic Q Waves on Electrocardiograms of Pediatric Patients with Confirmed Hypertrophic Cardiomyopathy: A Systematic Review of the Literature
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Abstract [+]
Objectives
The electrocardiogram (ECG) of patients with hypertrophic cardiomyopathy (HCM) ranges from normal to exhibiting evidence of ventricular hypertrophy, including pathologic Q waves and ST-T wave changes. Deep Q waves in the inferior and lateral leads are one of the classic ECG findings associated with HCM. The prevalence or frequency of this finding in pediatric HCM patients, however, is not well-established. Furthermore, other pediatric health conditions have also been associated with pathologic and non-pathologic Q waves and an awareness of those conditions is important to consider when Q waves are observed. The primary goal of this systematic review of the literature is to describe the prevalence of pathologic Q waves in the ECGs of pediatric patients with echocardiogram proven HCM. A secondary goal is to review other pediatric conditions that can present with pathologic and non-pathologic Q waves.
Methods
The databases PubMed, Web of Science, Scopus and cumulative index to nursing and allied health literature (CINAHL) were searched utilizing the preferred reporting items for systematic reviews and meta-analyses (PRISMA) format. The Rayyan systemic review software was used to screen articles for final review. The initial search (Search 1) consisted of the following terms: “dagger Q wave”, “dagger-like Q waves”, “dagger shape Q waves”. Subsequently, a broader search (Search 2) was conducted to determine if viable articles were omitted in the first search. This broader search strategy eliminated the term “HCM”. The authors then performed detailed review of the articles these two searches yielded, as well as a review of the references of these articles to find other relevant articles as well as produce a list of other pediatric conditions that may be associated with pathologic or non-pathologic Q waves.
Results
Of the articles found via the three searches, a total of nine English language articles that specifically addressed the prevalence of pathological Q waves in pediatric HCM patients were ultimately included in our systematic review. These nine articles described a total of 845 pediatric patients with HCM. Of these, 258 (30.5%) demonstrated pathological Q waves on their electrocardiograms. The range of percentages reported for pathological Q waves was 12.5 to 66.7%. Additionally, our review found fifteen different pediatric conditions reported to be associated with pathologic or non-pathologic Q waves.
Conclusion
Our systematic review confirmed that pathologic Q waves are a common and early electrocardiographic finding in children with HCM and may, in fact, be the only ECG finding. In addition, our review provided an extensive list of other pediatric diseases and conditions associated with pathologic or non-pathologic Q waves on the electrocardiogram.
Keywords
Hypertrophic cardiomyopathy; Q wave; Pathologic Q wave; Sudden cardiac death; Pediatric.
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Mandated Treatment for Troubled Adolescents and Substance Use Disorder: Identifying and Breaking Through Defensiveness and Denial
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Abstract [+]
Objective
This article presents an investigation of the defensiveness demonstrated by teens who are mandated to participate in treatment as compared to their non-mandated peers.
Methods
The data for this study was collected as part of The Substance Abuse Subtle Screening Inventory (SASSI) Institute’s third iteration of the Adolescent SASSI-A3. A total of 164 teenagers in treatment served as the dataset for the present study. All participant cases were provided by clinicians working in service settings throughout all U.S. Census Regions and serving in a variety of venues including substance use treatment, criminal justice programs, community corrections, private clinical practices, behavioral health centers, and social service organizations.
Results
We present two brief de-identified treatment case studies, aptly demonstrating defensiveness and denial from a clinical standpoint. Additionally, we review cases demonstrating high-levels of defensiveness and denial in mandated teen clients, and ethical ways to break through that barrier to treatment engagement.
Conclusion
Working with teens can be extremely difficult given their rapid mood changes, intensely felt experiences and shifting states of compliance, openness and defiance. When teens are mandated for treatment, they may often feel their choices have been taken away and the counselor may be viewed as more of a power authority rather than a concerned and helping figure. Contingencies
placed on the teen as part of the mandated treatment experience are generally the primary focus, rather than addressing their underlying substance use disorder (SUD). As a result, the teen, as well as the counselor, require greater focus than just making sure those requirements are met.
Keywords
Mandated treatment; Adolescent addiction; SASSI-A3; Defensiveness; Denial; Teen drug use.
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Omalizumab in Chronic Spontaneous Urticaria: Assessment of Response in Twenty-Five Patients
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Abstract [+]
Background
Omalizumab is a recombinant humanized monoclonal antibody against immunoglobulin E (IgE). It is approved for the treatment of chronic spontaneous urticaria (CSU) in patients ≥12-years of age.
Objective
We carried out a retrospective cross-sectional study in 25 patients with CSU to evaluate the characteristics of response of CSU to omalizumab treatment.
Method
A retrospective cross-sectional study of a convenient sample of all patients diagnosed as CSU who have been using omalizumab treatment during the study period from January 2018 to January 2020 in the Dermatology Department in King Abdulaziz Hospital, Makkah, Saudi Arabia.
Results
A total of 25 patients have participated in this study. The average age of patients was 40-years. Majority of the patients were female (52.0%, n=15). The average duration of illness was 1.32-years. Majority of the patients (72.0%, n=18) received two courses of omalizumab treatment. Minority of patients (28.0%, n=7) received one course of omalizumab treatment which was statistically significant (p value<0.01). Number of patients who have been using oral 2nd generation antihistamine during the first course and 2nd course was (72%, n=18 out of 25) and (50%, n=9 out of 18) respectively. Number of flare-ups during 2nd course (1.72 flares up per patient, n=31 flare-ups among 18 patients) was less than the number of flares-up during 1st course (2.96 flares-up per patient, n=74 flare-ups among 25 patients) which was statistically significant (p value<0.01). Number of patients who showed no flare-ups during the 1st and 2nd course of omalizumab treatment was (16%, n=4 out of 25 patients) and (27.77%, n=5 out of 18 patients) respectively. The average intensity of flares-up during 2nd course of omalizumab treatment was less than the average intensity of flares-up during first course of omalizumab treatment as the following; during 2nd course ( 33.33%, n=6 out of 18 patients), (27.77% n=5 out of 18 patients), (11.11%, n=2 out of 18 patients) mild, moderate and severe flares-up respectively and the severity during 1st course was (40.0%, n=10 out of 25 patients), (28.0%, n=7 out of 25 patients), (16.0%, n=4 out of 25 patients) mild, moderate and severe flares-up respectively. Conclusion According to expert’s guidelines, CSU of ≥3-years would be treated with omalizumab for a minimum of one-year. In our study, in spite of the short duration of CSU (average duration was 1.32-years), the majority of patients (72.0%, n=18) received omalizumab for 1-year (two courses of omalizumab treatment) suggesting that the majority of patients with CSU in general requires omalizumab ≥1-year. Our study also showed 5 patients who were free of any flare-up and they were not using 2nd generation antihistamines suggesting that omalizumab alone as monotherapy can be effective. Keywords Omalizumab; Urticaria; RCTs; Chronic spontaneous urticaria (CSU).
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Epidemiological Profile of Children with Neurodevelopmental Disorders in a Diagnostic Center in Southern Puerto Rico, 2006-2017
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Abstract [+]
Objective
This study has the purpose of developing an epidemiological profile of children with neurodevelopmental disorders in southern Puerto Rico.
Methods
This is an exploratory study with a mixed design that was carried out in a diagnostic center located in Ponce, Puerto Rico. The population under study were children within 0-18-years-old of both sexes diagnosed with a neurodevelopmental disorder using the diagnostic and statistical manual of mental disorders (DSM-4) and DSM-5 criteria. The sample under investigation were all the children in the secondary database of children who received health services in the diagnostic center during 2016-2017. Additionally, to the data from the secondary database, a hand-writing record review was performed to obtain data related to comorbidities and family history. The bivariate and multivariate analysis evaluated the association between each neurodevelopmental disorder, and each disease reported in the family history of diseases. Also bivariate, and multivariate analysis assessed the association between each neurodevelopmental disorder, and each comorbidity reported.
Results and Conclusion
The mean age and standard deviation of the sample were 5.2±3.20, and 80.5% were males. Most of the children lived in Ponce, Puerto Rico. The sample size did not have normal distribution because the sample size was too small and selected by non-probabilistic methods. Furthermore, 88.2% of the children received a previous evaluation related to the problem, and 70.5% received treatment for the symptoms. The results revealed that neurodevelopmental disorders frequently co-occurred. Also, other comorbidities commonly co-occurred with these disorders. Mental disorders were commonly reported with autism, attention deficit and hyperactivity disorder (ADHD) and communication disorders. Autism was also linked to a family history of mental disorders.
Keywords
Childhood; Neurodevelopmental disorder; Disabilities; Developmental delays.
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Role of Low-Level Laser Therapy as an Adjuvant in Functional Rehabilitation of Patients with Joint Stiffness in Post-Burn Contracture
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Abstract [+]
Introduction
Post-burn contracture is a known sequelae of burn injuries involving neck, axilla, elbow, and hand. There are many methods which are used as adjuvant in rehabilitation of post-burn contracture patients. The low-level laser therapy (LLLT) is one of the methods that can be used as an adjuvant in rehabilitation of joint stiffness following burns and but with very few data available from India. In this article we share our experience of using LLLT for functional rehabilitation of a patient with joint stiffness following postburn contracture.
Materials and Methods
This study was conducted in a burns centre in a tertiary care institute in South India. Informed consent and departmental ethical committee clearance were obtained prior to study. The subject was a young boy with no known co-morbidities with stiffness of metacarpophalangeal and interphalangeal joint of index and middle finger of right hand. Patient was treated with contracture release with full thickness skin graft. The patient received low-level laser therapy to induce collagenolysis and to increase the movement of the joints. Each joint received laser therapy for duration of 125-second every time for 15-minutes for 2 sessions in
a span of 4-days.
Result
LLLT has been found to be useful in early rehabilitation of post-burn contracture patients with joint stiffness. No side effects were observed during the study.
Conclusion
The LLLT is an effective, safe, and non-invasive adjuvant in functional rehabilitation of our patient with joint stiffness following post-burn contracture. We suggest further study including multiple subjects and a control group for validation of the result.
Keywords
Low-level laser therapy (LLLT); Post-burn contracture; Joint stiffness; Functional rehabilitation.
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Identifying Resource Needs and Experiences of the Lesbian, Gay, Bisexual, Transgender, Queer, and Questioning+ Community during the Coronavirus Disease-2019 Pandemic
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Abstract [+]
Introduction
Lesbian, gay, bisexual, transgender, queer, and questioning+ (LGBTQ+) people have historically faced disproportionate economic and health-related challenges, which have likely been further exacerbated by coronavirus disease-2019 (COVID-19). To provide support and equitable resources for this community, it is critical to identify resource needs and challenges and understand the experiences of this community during the COVID-19 pandemic.
Materials and Methods
We administered an online survey to examine the experiences and needs of minority LGBTQ+ people, ages 18-35, who resided in an Ending the Human Immunodeficiency Virus (HIV) Epidemic (EHE) metropolitan jurisdiction in the Southeastern United States (U.S.).
Results
Since the onset of COVID-19, the majority of survey respondents reported increases in mental health symptomology and substance use, and decreases in economic stability, food security, and medical care access.
Conclusion
The findings support the need for extended reach of substance use and mental health-related services, linkage to medical/sexual healthcare, and financial assistance.
Keywords
LGBTQ; COVID-19; Sexual and gender minority; Substance use; Mental health.
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Assessing Organizational Role Stress of Employees in Public and Private Sectors
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Abstract [+]
Introduction
Work plays a vital role in most people’s lives, and thus the impact of stress in the workplace is a significant issue. Since organisational role stress (ORS) has detrimental effects on both the organisation and employee, managing role pressures has greater importance.
Objective
This study analysed the comparative organisational role stress between India’s public sector and private sector workers. It also fulfilled its objective of ranking stressors to contribute to total ORS.
Materials and Methods
This descriptive-comparative analytical study selected 92 employees (41 private sectors and 51 public sectors) from different organisations in India. The study administered the organisational role stress scale developed by Udai Pareek to employees of both groups. For analysis independent sample t-test were used in the study.
Results
The study reveals that public sector employees score higher than private-sector employees in almost all scale dimensions other than role stagnation. Data analysis also inferred that inter-role stressor was the maximum contributor to overall organisational role stress, and the two groups differed most in the dimension of role overload.
Conclusion
These have important implications in policy-making to ensure enhanced well-being and productivity.
Keywords
Stress; Organisational role stressors; Causes of stress; Workplace stress; Coping strategies; Public and private sector; The stress of Indian employees.
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Mucormycosis: A Fungal Rarity Mangling Coronavirus Disease-2019 Patients in India
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Abstract [+]
Mucormycosis is a rare, non-contagious fungal infection with high fatality rates, identified since centuries. It was found that the filamentous fungi of the family Mucoraceae attacks immunocompromised patients on medication due to comorbidities like diabetes, organ transplant or malignancy. The coronavirus disease-2019 (COVID-19) recovering patients especially with diabetes mellitus or high glucose levels due to corticosteroid treatment made them vulnerable to this fungus. This was announced as an epidemic based on the rapidity of spread and the very high death rates. This was due to the fact that COVID-19 made the immune system of the patient so weak and the steroids given to treat corona provided an ambient bed for the speedy growth of the fungus and finally leading to death. The timely diagnosis of the infection can help to manage mucormycosis may it be by antifungal combination therapy, reduced use of steroids, control blood sugar levels, and removal of necrotic cells by surgical debridement. The review
article is an outline of the clinical manifestation, histopathology, mortality rates, diagnosis and treatment of this deadly disease.
Keywords
COVID-19; Mucormycosis; Black fungus; Diabetes; Immunocompromised patients.
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Antegrade Versus Retrograde Cerebral Perfusion in Aortic Surgery: Systematic Review and Meta-Analysis of 19365 Patients
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Abstract [+]
Background
Since the risk of neurological injury and mortality can be mitigated with the appropriate choice of established brain protection strategies, we performed a meta-analysis of studies reporting cerebral perfusion strategy outcomes. Our focus was on surgeries that can be performed through a minimally-invasive approach, to support the decision-making process of adopting surgeons.
Methods
We searched the Excerpta Medica dataBASE (EMBASE), Medical literature analysis and retrieval system online (MEDLINE), and Cochrane databases, as well as ClinicalTrials.gov, Google Scholar, and the reference lists of relevant articles for studies reporting early mortality and/or stroke outcomes of both retrograde cerebral perfusion (RCP) and antegrade cerebral perfusion (ACP) strategies. The principal summary measures were odds ratio (OR) with 95% confidence interval (CI) and p values (statistically significant when <0.05). The pooled ORs were combined across studies that met the eligibility criteria. Results We identified and included seventeen eligible studies with a total of 19,365 patients undergoing ascending aorta and arch surgery from 2008-2019 by means of ACP (a total of 10,473 patients) or RCP (a total of 8,892 patients). Random effect model analyses found no increase in mortality (OR=1.03, 95%CI:0.80-1.32) or stroke (OR=1.04, 95%CI:0.81-1.32) associated RCP when compared to ACP (p>0.05).
Conclusion
In ascending aorta and arch surgery, requiring cerebral protection, ACP and RCP have similar rates of early mortality and stroke. While optimal application of cerebral protection strategies is both patient and surgeon specific, surgeons can comfortably adopt RCP in minimally invasive cases after accounting for factors that determine the outcomes of aortic surgery adequately.
Keywords
Antegrade; Retrograde; Cerebral protection; Aorta and great vessels; Minimally invasive cardiac surgery.
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Potential Properties of Guabiroba (Campomanesia xanthocarpa O. Berg) Processing: A Native Brazilian Fruit
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Abstract [+]
Guabiroba (Campomanesia xanthocarpa O. Berg) is a native Brazilian fruit with an important nutritional value and a great economic potential for processing. This fruit is a source of fibers, carbohydrates, potassium, and bioactive compounds, such as polyphenols, carotenoids, and Vitamin C. The phytochemicals of guabiroba are elucidated regarding their high antioxidant activity, which is related to human health benefits when introduced into a dietary routine. In addition, the antioxidant property of this native fruit can act as a natural preservative against oxidative and enzymatic reactions, and microbiological spoilage, extending the shelf-life of food. Thus, the addition of guabiroba in the development of new products, in addition to improving the functionality of the food, can reduce the use of chemical additives. Studies related to encouraging the use of guabiroba in food formulation, as well as the use of emerging technologies in the processing of this native fruit, become the basis of this review that aims to expand the knowledge of this Brazilian fruit and enhance its application in the food industry.
Keywords
Myrtaceae family; Gavirova; New products; Emerging technologies; Technological approach.
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The Effect of Complexity of Ambulance Missions on Shared Mental Models in Virtual Teams
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Abstract [+]
Background
Empirical research on shared mental models (SMM) in virtual environments are almost non-existent. Pre-hospital emergencies presents an opportunity to examine team processes in virtual teams because the dispatcher is geographically separated from the ambulance and at the same time plays a significant role in coordinating, organizing, obtaining, evaluating, and conveying relevant information to the deployed ambulance. The present study aimed at mapping team behavior and cognition in critical real-life emergency medical missions based on the concept of SMM.
Methods
By investigating the frequencies of coordinating mechanisms and team competencies based on voice recordings from real-life missions, differences in team behavior between low and high-complexity missions were investigated.
Results
Lower frequencies of team competencies and coordinating mechanisms were found in high compared to low-complexity missions. The results showed a different profile in communication between high and low-complexity missions with more frequent use of both coordinating mechanisms and team competencies in low-complexity missions. Furthermore, the profiles revealed that SMM and closed loop communication were the only coordinating mechanism used, and leadership and team orientation were the only competencies exercised.
Conclusion
It was concluded that the lack of visual input of a team member during team interaction could lead to team process loss due to a breakdown of the team into sub-units. Potential improvement of team behavior is discussed within the SMM framework.
Keywords
Virtual medical first responder teams; Complexity; Shared mental models; Team processes; Coordinating mechanisms.
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Agreement and Validity of Existing Anthropometric Calibration Models to Estimate Whole Body Density in Male Professional Football Players
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Abstract [+]
Introduction
To date no calibration models exist to estimate whole body density (Db) of professional footballers, as such the development of practical anthropometric calibration models to make sound body composition judgements is imperative. The aim of this study was to investigate the agreement and validity of estimating Db from 15 existing calibration models through comparison to a criterion method of hydrostatic weighing (HW) in male professional footballers.
Materials and Methods
Data were gathered from a total of n=206 professional football participants (x±s; age=24.1±5.4-years, body mass=78.8±8.4 kg, stature=180.1±7.0 cm, Db 1.075±0.01 g.ml-1). Bland and Altman limits of agreement (LoA) approaches were used to determine bias and random variation derived from the calibration models.
Results
Bias and random errors for the published calibration models ranged from -0.005 to +0.015 g.ml-1 and 1.012 to 1.090 g.ml-1 respectively. A priori criterion (±3.8% p=<0.05 (g.ml-1)) was set as acceptable limits for the LoA method of which 13 calibration models found that (on average) estimated Db derived from HW was greater than Db derived from the models. Discussion A rank order of LoA identified the best model to use, however, LoA were not narrow enough for measurements to be of practical use and in most instances, selected models are not appropriate for estimating Db in male professional footballers. Keywords Whole body density; Calibration models; Anthropometry; Professional football players; Agreement; Validity.
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Potential Errors and Corrections in Early Phase Drug Development
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Abstract [+]
Many foreign and small companies trying to enter the United States biopharmaceutical market make avoidable errors in their early clinical phase drug development and clinical trials. They need to first understand the risks that they must endure with patent law, regulatory hurdles, the complexity and duration of the necessary clinical trials, and the large cost of drug development, which often necessitates raising substantial capital from investors. If appropriate capital for these clinical studies must be raised, then the company must be able to clearly articulate a realistic expected return on investment to these individuals. So, they must also understand the market, its exclusivity, and the competition. This must all be put together in a sleek pitch deck. Early errors frequently begin with too few, inadequate, or poorly constructed patents. These and other risks and errors may be prevented by the use of an experienced product development team. Many of these errors could be avoided if companies used more experienced drug development professionals to assist them in selecting the optimum patent strategy, regulatory plan, budget, contract research organization (CRO), clinical investigators, and etc. It is hoped that this opinion piece will help make early clinical trials more effective and save time and money.
Keywords
Clinical trials; Drug development; Biotechnology; Contract research organization (CRO); Principal investigators.
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The Efficacy of Open Mastoidectomy Versus Mastoidectomy with Temporalis Fascia Flap Obliteration
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Objective
To compare the efficacy of open mastoidectomy versus mastoidectomy with temporalis fascia flap obliteration in achieving postoperative dry ear chronic suppurative otitis media (CSOM) is a perforated tympanic membrane with persistent drainage of pus from the middle ear lasting more than 2-weeks. The global burden of illness from CSOM is estimated to involve about 65 to 330 million individuals with draining ears, 60% of them suffer from significant hearing impairment. Ninety (90) percent of burden is borne by developing countries, in Southeast Asia, the Western region of Africa. CSOM can occur with or without cholesteatoma, and the clinical history of both conditions can be very similar. The treatment plan for cholesteatoma always includes tympanomastoid surgery with medical treatment as an adjunct. The treatment plan for cholesteatoma always includes tympanomastoid surgery. After mastoidectomy the otologists facing mastoid cavity related problems such as otorrhoea, hearing loss. A variety of techniques have been proposed to perform obliteration.
Methods
Study design
Randomized Controlled Trial.
Setting
Department of ear, nose, and throat (ENT), Head & Neck Surgery, Saidu Group of Teaching Hospital, Swat, Khyber Pakhtunkhwa, Pakistan.
Duration of study
From Jan, 2019 to 17 July, 2021.
Sample size
Randomly assigned patients with evidence of atticoantral disease to two groups, 47 in each group. After canal wall down mastoidectomy in Group A cavity left without obliteration, in Group B a superior based vascularized temporalis facial flap was used to obliterate the resultant mastoid cavity and they were followed up to 8-weeks.
Results
As per efficacy of both groups is concerned, in Group A, 34 (36.17%) patients had achieved post-operative dryness on 8th week of mastoidectomy whereas in Group B, 40 (42.55%) patients achieved post-operative dryness of ear on 8th week subject to mastoidectomy with temporalis fascia flap obliteration. (p value=0.130).
Conclusion
Patients who underwent mastoidectomy with temporalis fascia flap obliteration yielded better results in comparison to patients who underwent open mastoidectomy. Further the common organism were found in our region Staph Aureus and Bacteriodes and Proteus mirabilis.
Keywords
Chronic suppurative otitis media (CSOM); Mastoidectomy; Ear, nose, and throat (ENT).
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Physical Activity Motives in the Exercise and Self-Esteem Relationship
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Abstract [+]
Aims and Objectives
The purpose of this investigation was to extend research examining physical and social influences in the exercise/self-esteem relationship by investigating the moderating role of physical activity motives. Research reveals multiple motives for exercise participation beyond physical health enhancement. It is thought that these motives may play an important role in the relationship between exercise and self-esteem. Previous research has established the contribution of the physical self-system in the relationship. Furthermore, research examining the contribution social self-system has shown promise, yet the mechanisms operating in the relationship are less clear. It was hypothesized that motivation for physical activity participation may be such a mechanism.
Results
A population of 147 undergraduates completed assessments of physical activity participation, motives for physical activity, and physical, social and global self-perceptions. As expected, physical activity participation influenced self-esteem through both physical and social systems. Additionally, socially motivated exercisers exhibited greater self-esteem enhancement through the social as opposed to the physical self-system.
Conclusion
The hypothesis that physical activity motives would play an important role in determining the pathway through which physical activity participation influences self-esteem was partially supported. Results showed that those who reported social motives for physical activity showed greater enhancement in self-esteem through the social self-system, while physical motives did not serve a moderating role. The findings from the present investigation are important not only from the perspective of self-esteem theory but also with regard to the numerous practical implications of the results. The findings confirm that the relationship between exercise participation and self-esteem is more complex than previously thought in that physical activity participation influences self-esteem through multiple pathways. What remains to be investigated is how to best flesh out which pathway is more meaningful to the exerciser and then how to best serve the interests of the exerciser with the ultimate goal of enhancing self-esteem.
Keywords
Self-esteem, Physical activity, Exercise, Self-concept, Motives.
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The Importance of Spirituality, Spiritual Intelligence, Hope and Social Support in Dealing with Cancer Patients: Some Comments
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Abstract [+]
Spirituality has been recognized as an important factor similar to hope and social support for improved quality of life (QoL) and survival rate in cancer patients. Literature has also demonstrated a higher relationship of survival rate, with higher spiritual intelligence and hope levels in cancerous patients than non-patients. Spiritual intelligence needs to be explored more deeply, to better understand how this construct affects cancer survival rates.
Keywords
Spirituality; Cancer diagnosis; Hope; Spiritual intelligence; Social support.
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Experimental Cardiac Toxicity Induced by the Injection of Uracoan Rattlesnake (Crotalus vegrandis) and the Black Rattlesnake (Crotalus pifanorum) Venoms
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Background
Snakebite is a collective health problem that afflicts areas with poor healthcare coverage. Venezuela has an important population of snakes, including the endemic species Crotalus vegrandis and Crotalus pifanorum, whose venom has not been fully characterized, especially of those aspects related to cardiac electrophysiology.
Aims
In this sense, this work aims to characterize the electrocardiographic and histopathological effect of crude venom of C. vegrandis and C. pifanorum on albino Naval Medical Research Institute (NMRI) mice.
Results
For this, mice were gathered in C. pifanorum and C. vegrandis experimental groups, including normal controls and envenomed mice injected with commercial antivenom. C. vegrandis venom showed a significant T and S wave flattening and pulmonic (pulmonary) regurgitation (PR) enlargement, in addition to atrial ectopic activity, notched R wave, triggered activity, and T wave inversion. C. pifanorum was the only group that registered triggered activity. Antivenom was able to revert conduction disorders showing a statistical increase in arrhythmogenic compared by χ2. The multidimensional comparison confirmed the statistical differences between C. vegrandis and C. pifanorum venoms and between antivenom vs non-antivenom groups, detecting variables associated with cardiac conduction, as the most important variables.
Conclusion
In conclusion, this work demonstrated, as far as we know, for the first time the cardiotoxic effects associated with C. vegrandis and C. pifanorum venom injection, subsequently suggesting the duty of including an electrocardiogram in the consultation of any accident caused by these species.
Keywords
Snake; Toxicity; Arrhythmias.
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Clinical Cases of Anterior Cervical Hypertrichosis
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Abstract [+]
Anterior cervical hypertrichosis (ACH) may be only an isolated aesthetic finding, but it may also be associated with other underlying conditions, including neurological and ocular disorders. In order to recognize this uncommon entity, it is imperative to provide detailed physical examination and clinical history to exclude the possible associated abnormalities in patients with ACH. In those cases that ACH represents only a cosmetic problem for the patient, laser hair removal is recommended. We hereby presented 2 cases of ACH in two young girls and discussed about all the differential diagnoses and how to rule out associated anomalies. The
most useful workout to rule out associated underlying conditions are described, and cosmetic treatment with laser hair removal devices is also commented.
Keywords
Hairy throat syndrome; Nevoid hypertrichosis; Dysraphism; Anterior cervical hypertrichosis; Congenital hypertrichosis.
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Thoughts and Experiences of Bias: A Personal Perspective
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This is a narration about observations on biases and cultural disquiets experienced in my personal and professional life both in my own birth place as well as in my country i.e., New Zealand where I currently live. In the following paragraphs, my personal experiences on biases has been described. Many academics have already written extensively about the types of biases I discuss in their research papers. My professional career has lasted for the past 43-years. Out of 43-years, 27-years have been spent in New Zealand, where I have worked in around 17 organisations. The time span covered is from May 1994 till now. Following questions are in my contemplation: Why are people so biased? What does it feel like to be overlooked for your efforts or contributions? The ubiquitous nature of bias has been documented in the scientific literature, as well as how it is ingrained in human characteristics and attitudes. Is it possible to eliminate bias? Is there a way to mitigate the negative effects of bias that we as humans impose on one another?
Keywords
Bias; Unconscious bias; Society; Culture; Organisation; Diversity and inclusion.
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The Stopping the Spread of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome through Relationship Engagement Study: An Opportunity for Human Immunodeficiency Virus Prevention in African American Adolescents with HIV-Positive Mothers
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Trends in Spatiotemporal Exposure to Air Pollutants and Adult Cardiovascular Emergency Room Visits in the Greater Pittsburgh, Pennsylvania, USA
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Abstract [+]
Introduction
The acute effects of air pollution and cardiovascular disease (CVD) have been studied, but very few studies have focused on spatiotemporally modeled exposure to air pollutants at the population level. This study aims to examine the short-term association of fine particulate matter (PM2.5), Ozone (O3), Nitrogen Dioxide (NO2) and Sulfur Dioxide (SO2) and CVD emergency room visits (ERV) in Allegheny County for a 13-year period using a case-crossover study design.
Aim
We sought to estimate the effects of acute exposure to these four pollutants adjusting for temperature on CVD ERV and to compare outcomes in 1999-2005 compared to 2006-2011.
Methods
Land-use regression was used to model the ground level exposures to PM2.5, O3, NO2 and SO2. CVD ER visits were requested from the local hospitals of the two health networks in Allegheny County, which operate the majority of the ER services. The discharge International Classification of Diseases-9 (ICD-9) codes were used to identify the CVD cases and CVD subgroups. We linked the Zone Improvement Plan (ZIP) code level air pollution data with the patients’ ZIP code (residence) to determine the individual level exposure estimation of both case days and control days. Conditional logistic regression with multi-pollutant and distributed lags of 0-3-days was applied to estimate the effect of acute exposure of these pollutants to CVD ER visits (ERV), adjusting for temperature.
Results
In the overall analyses, for every interquartile increase of O3 exposure (25.52 ppb), there was a 6.6% (95% CI: 0.8%-12.7%) increase in the odds of an acute myocardial infarction ERV. This was consistent across both time periods. Among women and Black ERV, we observed an association of PM2.5 with acute myocardial infarction, and with ischemic heart disease. Some of these associations persisted in the later years of the study period. The gaseous pollutants (NO2, SO2 and O3) were shown to increase risk of cardiovascular events in both time periods.
Conclusion
We found an association of PM2.5 and NO2 with CVD ER visits, and this association persisted in the stratified analyses, as well as in the later years with lower exposure levels. The findings suggest that further actions to reduce the pollution level in this area should be taken. Ozone and NO2 were related to increased risk for all CVD, ischemic heart disease (IHD) and acute myocardial infarction (AMI) underscoring the importance of gaseous pollutants and their effect on coronary heart disease (CHD) risk.
Keywords
Multi-pollutants; Cardiovascular emergency room visits; Spatiotemporal; Acute; Case-crossover.
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Management of Folliculitis in Burn Patients
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Abstract [+]
Whilst the management of burn wounds continue to evolve and improve over the years, folliculitis remains a common sequela in the burned patient.
Keywords
Burns; Burn wounds; Folliculitis; Skin graft.
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One Rain Does Not Make a Crop–Continuum of Care to Improve End-of-Life Care for Bariatric Patients
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Abstract [+]
Care of persons weighing over 500 lbs. poses additional challenges. For at least the past 20 years, training methods, resources, and equipment have been available to meet the demands of people weighing up to 500 pounds. However, this is not the case when exploring care options for the person weighing greater than 500 pounds. Hospital beds, magnetic resonance imaging (MRI) and computerized tomography (CT) scan beds, etc. are not usually designed to bear the weight of over 500 lbs. persons. According to Hale and others (2020), in 2017-2018 the age-adjusted prevalence of obesity in adults was 42.4%, and there were no significant differences between men and women among all adults or by age group. This case report illustrates the unique challenges and opportunities encountered by morbidly obese patients and healthcare professionals during end-of-life (EoL) care situations. It also categorically highlights the challenges, contextual discussions, and potential opportunities for healthcare delivery models to standardize and implement safe, effective, efficient, compassionate, person-centered, cost-effective care when serving bariatric persons.
Keywords
Bariatric patients; End-of-life; Compassionate care; Death with dignity; Palliative care physician.
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Safety and Efficacy of Rescue Nerve Blocks
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Abstract [+]
Background: The overall incidence of complications following peripheral nerve blocks is very low. Peripheral nerve blocks performed under ultrasound guidance are widely thought to present a lower risk to direct needle trauma than paresthesia and nerve stimulation techniques and have been shown to decrease opioid consumption by providing analgesia directly to the site of injury. Currently, when a nerve block fails altogether or provides inadequate analgesia, pain and opioid consumption increases which in turn decrease patient satisfaction and increases healthcare costs. Concerns remain whether the benefits of opioid reduction outweigh the risk of inadvertent needle trauma and other potential complications when performing a nerve block replacement, or ‘rescue block’.
Objective: Examine whether performing a rescue peripheral nerve block provides adequate analgesia to elicit a decrease in opioid consumption. Analyze the incidence of nerve injury following ultrasound-guided ‘rescue’ continuous peripheral nerve blocks.
Methods: Data was retrospectively collected from patient electronic medical records from a Level 1 academic Trauma Center at Regional One Hospital in Memphis, Tennessee from March 1, 2019 to May 31 2021. Inclusion criteria was patients over 18-years of age at time of admission who received consecutive continuous peripheral nerve blocks in the same relative location during a time when the peripheral nerves were likely partially or fully anesthetized (a rescue block). The primary outcomes assessed were 24-hour opioid consumption prior to the initial continuous nerve block, just prior to and after the ‘rescue’ block. Adverse outcomes potentially due to performing a ‘rescue’ block were also examined, including direct needle trauma, nerve injury related to extended exposure to local anesthetics, and local anesthetic systemic toxicity. Types of nerve blocks performed, range and median number of catheter days, and reason for rescue block was recorded for all patients. All available electronic healthcare records were reviewed to identify potential injury. Nerve blocks were categorized into low and high-risk for direct needle trauma based on the incidence of needle trauma found in the literature and whether the needle was required to be adjacent to a discrete nerve or nerve bundle in order to perform the procedure.
Results: Fifty-five (55) patients were examined. Of the 55 patients, 5 had multiple locations both blocked and rescued, bringing the total rescue procedures examined up to 60. Additionally, 10 patients had their rescue site re-blocked multiple times due to either multiple surgeries, displacements, or duration of analgesia required bringing the total number of rescue blocks performed to 74. Patients that received an initial continuous peripheral nerve block consumed significantly fewer opioids during the 24-hour period following the block than the 24-hour period before the block was performed (p=0.033). Continuous peripheral nerve blocks (CNPB) were replaced or ‘rescued’ for two general reasons: Failed or inadequate analgesia (21) and to extend the utilization of adequately functioning infusions (35). Once a rescue nerve block was performed, there was no significant change in opioid consumption than after the original block (p=0.64). Of the 60 rescue blocks that were recorded, there were 0 adverse outcomes that were attributed to the rescue block procedure.
Conclusion: Following failed CPNB or when performed to extend the utilization of CPNB infusions, ultrasound-guided ’rescue’ nerve blocks result in reduced opioid consumption to a similar level as the initial peripheral nerve block, and do not result in an increase in the incidence direct needle trauma. Given the relatively low incidence of needle trauma and other nerve block-related complications, larger studies are needed to confirm these initial findings, however, ultrasound provides numerous clinical strategies that can be employed that may reduce the incidence of direct needle trauma compared with traditional nerve localization
techniques.
Keywords
Pain; Analgesia; Regional anesthesia; Nerve block; Rescue; Opioid.
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Surgical Evolution in the Modern Era: From Quantity to Quality of Life to Surgical Innovation. The Paradigm of Esophageal Cancer Surgery
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Kwamteng Deity: A Culture-Historic Perspective in Demshin, Shendam Local Government Area Plateau State Nigeria
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Abstract [+]
Background
This paper examines and document the culture-historic and symbolic perspectives of Kwamteng in Demshin, Shendam Local Government Area Plateau State Nigeria. This paper has shown the communal values, norms and the symbolic perspectives of the infamous cult in Shendam. The research argues that in pre-colonial times, Kwamteng was a tool used in measuring moral and worthwhile characters in Demshin. It is shown here that the cult and the deity they worshipped ensured trust, loyalty and fulfilment of agreements between parties. Kwamteng also checked social vices including witchcraft, killing and stealing of peoples property or economic crops. This study shows the significant roles played by this cult within Demshin community, including assisting them out of tough challenges like conflicts (war), financial crises, infertility, sickness and low agricultural produce. The initiation process, initiation items and requirements, mode of worship, items of worship, taboos and other socio-cultural practices tied to this revered cult has been discussed in this work. Also, this work sheds light on its contributions to the socio-political landscape of Demshin.
Methods
The study also employed the use of archival materials or written documents, oral tradition through oral interviews and ethnography through participant observation, this research has revealed new information on Kwamteng from a culture-historical perspective.
Findings
Kwamteng has an organized religious system, Sustainable conflict management strategy, cultural heritage management, Kwamteng serves as the security and custodian of Goemai cultural history as well as judicial roles.
Conclusion
The research has shown that Kwamteng is an ancient tradition in the Goemai area and it played a very significant role in the upbringing of the male child through rigorous training as well as endurance of hardship from a very tender age to prepare the boy from the task that associates the man later in life.
Keywords
Shendam; Kwamteng deity; Goemai.
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Angulation and Translation Capabilities of a Minimized Orthopedic Hexapod Ortho-SUV Frame: An Experimental Study
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Abstract [+]
Introduction
Orthopedic hexapods demonstrated effectiveness and accuracy in deformity correction of limbs in both adults and children. Previous studies demonstrated the best reduction capabilities of the orthopedic hexapod Ortho-SUV Frame (OSF) versus other models of this group of external fixation devices. Minimized version of this hexapod (minimized Ortho-SUV Frame (OSFm)) was created to reduce common for this group disadvantages: large bulkiness and weight and limitation on working with “short segments”. However, the reduction capabilities of the OSFm have not yet been studied.
Aim
To evaluate translation and angulation capabilities of OSFm with standard struts size and to compare results to OSF with short struts size.
Materials and Methods
The experimental study was performed using plastic models of the tibia with osteotomy at the middle third of the shaft. Proximal and distal bone fragments were fixed with one-ring modules. The reduction capabilities of OSFm in the first series and OSF in the second series of the experiment were studied. According to the method of fixing the struts to the rings, experiments were divided into three groups: directly to the ring, using straight plates, and using Z-shaped plates. Translation and angulation capabilities were evaluated by the maximum displacement of the distal bone fragment relative to the proximal one until any of the struts reached its minimum or maximum possible length.
Results
In translation OSFm outperforms OSF by 2.8-9.5% fixed the struts directly to the rings, by 4.8-9.7% using straight plates, and by 27.3-29.3% using Z-plates. In angulation OSFm with struts fixed directly to the rings outperforms OSF by 33.9-55.4%, by 36.9-47.3% using straight plates, and by 29.6-36% using Z-plates.
Conclusion
OSFm exceeds OSF in translation and angulation capabilities in all series of experiment. Distraction and rotation capabilities and the bone fragments fixation rigidity should be evaluated as further research to prove application of OSFm as a possible better candidate for deformity correction of limbs in children and foot deformity correction.
Keywords
External fixation; Deformity correction; Orthopedic hexapod; Reduction capabilities.
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Primary Malignant Melanoma of the Bladder: A Rare Case Report
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Abstract [+]
Background
Primary malignant melanoma (PMM) of the bladder is a rare ailment and has a poor prognosis; only 40 cases of PMM reported in literature till date. In this case report we described a case of PMM of the bladder, treatment, and a review of the literature as the recommended treatment choices are not widely known.
Case Presentation
A 55-year-old Indian female came with a history of hematuria for two-months. Ultrasonography revealed a 18×16 mm size mass located in the antero-inferior wall of urinary bladder with involvement of bladder neck. She underwent transurethral resection of the bladder tumor outside and histologically reported to be malignant melanoma and confirmed on immunohistochemistry (IHC). No further primary sites of melanoma were found. Computed tomography (CT) showed an irregular enhancing mucosal thickening along internal urethral meatus and adjacent urinary bladder. The patient eventually underwent radical cystectomy with anterior pelvic exenteration with ileal conduit.
Conclusion
Primary bladder melanoma is very aggressive in nature. In most of the cases bladder malignant melanoma is secondary, so extensive search for any primary melanotic lesion is essential. It is often difficult to discriminate whether a bladder melanoma is primary or metastatic. Certain diagnostic features can be obtained through histopathological investigation, immuno-histochemistry, clinical history, and endoscopic evaluation. Despite a wide range of treatments, people with PMM still have a worst prognosis.
Keywords
Primary malignant melanoma (PMM); Hematuria; Anterior pelvic exenteration; Immunohistochemistry.
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Neutralizing Antibodies to Botulinum Toxin Type A as a Secondary Treatment Failure: A Case Report from Mumbai, India
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Abstract [+]
Botulinum toxin use in aesthetic medicine for treatment of facial rhytids is common and has become more and more popular in India in recent times. Botulinum toxin (BoNT) is produced by clostridium botulinum which is an anaerobic, spore forming, rod shaped bacteria. The botulinum toxin complex contains a 150 KD neurotoxin together with a complex additional protein. The
neurotoxin is cleaved by the clostridial proteases into heavy and light chain. The heavy chain (100 KD) after cleavage binds to gangliosides and a protein receptor on the presynaptic nerve ending, whereas the light chain (50 KD) blocks the release of acetylcholine, leading to a dose dependent weakening of the target muscle.
Keywords
Botulinum neurotoxin type A; Neutralizing antibodies; Secondary treatment failure; Aesthetic treatment; Facial rhytides.
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Role of Digital Assessment in Wound Management
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Abstract [+]
Aim
The aim of this study was to assess the role of digital planimetry in accurate measurement of wound size and guide in wound bed preparation in our patient. The calculation of wound surface area was done by using ImageJ software.
Methods
In our study, digital planimetry was used to measure the wound size using ImageJ software.
Results
In our study, digital planimetry helped inaccurate measurement of wound and helped to plan measures to decrease the wound size.
Conclusion
Digital assessment and ImageJ is a simple, easy, cost-effective technique of accurate wound measurement for wound management.
Keywords
Digital planimetry; ImageJ; Wound.
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Current State of Gonadal Shielding in Medical Imaging: A Review
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Abstract [+]
Introduction
In recent times the benefits of using gonadal shielding have been brought into question. Several professional bodies have released positional statements in support of ceasing the use of gonadal shields. However, in Australia the regulatory authority for radiation has not commented to date. This literature review aims to explore the risks and benefits of using lead protection and to establish the current state of the use of gonadal shields in clinical practice.
Methods
A search of the literature was conducted using online databases under the subject “Medical Imaging and Radiation Sciences”. Key terms and phrases included “lead protection”, “plain film imaging”, “lead shielding”, “gonadal shielding”, “X-ray”, “radiography”, “pelvic radiography”,
“radiation protection”, “methods”, “education” and “gonadal shielding”. Articles pertaining to radiation therapy, literature reviews and those not in English were excluded.
Results and Discussion
Gonad shields are often poorly used despite agreement of what constitutes accurate and inaccurate shielding. Inaccurate shielding relates to both inappropriate size and inaccurate positioning of shields. Retrospective studies demonstrated a higher incidence of inaccurate gonadal shield placement in females compared to males. Inaccurate shielding had implications for patients such as obscuration of important anatomy and pathology and increased radiation dose if repeat X-rays were required to correct positioning errors. Shield design innovation was identified as a future area of research that could assist with overcoming these errors. Where gonad shielding was found to be of benefit in patients with conditions that require regular follow-up imaging. This is especially important in conditions affecting children and adolescents who have increased radiosensitivity and longer life expectancy.
Conclusion
Studies have demonstrated high incidence of inaccurately positioned gonad shields for female patients, which leads to repeated X-ray images and increased dose to patients. However, shielding has been shown to be beneficial for patients requiring frequent X-ray examinations to reduce cumulative radiation dose. Establishing a standardised protocol regarding the application of gonadal shields, supported by regulatory agencies, is imperative.
Keywords
Radiography; Gonadal lead protection; Dose; Radiation protection; Regulation.
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Single Dose Diclofenac and Tamsulosin Effectiveness in Patients Undergoing Double J-Stent Removal Under Local Anaesthesia
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Abstract [+]
Purpose
The purpose of this study was to see effectiveness of diclofenac sodium and tamsulosin combination on patients’ pain perception after ureteral stent removal.
Materials and Methods
Study was carried out from October 2019 to March 2021. All patients with unilateral stent placement after renal or ureteric stone endoscopic surgery were randomized in 3 groups. Group-A include 20 patients who were given placebo drug 2-hours prior to double J (DJ) removal. Group-B included 20 patients who were given oral diclofenac 2-hours prior to DJ removal. Group-C included 20 patients who were given oral diclofenac and tamsulosin 2-hours prior to DJ removal. All patients received 10 cc 2% viscous lidocaine intraurethral before cystoscopy. No sedatives or analgesics were administered during the procedure. All patients provided consent before the procedure and they were asked to record their pain experience on a visual analog pain scale as soon as the procedure was finished. The pulse rate and systolic and diastolic blood pressure (BP) were also recorded 5-minutes before the procedure and during the procedure
Results
General characteristic of age, gender and indication for DJ-stenting were comparable in all groups. The mean pain score on the visual analogue scale (VAS) in Group-C was significantly lower than that in Group-A and B (p<0.001) A statistically significant difference was found between the two groups in terms of anxiety scores after cystoscopy, intraoperative systolic BP and pulse rate. Patients who were given oral diclofenac and tamsulosin two hours prior to DJ removal experienced less pain and anxiety. Conclusion Oral diclofenac plus tamsulosin combination prior to DJ removal improves patient’s comfort. Keywords Diclofenac; Tamsulosin; DJ removal.
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Assessing the Occipital Condyles for Age Estimation of Non-Adults
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Abstract [+]
Objectives
New methods for assessing age of non-adult remains are frequently sought to improve the ability to correctly identify individuals in for forensic and archaeological purposes. Especially when faced with comingled remains, it is helpful to have a bone appropriate tool for age estimation. Research was carried out to assess the usefulness of the occipital condyles for aging non-adult individuals using metric and morphology analyses. The research population included occipital condyles, both fused and unfused, of individuals of known age at death non-adult from the from the Hamann-Todd Collection, Museum of Natural History, Cleveland, Ohio, USA (N=69); Colecção Esqueletos Identificados, Natural History Museum, University of Coimbra, Portugal (N=113); Museu Bocage, National Museum of Natural History, Lisbon, Portugal (N=60). Length and width measurements were taken then regression was used to analyse the datasets. Three morphological factors were observed including, level of fusion at the synchondrosis intraoccipitalis anterior, presence/absence of billows and presence/absence of depressions.
Results
Accuracy based on the metric model ranged between 37-71%. The morphological model showed fusion present as early as 3-years of age, with all non-adults over 8-years showing 100% complete fusion. Only individuals below 13-years of age displayed billows or depressions present; presence not absence of the morphological variables can be used to estimate age with a 92% accuracy rate.
Conclusion
The metric model does not reach an acceptable level of accuracy for use in aging non-adults. Morphology of the occipital condyles do not follow a specific age progression but can be used as a quick age assessment guide; if these morphological features are present the individual very likely between 3-13-years of age.
Keywords
Age; Non-adult; Occipital condyle; Osteology; Skeletal; Juvenile; Aging; Forensic.
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Combat Pandemic: Coronavirus Disease-2019 Vaccines Production, Clinical Trials and Global Partnerships
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Abstract [+]
The advent of coronavirus disease-2019 (COVID-19), in March 2020, has forced the entire world into continuously changing dimensions, the emergence of variants has put forward a challenge to scientists and doctors, indeed the entire world to cope with it. A lot of clinical research was done, starting with the use of Chloroquine, an anti-malarial drug to treat COVID-19, antivirals and indeed entire world experienced havoc and a death toll due to the coronavirus which led to the emergence of various vaccine platforms developed against changing variants of coronavirus and in this pandemic messenger Ribonucleic acid (mRNA) and nanotechnology added new dimensions to vaccine development. Vaccines may induce additional cellular or humoral immune regulations, including The cell (helper T-cell) responses and germinal center responses, and form relevant memory cells, which in turn enhance their efficiency. As the benefit outweighs the safety issues with vaccination so far, the World Health Organization (WHO), has approved a total of ten vaccines, to use in emergencies, including 3 Indian vaccines (Covovax™, Covaxin® and Sputnik V). The first part, of this mini-review highlights vaccine production, and the clinical trials landscape, and the second part discusses the emergence of global partnerships, and the equity of vaccines to all, taken together, combating pandemics.
Keywords
Pandemic; Immunogen; Adenovirus; Vaccines; Clinical trials; Global partnerships.
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Integrative Medicine Approaches in Irritable Bowel Syndrome Painful Bladder Syndrome and Infertility in Women Health
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Abstract [+]
Chronic pelvic pain syndrome (CPPS) is one of the common diseases in urology, gynecology, and gastroenterology. CPPS is a multifactorial disorder where pain may originate in any of the urogynecology, gastrointestinal, pelvic musculoskeletal, or nervous systems. The aim of this article is to sensitize general observation for all integrative medicine practitioner to analyze data for a best interdisciplinary approaches-oriented results for health orientation. Indeed, CPPS could be severe enough to limit functioning, unrelated to menstrual cycle, pregnancy, local trauma, or pelvic operations. This syndrome is one of the diseases shared by urology and gynecology. Its frequency is between 3% and 10%, and it is more frequent among women. The costs of treating CPPS were estimated at about $880 million annually. About 15% of women reported loss of workdays and 45% reported decreased work efficiency. This review aims at presenting an interdisciplinary overview on CPPS patients focusing on links between irritable bowel syndrome, painful bladder syndrome and infertility, to illustrate the relevance of integrative medicine. We propose an integrative approach to treating the diverse symptoms of irritable bowel syndrome (IBS) by combining the benefits of and need for pharmacotherapy with known complementary and alternative medicine (CAM) therapies to provide IBS patients with the best treatment outcome achievable.
Keywords
Complementary; Alternative; Integrative; Therapies; Interventions; Nutrition; Antioxidants; Herbs; Supplements; Biofeedback; Phytotherapy osteopathy; Acupuncture.
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Lessons Learned from Designing an Aeronautical Reconnaissance Coverage Geographic Information System Dashboard in the Geographic Information System-Naïve Environment to Fit the Spatial Epidemiology Study
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Abstract [+]
Background
Since patient access to healthcare is controlled by geographic location, patient records routinely include street addresses, postal codes, or other location elements. By linking spatial, numeric, and categorical health data through a single interface, the aeronautical reconnaissance coverage geographic information system (ArcGIS) dashboard adds the dimension of location and the quality of health information needed at the point of care. Its functions may be used to answer questions that would be difficult to answer without integrating raw patient data with location intelligence technology. However, the provision of geographic information system (GIS) functionalities at the point of care has not been thoroughly investigated.
Aim
This paper evaluates the ArcGIS dashboard functionalities through a case study of disruption in care for international patient populations due to the coronavirus disease-2019 (COVID-19) pandemic based on their home locations at the tertiary hospital in the U. S. Since the data used in this case study comes from the hospital health data repository, constructing the dashboard afforded an opportunity to explore the provision of GIS functionalities in the GIS–naïve hospital environment.
Methods
The model used the loose-coupling approach where two components (electronic health records and GIS data) were integrated and visualized through dashboard linking operations and programming languages. The process resulted in three data-driven dashboard elements: area map, attribute table, and statistical plots, enabling simultaneous exploration of various properties of spatial data.
Conclusion
This paper underpins the potential benefits of the provision of GIS functionalities in the electronic medical records to improve health outcomes, lower costs, and advance spatial epidemiology research. Additionally, it evaluates dashboard scaling limitations and solutions for overcoming the implementation barriers and proposes the future integration of the GIS dashboard with electronic health records by using the health level seven (HL7) fast healthcare interoperability resources (FHIR).
Keywords
Geographic information system (GIS); Spatial epidemiology; International patient healthcare; Hospital operations; GIS-enabled information dashboard; COVID-19; HL7; FHIR; RPDR.
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How to Perform Endoscopic Ultrasound-Guided Fine Needle Aspiration/Biopsy of Pancreatic Lesions?
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Abstract [+]
A endoscopic ultrasound-guided fine needle aspiration/biopsy (EUS-FNA/B) of pancreatic solid and cystic lesions is a modality, which huge numbers of articles has showed its high diagnostic accuracy. The degree of technical difficulty, size and type of needle, endoscopic technique, use of suction to aspirate tissue, use or not use of a stylet in the needle assembly, maneuvers to have high quality tissue, availability of an on-site cytopathologist, and, finally, end sonographer’s experience and skills who does the procedure have impact on the EUS-FNA results. Standard 19-G and 22-G fine-needle aspiration needles with or without high negative pressure have proven to be reliable in obtaining high-quality histologic samples in various indications. Twenty-five-gauge (25-gauge) needles provide better diagnostic yield when sampling pancreatic lesions compared with 22-G needles. The novel 19-G and 22-G ProCore™ needles have demonstrated a high yield in obtaining histologic samples, whereas 25-G. ProCore™ seems unsuitable for histology. A cytopathology service should be involved early in the planning process for establishing an EUS-FNA service. Data on the newly developed 20-G ProCore™, SharkCore® and Acquire® needles are limited, but appear very promising. Use of the stylet does not increase the yield of endoscopic ultrasonography-fine-needle aspiration and is more cumbersome to use. In perspective, endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is expected to refine differential diagnostic capabilities, favor widespread EUS utilization, and pave the road to targeted therapies and monitoring of treatment response. Approximately 3 to 5 passes should be sufficient to obtain a diagnosis. We need further studies for assessment of the use of Suction, Capillary (“Slow-Pull”), Wet and Fanning techniques.
Keywords
Pancreatic mass; Endosonography; Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA); Tissue aquisition; Stylet; Diagnostic accuracy; Cytology; Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB).
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Airport Personnel and Coronavirus Disease-2019: A Seroprevalence Study in Taiwan
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Abstract [+]
Introduction
Many countries tried to lifted the travel restriction to revive their stagnant tourism-based economies. However, infection risks among airport personnel are incompletely understood. We therefore conducted this seroepidemiological study targeting airport personnel.
Methods
This cross-sectional study was conducted from October 20th, 2020 to February 28th, 2021 at the Taoyuan International Airport in Taiwan. All adults who worked at Taoyuan International Airport and were older than 20-years of age were eligible for participation. Serological tests were collected and study participants were asked to complete an online questionnaire which collected self-reported data including demographic characteristics, occupation, exposure risk assessment, recent symptoms, and self-perceived risk of infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Continuous data were expressed with median and interquartile ranges; categorical data were expressed with counts and proportions.
Results
A total of 450 volunteers agreed to participate in the study. Most of the participants worked as ground crew (40.7%). Approximately 43.6% of participants did not feel any symptoms in the 3-months prior to serologic testing. Only 8 participants (1.8%) reported close contact with confirmed coronavirus disease-2019 (COVID-19) cases. Overall, none of the study participants had serologic confirmation of immunoglobulin G (IgG) antibodies against SARS-CoV-2.
Conclusion
The SARS-CoV-2 infection rate among airport personnel was low. This study demonstrates that a well-designed border control strategy may work and so that transmission of SARS-CoV-2 may be controllable.
Keywords
COVID-19; Seroprevalence; Travel; Airport; Workers.
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Why 100-Years After the Discovery of Insulin and the Appearance of Insulin-Induced Lipodystrophy: Are We Still Struggling with this Nasty Complication?
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Abstract [+]
Since a century ago, insulin extracted from the animal pancreas has been used for therapeutic purposes. Lipoatrophy (LA) lesions came up first due to the impurities of preparations. However, as technology has progressed, we have had more purified insulin preparations available, now reduced to less than 5%. The 95% of local complications was represented by lipohypertrophy (LH), due to the recourse to narrow areas of skin, reuse of the same needle, injection of cold insulin. The average frequency of LH in the world is 47%, with peaks of 75%, reflecting the inappropriate educational activity of the diabetic teams. In this brief review, the causes of this failure are described, and feasible rehabilitative solutions are proposed.
Keywords
Diabetes; Insulin; Injection technique; Lipoatrophy; Lipohypertrophy; Education; Rehabilitation.
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Association of Gestational Hypertension and Eclampsia to Maternal Smoking by Pre-Pregnancy Body Mass Index Status Among Aged 20-29-Years in the United States
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Abstract [+]
Objective
To investigate whether gestational hypertension (GH) and/or eclampsia was associated with the timing of maternal smoking when stratified by pre-pregnancy body mass index (pBMI) status.
Study Design and Methods
1,376,271 US-born mothers aged 20-29 from the 2019 infant natality data who had a singleton birth (20+ weeks of gestation) were analyzed in this study. Maternal smoking status was defined into five groups, i.e., non-smokers, quitted smoking before pregnancy, quitted smoking before the 2nd trimester, quitted smoking before the 3rd trimester, and smoked whole-time. Odds ratios (ORs) of GH or eclampsia were estimated separately using multiple logistic regression for maternal smoking by pBMI status (kg/m2): underweight (<18.5), normal (18.5≤25.0), overweight (25.0≤30.0), and obese (≥30.0). Results
Compared to non-smokers, the adjusted ORs (95% CIs) of GH for mothers who quit before pregnancy with pBMI underweight, normal, overweight, and obese were 1.17 (0.92-1.49), 1.11 (1.03-1.19), 1.13 (1.05-1.22), 1.13 (1.08-1.19), respectively. While the ORs (95% CIs) of GH for mothers who smoked for the entirety of their pregnancy were 0.71 (0.60-0.84), 0.80 (0.75-0.84), 0.79 (0.74-0.84), and 0.82 (0.78-0.85), respectively. The adjusted ORs for eclampsia showed a different pattern, only that for mothers who smoked for their whole pregnancy with normal and obese showed significantly (0.69 (0.53-0.91) for normal weight, 0.73 (0.58-0.92) for obese).
Conclusion
In comparison to non-smokers, an increase in the odds of GH were observed amongst normal, overweight, and obese mothers quitting before pregnancy meanwhile a decreased odds were observed amongst mothers smoking throughout pregnancy in all pBMI classes.Keywords
Maternal smoking; Gestational hypertension; Eclampsia; BMI.
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A Rare Case of Gemcitabine-Induced Pulmonary Hypertension
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Abstract [+]
Context
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.
Case Report
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.
Conclusion
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.
Keywords
Cholangiocarcinoma; Gemcitabine; Pulmonary hypertension.
Abbreviations
CT: Computed Tomography; PE: Pulmonary Thromboembolism; GIPT: Gemcitabine-Induced Pulmonary Toxicity.
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Nutrient-Dense, Functional Foods Enhance Hair, Skin, and Nail Appearance
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Abstract [+]
Objective
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.
Methods
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.
Results
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.
Conclusion
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.
Keywords
Appearance; Diet; Functional foods; Nutrient-dense foods; Hair; Skin; Nails.
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Recombinant Protein D from Haemophilus influenzae Induces Mouse Bactericidal Antibodies Against Typeable and Non-Typeable Haemophilus influenzae, which Partially Protect Infant Rats Against Serotype b Bacteraemia
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Abstract [+]
Aim
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.
Methods
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.
Results
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.
Conclusion
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.
Keywords
Haemophilus influenzae (Hi); Haemophilus influenzae serotype b bacteraemia; Rats.
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Superior Mesenteric Artery and Nutcracker Syndromes in a Healthy 14-Year-Old Girl Requiring Surgical Intervention after Failed Conservative Management
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Abstract [+]
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.
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Micropulse Transscleral Cyclophotocoagulation: Our Experience
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Abstract [+]
Introduction
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.
Methods
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.
Results
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.
Conclusion
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.
Keywords
Glaucoma; Micropulse laser; Cyclophotocoagulation.
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An Unusual Case of Nausea and Vomiting in Pregnancy: A Case Report
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Abstract [+]
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.
Keywords
Ladd bands; Pregnancy; Nausea; Vomiting; Hyperemesis; Volvulus.
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Correlation of 18F-Fluorodeoxyglucose Glucose Uptake by Liver Cancer and Transcriptional Regulation of the Warburg Effects in ATT-MYC Mouse Model of Liver Cancer
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Abstract [+]
Background
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).
Aim
To evaluate the correlation of gene expression and non-invasive microPET information of the liver tumors at different points of the stage of growth.
Methods
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.
Results
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.
Conclusion
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.
Keywords
18-FFluorodeoxyglucose (FDG); MicroPET; Exon array expression; Hepatocellular carcinoma (HCC); Att-myc transgenic mice; Diethylnitrosamine (DEN), Butylated hydroxytoluene (BHT); Glucose metabolism.
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Clinical and Ultrasonographic Evaluation of the Pelvic Floor in Primiparous Women after Normal Vaginal Delivery with Episiotomy and without Episiotomy
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Abstract [+]
Objective
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.
Methods
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).
Results
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.
Conclusion
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.
Keywords
Clinical and ultrasonography; Primiparous; Normal vaginal delivery; Episiotomy.
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The Time is Now for Disruptive Innovation in Pre-Exposure Prophylaxis Adherence Monitoring
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Abstract [+]
Monitoring adherence to pre-exposure prophylaxis is a critical component of reaching ending the human immunodeficiency virus infection (HIV) epidemic goals in the US. Currently, providers still depend on “self-report” pre-exposure prophylaxis (PrEP) adherence, whereby providers ask their patients about their recent pill taking habits. There appears to be growing consensus across the HIV prevention community that “self-report” is an inadequate method of identifying that is in-need of additional adherence support services. In a recent survey, 97% of providers report utilizing self-reported adherence because it is convenient, but only 10% of these providers believe it is accurate. While “self-report” is convenient, evidence and testimonials from diverse stakeholders across the HIV prevention landscape indicate that there is a desire for more accurate, effective adherence monitoring methods. In this mini-review, we will briefly synthesize the emerging evidence and propose a solution to ensure all patients receive the support needed to protect them from HIV acquisition.
Keywords
Pre-exposure prophylaxis; HIV; Adherence; Prevention; Self-report.
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Model Liposomal Delivery System for Drugs and Vaccines
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Abstract [+]
Background
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.
Methods
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.
Results
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.
Conclusion
We produced a liposome formulation that can be used as a model system for the delivery of drugs and vaccines.
Keywords
Liposomes; Drug delivery; Vaccines delivery; Egg phosphatidylglycerol; Polyethylene glycol.
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Cesarean Section Rate at Lumbini Zonal Hospital, Nepal: An Analysis Using the Robson Ten Group Classification System
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Background
Caesarean section (CS) rates have increased globally. The World Health Organization (WHO) recommends the use of the Ten-Group Robson classification as the global standard for assessing appropriateness of CS. Nepal has higher-than-global average rates of CS requiring further investigation into appropriateness.
Aim
This study aims to investigate the caesarean section rates at tertiary care center in Nepal and make analysis based on the group-10 classification.
Methods
A retrospective cross-sectional study was carried out from 2016 April -2017 March in Lumbini Zonal Hospital, Butwal, Rupendehi, Nepal. 3,817 women who birth over a 12-month period were analyzed using this classification. The caesarean rate, its indications were calculated and categorized into groups according to Robson’s 10-group classification.
Results
Women with previous CS (Group 5) comprise the largest proportion (9.4%) of the overall 26.41% CS rate. The second largest contributor was a singleton nulliparous woman with cephalic presentation at term (6.6% of total 26.41%). Caesarean section rates in single breech pregnancies were very high (>65%). Robson’s Group 5 was the highest contributors to overall CS rate contributing 35% of all C-sections, followed by Group 2 (24%), and Group 1 (13%).
Conclusion
The ten-group classification helped to identify the main groups of the subjects who contribute the most to the overall caesarean section rate. This study results suggest that women with previous CS are at risk for having another CS delivery in subsequent pregnancies and therefore there is an urgent need for a dedicated vaginal birth after caesarean section (VBAC) clinic to support this such women to ensure CS are only done when indicated. Furthermore, reducing the CS rate for nulliparous i.e. Group 1 and 2 would, in the long-term, also reduce the size of Group 5 in the future.
Keywords
Cesarean rate; Caesarean section; Robson’s group classification.
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Implant-Supported Removable Partial Denture: An Approach to Rehabilitate Maxillary Kennedy Class I
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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.
Keywords
Dental implant; Distal extension removable partial denture; Kennedy Class I; Attachment denture.
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Accuracy of Bioimpedance Modalities for Fluid Assessment in Hemodialysis Patients: A Randomized Observational Study
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Aim
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.
Methods
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.
Results
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.
Conclusion
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.
Keywords
Body composition/physiology; Body fluid/physiology; Electric impedance; Extracellular fluid/metabolism; Renal dialysis.
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Revision of Maryland Minor Consent Law on Human Immunodeficiency Virus Infection Prevention: An Outcome of Advocacy
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Objectives
To date, only few United States (US) states have explicit regulations that allow minors to independently give consent for human immunodeficiency virus infection (HIV) prevention treatments. This manuscript will reflect upon key advocacy efforts leading to the revision of the Maryland Minor Consent Law, evaluate current human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) prevention laws for minors in U.S. states, and highlight resources for health advocacy.
Methods
Between 2018-2019, public health professionals in Baltimore, Maryland reviewed the Maryland Minor Consent Law and other adolescent consent laws within the U.S. The professionals advocated for a legal review of the gap by the State Senate and the Office of Attorney General.
Results
In May 2019, the public health advocates were successful in their effort for a revision of the Maryland Minor Consent Law to include Treatment for the Prevention of HIV-Consent by minors. Upon their review of all adolescent consent laws within the U.S., they found that only eleven states currently have explicit language indicative of an adolescent’s ability to give consent for pre-exposure prophylaxis (PrEP).
Conclusion
This inquiry can change upstream factors such as laws, regulations, policies and institutional practices.
Keywords
HIV, Prevention, Pre-exposure prophylaxis, Adolescents, Minor consent law.
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Anti-Platelet-Derived Growth Factor Receptor-Beta Therapy Does Not Trigger Retinal Endothelial Cell Toxicity
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Background
Retinoblastoma (Rb) is a highly angiogenic tumor, for which anti-vascular endothelial growth factor (VEGF) therapies have shown limited success in clinical setting. Recent investigations demonstrated upregulation of ancillary axis including the platelet-derived growth factor (PDGF) when VEGF is inhibited. This illustrates the need for novel therapeutics. Previous work from our lab showed inhibition of the platelet-derived growth factor receptor-beta (PDGFR-β) by imatinibmesylate (IM), inhibited Rb cells proliferation in vitro. Novel therapies ideally are tumor-specific, leaving normal non-cancerous cells a stroma to perform their homeostatic functions. Rb treatments induce apoptosis of the retinal endothelial cells, causing the release of pro-inflammatory cytokines and chemokines to the microenvironment.
Aims
We investigated the role of the PDGFR-β in the tumor microenvironment and how inhibition of this signaling pathway, as a potential targeted therapy, impacts angiogenesis in human retinal microvascular endothelial cells (hRECs), specialized neurons arborizing the retinal microvasculature.
Results
Our results demonstrated that inhibition of the PDGFR-β signaling pathway by IM affects the proliferation of the Rb cells, but not hRECs. PDGFR-β signaling is not required for hRECs angiogenic activity, although it reduces the percentage of VEGF-Aproducing cells.
Conclusion
These results illustrate a lack of functional activity PDGFR-β signaling in hRECs and points to a more tumor-specific therapeutic option. This is of critical importance as success of treatment also depends on the ability of the normal tissues to remain healthy after sensitization and/or killing of the Rb tumor.
Keywords
Retinoblastoma; Retinal endothelial cells; Ocular oncology; Imatinib mesylate.
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Natural Honey as a Safe and Efficacious Alternative to Skin Grafting Post-Surgical Excision for Necrotizing Fasciitis at Primary Care Level: A Preliminary Study
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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.
Keywords
Natural honey; Necrotizing fasciitis; Primary care; Wounds.
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The Promise of Small Data for Telemedicine in Chronic Condition Management: A Real-World Case Series
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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.
Keywords
Telemedicine; Small data; n-of-1; Internet of things; Chronic conditions; Self-management; Predictive analytics.
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Prolonged Cardiac Arrest in Severe Bupropion Intoxication: Everything You Should Know About Anti-Arrhytmics, Transesophageal Echocardiography Guided Resuscitation and Extracorporeal Membrane Oxygenation
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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.
Keywords
Bupropion; Intoxication; Extracorporeal membrane oxygenation; TEE guided resuscitation; Antiarrhythmic therapy.
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The Effects of the Oral Supplementation with a Natural Keratin Hydrolysate (Kera-Diet®) on Hair and Nails: Randomized, Placebo and Benchmark-Controlled Clinical Trial on Healthy Females
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Background
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.
Objective
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.
Methods
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.
Results
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.
Conclusion
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.
Keywords
Keratin hydrolysate; Oral supplementation; Telogen effluvium; Hair growth; Brittle nail syndrome; Onychoschizia; Clinical study.
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Development of Yoghurt Spread from Goat Milk and its Qualitative Valorization Using Chia Seed Oil
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Aim
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.
Methodology
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.
Results
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.
Conclusion
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.
Keywords
Yoghurt spread; Goat milk; Chia seed oil; Qualitative valorization; Shelf life.
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Paediatric Urolithiasis an Emerging Concern: Single Centre Experience in a Non-Endemic Region in South India
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Introduction
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.
Methods
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.
Results
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.
Conclusion
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.
Keywords
Paediatrics; Urolithiasis; Urinary tract infection (UTI).
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Treatment of Acute Antibody-Mediated Rejection in Children Post-Kidney Transplantation: A Single Center’s Experience
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Introduction
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).
Methods
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.
Results
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.
Conclusion
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.
Keywords
Acute antibody-mediated rejection (aAMR); Intravenous gamma globulin (IVIG); Pediatric renal transplant recipients (pRTRs).
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A Shared Information Technology-Business-Health Model: Lessons for Healthcare Leaders on Integrating Technology from Investment
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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.
Keywords
Health care; Business; Information technology; Shared; Leadership; Understanding; Straight through processing.
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A Case of Glomus Tympanicum During Stapedotomy Surgery for Otosclerosis
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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.
Keywords
Glomus tympanicum; Otosclerosis; Paraganglioma; Stapedotomy.
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Immunotoxic Effects of Cypermethrin in Male Wistar Rats: Attenuation by Co-Administration of Zinc and Alpha-Lipoic Acid
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Aim
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.
Methods
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.
Results
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. Conclusion 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. Keywords Cypermethrin; Zinc and alpha-lipoic acid; Total serum immunoglobulin; Blood mononuclear cell proliferation; Phagocytic index.
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Psychological Effects of Coronavirus Disease 2019 on Students
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Background
This qualitative study investigated the psychological effects on 21 U.S. high school students during the coronavirus disease 2019 (COVID-19) pandemic.
Aim
The study aimed to identify and assess the pandemic’s effect on the mental health of these students.
Method
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.
Results
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.
Conclusion
This study’s results may help create programs that better meet students’ mental and social needs.
Keywords
COVID-19; Pandemic; High school; College students; Mental health; Stress; Anxiety; Coping strategies; Depression.
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Using PF-MOUTH GELTM for Sore or Painful Tongue Improved Symptoms and Stabilized Dryness and Trapping of Food: A Case Report
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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.
Keywords
Tongue; Fucoidan; Inflammation; Treatment; Gel.
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Comparative Study of the Antimicrobial Activity of Clove Oil and Clove Extract on Oral Pathogens
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Objective
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.
Results
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
Conclusion
The clove oil has the potential to be used as a natural antibacterial agent for oral pathogens.
Keywords
Syzygiumaromaticum; Clove extract; Clove oil; Antimicrobial; Oral pathogens.
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Ultra-Early Cord Decompression in the Emergency Setting and its Impact on Outcome
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Background
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.
Case Presentation
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.
Conclusion
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.
Keywords
Cervical spine; Early decompression; Surgery; Trauma.
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A Comparison of Efficacy, Safety and Cost Between MANTATM and Proglide Vascular Closure Devices Following Transfemoral Transcatheter Aortic Valve Implantation
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Aims
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.
Methods
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.
Results
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).
Conclusion
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.
Keywords
Transcatheter valve interventions; Vascular complications; Vascular closure devices (VCD).
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Cardiovascular Health and Healthcare Use of United States-Born and African-Born Blacks: A Review
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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.
populations.
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.
Methods
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.
Results
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.
Conclusion
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.
Keywords
Cardiovascular health; African-born Blacks; U.S-born blacks; Healthcare utilization.
Abbreviations
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.
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Oral and Gut Health Can Play an Important Role in Psychosomatic Illness Associated with Coronavirus Disease 2019 Patients
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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.
Keywords
COVID-19; SARS-CoV-2; Dental; Stress; HPA.
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Current Opinion in Pharmacological and Non-Pharmacological Treatment of Migraine: A Focus on Calcitonin Gene-Related Peptide
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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.
Keywords
Migraine treatment; CGRP antagonists; Neuromodulation; Nerve stimulation; Trigeminal activation; Cortical spreading depression.
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The Role of Intravenous Lidocaine in Preventing Chronic Post-Operative Pain
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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
surgery.
Conclusion
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.
Keywords
Chronic pain; Chronic post-operative pain; Chronic post-surgical pain; Intravenous lidocaine.
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Comparison of Anthropometric Equations and Dual X-ray Absorptiometry to Determine Body Composition in Active Breast Cancer Survivors
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Objective
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.
Results
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. Conclusion 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. Keywords Breast cancer; Body composition; Percentage fat; Bone mineral density.
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Idiopathic Primary Retroperitoneal Cyst: A Case Report
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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.
Keywords
Retroperitoneal Cyst; Ultrasound; Histopathology.
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Autonomic Dysreflexia: Atypical Complication from Immediate Release Tapentadol
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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.
Keywords
Spinal cord injury; Transverse myelitis; Pharmacokinetics; Opioids.
Abbreviations
TM: Transverse myelitis; CNS: Central nervous system; AD: Autonomic dysreflexia; VAS: Visual analogue scale; MET: Medical emergency team.
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Pulsed Electromagnetic Stimulation Therapy for Erectile Dysfunction
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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.
Keywords
Erectile dysfunction; Electromagnetic stimulation therapy; Latest treatment; Non-invasive treatment;
Erection hardness scale (EGS).
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Criminal Justice Alcohol and Drug Screening in Practice: Using the Substance Abuse Subtle Screening Inventory to Identify Substance Use Disorder in Offenders
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Objective
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.
Results
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.
Conclusion
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.
Keywords
Subtle SUD screening; The SASSI Institute; Criminal offenders; Corrections; Recidivism; Alcohol and drug screening.
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Vitamin C, E and Zinc Ameliorates Cadmium-Toxicity Induced Biochemical Changes in Male Albino Rats
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Background
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.
Methods
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.
Results
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. Conclusion Our results demonstrate that co-administration of Vitamin C, E and Zinc ably protects the toxicity of CD in Wistar rats significantly. Keywords Cadmium; Wistar rats; Oxidative stress.
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Botulinum Toxin Type A in Neurogenic Overactive Bladder Dysfunction in Patients with Multiple SclerosisBotulinum Toxin Type A in Neurogenic Overactive Bladder Dysfunction in Patients with Multiple Sclerosis
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Introduction
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.
Outcomes
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. Conclusion Botulinum toxin generates a positive impact on the QoL of patients with neurogenic OAB with MS.
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Pinna Swelling an Angiolymphoid Hyperplasia with Eosinophilia: A Rare Case Report
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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.
Keywords
Pinna; Swelling; Angiolymphoid; Hyperplasia; Eosinophilia.
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Relationship between Academic Stress and Emotional Intelligence in High School Students
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Background
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.
Method
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.
Results
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.
Keywords
Academic stress; Emotional intelligence; High school students; Family structure.
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Nutritional Interventions for Surgical Patients
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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.
Keywords
Nutrition; Orthopedics; Cosmetic; Surgery; Outcomes; Supplementation; Healing; Recovery.
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Hyperbaric Oxygen Attenuates Aortic Vasoconstriction after Simulated Microgravity in Rats
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Background
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.
Methods
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.
Results
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).
Conclusion
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.
Keywords
Hyperbaric oxygen; Vascular reactivity; Hindlimb suspension.
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Impact of Evidence-Based Functional Intervention Approach on an Individual with Wernicke’s Aphasia Based on International Classification of Functioning, Disability and Health Framework: A Case Study
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Background
Severe comprehension impairments in Wernicke’s aphasia (WA) are often seen to be associated with auditory related impairment and phonological processing, including semantic and executive difficulties. This study investigated whether an intensive functional approach regime underpins the improvement in speech, language and cognitive domains in an individual with WA resulting in a positive impact on functional communication skills and quality of life-based on international classification of functioning (ICF), disability and health framework.
Aim
To study the impact of evidence-based functional treatment approach on the speech, language, cognitive and quality of life (QoL) domains in a patient diagnosed with WA based on ICF Framework.
Objective
The purpose of this longitudinal case study was to compare before- and after-scores of speech and language abilities, cognitive abilities and QoL in a patient diagnosed with WA after providing an intensive evidence-based functional communication treatment approach.
Material and Methods
A case aged 60-years-old male with a one-month history of stroke; was diagnosed as WA. The patient received intensive functional treatment approach focusing on language and cognition for one hour continuously per session, for eight sessions, within 2-months which involved different therapy approaches to improve his communication abilities. The measurement of language, cognitive abilities and QoL was assessed using the English adaptation of the Western Aphasia Battery (WAB), Addenbrooke’s Cognitive Examination-Revised (ACE-R) and World Health Organization Quality of Life Instrument, Short Form ((WHOQoLBREF) respectively. The results obtained were analyzed based upon the scores obtained across the domains of WAB, ACE-R, and
QoL in two stages i.e. pre- and post-intensive aphasia functional language intervention program.
Results
The outcome of the current study revealed improved scores in WAB, ACE-R, and WHOQoL which highlighted the fact that aphasia therapy techniques targeting the language and functional goals must be followed and implemented during the therapeutic sessions based on the client’s type of aphasia.
Conclusion
The findings of the case study suggests that the impact of functional communication approach targeting the maximum participation of the person with aphasia seems to be one of the most effective and efficient way to rehabilitate aphasics to improve their QoL.
Keywords
Wernicke’s aphasia (WA); Functional communication; Quality of life (QoL); International classification of functioning (ICF).
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Association of Fat Mass and Obesity Associated, Dopamine Receptor Type 2 and Ankyrin Repeat and Kinase Domain Containing 1 Genes with Pediatric Obesity and Metabolic Risk: A Case-Control Study
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Background
Genetic polymorphisms that affect the availability and secretion of dopamine can affect the risk of obesity.
Objectives
To investigate the relationship between pediatric obesity and cardiovascular risk factors (CRF) with the polymorphisms of “Fat Mass and Obesity Associated” (FTO) rs9939609, “Dopamine Receptor type 2” (DRD2) rs6277 and “Ankyrin Repeat and Kinase Domain Containing 1” (ANKK1) rs18000497 genes.
Methods
Case-Control study conducted with 226 pediatric patients from 5 to 16-years of age. The two main groups, Obese (O) and Eutrophic (E), were subdivided according to the value of HOMA-IR into obese with insulin resistance (ORI) or insulin sensitivity (OSI) and eutrophic resistant (ERI) or sensitive (ESI) to insulin. According to the presence of two or more CRF, they were subdivided into metabolically unhealthy or metabolically healthy groups: Obese Metabolically Unhealthy (OMU), Obese Metabolically Healthy (OMH), Eutrophic Metabolically Unhealthy (EMU) and Eutrophic Metabolically Healthy (EMH). Polymorphisms were determined by real-time Polymerase Chain Reaction (PCR) or Restriction Fragment Length Polymorphisms (PCR-RFLP).
Results
In the obese group, the higher the number of risk alleles of FTO and ANKK1 genes isolated and the three genes combined, the higher the mean BMI (p<0.0001). Regarding the FTO gene: the frequency of the risk allele was: 57.7%-ERI, 37.4%-ESI (p=0.048), and the homozygous wild genotype was: 29.5%-OMU, 37.5%-OMH (p=0.02). Regarding the DRD2 gene: the genotypes with the risk allele were present in 84.6%-OMU and 67.5%-OMH (p=0.031). Regarding the ANKK1 gene: the frequency of the homozygous risk genotype was current in 15.4%-ERI and 13.5%-ESI (p<0.0001) and 62.5%-EMU and 41.5%-OMH (p=0.031). Conclusion Risk alleles of FTO, DRD2 and ANKK1 genes had an additive effect on the outcome of pediatric obesity in Brazilian children and conferred a higher risk of insulin resistance (FTO and ANKK1) and CRF. Keywords Childhood obesity; Genetic polymorphism; Insulin resistance; Metabolic syndrome; Dopamine.
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Effectiveness of Endoscopic Pitch Raising Surgery in Male to Female Transsexual Individuals
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Aim
This study was performed to investigate the effectiveness of two endoscopic techniques for transsexual females.
Method
Web of Science, Google Scholar, and PubMed databases were searched for studies suitable for inclusion in this meta-analysis. Studies in which Wendler’s glottoplasty or laser-assisted voice adjustment were analysed for the data criteria. Studies which included
pre-operative and post-operative fundamentals frequency values were selected. Five articles were included in the present study (total of 94 cases). As dependent groups were used in these studies, standardized mean differences were obtained using a random effect model. Analyses were performed using the meta for package for the R-statistical program.
Results
Standardized mean values before and after operations were very different and post-operative mean values were significantly higher than the pre-operative mean values.
Conclusion
Endolaryngeal surgical techniques are valuable for pitch elevation.
Keywords
Transgender; Phonosurgery; Voice; Gender and the voice; Endoscopy US version.
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A Clonorchis Sinensis in the Gallbladder: A Rare Case in Kuwait
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Clonorchis Sinensis is an important foodborne pathogen. It is actively transmitted in far-East countries and Asia, especially in China. It enters the biliary system via ingestion of infected cysts. It is exceedingly rare to encounter such a presentation in the Middle East, particular in Kuwait. The presence of liver fluke in the biliary system may lead to adverse complications. We are presenting a case report describing quite an unusual gallbladder finding in a 55-year-old Chinese lady.
Keywords
Clonorchis sinensis; Gallbladder; Acute cholecystitis; Liver fluke.
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Decision-Making in Diagnosis and Management of Extraintestinal Manifestations of Inflammatory Bowel Disease
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In the absence of certainty regarding the causes of both inflammatory bowel disease (IBD) and its extraintestinal manifestations (EIMs), there is necessarily ambiguity in both academic and clinical arenas concerning the diagnosis, classifications, and treatments of EIMs. While the “true” EIMs are considered extensions of the IBD gut pathogenesis with an immunologically mediated inflammatory consequence, other EIMs are considered to be complications of IBD itself or its treatment. A third group of IBD EIMs includes those disorders which seem to occur more often in IBD but for which an etiologic or pathophysiologic connection to IBD is highly theoretical. Patients with IBD and EIMs tend to have more severe, long-duration disease, and a reduced quality of life. EIMs presentation may or may not parallel IBD gut inflammatory activity. The clinical decision-making processes necessary for successfully managing simultaneously the gut component of IBD and its EIMs are presented. Based upon clinical experience and review of leading publications, the consensus of best practices, differential diagnoses for EIMs, and
current management programs are presented with enumeration of specific decisions and considerations required for successful management of EIMs. EIMs of inflammatory bowel disease reflect the immunopathologic common ground and hence the systemic nature of the IBD. A defined decision-making process is offered which includes consultations and attention to the differential diagnosis to avoid not uncommon mistakes in diagnosis. Management of all EIMs requires assessment of both the clinical and pathologic status
of the gut component of IBD combined with judicious selection of general and /or immunosuppression therapy for the EIMs.
Keywords
Ulcerative colitis; Crohn’s disease; Erythema nodosum; Pyoderma gangrenosum; Primary sclerosing cholangitis; Spondyloarthritis; Uveitis; Paradoxical dermatitis.
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Clinical Descriptive Study of Psoriasis in India: Triggers, Morbidities and Coincidences
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Background
Psoriasis is a T-cell mediated chronic inflammatory, a papulosquamous disease involving complex interactions between the innate and adaptive immune system and commonly manifested by skin lesions. It is characterized by hyperproliferation of keratinocytes and inflammatory infiltration in the epidermis and dermis. Chronic psoriasis can be a risk factor for developing comorbid diseases that share common immune pathophysiology and can be triggered by environmental factors in genetically susceptible individuals.
Aim
To study the clinico-demographic profile, determine the most common triggering factors and determine comorbidities’ coexistence in patients with psoriasis at a tertiary care centre.
Study Design
A cross-sectional study.
Methods
A teaching hospital-based cross-sectional study including 231 psoriasis patients visiting skin outpatient department (OPD) was conducted by the dermatology departmentat Sri Krishna hospital, Karamsad, India following acceptance of the study proposal by the human research ethics committee. This study was outcome of the dissertation topic of the author during dermatology residency. Total 5 qualified dermatologists working in the dermatology department and 3 resident doctors took part in the study as evaluators. After taking informed consent, detailed history regarding aggravating factors, progress and morbidities was taken with clinical examinations, and the diagnosis was purely clinical. Data were analysed using statistical package for the social sciences (SPSS).
Result
Our study revealed a peak incidence of psoriasis in the fourth and fifth decade of life with male preponderance (1.9:1). The most commonly found psoriasis type was psoriasis vulgaris, and chronic plaque psoriasis and the most common site of involvement was extensors and trunk. Pruritis was the most disabling complaint (91.34%), and the disease course was progressive. Aggravating factors included stress, winter season, implant insertion, smoking, alcohol consumption, tobacco chewing and obesity. Koebner phenomenon was commonly found with implant insertion in psoriasis patients (76.2%). Family history was one of the well established risk factors for developing psoriasis (14.2%). Our study’s most commonly found nail changes were pitting (35.49%) and dystrophic changes (18.61%). Palmoplantar keratoderma (4.76%) and vitiligo (4.76%) were the most commonly found dermatological condition with psoriasis and have been associated with various comorbidities such as cardiovascular disorder, metabolic syndrome, psoriatic arthritis and psychiatric disorders. As it was a cross-sectional study, no controls were used.
Conclusion
The study shows male preponderance and extensors, trunk as common sites of psoriatic lesion presentation. Aggravating factors included stress, winter season, implant insertion, smoking, alcohol consumption, tobacco chewing and obesity. Screening is
encouraged for symptoms of psoriatic arthritis, cardiovascular diseases and metabolic syndromes in psoriasis patients due to its predilection with systemic comorbidities.
Keywords
Psoriasis; Comorbidities; Cardiovascular disease; Metabolic syndrome; Risk factor; Triggers.
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A Case of Progestogen Hypersensitivity
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Progestogen hypersensitivity (PH) is a cyclical dermatosis that occurs in fertile women during the luteal phase of the menstrual cycle. The clinical presentation is variable and non-specific. We report the case of a 42-year-old woman with a 10-year history of itchy skin lesions that recurred monthly. Determined with her basal body temperature chart, her skin symptoms were related to progesterone surges. Skin examinations revealed multiple and extensive monomorphic red papules, mainly on her arms and legs, as well as on her chest and back. She had no history of associated fever or dyspnea. Her hair, nails and mucous membranes were normal. A blood test at the time of the worst skin eruption revealed mild elevation of serum thymus and activation-regulated chemokines and eosinophilia. Her total serum IgE level was normal. She showed a delayed skin reaction to progesterone. Ultra-low-dose combined oral contraceptives (COCs) improved her symptoms by suppressing ovulation. Accordingly, a diagnosis of progestogen hypersensitivity was made. A T-helper (Th)2 response rather than a Th1 response was suggested to be involved in this case. Atopic dermatitis (AD) can be classified into the major extrinsic type with high serum IgE levels and the minor intrinsic type with normal IgE levels. PH and AD share similarities in that they present with eczema, IgE-mediated sensitization and delayed hypersensitivity responses, and their pathophysiology remains to be fully elucidated because of their heterogeneous aspects. The symptoms of this case were in line with IgE-low AD rather than IgE-high AD, which implicates endogenous progesterone as a trigger.
Keywords
Progestogen hypersensitivity; Woman’s issues; Dermatitis; Diagnosis.
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Giant Iatrogenic Lumbar Pseudomeningocele: A Case Report and Literature Review
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Post-discectomy iatrogenic lumbar pseudomeningoceles are an uncommon complication. This pathology is an extradural, encapsulated, cerebrospinal fluid collection which develops at the site of previous surgery as the consequence of an unnoticed or unrepairable dural tear. A pseudomeningocele is defined as giant if it grows beyond 8 cm in length. Giant iatrogenic pseudomeningoceles with detailed information are quite rare in the literature with only 21 reported cases including the current case. Herein, we present a middle age woman with a giant pseudomeningocele which had developed subsequent to L4-L5 discectomy.
Keywords
Iatrogenic lumbar pseudomeningocele; Pathology; Discectomy.
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A Clinical Paradigm and Pertinent Literature Review for Placing Short Implants
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Placing an implant to replace missing teeth can be challenging because of lack of vertical and/or horizontal bone ridge, maxillary sinus pneumatization and inferior alveolar nerve position. Additional surgical procedures may be necessary, with varying predictability,
where vertical augmentation being the least predictable. An alternative option is to place short implants and exclude the additional surgical grafting procedures. By reviewing studies, this paper explores the predictability of the short implants for use in the methods. Bicon SHORT® implants are available in 5 and 6 mm lengths and seem to be able to overcome such limits but more long-term studies are still needed to determine long-term prognosis and success of short implants in terms of them being comparable or equal to longer or standard length implants.
Keywords
Short implants; Bone augmentation; Ridge height; Implant length; Implant width.
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Acute Mesenteric Ischemia in Severe Coronavirus (COVID19): Cases Report of 3 Patients
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Background
Coronavirus disease 2019 (COVID-19) is a respiratory disease with pulmonary infection, but some patients experiment gastrointestinal symptoms, in the literature only few cases of mesenteric ischemia in patients with severe COVID-19 infections have been described.
Cases
We present 3 cases of patient with severe COVID-19, with gastrointestinal manifestation in which bowel lesion was observed and which took benefits from bowel resections. No evidence available conclusively demonstrated a thrombotic or embolic event in our cases, therefore a precise knowledge of the mechanism of bowel lesion in COVID-19 patients is essential. Clinical managing patients with COVID-19 whom manifest gastrointestinal symptomatology should be aware of the mesenteric ischemia involvement.
Conclusion
In conclusion, patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may show atypical presentations, such as gastrointestinal symptoms, precise knowledge of the mechanism of bowel lesion in COVID-19 patients are essential.
Keywords
COVID-19; Mesenteric ischemia; Severe coronavirus.
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Strategies and Challenges in the Development of Coronavirus Disease-2019 Vaccine
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The novel coronavirus infection (coronavirus disease-2019 (COVID-19)) emerged from Wuhan in the Hubei Province of China in late 2019. Millions of people were infected with COVID-19 pandemic due to the long incubation period of the virus inside the human body and the dearth of available treatments or vaccines. High transmission rates created havoc, which highlighted the urgent need for effective interventions to stop the spread and clinical impact of the virus on patients and populations. Previous research on severe acute respiratory syndrome coronavirus (SARS-CoV) provides information on vaccination strategies that could inform how governments approach the elimination of this novel coronavirus. Numerous efforts have been made to develop vaccines against Middle East respiratory syndrome (MERS) and SARS. The spike glycoprotein or S protein is the critical target for most of the drugs and vaccines against coronavirus. The virus uses the spike (S) protein for entering the host cell, by interacting
with the receptor called angiotensin converting enzyme-2 (ACE2). Various vaccine platforms are available such as nucleic acid vaccine, protein-based vaccines, virus-vectored vaccines and live or attenuated vaccines, with each having their advantages and disadvantages. This review focuses on the overview of different vaccine candidates used, those currently in development, and the challenges encountered while developing effective vaccines.
Keywords
SARS-CoV-2; Vaccine development; Clinical trials.
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Acute Liver Injury after Three Doses of Nitrofurantoin
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A 56-year-old lady presented to the hospital with 2-day history of flu like symptoms. These had begun within a few hours after starting Nitrofurantoin for urinary tract infection that was prescribed by her primary care doctor. Blood tests upon admission revealed elevated aminotransferase levels with normal bilirubin levels. The medication was stopped, and other causes of hepatitis were investigated. Nitrofurantoin induced idiosyncratic drug-induced liver injury (IDILI) was confirmed by excluding all other causes. Patient’s symptoms and liver enzymes improved the next day and she was discharged. A follow-up on the laboratory’s nine-days later revealed liver enzymes almost back to normal.
Keywords
Nitrofurantoin; Urinary tract infection; Idiosyncratic drug induced liver injury; Acute reversible hepatotoxicity; Flu-like illness; Elevated transaminases.
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The Dermoscopic “Chromosome Arms Sign” for Terra Firma-Forme Dermatosis
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Introduction
Terra firma-forme dermatosis (TFFD) belongs to the group of “dirty dermatoses” and represents a not well-known and surely underestimated skin condition.
Clinical cases
We present 2 cases of TFFD and present clinical and dermatoscopical findings.
Results
We present specific dermatoscopical findings of TFFD.
Conclusion
We propose the denomination “chromosome arms” sign for Terra firma-forme dermatosis.
Keywords
Terra firma-forme dermatosis; Dirtydermatoses; Dermatoscopy; Chromosome arms; Duncan’s dermatosis.
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Chylous Ascites Associated with Internal Hernia Post-Roux-en-Y Gastric Bypass: A Case Report
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Chyloperitoneum is a rare intra-abdominal finding in internal hernia, only a few cases reports mentioned in the literature. It presents around 0.001-0.005% of hospital admissions. The presence of chylous ascites and swirl sign in a patient is a good indication of internal hernia and the bowel’s validity.
Keywords
Chylous ascites; Chyloperitoneum; Internal hernia; Roux-en-Y gastric bypass.
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Extra-Pulmonary Manifestations of Coronavirus Disease 2019: A Multi System Disease
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Introduction
The outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV- 2), has been recently declared a pandemic by the World Health Organization. Apart from acute respiratory manifestations, SARS-CoV-2 may also adversely affect other organ systems. To date, however, there is a very limited understanding
of the manifestations and management of COVID-19 related conditions outside of the pulmonary system. This study provides an overview of the current literature about the extra pulmonary manifestations of COVID-19 that may affect the renal, cardiovascular, gastrointestinal, hematological, hematopoietic, neurological, or reproductive systems. This study also describes the current understanding of the extra pulmonary manifestations caused by COVID-19 to improve the management and prognosis of patients with COVID-19.
Materials and Methods
A total number of 200 hospitalized patients with COVID-19 disease were retrospectively evaluated for extra-pulmonary manifestations findings or complications. These patients had undergone various imaging studies, blood examinations during the course of hospital stay. The data reviewed using the institutional PACS, database system over a period of four months (August to November 2020).
Results
Among the 200 patients (males and females), 175 of them had extra-pulmonary complications. Various extra-pulmonary findings such as acute kidney injury, renal failure, cytokinase strome, acute myocardial injury, congestive cardiac failure, pulmonary thromboembolism,
gastrointestinal, neurological complications were observed.
Inclusion and Exclusion Criteria
All retrospective clinical studies, case series, and case reports with data on extra-pulmonary manifestations in COVID-19 that were published from the end of December 2019 till the end of February 2021 were included. Studies that did not mention extrapulmonary manifestations were excluded.
Literature Search
The review was based on publications available on PubMed and data collected by the World Health Organization (WHO). Search terms used were ‘novel coronavirus 2019 (2019-nCoV)’, ‘SARS- CoV-2’, or ‘COVID-19’ combined with ‘asymptomatic’, ‘gastrointestinal’, ‘cardiac’, ‘neurological’, ‘hepatic’, ‘hematological’, ‘renal’, ‘psychiatric’, ‘hematological’, and ‘atypical’.
Keywords
COVID-19; SARS-CoV-2; 2019-nCoV.
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Adipofascial Turnover Forearm Flap for a Large Defect in Hand after Squamous Cell Tumor Extirpation. A Case Report
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Squamous cell carcinoma is a cancer that is rare in the hand. The extirpation of this cancer can leave an important cutaneous defect in many cases. The cutaneous covering at the back of the hand is a challenge for any surgeon, especially when there are large skin defects with exposure of tendons, bones or neurovascular structures. Here, we describe a clinical case where an adipofascial turnover forearm flap and full thickness skin graft were performed, after the extensive extirpation of the well-differentiated squamous cell carcinoma has been made.
Keywords
Flap; Adipofascial; Forearm; Hand; Skin defect; Carcinoma; Tumor; Squamous cell.
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Using MapMCDA Tool for the Spatial Epidemiology of Animal Rabies in Morocco: How to Improve the Rationality of a Qualitative Risk Assessment
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Objective
The objective behind this article is to better characterize spatial distribution of animal rabies in Morocco through qualitative risk assessment framework. In Morocco, the occurrence of the disease is neither clearly distributed nor complete. Therefore, risk assessment methods become strongly recommended to cope with distorted geographic patterns.
Methods
Based on data collection set from 168 counties, qualitative changes on spatial epidemiology of rabies were analysed by mapMCDA tool covering a period from 2004 to 2017 and including information on determinants of the geographic distribution of animal rabies in Morocco defined in previous work.
Results
To validate the risk assessment model, the results were compared to rabies cases reported during the study period. The clustering of the rabies risk estimates is decisive and highly reliable. A significant alignment was shown between the very high and high-risk estimates.
Conclusion
This study is the first attempt that has been made for using MapMCDA for rabies. For a normative process aiming to avoid subjectivity related to expert-opinions, authors suggest conducting initially a statistical multiple component analysis that will provide quantified estimates of risk factors. It would be an advisable decision-making tool that helps to design oriented surveillance and allows better referral of actions to control the disease.
Keywords
Animal rabies; Canine rabies; Spatial epidemiology; Qualitative risk assessment; MapMCDA; Veterinary science; Public health; Morocco.
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The Case for Digital Pill Use in Clinical Trials
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Medication adherence in clinical trials is significantly overestimated through every phase of drug development. This can cause a reduction in statistical power, potentially resulting in incorrect conclusions regarding efficacy, safety, tolerability, and dose-response relationships, in addition to major cost overruns. Digital pill systems enable adherence measurement through an embedded ingestible sensor paired with an external receiver. An oral pharmaceutical product is over-encapsulated by a pharmaceutical-grade shell containing a biocompatible sensor. Upon exposure to gastrointestinal fluid, the shell dissolves and the sensor is activated. Medication ingestion data is transmitted via a digital signal. Clinicians and researchers use this data to track, in real time, when and if a medication was taken. These systems have demonstrated a 99.4% rate of accuracy, and have over 15-years of supporting
experience and safety data. Spurred by the accelerated adoption of technology in healthcare and in everyday life, patients have become tech-savvy. They quickly adapt to these devices, and are able to use them safely and effectively. Digital pills can be implemented in most types of studies. In early-stage trials such as pharmacokinetic and pharmacodynamic studies, or dose-finding studies, accurate information on maximum-tolerated dose levels is essential and cannot be established unless study participants are highly adherent. In later-stage pivotal trials, effective medication adherence tracking can strengthen the dataset and confidence in the study results. Significant nonadherence may generate results that do not meet statistical or clinical significance for the critical endpoints, resulting in at worst, a failed trial, or at best, the need to enroll additional patients at substantial additional cost. Most clinical trials fail to achieve statistical significance, and poor medication adherence is often an important contributor. A digital pill system can ensure the quality and integrity of adherence data, increase confidence in the overall study data, and improve clinical trial efficiency.
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Factors Affecting Access to E-Learning during the Coronavirus Disease 2019 Pandemic Among Rural-Based Pharmacy Students in Zambia: A Qualitative Study
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Background
The coronavirus disease 2019 (COVID-19) pandemic has negatively affected the education sector globally. This has resulted in learning institutions adopting e-learning techniques. E-learning implementation in higher education continues to gain prominence in both developed and developing countries. Most universities are exploring different ways of using information and
communications technology (ICT). However, ICT remains a challenge more especially for students who come from rural areas.
Aim
This study was aimed at exploring the factors that affect access to e-learning among rural-based pharmacy students in Zambia.
Methods
A qualitative case study was conducted among ten (10) purposively sampled pharmacy students at the University of Zambia. The study participants were from the Manying, a district of North-Western Province, the Sinda district of Eastern Province, the Nalolo district of Western Province, the Chipili district of Luapula Province and the Mbala district of Northern Province. Semistructured interviews were used to collect data from the respondents. Data were analyzed using the framework analysis. The sociodemographic characteristics indicate that ten (10) respondents were drawn from Zambia’s five (5) provinces. Six qualitative themes were generated these included devices used for e-learning; the effectiveness of the devices; student performance; internet connectivity; and electrification of the houses. Key findings suggest that the most commonly used device was a smartphone, which posed challenges to effective learner participation in e-learning. Poor internet connectivity, non-electrification of students’ houses, electricity outages, and costs-associated with internet use negatively affected students in accessing online learning and could adversely affect their academic activities and performance.
Conclusion
The COVID-19 pandemic has negatively affected access to e-learning among rural pharmacy students in Zambia. The implications of the challenges faced by the rural pharmacy students are that their academic activities and performance were negatively affected. Therefore, this posed a threat to the rights to universal access to education of the rural students who were mostly venerable.
Keywords
Academic performance; COVID-19; Coronavirus disease; E-Learning; Online learning; Pandemic; Pharmacy students.
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Helping Public Health Decision-Makers Refine Community Coronavirus Disease-2019 Vaccination Efforts–Association between Confirmed Coronavirus Disease-2019 Cases and Vaccinations
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Introduction
The response to the coronavirus disease-2019 (COVID-19) epidemic included biomedical and vaccine research as well as identification of COVID-19 cases, contact tracing, community health promotion and disease prevention and community vaccination. The COVID-19 vaccinations remind public health professionals and non-professionals alike of this essential public health intervention for controlling infectious diseases. Actions that seek to improve existing vaccination efforts are equally important for effective public health programming.
Methods
Secondary data analysis uses an ecological study design to examine any possible associations between the number of COVID-19 cases identified at medical facilities (facility names not identified) within a healthcare system and the number of COVID-19 vaccinations administered within the system and reflect upon the findings for public health action. A loess curve was plotted to help to identify if a curvature pattern was present in a scatter plot.
Results
The statistical algorithm for the loess curve identified a curvature pattern. All plots showed that values became more separated in moving from left to right.
Discussion
This aggregate pattern in number of COVID-19 cases and number of vaccinations administered might be present in other public health settings or healthcare systems. Four refinements were proposed to help public health decision-makers to improve vaccination efforts: explore the reasons for differences in COVID vaccination given the number of confirmed COVID cases between
facilities; provide vaccination outside traditional settings; facilitate public health and primary care partnerships for community vaccination; and address vaccine knowledge-gaps in the community and other barriers to vaccination.
Keywords
COVID-19 vaccination; Refining vaccination efforts; Public health decision-makers; Public health and primary care partnerships; Ecological study; Loess curve.
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Effects of Garcinia Cambogia Compounded Supplements on the Formation of Body Fat Induced by a High Energy Diet in Obese Rats
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Background
Obesity is a public health concern in many countries. Obesity is often accompanied by other diseases and, in addition to its effects on personal health, also increases national health expenditure and medical costs. Currently, weight loss can be achieved through several medical means, such as gastric bypass surgery, liposuction, or the use of weight loss drugs. However, these options may lead to side effects or increased mortality. As such, the development of anti-obesity supplements that are natural and safe merits greater research attention. Garcinia cambogia extract, green coffee bean extract, mulberry leaf extract, chromium yeast, and wakame
extract are known to have the potential to combat obesity and adjust physical constitutions; however, the effect on fat loss of these agents in a compound supplement has not been researched or discussed.
Objective
This study investigated the effects of a compound supplement (hereafter referred to as Garcinia cambogia compounded supplements (GC)) containing Garcinia cambogia extract, green coffee bean extract, mulberry leaf extract, chromium yeast, and wakame extract on fat accumulation induced by a high energy (HE) diet in rats.
Design
Six-week-old, male Sprague–Dawley rats were assigned to a control group or an experimental (HE) group. The control group comprised 12 rats who were given regular feed. The HE group comprised 36 rats who were given HE diet and were further divided according to whether they received carboxymethyl cellulose (CMC) or GC (305 and 1220 mg/kg, denoted as GC-L and GC-H,
respectively) for 5-weeks. Starting from the sixth-week, the rats were tube-fed various dosages of GC. After the ninth-week, the rats’ body weight, food intake, body fat mass, serum biochemical properties, and liver fat were analyzed.
Results
The results demonstrated that the HE+GC-L rats had significantly lower weight and body fat mass (569.5±51.3 g; 36.6±9.6 g) than the HE+CMC rats (618.5±57.1 g; 46.3±12.2 g). Food efficiency and calorie utilization were also significantly lower in the HE+GC-L rats than in the HE+CMC group (p<0.01). Compared with the HE+CMC group, food efficiency, calorie utilization, total cholesterol, low-density lipoprotein cholesterol (LDL-C), and concentration of free fatty acids were also significantly lower in the HE+GC-H rats (p<0.05). Conclusion The GC supplementation significantly reduced body weight, body fat mass, body fat percentage, food efficiency, and calorie utilization in rats, and it thus has potential as a natural and safe plant extract dietary supplement. Its long-term effects on the human body should be investigated in the future. Keywords Obesity; Garcinia cambogia extract; Green coffee bean extract; Mulberry leaf extract; Chromium yeast; Wakame extract.
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The Boss is Dead Leadership between Perfection and Explosion – A Psychological Study
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The authors consider themselves organizational and leadership developers. They have been active in the corporate world for a long time, working and consulting. Their work is based on morphological psychology, a psychological approach developed by Wilhelm Salber, that aims at understanding behavior as it is in constant state of change. It is not about measuring and explaining, but about describing and understanding how things interact and change. With its comprehensive approach in describing everyday life, morphological psychology is an excellent tool for examining and understanding corporate culture. In this book, the authors examine what constitutes leadership in the corporate work environment psychologically, how “change” is managed, and what happens between “perfection” and “explosion” in leadership.
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Vertebral Artery Dissection Mimicking Migraine: A Case Report
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Vertebral artery dissection (VAD) is caused by an intimal tear that leads to bleeding into the vascular wall, which may cause vascular occlusion by thrombus formation and subsequent distal emboli (leading to ischemic stroke), aneurysm formation and subarachnoid hemorrhage. Cervical artery dissections (either carotid or vertebral artery dissection) are an important cause of stroke in patients under 50-years of age. Headache with or without neck pain is a common symptom. Usually, it occurs with focal neurological signs but sometimes it may occur without any neurological deficits and may mimic migraine. Often it occurs spontaneously without trauma but sometimes there is history of minor traumas, sudden neck movements or chiropractic manipulation. Imaging modalities include magnetic resonance imaging (MRI) brain, magnetic resonance angiography (MRA), and computed tomography angiography (CTA). Treatment involves anticoagulation or antiplatelet agents.
Keywords
Vertebral artery dissection; Migraine; Headache; Neck pain.
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A Review of the Antiviral Activity of Ivermectin and Its Use in the Treatment of Coronavirus Disease-2019
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Background
The coronavirus disease-2019 (COVID-19) originated in China and was declared a pandemic by the World Health Organization (WHO) on 11th March 2020. Since its emergence in December 2019, worldwide, we have developed preventive vaccines but no definitive treatment directed at the virus itself. Currently, the treatments for COVID-19 include symptomatic treatments, supportive therapy, antiviral drugs, immunotherapy and cellular therapy. However, most of the treatments are still under investigation and development and treatment guidelines vary according to countries or regions. Ivermectin is one of the drugs that are being used as part of treatment guidelines in certain countries like the Republic of Peru. However, the WHO advices that ivermectin only be used in clinical trials.
Aim
The authors conducted this review to explore published studies on the possible therapeutic effects of ivermectin against active infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), a causative agent of COVID-19.
Methods
A literature search was conducted using Google Scholar, PubMed and EMBASE for articles published from 2010 to 2021. Search words used included ivermectin, antiviral, COVID-19, efficacy, safety, dosing, lower mortality rate, hospitalised patients and the Boolean operator ‘AND’.
Results
A few clinical trials have shown that ivermectin is safe for use in humans at specific doses and reduces the severity of the infection. Ivermectin was seen to reduce the signs and symptoms associated with COVID-19 in some studies while others showed no significant reduction. However, more studies must be conducted to ascertain its use in treating COVID-19.
Conclusion
Since many clinical trials are being conducted on the use of ivermectin to treat COVID-19, full evidence will be used to support its use in humans. Currently, some countries that are using ivermectin for treating COVID-19 have reported it to be effective and reduce morbidity and mortality associated with the disease. Therefore, countries should collaborate and provide full evidence for the use of ivermectin in humans to manage COVID-19.
Keywords
Ivermectin; COVID-19; SARS-CoV-2; Clinical trials; Antiviral.
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A Study on the Role of Public Health in Reducing the Abuse of Ambulance Services
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Background
Demand for emergency medical services or ambulance response is situated within the context of other healthcare and social welfare services. Worldwide ambulance providers have a wide variety of services available, but many services are struggling to meet service demand. Inappropriate use of ambulance services is one of the biggest concerns globally. The burden of using the ambulance services includes transporting non-critical patients to the hospital. Misuse of the ambulance services is a serious problem that must be addressed and solved.
Objective
The purpose of this study is to evaluate the public perception of appropriate usage of ambulance services and determine the applicable role of public health to reduce the inappropriate use of an ambulance.
Methodology
A cross-sectional study was conducted to collect data from the general public using an online survey. The survey contains 9 questions that evaluate the public awareness of appropriate ambulance use. Participants are people from the public within the age of 18 and above.
Sample Size
A total of N=97 of participants’ responses were used to analyze the data.
Inclusion Criteria
Complete surveys and answer data using the English language.
Exclusion Criteria
Uncompleted surveys, and answered with other languages.
Results
During the online survey, a total of n=97 participants enrolled voluntarily. The majority of the residents are aware of when to and whom to call in case of a medical emergency. N=35 (36%) of the participants believe that ambulance services are misused.
Conclusion
The conducted study demonstrated that almost 36% of participants believed abuse of ambulance services, though there might be numerous reasons for calling ambulance unnecessary. Public health plays a vital role to reduce inappropriate ambulance calls when both ambulance services and public health are integrated into one system of care.
Keywords
Public health; Ambulance services; Emergency medical services (EMS); Emergency care pathway; Misuse of ambulance services; Paramedic; Scope of public health in EMS.
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A Unique and Rare Presentation of Obstructed Choledochal Cyst in an Adult: A Case Report
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Choledochal cysts in adults are rare congenital abnormalities. Approximately 80% are found in childhood. Thus, their presentation in adults is always associated with complications, such as stone formation, inflammation and malignancies. The pathophysiology of this disease is yet uncertain. There are different types of choledochal cysts. Diagnosis can be challenging clinically; however, imaging techniques, such as ultrasound, magnetic resonance cholangiopancreatography (MRCP) and computed tomography (CT), can be helpful. We found several procedures performed in the extant literature, such as choledochoduodenostomy and choledochojejunostomy submucosal excision of the cyst; however, the best surgical option is excision with hepaticojejunostomy. We discuss the unusual presentation of a 33-year-old female patient with an obstructed choledochal cyst, despite having undergone a drainage procedure in childhood.
Keywords
Choledochal cyst; Hepato-jejunal anastomosis; Biliary system anomaly; Choledochal cyst in adults.
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Design and Statistical Methods for Handling Covariates Imbalance in Randomized Controlled Clinical Trials: Dilemmas Resolved
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Introduction
In practice, between groups baseline imbalance following randomization not only opens effect estimate to bias in controlled trials, it also has certain ethical consequences. Both design and statistical approaches to ensure balanced treatment groups in prognostic factors are not without their drawbacks. This article identified potential limitations associated with design and statistical approaches for handling covariate imbalance in randomized controlled clinical trials (RCTs) and proffered solutions to them.
Methods
A careful review of literatures coupled with a robust appraisal of statistical models of methods involved in a way that compared their strength and weaknesses in trial environments, was adopted.
Results
Stratification breaks down in small sample size trials and may not accommodate more than two stratification factors in practice. On the other hand, minimization that balances for multiple prognostic factors even in small trials is not a pure random procedure and in addition, could present with complexities in computations. Overall, either minimization or stratification factors should be included in the model for statistical adjustment. Statistically, estimate of effect by change score analysis (CSA) is susceptible to direction and magnitude of imbalance. Only analysis of covariance (ANCOVA) yields unbiased effect estimate in all trial scenarios including situations with baseline imbalance in known and unknown prognostic covariates.
Conclusion
Design methods for balancing covariates between groups are not without their limitations. Both direction and size of baseline imbalance also have profound consequence on effect estimate by CSA. Only ANCOVA yields unbiased treatment effect and is recommended at all trial scenarios, whether or not between groups covariate imbalance matters.
Keywords
Randomization; Covariate imbalance; Stratification; Minimization; Change score analysis; ANCOVA.
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Bipedicular Basi-Vertebral Nerve Ablation: A Case Report
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Introduction
Intraosseous ablation of the basivertebral nerve (BVNA) is an emerging minimally invasive treatment to relieve chronic mechanical axial low back pain associated with Modic type 1 or type 2 vertebral end-plate changes. Randomized controlled trials demonstrate improvements in pain and function sustained for up to five-years.
Methods
A 40-year-old woman presented with an eight-year history of central low back with mechanical features. There was minimal response to active physical reconditioning techniques, breast reduction surgery and chronic opioid prescription. Imaging disclosed modic type 1 vertebral end-plate changes at the L5/S1 segment. Following a positive short-term response to bilateral L5/S1 facet joint injections, the L5/S1 facets were treated with radiofrequency ablation of the L4 medial branch and L5 dorsal ramus bilaterally but with minimal benefit. BVNA at L5 and S1 was provided using a bi-pedicular bipolar radiofrequency approach (description attached).
Result
Six-week outcomes data disclosed decreased pain intensity from 8/10 to 3/10 and improved function with a decrease of 22 points on the oswestry disability index (ODI). Measures of depression, anxiety and stress, and quality of life improved significantly. Opioid usage decreased with a weaning plan. Magnetic resonance imaging (MRI) findings demonstrated new sclerosis with surrounding bone marrow oedema of the right and left sides of the L5 and S1 vertebral bodies consistent with the BVNA treatment.
Discussion
This case reports technically successful BVNA using a bipedicular approach. The early result is consistent with the published literature using the uni-pedicular approach. Follow-up plans are in place. A case series will follow. In Brief A bi-pedicular bipolar radiofrequency technique for basivertebral nerve ablation to treat vertebrogenic chronic low back pain is described, including early clinical outcomes and MRI findings.
Keywords
Bipedicular; Radiofrequency; Basivertebral nerve; Vertebrogenic; Modic end-plate changes.
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The Emergency Coil Embolization of Iatrogenic Injury to Carotid with Supraclinoid Pseudoaneurysm and Carotid Cavernous Fistula: A Case Report
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Carotid cavernous fistulae (CCF) are unique communication between the cavernous segment of the internal carotid artery (ICA) and the cavernous sinus. CCF are rare and result from traumatic skull base fractures (0.2-0.8%). CCF resulting from iatrogenic intradural traumatic aneurysms are not common, and they are hard to treat using a surgical approach. This report presents the case of a female patient with iatrogenic CCF, which resulted from proximal ICA injury. The CCF was successfully treated using the endovascular coil embolization. The patient has reported improvement in her vision, one-year follow-up routine has indicated
no recurrence with this technique.
Keywords
Coil embolization; Traumatic cerebral pseudoaneurysm; Carotid cavernous-fistula.
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Assessment of Level of Awareness Towards Radiation Protection Among the Staff Working at Angiography Suite at Public Hospitals
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Introduction
Several challenges with radiation protection and safety culture in radiology departments needs to be addressed as few studies done in this aspect in our country. Especially with regard to the awareness about radiation protection, hazards, dosimetry usage and measurement.
Objective
The objective of this study is to find knowledge about radiation exposure hazard and practices among various auxiliary staff working in radiation units.
Material and Methods
Cross-sectional study done by using stratified random sampling method. A questionnaire made to check the awareness level of the radiological staff regarding radiation protection working in angiography suite. The questionnaire had two parts with various questions about radiation protection measures and safety related knowledge for staff and patient. Data collected from angiography suite of three public sector hospitals of Lahore, Pakistan. All the data entered in statistical package for the social science (SSPS) version 16 and analyzed for statistically significant outcomes.
Results
Total of 67 staff members were included in this study from three different public sector hospitals, 55.2% were males 44.77% were females. Twenty-nine (29) persons belonged to the age group of 20-30-years. Twenty (20) doctors, 21 nurses, 12 radiographers and 14 paramedical staff were included. 89.55% staff members were aware of radiation hazard. 55.22% had training on radiation protection and 44.77%. 56.71% were aware of dosimeter. Only 16% were aware of as low as reasonably achievable (ALARA).
Conclusion
The radiological staff members were partially aware about radiation hazards and radiation safety. They were lacking from training and workshops. Essential steps required to develop nationwide strategies for improving the situation and maintaining a safe working environment.
Keywords
Angiography; Radiation hazards; Radiation protection; X-ray; Radiation protection devices.
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A Case Study of Inositol and Soluble Fiber Supplementation on Glycemic Control in an Overweight Subject
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Background
Soluble fiber has been shown to improve glycemic control by slowing the absorptions of glucose. And inositol has been shown to improve glycemic control in type 2 diabetes (T2D) and gestational diabetes via recruiting glucose transporter type 4 (GLUT4) to cell surface. However, neither inositol supplementation nor combination of inositol and soluble fiber supplementation has been studied in overweight.
Objective
To investigate if supplementation of inositol improves biological markers of glycemic control overweight and obesity, and that supplementation of inositol in combination with soluble fiber have synergistic effects to further improve these markers.
Design
A single cohort, uncontrolled, test-retest design was planned to be implemented over 5-weeks in which the participants supplemented 2 grams of myo-inositol twice daily for 4-weeks and then 2 grams of myo-inositol plus 2 grams of soluble fiber each twice daily for 1-week in overweight and obese subjects. Only one overweight subject was able to complete both phases of supplementation due to coronavirus disease-2019 (COVID-19), therefore the study is reported as a case study.
Results
Supplementation of 4 grams of myo-inositol daily for 4-weeks resulted in improved glucose parameters and lipid parameters including fasting blood glucose, post-prandial blood glucose, total blood cholesterol level, blood high-density lipoprotein (HDL) cholesterol level, and blood triglyceride level. The combination of inositol and soluble fiber supplementation further improved
the total blood cholesterol level.
Conclusion
These results indicate there is potential benefit of inositol supplementation for sub-clinical hyperglycemic, overweight subjects on glycemic control.
Keywords
Dietary supplementation; Overweight; Glycemic control; Inositol; Soluble fiber; Type 2 diabetes (T2D); COVID-19.
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Assessing the Private Sector and Civil Society Engagement in Poliomyelitis Myelitis Vaccination among Internally Displaced People in Khartoum State, 2019
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Background
Poliomyelitis is an oro-fecal vaccine preventable disease affecting mainly children under five-years-old and is prevalent in poor sanitation and hygiene environment. The World Health Organization (WHO) stressed the need for coordination between the public and the non-governmental (particularly private) sectors to increase the coverage with immunization. This study aims to assess the private sector and civil society engagement in the implementation of poliomyelitis vaccination among internally displaced people and irregular settlement in Khartoum. Specifically, the study aimed to identify the major gaps in immunization program among internally displaced people (IDP), and to determine the enablers and barriers for the private sector and civil society active engagement in the immunization program.
Methods
This cross-sectional study used both quantitative and qualitative methods. Data was collected from the health facilities mangers and the expanded program of immunization (EPI) service providers at private and civil society’s facilities in the targeted areas using a semi-structured interview guideline and a self-administered questionnaire respectively. The obtained quantitative data was coded and then analyzed using the statistical package for social science (SPSS version 21) and presented using tables. For qualitative part, all data were transcribed verbatim and analyzed using a thematic analysis, paying particular attention to axes of difference, including gender, private center and non-governmental organization.
Results
The major gaps were the insufficient number of health facilities together with uneven distribution of the available ones, and unclear mandate of non-governmental organizations (NGOs) and private sector in EPI programme. Most of the managers complained from the lack of human resources for vaccination but stressed on the fact that training of the existing staff made the availability of the service easier. Twelve (12) out of 23 health facilities visited by the field team where in areas that do not have electricity or water supply which imposed more efforts to preserve the vaccines.
Conclusion
Private and civil societies were not well utilized by EPI program in Khartoum, Sudan. A clear mandate for engagement and periodic training for the service providers is highly needed.
Keywords
Private sector; Civil societies; Poliomyelitis vaccination; Internally displaced people (IDP).
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Developing a Probit Regression Model for Estimating the Chance of Mortality for Coronavirus Disease-2019 Patients
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Rational
Although the number of deaths of coronavirus disease-2019 (COVID-19) is decreasing over the world due to vaccination process, but appearing its new variants remain it as the remarkable challenge for health authorities.
Purpose
The aim of this study is to develop a probit regression model to estimate the chance of mortality for the patients infected to COVID-19.
Methodology
The contributing factors of age, symptoms and underlying diseases have been considered as independent variables as well as the clearance type of death as dependent variable have been studied for estimating the mortality rate. Patients have been divided into two categories; 1) recovered or transferred and 2) death, followed by developing a probit regression model by the well-known technique of Max likelihood method.
Data Collection
Data have been collected for 1015 patients tested positively to COVID-19 and subsequently received clinical treatment or intensive care.
Conclusion
The results revealed the model is capable of estimating the chance of mortality based on age, symptoms and underlying diseases. As implication, the health authorities ultumately can estimate the patient mortality rate prior to admission procedures in hospitals.
Keywords
COVID-19; Mortality rate; Healthcare management; Probit regression; Maximum likelihood.
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The Use of Lead Protection for Staff in Mobile Radiographic Settings: Can Staff Abandon Its Use?
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The use of lead protection in patient contexts has recently come under scrutiny, with organisations moving towards ceasing its use in plain film radiography. The use of lead shielding in protecting staff in low-dose settings, such as plain film and mobile radiography,
is therefore an important aspect of practice to be reviewed. The objective of this review is to evaluate the use of lead shielding in protecting staff in plain film and mobile radiography, while also exploring the evolution of occupational doses and perceptions of lead protection. While literature is limited on the use of lead protection for staff in mobile settings, lead protection has been shown to reduce staff and adjacent patient dose from scatter. Furthermore, despite the increased frequency of medical imaging procedures in contemporary radiography, the occupational doses of medical radiation workers have reduced over time. With literature demonstrating gaps in current understandings of radiobiological mechanisms at low doses, the linear no-threshold model utilised to estimate radiation risk and develop protection standards cannot be rejected. Thus, this review finds the need for further research to be undertaken to improve risk estimates at low doses in larger cohorts of medical radiation workers, for the demonstration of long-term effects from occupational exposure, prior to ceasing staff lead protection.
Keywords
Radiation protection; Occupational dose; Lead protection; Mobile radiography; Radiography; COVID-19 pandemic.
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A Case Report of Severe Theophylline Poisoning: Management and Review of Literature
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Background
Theophylline poisoning leads to multisystem toxicity. Management of theophylline overdose is focused on stabilizing cardiovascular manifestations of arrhythmia and hypotension, correcting metabolic derangements, aborting seizures and removing the drug from the system. We present a case of refractory seizures and haemodynamic instability from theophylline poisoning and reviewed
the literature to update the management of severe theophylline overdose.
Case Presentation
A 73-year-old Chinese gentleman presenting with chills and rigor was admitted for management of sepsis. While admitted suffered seizures which were refractory to benzodiazepine and anti-epileptic drugs. Based on his previous admission for theophylline overdose, serum levels were done confirming severe theophylline poisoning. He was resuscitated and subsequently started on haemodialysis following which seizures were eventually aborted when theophylline levels were successfully reduced.
Conclusion
Severe theophylline poisoning should be identified early and appropriate treatment initiated promptly. In the management of refractory hypotension, methylene blue and venoarterial-extracorporeal membrane oxygenation are reasonable rescue therapies to consider. Multi-dose activated charcoal and extracorporeal treatments for elimination of drugs should be administered in severe theophylline poisoning.
Keywords
Theophylline poisoning; Theophylline-associated seizures; Haemodialysis; Case report; Methylene blue; Venoarterial-extracorporeal membrane oxygenation; Multi-dose activated charcoal.
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Coronavirus Disease-2019 Vaccines and the Vaccination Challenges in India: A Review
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The severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) designated as novel coronavirus is a cause of highly infectious disease referred to as coronavirus disease-2019 (COVID-19). The global pandemic that affected millions of people worldwide has claimed many lives and brought about catastrophe in low-income countries. The high mortality and rapid spread of the infection have brought about an urgent need for a safe and effective vaccine to control the pandemic. In this perspective, it becomes essential to understand the structure, mode of transmission, and virulence of SARS-Cov-2. In this article, an emphasis is made on understanding the infection pathogenesis and the host defense mechanisms against the infection to break the chain of transmission. Furthermore, we have tried to summarize the development and characteristics of different types of COVID-19 vaccines. In addition to this, we have highlighted the challenges of the public health system in the procurement and delivery of
the vaccine to the community and especially to the most vulnerable society. It becomes the main priority to find support financially and make the public health system ready to imbibe the importance of vaccination through meticulous strategies so that vaccine reaches out to the community.
Keywords
SARS-CoV-2; COVID-19; Vaccine; COVID-19 treatment.
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Multi-Level Group Selection and its Connection to Empathetic, Community-Driven Pedagogy: A Research Study Framework Proposal
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Background
Multi-level group selection theory is a presently rejuvenated framework for explaining the empathic tendencies of group culture and behavior as means of beneficial natural selection utility.
Purpose
The purpose here is to simply articulate the ways in which the anthropological theory of multi-level group selection overlaps with the latest psychological research on child conceptualization of equity and empathy so that a focused line of thought can be followed in subsequent research on how childhood psychology interacts with classroom environs moving forward.
Conclusion
The impact these studies stand to have on the broader culture of education would be largely equitable, ensuring that all students from all demographics would be encouraged by like-minded teachers to further propagate their applied learning for mutual advantage and benefit while also exciting each other about what they learn by finding shared relevant experiences and desires to make relevant connections too.
Keywords
Multi-Level; Group selection; Kin selection; Empathy; Pedagogy; Pedagogical practice; Evolution; Natural selection; Classrooms; Education.
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Worrisome Features for Intraductal Papillary Mucinous Neoplasm: Should We be Worried?
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Although worrisome features represent an indication to perform endoscopic ultrasound study, recent studies have showed that these conditions are not strictly related to high risk of malignancy. Pancreatic resection for worrisome imaging features often demonstrates pathology consistent with low-grade dysplasia. Worrisome features should be considered as indicators of mostly
low-grade dysplasia. High-risk stigmata are more consistent for diagnosis of malignant lesions.
Keywords
Worrisome features; High-risk stigmata; Intraductal papillary mucinous neoplasm (IPMN); Pancreatic neoplasm; Pancreatic high-grade dysplasia; Pancreatic low-grade dysplasia.
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Healthcare Issues in Children with Developmental Disabilities (Autism)
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Developmental disabilities (DDs) refer to a group of conditions that influence the early development of children and cause changes in their normal developmental pattern affecting their physical, language and mental abilities or behavior. Children with DDs just like normally developing children have health issues that need to be addressed. This special group of children especially those having autism frequently suffer from associated conditions such as gastrointestinal disorders, eating and feeding challenges, seizures, sleep disturbances, attention deficit and hyperactivity disorder, and anxiety among others. These health problems affect the health of these children in different ways and extent. Thus, children with DDs need to access healthcare services and receive quality medical care just like their normally developing peers. However, the health needs of children with DDs particularly autism are not being met as required even though this special population are more likely to seek medical care due to their disabilities and associated conditions. Children with autism and other DDs experience disparities in health and healthcare service utilization. Autism is linked to many health conditions such as epilepsy, gastrointestinal problems and other mental disorders. These health problems affect each individual with autism in a unique way negatively affecting his/her existing social interaction and communication impairments. Again, health facilities and medical equipment are not disability-friendly making it difficult for this special group to effectively have access to quality care. In addition, most healthcare providers do not possess adequate knowledge and skills required to make critical decisions regarding this very special group of persons. Furthermore, due to cultural differences certain diagnosis and treatment regarding autism and other developmental disabilities may not be welcomed. The public health sector of all nations has the duty to promote health and prevent diseases for all including persons with disabilities.
Keywords
Developmental disabilities; Children with autism; Health conditions; Disparities in health;
Disparities in healthcare service utilization.
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Colotomy to Resolve Constipation Secondary to Spinal Cord Injury: A Case Report
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Urinary and bowel dysfunction is a condition that encompasses loss of bladder and bowel control which is characterized by partial or complete loss of defecation and urination. Urinary and bowel dysfunction is multifactorial and mainly caused by spinal cord injury at the lumbosacral level or more cranial. The present case report was aimed to show techniques and outcomes of colotomy to resolve constipation secondary to bowel dysfunction in a cat. A 1-year-old female cat weighing 1.3 kg was presented to Veterinary Teaching Hospital with a history of anorexia dullness, abdominal distension, and absence of defecation for the last 8-days. Clinical examination revealed stunted growth, poor body condition, very weak anal and pedal reflex, distended abdomen, dehydration, and lateral recumbency. Based on the history and clinical findings the case was diagnosed as constipation and exploratory laparotomy was indicated after sufficient stabilization. The caudal ventral midline was used to perform colotomy to remove accumulated feces. Post-operatively fluid therapy, antibiotics, laxative, and vitamins were administered accordingly. Upon 52-days follow-up; the patient was able to pass her feces completely, while urine retention and incontinence remains unresolved. Therefore, the owner was advised how to apply gentle external compression of the bladder to assist urination.
Keywords
Cat; Colotomy; Constipation; Incontinence.
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First Year Student Pharmacists’ Views on the Opioid Epidemic
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Objective
To determine first-year student pharmacists’ views on the opioid epidemic.
Methods
First-year pharmacy students were asked to complete an online survey to assess their views and opinions on the current opioid crisis using Likert-scale type questions.
Results
Forty-four pharmacy students were surveyed, and all participants completed survey questions, 100% response rate. Majority of participants were female (N=34, 77.3%), with more than half of participants falling in the age range of 18-24 (N=25, 56.8%). Geographically, most of the participants home residences are in other states out of the DC, Maryland, Virginia (N=25, 56.9%). In addition, majority of participants worked before starting pharmacy school (N=42, 95.5%) and a majority had a pharmacy and health related occupations before pharmacy school (N=36; 81.9%). Most study participants reported an annual income of less than $10,000 (N=17, 38.6%) and obtained a bachelor’s degree (N=26, 59.1%). Majority of participants strongly agree that the opioid epidemic is becoming a severe crisis for society (N=42; 95.5%) and that opioid should be readily available when it is medically necessary to people (N=27; 61.4%). When asked if they know anyone personally who suffers from the opioid crisis, over three-quarter (N=34; 77.3%) said no. However, over two-third (N=29; 65.9%) of participants said that they have taken opioids in the past themselves to relieve pain. Although, almost all of them strongly agree that prescription opioids are addictive (N=42; 95.5.%); about eighty percent (N=35; 79.5%) agree that taking opioids is an effective way to alleviate severe pain.
Conclusion
Our results indicate that pharmacy students perceive the opioid epidemic as a crisis and despite their views that opioids are addictive and knowing someone who suffers from opioid use disorder, they believe opioids are a clinically effective way to alleviate pain.
Keywords
Survey; Opioids; Epidemic; Students; Pharmacy.
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Comparison of Body Composition between Pre-Menarche and Post-Menarche Sabar Girls of Purulia District, West Bengal, India
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Background
It was known that menarche plays a significant role to change body composition during adolescence. And there is a paucity of information on body composition in relation to pre- and post-menarcheal status on comparative manner among the tribal adolescence girls of West Bengal, India.
Objectives
To assess the body composition and compare the relative distribution of fat between the pre- and post-menarcheal girls and to explore the impact of body composition on menarcheal status among the Sabar tribal adolescence girls of the Purulia district, West Bengal, India.
Methods
The present cross-sectional study was conducted from three different blocks of Purulia district during June 2019 to December 2019. A total of 65 adolescence girls were randomly selected from the aged between 10 to 18-years. Among them, 34 girls were post-menarche stage and 31 girls were pre-menarche stage. Anthropometric measurements (height, weight, triceps and sub-scapular skinfolds) were measured. Spearman’s rho correlation coefficient and Mann-Whitney U-test, Binary logistic regression were performed through SPSS version 25.
Results
It was depicted that significant differences were found in all anthropometric and body composition characteristics between the pre and post menarche state. The mean values of percent body fat (PBF), fat mass (FM), fat free mass (FFM), fat mass index (FMI) and fat free mass index (FFMI) in pre-menarche girls were 14.61%, 4.45 kg, 24.35 kg, 2.33 kg/m2 and 13.08 kg/m2, respectively. Similarly, the mean values of PBF, FM, FFM, FMI and FFMI in post-menarche girls were 20.37%, 8.07 kg, 31.00 kg, 3.70 kg/m2 and 14.29 kg/m2, respectively. The results of Spearman correlation coefficients (r) showed that the body composition measures were significantly correlated with the anthropometric variables except FFM and FFMI among the post-menarche girls. Menarcheal status of the Sabar tribal adolescent girls of Purulia district was pretentious of PBF and FFM.
Conclusion
The body composition characteristics were significantly different between pre- and post-menarche-state. So, further study in larger augmentation is required to validate the present findings.Keywords
India; Tribes; Sabar girls; Menarche; Body composition.
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Lycopene for Hypertension and Factors Affecting Its Use: A Survey of Pharmacy Students
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Purpose
To better understand and assess the potential obstacles to the adoption of lycopene for treating high blood pressure.
Methods
A cross-sectional observational study was conducted by administering a survey to 42 Howard University College of Pharmacy students. Descriptive statistics and risk estimates were calculated using statistical package for social studies (SPSS) software.
Results
Only 33.3% of students had ever heard of lycopene, and lycopene knowledge score was poor among 88% of respondents. Non-D.C. residence, dietary supplement use and the belief that dietary supplements such as lycopene interact with prescription drugs and should be used cautiously, were all correlated with a lesser risk of having poor lycopene knowledge. Annual income >$40,000 was correlated with a greater risk of being in the poor lycopene knowledge group. Despite this data, 59.5% report that will incorporate more lycopene into their diet.
Conclusion
Lycopene knowledge is generally poor among the observed cohort; however, this does not seem to be a great obstacle in the path of adoption.
Keywords
Lycopene; Dietary supplement; Hypertension; Cardiovascular.