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letter to the editor
Objective: This study aimed to conduct an evaluation of music therapy clinical trials
worldwide, to understand what trials have been conducted and to show the chronological
changes. Additionally, we sought to clarify issues related to providing clinical trial registration
Methods: We searched the International Clinical Trials Registry Platform (ICTRP) database for
“music therapy,” and identified the disease target for each article found.
Results: A total of 150 clinical trial studies were found in the ICTRP using the term “music
therapy.” In these trials, music therapy was used for improvement of social functioning in
schizophrenia and/or serious mental disorders, anxiety and depressive symptoms, and cancer
symptoms. Twenty-five clinical trials were actively recruiting. Sixteen of the 25 trials were
registered in the United States at ClinicalTrials.gov, of which 9 trials were conducted in the US.
Seven trials were conducted in other countries such as Spain, Taiwan, and China.
Conclusion: A search for music therapy clinical trials retrieved 150 trials from the ICTRP, and
the number of clinical trial registrations has increased yearly. Music therapy is widely used in
patients with various diseases, including Alzheimer’s disease, anxiety, and arthritic pain and
has the potential to improve certain disease outcomes, but there is not enough evidence to
substantiate its efficacy. It is important to enlighten researchers and pharmaceutical companies
on the proper management of the quality of such clinical trial information, as this is an important
Mechanisms by which some plants with antihyperglycemic effects reduce postprandial hyperglycemiaare not fully elucidated. This study was designed to investigate some action mechanisms of extracts from stem bark of Citrus sinensis, seeds of Persea americana and bulbs of Allium sativum including in vitro inhibition of α-amylase and invertase; glucophagic capacity, absorption capacity on yeast cells and psoas tissues.
Cancer immunotherapy has evolved enormously in the recent years with better understanding of immune reactions, immune microenvironment and immunosurveillance. Breast cancer is characterized by large heterogeneity, a fact which rather complicated the development and the approval of novel therapeutic options in comparison to the majority of other solid tumors since each subtype has required a unique scientific approach and different targets and goals. Triple negative breast cancer (TNBC) is considered the most aggressive of the breast cancer subtypes with limited treatment options and worse outcome compared to others. This article summarizes some of the early clinical studies and the recently presented phase III clinical study of immunotherapy checkpoint inhibitors in this difficult setting.
Keywords: Cancer; Immunotherapy; Triple negative breast cancer (TNBC); Breast cancer.
In most African countries, the elderly face challenges that affect their health and wellbeing and are more pronounced because of the systemic factors of inadequate health care, food insecurity and the general care. Increasing population of the elderly persons in Uganda is raising concern than ever before. The purpose of this paper to ascertain care available to the rural elderly persons and their role as carers for their grandchildren and implications on their wellbeing.
This was a qualitative study conducted among the rural elderly aged 60 years and above in eight purposively selected district that included Lira, Nebbi, Kampala, Luwero, Pallisa, Jinja, Mbarara, and Ntungamo. The study sample consisted of 101 elderly person from whom in-depth interviews were conducted. Data was analysed using qualitative thematic content analysis.
Rural elderly in Uganda face a lot of constraints that include access to healthcare and information, poor economic status, food insecurity and poor nutrition, and poor accommodation and housing conditions. Two broader themes emerged inductively from the analysis that include care available for the rural elderly and providing care to grandchildren. These themes generated several subthemes. Taking care of grandchildren crippled the elderly and reduced the economic benefits. That said some rural elderly were happy and felt fulfilled to care of the grandchildren despite the lack of resources.
The rural elderly in Uganda are living in doleful conditions with limited care and support. They need care but are the providers of care to the grandchildren. They are frails and may not afford to provide adequate care. They care for grandchildren many of whom are orphans and vulnerable yet they themselves need care. It is important the government and the community re-enforce this care not to put strain on elderly. The rural elderly unique challenges necessitates special targeting and mobilization of resources at the household, local, district and national levels.
Grandparents; Care; Orphans; Grandchildren; Skip-generation; Uganda.
The Breast Imaging-Reporting and Data System (BI-RADS) is a classification system aimed at standardizing risk assessment during breast ultrasound to ensure patient safety. BI-RADS is currently used in Uganda so as to standardize breast ultrasound reporting and enhance patient management.
This study aimed at exploring staff perceptions towards the use of the BI-RADS ultrasound characterization of breast masses.
It was an exploratory qualitative study that involved staff who perform breast ultrasound at Mulago Hospital in Uganda. Focus group discussions and individual interviews were conducted.
All staff used the BI-RADS system, however, some of them had a negative attitude towards BI-RADS. The three major themes that emerged were: standardization of breast ultrasound reporting for patient safety; need for more Continuous Professional Development (CPD) and challenges with the BI-RADS system.
The study demonstrated that the staff generally had positive perceptions and attitude of the BI-RADS system and felt that it was an efficient system for ensuring patient safety and further reduce mortality from breast cancer.
Breast imaging-reporting and data system (BI-RADS); Breast; Ultrasound; Staff perceptions.
To study the role of sound enhancer device in teleconsultation.
This study was conducted in the plastic surgery department in a tertiary care centre in the month of May-June 2019. A sound enhancer device was used with mobile phone for videoconferencing as form of teleconsultation by plastic surgery trainees in operation theatre and outpatient department. At the end of the study feedbacks were taken from the trainees.
It was found that on using the sound enhancer device, the sound quality improved and it was helpful in the teleconsultation sessions using videoconferencing.
The use of sound enhancer is a simple, cost-effective, innovative method of using a simple technology to aid in utilisation of teleconsultation facilities in a very non-sophisticated way.
Sound enhancer device; Teleconsultation; Telemedicine.
Cervical cancer is a common cause of cancer-related deaths in women worldwide, with a fatality rate second only to breast cancer. Human papillomaviruses (HPVs) are the main causative agents of cervical cancer, and are therefore obvious targets for vaccine development. Although two prophylactic HPV vaccines have been commercialized, therapeutic vaccines against HPVs have not been developed yet. Current vaccine technologies emphasize the power of small particles in targeting immune cells, and particles of 20-50 nm have been reported to induce optimal immune responses against a variety of pathogens and cancers.
We synthesized new nanoparticle-based vaccines against cervical cancer by using antigenic 8Qmin peptide epitope derived from HPV-16 E7 protein, a hydrophilic poly-(L-glutamic acid) (PGA) linker, and an 8-arm poly (tert-butyl acrylate) dendrimer-based delivery system (D8).
Four different peptides containing 8Qmin and PGA of different lengths were successfully synthesized with high yield and purity. These were then conjugated to alkyne-functionalized D8 by copper-catalyzed alkyne-azide cycloaddition “click” reaction. The conjugates self-assembled into nanoparticles, with decreased particle size corresponding to a greater number of Glu units. The four vaccine candidates were tested in C57 black 6 (C57BL/6) mice bearing well-established (7-day-old) tumors to examine their therapeutic effects.
Interestingly, only one conjugate delayed tumor growth, and montanide adjuvanted antigen, used as a positive control, failed to demonstrate any therapeutic effect.
Peptide-based subunit vaccine; Human papillomavirus; Polyglutamic acid; Therapeutic cancer vaccine; Polymer-peptide conjugate; Self-adjuvanting; Cervical cancer.
Breast cancer is among the most common cancers affecting women worldwide, including Egypt. Age is a well-known determinant of breast cancer risk; however, more data is needed to better understand the importance of age on incidence of breast cancer in the Middle East. Being overweight or obese are also known risk factors—especially for post-menopausal women–however, these data are not available for women in developing countries.
The purpose of this study was to qualitatively explore the association between age, breast density, and demographic factors of breast cancer patients, across a spectrum of radiological breast diagnoses at a large Breast Imaging Clinic in Cairo, Egypt.
Materials and Methods
We explored the association between age, demographic factors, and Breast cancer incidence among 6,711 women undergoing mammographic screening over a consecutive period of 6-years. Data was collected from March 2007 until March 2013 and extracted
from an electronic data base system.
A total of 6,711 participants were included in this study. The median age of all patients was 46.1. Mean body mass index (BMI) of 28.5, where 34% of the patients were overweight and 32.4% were obese. Older women were more likely to be obese compared to younger women (38.4% vs 18.1%, p<0.001). Older females were more likely to have less dense breasts (ACR: A) compared to younger females (18.1% vs 8.7%, p<0.001). Women older than 40 had a higher confirmed number of breast cancer diagnoses compared with the younger age group (10.7% vs 3.5%, p<0.001). Women with breast cancer were more obese (p<0.001), had denser breasts (p<0.001), were post-menopausal (p=0.002), and more likely to be Muslim (p=0.0021). In the multivariate analysis, aforementioned factors were significant predictors for confirmed diagnosis.
To our knowledge this is the largest study to examine the association of radiological breast assessments on breast cancer incidence, obesity and demographic factors in Egypt. Although data shows the global burden of breast cancer is shifting to the developing world and affecting younger women at alarming rates, our data demonstrated a very low occurrence of breast cancer in both age groups.
Breast cancer; Breast radiological diagnoses; Phenotypic variations; Breast imaging-reporting and data system (BI-RADS).
To study the role of bactiguard infection technology (BIP) in preventing Catheter-associated urinary tract infections. This study was conducted in a tertiary care centre in the Department of Plastic Surgery, JIPMER, Pondicherry, India in the month of August 2019. The study subject was a 55-year-old gentleman with Fournier’s gangrene and type 2 diabetes mellitus (DM). The Foley’s catheter with BIP technology was used and its role in preventing urinary tract infections (UTI) was studied over a period of 10-days. During the period of the catheter use in our subject, patient did not develop features of urinary tract infections. BIP technology is claimed to be effective in preventing Catheter-associated urinary tract infections but further studies in more individuals is required to validate the same.
Bactiguard infection technology (BIP); Catheter associated urinary tract infection (CAUTI); Biofilm.
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Recruitment in clinical research trials can be challenging in trials that are time-sensitive and/or are rare disease and critical care trials. One of the hurdles for recruitment in these types of clinical trials is due to the consent process, and the need to have consent of the patient within a certain timeframe, or the patient unable to consent for themselves. This paper will discuss the usage of the utilization of remote consent options for these trials.
Recruitment; e-consent; Remote consent; Clinical trials; Rare disease; Time-sensitive.
Pseudotumoral calcinosis is a rare condition characterized by periarticular calcium deposition. It preferentially affects large joints such as the hip, shoulder and elbow. It is a severe complication of chronic renal failure. We report a case of secondary pseudotumoral calcinosis in a chronic hemodialysis patient.
Tumoral calcinosis; Chronicrenal failure; Hemodialysis.
Circulating tumor cells (CTCs) are the precursors to metastases and increased numbers of CTCs in the peripheral circulation have been shown to correlate with decreased progression-free and overall survival. Although the current clinical utility has been focused on the prognostic significance, other clinical applications are being explored, such as determining if a patient is a candidate for treatment, determining the efficacy of treatment, evaluation for resistance to therapy, prediction of metastatic site, or as an early predictor of metastases. Current methodologies are based on quantifying CTCs and include technologies based on physical, immunological, and molecular techniques. However, these have limitations, of which most of them do not have the ability to perform morphological evaluation. Using morphological evaluation, CTCs in body fluids could be used for primary diagnosis in the setting of cancer of unknown primary (CUP) or in initial or early diagnostic scenarios. Additionally, cytological specimens have been shown to be useful for ancillary testing in patients when surgical resection specimens or biopsies are not available. Evaluation of CTCs should incorporate histological, immunehistochemical, and molecular characterization to enable clinicians to obtain the comprehensive diagnostic, prognostic and therapeutic information necessary to provide appropriate personalized care to cancer patients.
Circulating tumor cell (CTC); Circulating; Tumor cell; Cancer; Isolation; Detection; Metastasis; Prognosis.
CTC: Circulating tumor cell; RT-PCR: Reverse transcriptase-polymerase chain reaction; EMT: Epithelial-mesenchymal transition; MET: Mesenchymal-epithelial transition; TRAIL: Tumor necrosis factor-related apoptosis-inducing ligand; CEA: Carcinoembryonic antigen; CUP: Cancer of unknown primary; CAP: College of American Pathologists; AMP: Association for Molecular Pathology; ASCO: American Society of Clinical Oncology.
Documentation of advance care planning (ACP) in the electronic health record (EHR) is a quality measure promoted by both the Centers for Medicare and Medicaid Services (CMS) and the Department of Veterans Affairs (VA). There is no best practice model for promotion of ACP in primary care. Clinic prompts reminders from staff, and provision of forms and handouts modestly increase ACP completion. Targeted advance care planning and goals of care discussions for high-risk high-need older patients may help promote ACP in primary care.
High-risk, high-need geriatric patients were identified by the clinical assessment of need (CAN) risk calculator for a telehealth intervention by an advanced practice nurse trained in palliative care and embedded in the geriatric patient-aligned care team (Geri-PACT) and provided telehealth outreach for ACP and goals of care discussions.
At baseline the Geri-PACT panel had a 54% prevalence of ACP in the EHR. Completion of a life-sustaining treatment note (LST) increased from 39% to 74% following the telehealth intervention producing a total of 89% ACP documents in the EHR. Additionally, 9% of patients received goals of care discussions and a need for additional home and community-based services was identified for 12% of patients contacted. Outreach to three practices in an established physician referral and patient visit network which included 10 providers indicated that primary care providers desired to approach their own patients for ACP. These providers were educated and provided tools and information about CMS and VA ACP quality improvement directives.
A focused telehealth intervention performed by a nurse trained in palliative care and embedded in a geriatric patient-centered medical home was able to significantly increase ACP documentation in the EHR for elderly patients in the practice. Primary care providers place core importance on the value of the patient-clinician relationship and prefer to approach their own patients rather than rely on consultation for ACP. Education for primary care providers and provision of resources to perform ACP and goals of care discussions for their patients may be a worthwhile strategy to improve ACP completion and documentation in the EHR.
Advance directives; Primary care; Telehealth.
The global prevalence of obesity has reached epidemic proportions. Given the negative strain that obesity and associated chronic diseases, such as type 2 diabetes, put on the healthcare system and the economy, disease management has begun evolving to help individuals change their behaviors. Obesity is often difficult to treat and even harder to maintain. Past studies have failed to show weight loss maintenance over long periods after interventions. To overcome the complexity of obesity, a multifaceted precision care treatment approach should be adopted.
The aim of this case study was to assess the health benefits and weight loss journey of a cohabiting Caucasian heterosexual married couple using the Digbi Health personalized obesity management program. A personalized integrative nutrition plan is created based on one’s genetic and gut microbiome obesity risk profile and incorporates daily digital tracking and lifestyle coaching. Never before has a program offered personalized data including genetic, gut microbiome and lifestyle coaching to help people understand the best plan to lose weight and keep it off long term.
The male subject achieved a total change in weight loss of 15.94%, as well as a reduction in A1C and blood pressure levels and the female subject achieved a 13.65% change in weight loss over a period of four months. The couple have still been able to maintain their weight loss goals four months after completing the program, stating their individual and personalized approach gave them the tools long-term to maintain.
A supportive environment for cohabiting couples following a personalized weight loss program based on their genetic and gut microbiome profile may help with weight loss and long-term maintenance.
Diabetes; Gut microbiome; Obesity; Diet; Physical exercise; Overweight; Body mass index (BMI); Couples; Hypertension.
Differentiating between cystic lesions of pituitary gland may be challenging. Usual differentials are cystic pituitary adenoma (cPA) and Rathke’s cleft cyst (RCC). Diagnostic certainty of magnetic resonance imaging (MRI) is limited in the absence of usual suggestive features. Furthermore, RCC can co-exist with approximately 2% of pituitary adenomas. Over time, these cystic lesions may remain static, resolve spontaneously, or result in symptomatology relating to mass effect and/or hormonal disruption. In cases of an asymptomatic lesion being found incidentally, little is known about how it may progress, raising question whether to proceed with surgical management or follow-up. We a present case of a spontaneously resolving pituitary cystic lesion with imaging features more suggestive of cPA than RCC, for which watchful waiting proved a successful treatment strategy. The current case serves as a reminder that small cystic lesions can be followed-up with spontaneous resolution and should be offered active treatment only when clinically required.
Pituitary gland; Pituitary cystic lesion; Cystic pituitary adenoma (cPA); Magnetic resonance imaging (MRI).
Absorbable threads represent one of the most exciting breakthroughs in aesthetic medicine. The innovative composition of absorbable poly-L-lactic acid (PLLA)/caprolactone (PCL) threads enriched with hyaluronic acid (HA) has triggered the interest of aesthetic practitioners.
To compare the aesthetic outcomes of armouring procedures with absorbable PLLA/PCL threads versus the same procedure performed with PLLA/PCL/HA threads (APTOS, Tbilisi, Georgia threads).
Eight patients underwent thread insertion in the face (PLLA/PCL threads on one side and PLLA/PCL/HA threads on the other). Aesthetic outcome was determined subjectively by the patient after 7 days using a 5-point rating questionnaire. Wrinkles were evaluated objectively using 3D photosystem software after 7, 30, and 90 days.
Seven days after treatment there was significantly less pain, less swelling, less burning and a faster reduction of skin irregularities on the side treated with HA-enriched threads (all p<0.05). The side of the face treated with HA-enriched threads also demonstrated faster and more obvious improvement of wrinkles.
Absorbable PLLA/PCL threads have a reliable reputation for oval correction of the face and long-lasting biostimulation. The new HA-enriched threads shorten the post-procedure downtime, accelerate rejuvenation and provide more significant patient satisfaction.
Absorbable thread; Thread lifting; HA-enriched threads; Aesthetics.
The Lactobacillus is an industrially-important group of probiotic organisms that plays an important role in human health by inhibiting harmful and pathogenic bacterial growth, boosting immune function, and increasing resistance to infection. The aim of this study was to identify the probiotic bacteria Lactobacillus based on their phenotypic features and genotypic features. This study also shows the importance of probiotic bacterium, and the effects of their antibiotic resistance to human.
Six different brands were cultured on man, rogosa and sharpe (MRS) agar. The identity of the culture was based on the characteristics of the strains of Lactobacillus spp. which was characterized using their phenotypic features (cell morphology, Gram’s staining tests which are specific for Lactobacillus genus). The bacterial deoxyribonucleic acid (DNA) was extracted by two different methods, boiled cell method and cetyl trimethylammonium bromide (CTAB) method. Furthermore, the extracted DNA yields were compared to determine which gives the best yield. The bacterial genus was detected with using genus specific primers, specific to the Lactobacillus. All the isolates were further subjected to antibiotic resistance test using disc diffusion method against a total of 4 antibiotics (Erythromycin, Tetracycline, Vancomycin and Ampicillin) and the antibiotic resistant genes of tet(M) & erm(B), were analyzed by polymerase chain reaction (PCR).
Five isolates out of six samples (A to E) were found to exhibit multiple resistance against some of the most commonly used antibiotics. The isolates showed resistance toward tetracycline, erythromycin & vancomycin. Besides that, the isolates displayed a low-level of resistance toward ampicillin.
This study proves that antibiotic resistance is present in different species of probiotic strains, which may pose a food safety concern.
Lactobacillus; Probiotics; Antibiotics; Tetracycline; Vancomycin; Erythromycin; Ampicillin; Antibiotic resistance.
To compare the effectiveness of 5 different skin moisturizers using JELL-O® as a model for the human skin.
In this study five different moisturizers (Equate®, Burt’s Bees®, Suave®, Aveeno® and Vaseline®) were applied to equivalent samples of JELL-O®. Observations were made over a 12-day period and data was collected at 15 different time intervals. The primary outcome was the height (cm) and weight (g) of the JELL-O® sample at each time interval. The study was an ex vivo experiment conducted in a home laboratory. No Institutional Review Board (IRB) approval was required since the research does not involve living organisms.
Overall, the JELL-O® sample that had the Vaseline® applied on it had the lowest loss of height and weight. The height stayed at 100% of its original value and the weight only decreased to 97.2% of the original value by the end of the observation period. In contrast, the sample which had Suave® applied to the surface its height and weight decrease the most (42% and 28% respectively). The other moisturizers had effects intermediate between these two extremes.
Based on this ex vivo head to head study using JELL-O® as a model for the human skin the 5 moisturizers examined had widely differing levels of effectiveness with Vaseline® appearing to be the most protective against evaporative losses and Suave® appearing to be the least.
Moisturizers; Dry skin; Different moisturizers; Skin lotions; Vaseline® effectiveness.
Deoxyribonucleic acid (DNA) microarrays are collections of DNA probes arranged on a base pair and the latest commercialized molecular diagnostic technologies that offer high throughput results, more sensitive and require less time. It is the most reliable and widely accepted tool facilitating the simultaneous identification of thousands of genetic elements even a single gene. Microarrays are powerful new tools for the investigation of global changes in gene expression profiles in cells and tissues. The different types of DNA microarray or DNA chip devices and systems are described along with their methods of fabrication and their use. The DNA microarrays assembly process is automatized and further miniaturized. DNA microarrays are used in the search of various specific genes or in gene polymorphism and expression analysis. They will be widely used to investigate the expression of various genes connected with various diseases in order to find the causes of these diseases and to enable their accurate treatment. Generally, microarray analysis is not only applied for gene expression studies, but also used in immunology, genotyping, diagnostics and sequence analysis. Additionally, microarray technology being developed and applied to new areas of proteomics, cancer research, and cellular analysis.
Application, DNA, Microarray, Principle.
Organic livestock farming is a useful strategy to overcome the challenges of the agricultural sector like sustainability, food security, and food safety while matching with a high status of animal welfare, care for the environment, restricted use of medical drugs, growth promoters, synthetic fertilizer and the production of healthy food products without drug residues. Furthermore, organic livestock farming could also be an interesting strategy for the eternal rural development issue and solution for the farms’ decreasing profitability. The regulation of organic animal production is comprehensive and affected by different aspects such as feeding, housing, breeding, health care, and medical treatment. In contrast to conventional production systems, animals under organic livestock production are allowed a larger housing area, have obligatory straw bedding, fed organic feed, and roughage. The animal feed is a strong determinant of the fatty acid composition of the milk, egg or meat. In relation to animal health and welfare, the application of breed selection, good management, nutrition, and husbandry plays a greater role in disease prevention and good animal welfare. Now-a-days, antimicrobial resistance is a global public health issue and a threat to the modern health care system which is recognized by many international health organizations. Accordingly, over the last few years, the demand for organic products and availability in the market has been increased and made significant development in the economy. Several people have started to consider organic food instead of conventional food because it is healthier and less prone to the impact of chemical residues. Consequently, awareness creation and encouraging the importance of organic products for customers is important for the development of organic production.
Conventional production; Organic market; Organic production; Public health.
Prolonged pregnancy is defined as a pregnancy that lasts for more than 294-days compared with term gestation which is between 260 and 293-days. This case report was prepared with the aim of describing and documenting the surgical procedures, techniques of cesarean section and its outcome on eight-years-old crossbred cow that was referred to the veterinary hospital, Mekelle University from a field; Edaga Hamus Veterinary Clinic. According to the owner’s history, the cow was presented to the clinic with an extended gestational period over 345-days than anticipated according to their own record. Thus, based on the history and clinical findings, the case was diagnosed as prolonged pregnancy. After aseptic preparation of the surgical site, stabilizing the animal and locally desensitizing the incision area; a vertical skin incision with a distance of approximately (~40 cm wide) on the left flank region approximately (~10 cm) below the lumbar transverse process. After the incision of the abdominal muscles and uterus, the non-viable and abnormally oversized calf was taken out with the help of an assistant. Moreover, the uterus was filled with excess and abnormal dark brown colored blood and was properly drained, washed with sterile isotonic saline solution. The uterus was closed using a double layer of Utrecht suturing pattern whereas the peritoneum and abdominal muscles were separately closed with a continuous lockstitch pattern and simple interrupted pattern using 2-0 size sterile absorbable polyglycolic acid, respectively. After that, the skin was closed using silk 2-0 size in a horizontal interrupted mattress. Lastly, with proper antibiotic follow-up, dressing and cleaning of the surgical site, the cow was successfully recovered after two months.
Dairy cow; Caesarean section; Prolonged pregnancy.
The objective of this study was to assess the major welfare problems in working donkeys in Hosaena district, Hadiya Zone, Southern Ethiopia.
Methods and Materials
A total of 318 male and 76 female working donkeys were randomly selected using a cross-sectional study from November 2015 to April 2016.
According to the current investigation, 70% of donkeys were used for draught and 30% were used for pack type of work. All females (100%) were used for packing purpose, whereas 86.8% of male donkeys were used for draught purpose. Overall, 41.6% of donkeys had a poor body condition in all age groups, whereas most donkeys (44.3%) under the age group less than 5-years were having poor conditions. Regarding wound on the skin, a higher proportion (82.2%) of back lesions were observed in pack donkeys whereas lip lesions were observed in 87.7% of draught donkeys. Besides, the welfare problem was observed in 28.9% of working donkeys due to overloading. A significant association (p<0.01) was found between the duration of working hours of donkey and poor body condition. Out of the interviewed, the majority of animal owners (76.4%) had one donkey.
The assessment showed that working donkeys in the present study area were experiencing multiple welfare problems. Accordingly, awareness creation through mass education, training and extension service should be promoted in the study area in order to ensure better donkey welfare and productivity.
Assessment; Ethiopia; Hosaena; Welfare of working donkey.
A Holstein Friesian (HF) crossbred dairy cow of 5-years-old and 38.5-weeks pregnant was presented to the Veterinary Hospital of College of Veterinary Science, Mekelle University with a history of repeated prolapse since last 10-days. Upon clinical examination, the case was confirmed as prepartum cervico-vaginal prolapse due to excess labor and straining to deliver the fetus. After caesarean section, the cow was restrained on sternal recumbency and the prolapsed mass was made aseptic by washing with a 2% potassium permanganate solution and was repositioned into the pelvic cavity. The cow was kept on fluid therapy (stat), antiinflammatory and antibiotic for three successive days. A modified Buhner’s technique, using infusion set tube as suture was to keep the prolapsed tissue in position to prevent the recurrence and the cow had an uneventful recovery. A successful management of recurrent prepartum cervico-vaginal prolapse using modified Buhner’s suture after caesarean section in a crossbred Holstein Friesian dairy cow is discussed.
Modified Buhner’s suture; Cervico-vaginal prolapse; Crossbred Holstein Friesian cow; Recurrence.
Lycopene is one of the six major dietary and serum carotenoids, and a potent antioxidant and anti-inflammatory agent. A large and growing body of scientific evidence supports the role of lycopene in multiple areas of health, including cancer, prostate, cardiometabolic, lung, skin, and liver health, and elucidates lycopene’s mechanisms of action. This paper provides an overview of several benefit areas, specifically prostate, testes, cardiovascular, liver and skin health.
Lycopene; Carotenoids; Cardiovascular disease (CVD); Human health.
We herein present a case report of a 60-year-old male patient diagnosed with squamous-melanocytic tumour (SMT) in his anal region, comprised of two intermingled different phenotypic lesions. This dual tumour is quite uncommon and could potentially be challenging on both diagnose and also management. It is the first case reported on this location, moreover, the lack of consensus for these lesions makes it difficult to classify them. We reviewed the literature of similar SMT’s and discussed its histogenesis. As they are rare, their biological behavior and potential metastasis remain unclear. Therefore, close follow-up is advised.
Combined neoplasia; Squamous-melanocytic tumour; Uncertain; Anal canal.
The current study was conducted to assess chemical and drug use in dairy farms of Hawassa town, Southern Ethiopia.
A total of 45 dairy farms were selected based on the willingness of the owner and the availability of information using a cross-sectional study from December 2017 to April 2018. Besides, data were collected through a questionnaire survey and close observation.
Accordingly, based on observational assessment, most farms commonly used savlon (88.9%) iodine (60%) and detergent (20%) as antiseptics. Albendazole was the common anthelmintic by all dairy farms. Besides, Diazinon is used as acaricides (51.1%) and 57.8% of farms used sulfa drugs as an antiprotozoal agent. Similarly, all dairy farms in the study area used penicillin-streptomycin combination injection and ampicillin-cloxacillin combination for the treatment of mastitis. Based on a questionnaire assessment on 24 animal health assistants from different farms in of the study area, most (79.2%) did not remind owners to avoid the use or sale of animal products during withdrawal time. Out of the total, 27 (60%) of them offer or sell products to the public from animals treated with any of drugs without holding the withdrawal period of the drug.
The current study revealed that there was a high risk of drug and chemical residues in dairy products in the study area which can be a great threat to public health. Consequently, awareness creation through mass education, training and extension service should be promoted in the study area in order to ensure better chemical and drug use and minimize its public health hazards.
Assessment; Chemicals; Dairy farms; Drugs; Milk.
The study was aimed to assess the results of treatment for fracture-dislocations of the proximal humerus (PH) within different time frames for optimizing treatment tactics.
Patients and Methods
This retrospective cohort study evaluated clinical outcomes of 25 patients with fracture-dislocations of the PH (15 patients were analyzed for short- and medium-term results, and 10 – for long-term results). The follow-up period ranged from 1 to 9-years. All patients underwent: clinical examination, constant score assessment and shoulder X-ray examination. Clinical, radiological and statistical methods were used for analysis.
Assessment of the degree of initial displacement of tubercles and its impact on the results of treatment showed that significantly better results were obtained in case of displacement no more than 10 mm (p=0.041). Patients with displacement no more than 10 mm had an average score of 68.0±16.1 points (Mean=69.5), while those with displacement of the tubercle(s) exceeding 10 mm had an average score of 49.5±19.5 points (Mean=44). Analysis of the results of treatment showed that the delay in restoring normal anatomy of the PH or avoiding surgical interventions at all led to functional disorders of the shoulder joint. It was also demonstrated that neither patients, nor doctors were satisfied with the outcomes of the unipolar shoulder replacement (USR). Based on the results of the study, we proposed an algorithm for determining the tactics of surgical treatment in cases when a fracture-dislocation of the PH with complete dislocation of the fragment involving the articular surface of the humeral head is diagnosed.
The present study demonstrated some factors affecting the outcomes of treatment for fracture-dislocations of the PH. Current approaches for endoprosthesis replacement in these cases remain debatable and require further investigation.
Trauma; Fracture; Shoulder joint; Fracture-dislocation of the proximal humerus.
A 21-year-old male underwent screening for a positive family history of colloid cyst with an MRI scan. This suggested a lesion in the region of the roof of his 3rd ventricle which was confirmed on a computerized tomography (CT) scan as a colloid cyst measuring 6 mm. Seven-years before his evaluation, the patient’s father was found to have an approximately 20 mm colloid cyst with acute hydrocephalus for which he underwent excision. His sister suffered a sudden death at the age of 25. The cause of death was confirmed on autopsy as a colloid cyst which was undiagnosed and associated with acute hydrocephalus. At the time of evaluation, the patient was asymptomatic. On serial imaging in 1-year, there was a definite increase in size of the colloid cyst which now measured 8 mm along its maximum dimension. The colloid cyst also changed in signal intensity appearing more hyperintense on T2-weighted images and fluid-attenuated inversion recovery (FLAIR) sequence. A serial magnetic resonance imaging (MRI) was performed in 18-months as a part of ongoing surveillance with neuroimaging following the first presentation. This demonstrated a decrease in size and change in the shape of the colloid cyst, measuring 5 mm in maximum dimension, with associated decrease in ventricular size and resolution of hydrocephalus suggesting some spontaneous rupture of the colloid cyst. A CT head with unenhanced volume acquisition of the head demonstrated residual partially international organization for standardization (ISO), partially hyperdense colloid cyst seen at the foramen of Monro. This confirmed the findings of MRI with a decrease in size of residual colloid cyst measuring approximately 5 mm in maximal diameter with no residual hydrocephalus.
Neuroradiology; Central nervous system cysts; Colloid cyst; Magnetic resonance imaging; Third ventricle; Foramen of Monro.
The American diet is nutrient-poor and rich in unhealthy compounds like sodium, sugar, and saturated fats. Whether food has an effect on appearance has not been fully elucidated. The purpose of this prospective, single-armed study was to evaluate the impact of consuming two nutrient-dense functional foods, which are low in salt, sugar, and saturated fats, on hair, skin, and fingernail health.
Both subjective (self-reported questionnaires and photographs) and objective (i.e., salivary pH and skin hydration) tests were used to evaluate appearance. Weekly compliance with nutrient-dense foods, body weight, and quality of life assessment were also recorded.
Participants(n=28) consumed most of the nutrient-dense foods and remained weight stable, which was the goal of the study to exclude the effect of changes in body weight on appearance. Neither objective measurement of appearance showed significant improvements. Subjective measurements using questionnaires specific to hair, skin, and fingernails improved significantly over the 8-week study. Rating of photographs that the participants took of themselves improved significantly over the 8-weeks. These included reduced redness, decreased pore size, and better skin color. Using an acne-rating scale, a significant improvement was observed at week 8 compared to baseline. The quality of life parameters improved significantly including feeling of well-being, feeling full, having more energy, sleeping better, having less stress, and being more focused.
Inclusion of two nutrient-rich, functional foods in the diet improved the appearance of hair, skin, and fingernails. These foods were well-received and easy-to-prepare, leading to excellent compliance with the dietary protocol.
Appearance; Diet; Functional foods; Nutrient-dense foods; Hair; Skin; Nails.
Some clinical medicine, public health, and health systems administration professionals recognize the role of data in identifying conditions that could be used in the diagnosis and treatment of individuals, as well as, in the development of public health policies or allocation of resources to prevent disease and promote health in populations. Data is important to assess the efficacy of a public health or health system program. In this short communication, key terms of public health, population health, and population health management are defined and, then, a role for data analytics is described to help health system administrators with population health management activities.
Public health; Population health; Population health management; Data analytics; Health system administration.
Bystanders are an integral part of an emergency scene. Their presence on site makes them the immediate potential responders, who can provide life-saving assistance as well as various rescue actions. Research has shown that bystanders are willing to and are capable of helping, especially (but not limited to) when a leader emerges, as the help is rooted in a collective action. In this article, we suggest a new framework for understanding the effectiveness of bystanders help, based on the evolving social process between bystanders and first responders. As we show, the transition from no help, at the very first moment right after the emergency has occurred, to an effective coordinated response where first responders and bystanders act together, goes through engagement of bystanders. Further, first responders should acknowledge the social organization of bystanders, utilize and leverage it in order to optimize their efforts. This framework has important insights for policy makers when managing emergency and disaster situations with limited resources.
Bystanders; First responders; Mass casualty incident; Help; Emergency; Cardio-pulmonary resuscitation (CPR).
This case documents the treatment of a middle-aged woman with chronic, unresponsive adhesive capsulitis (frozen shoulder) using manipulation, active release therapy, and electronic acupuncture. She had not responded to typical physical therapy but did respond to active release therapy along with adjunctive manipulation and acupuncture. In our course of treatment we wanted to see if we could significantly improve pain-free range of motion and normal; function without using invasive treatments like surgery and manipulation under anesthesia. Over a course of five weeks, using a soft tissue manipulation technique known as active release technique along with electrified acupuncture and home exercises, we were able to increase her range of motion to near normal and her function to normal. She was not forced to miss any work because of the treatment and can now do all the things she needs to do for work.
Frozen shoulder; Adhesive capsulitis; Manipulation; Active release therapy; Non-invasive treatment.
Microaggressions — as a cumulative psychosocial stressor — may be a unique mechanism in the development of cardiovascular diseases, via transient changes in cardiovascular reactivity (CVR), for Latinx.
Experimental study with Latinx college students (n=33) randomly assigned to either a microinsult, microinvalidation, or control condition. Independent variables for MANOVA/MANCOVAs were the study conditions and dependent variables were blood pressure (BP) and impedance cardiography (ICG) indicators.
At baseline, two one-way MANOVAs showed no differences by condition for BP or ICG indicators. For the manipulation, results indicated no significant differences by condition for BP or ICG indices. During recovery, results demonstrated no significant differences by condition in BP or ICG indicators. Lastly, baseline experiences of microaggressions were not significantly associated with BP and ICG at recovery.
The experimental manipulation produced no significant difference in CVR by condition. Inferiority and second-class citizen microaggressions were not significantly associated with CVR at recovery. Findings do not negate the existence or cardiovascular impact of microaggressions; rather, these effects appear to be subtle. Implications for Latinx cardiovascular health are discussed.
Blood pressure (BP); Impedance cardiography; Cardiovascular reactivity; Latinx; Racial/ethnic microaggressions;
Cardiovascular health disparities.
Reproductive biotechnology is one of the options which have a role in the improvement of livestock. It is a technology that improves livestock production by improving the reproductive insufficiency of the animal through different techniques. These are artificial insemination (AI), cloning, estrus synchronization, embryo transfer (ET), transgenesis and in vitro fertilization. These techniques are very important techniques to advance livestock production and to meet the people’s demands now-a-day. These reproductive biotechnologies have a dramatic effect on the world’s economy through the improvement of livestock genetics, preventing disease, facilitate transportation, keeping endangered animals and reducing economic loss. Artificial insemination in animals was originally developed to control the spread of disease, avoiding the transport of animals with potential pathogens to other animal units for mating and avoiding physical contact between individuals. The use of semen extenders containing antibiotics also helped to prevent the transmission of bacterial diseases. AI is broadly used in developing countries including Ethiopia. Even if reproductive biotechnologies are effective to change livestock production status of the countries, they are not applied routinely due to the presence of different challenges. Therefore, this review highlighted the major reproductive biotechnology options and their roles in the improvement of livestock production.
Artificial insemination; Estrus synchronization; Embryo transfer; Livestock; Reproductive biotechnology.
This essay has emerged through my research engagements with life history as a research method in anthropology. It is based on the life events of a woman artist. The past few decades have brought an explosion of cultural criticisms and also explorations of women’s creative expressions across cultures. Some of the queries addressed are, how do external forces shape the creativity of female artists. Also, how do creative women respond to such forces? Creative women, then, have a unique relationship to their cultural contexts, as well as to the creative genre to which they respond. This essay also delves into myths related to insanity and women. It discusses creativity, as a mode of engagement with rigid social structures.
Life history; Women; Creativity; Body psyche; Insanity; Myths; Anthropology.
Point of care ultrasound (POCUS) has been adopted across many countries as a way of addressing the human resource gap of radiologists and sonographers. It involves providing basic and focused ultrasound skills to non-radiology health care providers to enhance their routine clinical work.
The purpose of this study was to explore the perceptions of radiology professionals about POCUS training.
The study was qualitative, involving radiologists and sonographers who perform ultrasound examinations. Purposive sampling was used to select the participants. Purposive sampling is a type of sampling where participants are selected because they have the knowledge and experience needed to answer the research objective. Focus group discussions and individual interviews were used to collect data and thematic analysis employed.
Participants generally held negative perceptions towards POCUS training. These were reflected in four major themes: 1) Absence of standardized training curriculum; 2) Limited consultations with radiology professionals; 3) Fear of loss of professional identity and 4) Challenges with POCUS training.
The participants felt negatively about POCUS training. For future acceptability, we recommend involvement of radiology professionals in designing a POCUS curriculum as well as having a regulatory mechanism for monitoring the trainees.
Point of care ultrasound (POCUS); Training; Perceptions; Radiology professionals.
To evaluate the immunogenicity of a recombinant protein D from Haemophilus Influenzae (Hi) and the functional activities of the induced protein D antibodies in a mouse model.
Female Balb/c mice were immunised subcutaneously with recombinant protein D in the presence or absence of adjuvants and the serum immunoglobulin G (IgG) response to protein D was assessed by ELISA. The functional activity of the immune sera was evaluated in vitro using bactericidal assay against typeable Hi serotype b (Hib) and non-typeable Hi (NTHi) clinical isolates and in vivo using an infant rat bacteraemia model and a Hib clinical isolate.
A dose-dependent IgG response was induced in mice immunised with the recombinant protein D and this response was further increased by the adjuvants used [CPG, AlPO4 and Al(OH)3], with the latter showing the greatest effect on the antibody response. Immune sera were very effective in bactericidal assay against several Hib and NTHi clinical isolates, with a higher serum bactericidal titre against the NTHi than against the Hib isolates. This is possibly due to the lower expression of protein D on the Hib isolates used in our study, compared to the NTHi isolates. In addition, anti-protein D antibodies were partially protective in vivo infant rat bacteraemia model against a challenge with Hib Eagan strain.
Our results suggest that recombinant protein D is a good vaccine candidate against Hi and should be given in combination with other vaccine candidates to ensure complete protection against Hib and NTHi.
Haemophilus influenzae (Hi); Haemophilus influenzae serotype b bacteraemia; Rats.
Presenting in her late twenties, this case report examines a G6P2 patient at 11-weeks gestation that was diagnosed with a blighted ovum, as well as the subsequent outcome and methods of additional management. A blighted ovum refers to a fertilized egg that does not develop, despite the formation of a gestational sac. The most common cause of a blighted ovum is of genetic origin. Trisomies account for most first trimester miscarriages, while consanguineous marriages result in recurrent miscarriages due to a blighted ovum. Additionally, a higher percentage of deoxyribonucleic acid (DNA) damage in sperm carries a higher rate of miscarriage. Nutritional factors that may lead to a blighted ovum include low-levels of copper, prostaglandin E2, and anti-oxidative enzymes. High body mass index (BMI), especially in women with a BMI≥30 kg/m2 has been shown to be linked to a blighted ovum. Globally, it has been shown that a blighted ovum is a serious adverse event related to vaccination against dengue fever.
This case report 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.
The purpose of this study was to explain the quality of 5%, 8%, and 12% of grass carp fish protein concentrate (FPC) supplemented cake. Proximate composition, batter rheology, texture analysis, baking loss, color evaluations, and sensory analysis were performed to explain the quality.
Grass carp fish of about 40 cm length and 4 kg weight, sugar, flour, vegetable oil, baking soda, and baking powder were bought from the local market in Wuxi, Jiangsu, China, while vanilla essence, hydroxy propyl methyl cellulose (HPMC) and glycerol monostearate (GMS) were obtained from Jiangnan University Food Science Laboratory.
Results and Discussion
An impressive increment in the crude protein (9.10-16.75%), crude fat (10.39-12.30%), and ash (1.22-1.35%) were noticed for FPC supplemented cake. With the increase in FPC quantity, the viscosity of batters lightly decreased (106.41-106.00) and specific gravity increased from 0.9619-1.0073. A non-uniform change was observed in hardness but gumminess and chewiness were increased while cohesiveness and elasticity were found to be decreased. Baking loss (CL) was increased (10.28-11.13) with an increasing level of FPC. The brightness (L*), yellowness (b*) and redness (a*) of FPC 5%, 8%, and 12% fortified cake was recorded as 59.56-57.15, 29.23-31.24, and 10.85-12.75, respectively.
The cakes prepared with 12% FPC have high nutritional value but showed low sensory attributes due to its dark color and slight fishy flavor while cakes prepared with 8% FPC supplementation revealed the best results for all sensory attributes. In short, a protein-enriched with acceptable quality and sensory attributes, the cake could be prepared by 8% FPC incorporation and eventually could assure effective utilization of fish.
Grass carp fish; Cake; Fish protein; Fortification; Sensory evaluation.
Unique difficulties and challenges can arise for rare diseases and orphan disease indications within a clinical trial. Some of the challenges encountered by trials that are working on rare diseases can include recruitment and enrollment. One of the explanations for the challenges that are encountered in rare disease trials is because of the trial design of study, where the investigational product is being compared to the placebo. This review paper discusses the usage of placebo and when other options could be taken into consideration while creating the protocol, specifically with consideration to rare disease studies. It is essential for the investigators and those designing the protocol to consider alternative options from the standard randomized controlled trial. The aim of this paper is to review alternative trial design options. The trial designs discussed in this review paper include crossover trials, single arm studies and historical data, and n-of-1 trials.
Recruitment; Enrollment; Placebo controlled; Clinical trials; Rare disease; Crossover trials; Single arm study;
Historical data; n-of-1 trials.
Perniosis or chilblain pernio is an inflammatory skin disease, typically located on acral skin surfaces secondary to prolonged exposure to cold temperatures and damp conditions. This disorder can appear as an idiopathic dermatosis, usually in young women, but occasionally it is associated with diseases such as anorexia, intestinal lymphoma, chronic myelomonocytic leukemia, monoclonal gammopathies, cryoproteinaemia, viral infections, as well as connective tissue diseases, especially lupus, picture that is known as chilblain lupus. We present a case of perniosis associated with Systemic Lupus Erythematosus and review the literature.
Chilblain lupus; Perniosis; Chilblain pernio; Rare cutaneous; Myelomonocytic leukemia; Systemic Lupus Erythematosus.
Digital tomosynthesis (DT) is a novel imaging modality that has yet to be adopted widespread in Australia, but has potential to enhance patient outcomes both in diagnosis and reducing radiation dose. A review of the literature was performed to develop an introduction to digital tomosynthesis, and identify its uses and viability in general radiography.
Scopus, Ovid, MEDLINE and PubMed were utilised initially to identify literature published within 5-years, using several search terms linked with AND and OR. Articles were assessed according to specific guidelines, and categorised. Journal databases, medical imaging vendor websites, and article references were also evaluated for relevant information.
Based on tomography, digital tomosynthesis is offered as an add-on to general radiographic equipment from general electric (GE), ShimadzuTM and Fujifilm. It’s technology involves a sweep of the X-ray tube over a limited angle onto a stationary flat panel detector. The data is reconstructed to produce multiple slices in the acquisition plane, providing limited depth resolution in a radiographic setting, at a substantially lower dose to computerized tomography (CT) examinations. It’s use has been highlighted in orthopaedic imaging, in detecting occult fractures when radiography has ambiguous results. Additional uses are mainly in surveillance; digital tomosynthesis has higher sensitivity and similar specificity to radiography, and thus can be used to monitor solid lung nodules, nephrolithiasis and deterioration of arthritic conditions.
At a lower cost to CT, digital tomosynthesis has the potential to become a bridging modality from radiography to both save patient dose and reduce their overall waiting times. However, more large-scale studies are required to confirm this.
Digital tomosynthesis (DT); Radiography; Medical imaging; Emerging imaging; Whole body imaging; Tomosynthesis; Future prospects.
This autobiographical narrative focuses on my life experiences learning two languages as well as the cultures. It acts as an archive from which I elicit evidence in exploring issues and themes related to learning language and culture, particularly those issues and themes relating to the complex dynamics of context. It explores factors influencing learning language/culture, such as subjective constructions and interpretations of teachers and learners, cultural, social, geographical, political, and local community aspects.
Learning language; Teaching; Conceptual background; Methodological background; Autobiography.
This case report illustrates a challenging case of worsening heart failure in a previously well-compensated patient with unclear etiology. Further workup revealed the patient’s cardiac resynchronization therapy-defibrillator (CRT-D) left ventricle (LV) lead was losing capture during positional changes. This case demonstrates the importance of device optimization, as well as electrocardiogram (ECG) monitoring to elucidate possible causes of acute systolic heart failure.
Cardiac resynchronization; cardiac resynchronization therapy (CRT); Systolic heart failure; Lead positioning;
Advanced heart failure.
Pubo-penile ectopic testis is a rare congenital anomaly whose etiopathogenesis is still poorly understood. We report one case of bilateral pubo-penile ectopic testis in a two-year-old child. The diagnosis was made on physical examination alone. Orchidopexy in the dartos muscle was easy to perform.
Pubo-Penile ectopic testis; Orchidopexy
brief research report
Previous literature has reported ill-effect of ototoxic drug on hearing and balance. Present study investigated awareness among medical doctors for the same.
A total of 55-medical doctors of multiple specialties from Assam, India participated in the present study. A total of 14 questions with Likert Scale based scoring pattern were framed and validated for the present study.
Outcome of the present study showed high awareness percentage about side effect ototoxic drugs was obtained, which was a satisfying outcome.
While low audiological referral and consultation awareness was identified as an area of concern.
Ototoxicity; Doctors; Assam; Awareness.
Everyday all of us use rechargeable solutions either its smartphones, televisions, or any other electronic devices. Faster streaming of these electronic devices to other external devices may be facilitated through wireless connectivity. Wireless streaming demands much more battery backup. With advancement of hearing aid technology many features exists in hearing aids which may facilitate better spectral information, improved speech understanding in presence of background noise and thus improving communication and quality of life of the users. The use of these advanced features often requires continuous uninterrupted power supply. Traditional disposable hearing aid batteries cannot be assured of their performance due to their inopportune time discharge. Recently rechargeable solutions in hearing aids have been discovered that can support long-lasting wireless streaming. Modern day rechargeable batteries are expected to be easy to charge which can last for longer duration with more reliability and durability. Rechargeable as a feature is added on over and boon. Rechargeable battery solutions based on its various benefits may support as boon for environment, hearing aid users and professionals (better counseling and more satisfied users). The aim of this article is to highlight the awareness of these different rechargeable solutions for the users and professionals. In addition mentioning in brief the superiority of Lithium ion battery which is widely accepted in rechargeable hearing aids.
Rechargeable hearing aids; Wireless streaming; Batteries for hearing aids; Li-ion batteries.
Intracranial hygroma is a rare and probably missed complication of epidural analgesia secondary to accidental dural breech. The patient presented had a presumed spinal cerebrospinal fluid leak with symptoms of intracranial hypotension. Unusually the patient had both an intracranial subdural hygroma and rarely reported extensive spinal intradural (extra-arachnoid) collection following a lumbar epidural, administered in labour. Given the potential for progression to symptomatic neurological deficits, anesthetists should consider subdural hygroma when encountering patients with features of intracranial hypotension, or altered neurology following epidural. Pathophysiology, imaging and management are discussed.
Subdural hygroma; Epidural; Dural puncture.
Congenital anomalies planned for ocular surgeries range from the rare to atypical to common. Many of this rare ophthalmopathy are associated with clinical syndromes and have important anesthetic implications. Not only is it important to know the syndrome we are dealing with, but it’s also the more important to understand the systems that are involved, the extent of involvement, potential anesthetic complications, right from the cerebrovascular, cardiovascular, endocrine, metabolic, neuromuscular, genitourinary systems to airway. Understanding these aspects becomes more important in rare clinical scenarios as it helps to plan the case, anticipate and treat the complications. Congenital anophthalmia is one of the rare conditions with an incidence of <3/1000 with microphthalmia reported in up to 11% of blind children, hence we report a rare case of bilateral congenital anophthalmia planned for excision of right ocular swelling.
Ophthalmopathies; Congenital anophthalmia; Microophthalmia; Ocular surgery.
Maintenance of the airway and adequate ventilation are essential for the anesthetized patient and may be compromised in patients with pan-facial trauma, abnormal dentition, abnormal mandibular space, or presence of dental hardware. We present an unusual case of a patient with a lack of natural mandibular structure and exposed mechanical hardware with fistula complicating intubation and ventilation prior to surgery.
A 35-year-old male with a history of a self-inflicted gunshot to the left submandibular region approximately 6 years prior was scheduled for urgent mandibular hardware removal, closure of left facial fistula, and removal of several teeth. Pre-oxygenation and ventilation were complicated by extruding hardware and eroded skin, causing interference with a conventional facemask seal. The patient was pre-oxygenated using the SuperNO2VA™ nasal mask with which an adequate seal was achieved without use of a nasal trumpet and with a modified grip. Tracheal intubation via oral video laryngoscopy was successful, and the case proceeded uneventfully.
Adequate ventilation and airway maintenance can be difficult to achieve in patients with abnormal facial structure or mandibular mechanical hardware using conventional methods. The SuperNO2VA™ nasal mask can address airway issues for these patients peri-operatively.
Anesthesiology; Airway management; Difficult airway; Airway devices; Difficult intubation; Ventilation; Oxygenation; Facial trauma; Mask ventilation.
Pneumocephalus is a complication seen either after head trauma or post-neurosurgical procedure. It can be life-threatening if it turns into tension pneumocephalus. The presence of intracranial air indicates the presence of an open communication of cerebrospinal fluid. Air enters dura matter even without connection. Thin air flows upstream along the cerebrospinal fluid (CSF) pathway. Herein, we report a case of pneumocephalus in a 62-year-old female after epidural injection of Bupivacaine and Ozone for the treatment of a prolapsed disc. She was shifted to our hospital post-epidural injection for the management of severe headache. Though it is a rare complication, keeping this in mind will help to quickly diagnose, if need arises.
Pneumocephalus; Head trauma; CT; Thunderclap headache.
systematic review based hypothesis
There is a need for an understanding of the genomic reality that realizes a connector between the genotype and the phenotype by addressing HOW the genotype actually manifests as the phenotype, as a function of the locus or the allele, mutated, variant or wildtype. That understanding is encompassed by the notion of the PRAXITYPE, which assembles and presents the available answers to the HOW!
Cancer is one of the leading causes of death in people with human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS), due to behavioral choices and overlapping risk factors.
The purpose of this report is to determine the long-term incidence of human papilloma virus (HPV)-associated cancer in women with pre-invasive cervical neoplasia, and compliance with medication and cancer screening recommendations.
HIV-infected women diagnosed with pre-invasive cervical neoplasia and an HPV-associated malignancy between 1995-2008 were identified. Data collected includes: demographics, HIV treatment/response, malignancy treatment/response, other healthcare utilization, use of health navigators, and compliance.
Seventy-one subjects were identified with HIV infection, cervical dysplasia, and at least ten years’ follow-up. 17/71 (24%) were identified with an HPV-related malignancy. The mean age of those diagnosed with HPV-related malignancy was 39-years. Malignancies included: Cervix-9, Vulva-7, Anal-4, Vagina-3, Uretha/Bladder-2, Oropharyngeal-3. Eight also had in-situ neoplasms: Cervix-4, Vulva-3, Oropharyngeal-1. Four subjects had 3 separate malignancies, and two others had 2 malignancies. Compliance with HAART correlated strongly with immunocompetence, response to therapy, use of patient navigators, and survival. Sixty out of saventy one (84.5%) subjects underwent screening mammography, 57/71 (80.3%) underwent colonoscopy, and 67/71 (94.3%) underwent pap smear testing. Compliance with screening compared favorably with the general population, and overall survival was similar.
Discussion and Conclusion
The long-term incidence and mortality from cancer in women with HIV and cervical dysplasia appears to be comparable to that seen in the general population, with the possible exception of oropharyngeal cancers. Compliance with cancer screening recommendations appears to be higher than in the general population. This suggests that structured primary care programs for HIV-infected women are effective in prevention/early diagnosis of cancer. Standardized screening programs for oropharyngeal cancers should be considered in this population.
Human immunodeficiency virus (HIV); Cancer; Human papilloma virus(HPV); Women; AIDS;
Highly active anti-retroviral therapy (HAART).
Isthmocele is a pouch defect of the anterior uterine wall, detected at the site of the previous cesarean scar. It can be asymptomatic or cause abnormal uterine bleeding, pelvic discomfort and difficulty conceiving. The main objective of this review is to highlight the hysteroscopic and laparoscopic approaches in the management of this disorder.
During the hysteroscopic approach, the superior and inferior edges or just the superior edge of the defect are resected, removing the fibrotic tissue and allowing renewal of the continuous canal between the cervix and the uterine cavity. Whereas, the laparoscopic approach consists of direct visualization and removal of the defect followed by re-approximation of the myometrium. Both methods lead to significant improvement in symptoms and fertility.
While hysteroscopy is a quick non-morbid procedure that allows concurrent removal of other uterine pathology, laparoscopy is characterized by improved visualization and decreased risk of complications with defects less than 3mm as well as the possible correction of uterine retroversion. Definitely, randomized controlled trials are required in this field for better guidance of the diagnosis and management.
Isthmocele; Uterine niche; Cesarean scar defect; Cesarean scar syndrome; Hysteroscopy; Laparoscopy.
To investigate the additional beneficial effects of combined oat bran consumption and brisk walking exercise compared to oat bran consumption alone on bone metabolism markers in 40 to 50 years-old hypercholesterolemic women.
Thirty-three hypercholesterolemic women participants aged 40 to 50-years-old were recruited and were assigned into three groups, with eleven participants per group (n=11): sedentary without oat bran consumption control (C), oat bran consumption alone (Ob), and combined oat bran consumption and brisk walking exercise (ObEx) groups. Participants in the ObEx group performed brisk walking exercise sessions 30 minutes per session, 3 sessions per week for 6 weeks. Participants in the Ob group and ObEx group consumed 18 g of oat bran powder, 7 days per week for 6 weeks. Participants’ anthropometry and blood bone metabolism markers were measured at pre- and post-tests.
There were no significant main effects of time (p>0.05) in serum total calcium, serum phosphorus and serum C-terminal telopeptide of type 1 collagen (1CTP) (bone resorption marker) concentrations in all the groups. However, significantly (p<0.05) increase in serum alkaline phosphatase (bone formation marker) concentration was observed in Ob group and ObEx group respectively.
The present observations did not show large difference in the beneficial effects of combined oat bran consumption and brisk walking compared to oat bran consumption alone on bone metabolism markers. Future studies with longer duration may be needed to elicit greater effects of combined oat bran consumption and brisk walking than oat bran consumption alone on bone metabolism markers in middle age hypercholesterolemic women.
Bone metabolism; Brisk walking; Hypercholesterolemic; Oat bran consumption; Middle age women.
To evaluate the effectiveness of medial flap inferior turbinoplasty for the treatment of nasal obstruction in children.
Patients and Methods
This study was conducted at the ear nose throat (ENT) Department at Minia University Hospital, Minia, Egypt which include 40 children with bilateral nasal obstruction due to bilateral hypertrophied inferior turbinates that did not respond to medical treatment for 3 successive months in the form of (systemic antihistamines, systemic and local decongestant drugs and local corticosteroid spray) who attended the ENT outpatient clinic. All patients were subjected to turbinate reduction through medial flap inferior turbinoplasty.
Forty patients with bilateral hypertrophied inferior turbinates were assessed. Ninety days after surgery, 90% of patients transformed from severe or moderate degrees of nasal obstruction “pre-operatively” to mild degree or completely with no nasal obstruction; 80% of patients had grade I improvement in nasal obstruction and 14 patients had only grade II improvement; only
10% of patients had crustation.
Medial flap inferior turbinoplasty is safe and effective in the treatment of nasal obstruction in children with almost no complications was recorded.
Inferior turbinate hypertrophy; Inferior turbinoplasty; Nasal obstruction; Children.
The coexistence of a head and neck cancer and a lymph node tuberculosis is rarely described. The problem is essentially diagnostic. We report the case of a patient with cervical lymphadenopathy and non suspect swelliing of nasopharynx. Histopathological study of lymph node reveled an association of a tubercular adenitis and a metastasis of a squamous cell carcinoma.
There is a global increase in occupational exposure to solvents, some of which are suspected to cause acute or chronic toxic nephropathies in humans. However, limited studies have been done to evaluate the systemic effects of exposure to some of the commonly used solvents such as paints.
The aim of the present study was to assess the effect of chronic exposure to paint fumes on renal and hepatic functions of industrial spray painters. Methodology In this cross-sectional study, 49 occupationally exposed male industrial spray painters who had served for greater than 5 years were evaluated for changes in renal, hepatic and hematological indices using standard instruments and results were compared with levels in the unexposed (sex and age-matched) participants.
Significant changes in markers of renal, hepatic and hematological functions were observed in the exposed compared with unexposed participants including significant decrease in estimated glomerular filtration rate (eGFR) and serum levels of potassium (K+) and chloride (Cl-), and significant increases in serum levels of creatinine (Cr), sodium (Na+), urea (Ur) and uric acid (UA) in the exposed compared to levels in the unexposed group. Abnormal serum levels of hepatic enzymes (AST, ALT and ALP) and hematological indices (PCV, total-RBC, nuetrophils, basophils, monocytes and lymphocytes) were also observed in the exposed compared to levels in the unexposed participants.
Prolonged exposure to paint fumes may be associated with a significant risk for hepato-renal dysfunction and hematotoxicity. Preventive measures should include limiting exposure and using antioxidant medications.
Spray painting; Toxicity; Workers; Kidney; Liver; Blood cells.
Abbreviations ALT: Alanine transaminase; ALP: Alkaline phosphatase; AST: Aspartate transaminase; eGFR: Estimated glomerular fitration rate; C-G: Cockroft-Gault; MDRD: Modification of diet in renal disease; Na+/K+/ATPase: Sodium potassium adenosine triphosphatase; PH: Hydrogen Concentration; PCV: Packed cell volume; RBC: Red blood cells; ROS: Reactive oxygen species; UA: Uric acid; Ur: Urea.
Introduction: Overt type 2 diabetes mellitus (T2DM) is a chronic progressive disease which is produced by the collusion of three metabolic defects-increased hepatic glucose production, impaired pancreatic β-cell insulin secretion and decreased insulin action. The measurement of plasma glucose 2 hours post-ingestion of 75 g of glucose during the oral glucose tolerance test (OGTT) may be used to classify individuals as normal glucose tolerant (NGT), impaired glucose tolerant, T2DM and T2DM with pancreatic β-cell failure.
Objectives: This study was undertaken primarily to show the importance of assessing the pancreatic β-cell function especially during the care of the diabetic patient.
Methods: A standard 75 g glucose tolerance test (OGTT) was administered to four groups of 8 subjects (4 male, 4 female). Blood was drawn every 15 minutes for 2 hours for the measurement of glucose, insulin and C-peptide and the measurement of the area under the curve (AUC(0→2)) over the 2-hour period.
Results: American Diabetes Association (ADA) criteria were used to classify the subjects. The normal glucose tolerant (NGT), had 2 h glucose 111±11 mg/dL, those with impaired glucose tolerance (IGT) had 2 h glucose 160±13 mg/dL. The 2 h glucose for the T2DM group was 258±27 mg/dL and those for the T2DM-PE group was 260±42 mg/dL. The AUC(0→2) for NGT group were 254±40 mg/dL/h, 112±61 μU/mL/h and 10.2±4.6 ng/ml/h for glucose, insulin and C-peptide, respectively. The AUC(0→2) for the IGT group were 394±32 mg/dL/h, 160±48 μU/mL/h and 19.8±7.7 ng/ml/h for glucose, insulin and C-peptide, respectively. The AUC(0→2) for the T2DM group were 474±62 mg/dL/h, 194±40 μU/mL/h and 13.4±4.7 ng/mL/h for glucose and insulin, and C-peptide, respectively. The AUC(0→2) for the T2DM-PE group were 481±80 mg/dL/h, 51±29 μU/mL/h and 7.2±2.8 ng/mL/h for glucose, insulin and C-peptide, respectively. There was no significant difference between the diabetic groups with respect to the glucose AUC(0→2) but a significant difference existed in the insulin AUC(0→2), (p<0.0001) mirrored by the fasting plasma insulin levels (30±8 μU/mL vs 14+8 μU/mL, for T2DM and T2DM-PE, respectively, p<0.0005). Although there was about a 300% increase in fasting insulin between the IGT and T2DM groups, the corresponding fasting C-peptide levels were only about 15%. This is probably due to differences in hepatic and renal functions in those two groups, the processes that control insulin and C-peptide levels in the body.
Conclusion: Although measurement of blood glucose appears adequate in the diagnosis of the diabetes, it seems that plasma insulin/C-peptide measurements could guide physicians in their choice of medications for the treatment of diabetic patients, especially when the pancreas begins to fail. To that end, larger studies are warranted to study the effects of hypoglycemic agents on hepatic insulin extraction and renal C-peptide excretion to ascertain the reliability of the plasma insulin and C-peptide levels.
Type 2 diabetes mellitus; Pancreatic β-cells; Oral glucose tolerance test; Pancreatic exhaustion.
Despite previous findings attesting to the syndemic nature of human immunodeficiency virus (HIV), chronic disease and mental illness coordination of these issues remains a significant barrier to initiating and maintaining the delivery of mental and physical health care to persons living with HIV (PLWH). These inequities are even greater when applied to rural settings, particularly in areas that are medically underserved. To date, there is scarce research regarding the lived experiences of African American PLWH
in rural settings. Constructivist grounded theory was used to analyze this qualitative data set. These discourses provide a rich narrative regarding effective systems of care, the context in which these processes take place and related constraints or limitations of the current systems.
In-depth interviews with 24 African American PLWH both inside (N=20) and outside (N=4) of care in rural Northwestern Virginia were conducted. Rural African American PLWH were queried about their perceptions of the provision of HIV health care services, barriers to linkages to care, retention of PLWH in care, and recommendations for improving HIV health care services for rural PLWH.
Participants offered insights on the linkages to health and mental health care consistent with the pattern recommended by the cascade of care (i.e. pre-screening, testing, refer to treatment, treatment and sustain treatment). Participants identified contextual factors, including traumatic events, medication (side effects), other chronic health issues, issues with the current health and mental health system, stigma, and lack of social support. We highlight PLWH’s recommendations for linking rural PLWH into care and sustaining that care.
We discuss the implications of these findings for programmatic development in the rural context.
Rural African Americans living with HIV; Barriers to HIV health care; Rural South; HIV lived experience.
One of the most common sphingolipidosis, Gaucher disease (GD) remains rare till date. A case report of a 56-year-old patient diagnosed with GD is presented herein. Her sister was known to have Gaucher disease. Her personal medical record consisted of splenectomy, anemia, recurrent infections, and bone lesions at a young age. Taking into consideration her personal and familial history, the clinical and paraclinical examinations, she was diagnosed with Gaucher disease which was confirmed with enzyme and gene testing. Upon introduction of specific enzyme replacement treatment for Gaucher patients,much evidence demonstrated the substantial improvement of hematological and visceral parameters. However, it has been observed that the bone tissue does not respond equally to the treatment.
• The physician should always investigate the splenomegaly of unknown etiology before deciding to do a splenectomy
• Bone lesions in Gaucher disease are sometimes irreversible, hence the importance of early diagnosis of this rare disease
Gaucher disease; Bone lesion; Splenomeagly.
GD: Gaucher disease; Hb: Hemoglobin; MRI: Magnetic resonance imaging; ERT: Enzyme replacement therapy.
Cardiovascular surgery is increasingly performed in children for congenital malformations of the heart and great vessels. Observed as vocal fold immobility, recurrent laryngeal nerve injury is a well-described complication. As overall outcomes improve and patients live longer, the sequelae of vocal fold immobility amplify insignificance. Families are often unaware of the longterm issues related to vocal fold immobility especially with regard to need for alternative alimentation routes. We report on the incidence of use of feeding tubes, the timing of vocal fold function return and need for additional aerodigestive interventions.
We reviewed 65 patients <2-years who underwent cardiovascular surgery at a tertiary center from 2008-2013 and were diagnosed post-operatively with vocal fold immobility by fiberoptic examination.
Patent ductus arteriosus and hypoplastic left heart syndrome were the most common of the cardiovascular anomalies included. The majority (92%) had unilateral left immobility. Recovery of motion was observed in 29% ranging from 1-month to 3-years. Hypoplastic left heart syndrome had a significant negative correlation with recovery. Forty-six percent required gastrostomy tube placement either to supplement their oral intake or to completely meet their nutritional needs. Forty-eight percent required subsequent aerodigestive surgery including direct laryngoscopy/bronchoscopy (22%), tracheostomy (8%) and vocal fold injection (5%).
Counseling of families and primary care providers regarding the impact of pediatric vocal fold immobility after cardiac surgery should include the high potential requirement for supplemental alimentation as well as the need for feeding and speech therapy. Longitudinal otolaryngology and speech pathology care is imperative with vocal fold immobility since the majority of these patients do not experience functional recovery and may require further interventions over time.
Vocal cord paralysis; Pediatric cardiovascular surgery; Pediatric aerodigestive disorders; Voice; Swallow; Gastrostomy.
Date palm pollen (DPP) is a natural product well-known in folk medicine in the Arab world. It is used to improve the fertility of human beings and studies have tested this activity on rabbits and rats. In the region of Sfax from Tunisia, a huge quantity of DPP could be discarded. Taking into account of the richness of this typical product of different components and of the trend of producing food supplements that could be sold at medium price comparing with the existing product, DPP was analyzed on the basis of physical and chemical properties in order to promote its use as a techno-functional ingredient in the agri-food and pharmaceutical field.
X-ray diffraction showed that DPP is characterized by an amorphous structure which leads to better techno-functional properties while stored in a water-air-tight container. Findings proved that DPP is capable to reduce the surface tension. Collected data from thermal analysis proved that DPP is thermally stable during storage and in different food systems.
The present study demonstrated that DPP could be used in the agri-food and pharmaceutical field. The obtained results help to define the suitable storage conditions of DPP and to predict its behavior when used as an ingredient. DPP can be used as a whole in food formulations or after extracting protein which is the main responsible agent for surfactant property. DPP proteins might be used as a food supplement in commercial sports nutrition products that can be sold at medium prices compared to some existing products.
Date palm pollen; Physico-chemical; Morphology; Surface; Thermal.
To assess reasons for patients being lost-to-care (LTC) at an urban health center (Philadelphia, PA, USA) that provides access to oral tenofovir/emtricitabine(TDF/FTC) as pre- exposure prophylaxis(PrEP) to patients ages 13-30 years through a drop-in model of care.
Ninety-nine patients were identified as LTC based on not visiting a clinician in ≥4 months during the period April 2016-January 2017. Patients were contacted by phone/email to participate in a voluntary telephone survey regarding reasons for falling out of care. Results were analyzed descriptively.
Of the 99 patients preliminarily identified as LTC, 19 completed the survey. Reason(s) for becoming LTC included: 47%(9) relocation, 11%(2) transportation difficulties to/from clinic, 26%(5) financial/insurance problems, 5%(1) perceived medication side effects, 16%(3) trouble remembering to attend appointments regularly, 5%(1) difficulty with daily medication adherence, and 0% social stigma. Furthermore, 21%(4) remain at high-risk of HIV/STI acquisition after becoming LTC. The main study limitations are selection bias and small sample size, where the small sample size did not allow for statistical significance.
While the major cause for becoming LTC was relocation, these findings suggest 37% of LTC incidences may be preventable with additional/up-front support. Because 21% of LTC patients remain at high-risk of HIV/STI acquisition, proactive re-engagement initiatives are potentially useful.
HIV/AIDS; Pre-exposure prophylaxis; Retention and care; Socioeconomic factors; Adolescent Health; Lesbian/Gay/Bisexual/Transgender Persons.
Music therapy (MT) is part of the care plan in many end-of-life (EOL) settings, though several authors remain cautious about its effectiveness to improve EOL symptoms and patient well-being.
Our primary goal was to design and test the feasibility of a clinical trial protocol that would address the main critiques of MT trials previously reported in the literature.
We conducted a literature review guided by the questions: (1) What is the set of indicators and tools that can be used to measure effectiveness of MT for seniors in palliative care and EOL settings? (2) What are the characteristics of a well-designed clinical trial protocol that can measure effectiveness of MT in palliative care and EOL settings and can be used for a future large scale study? Based on best practices from the review, we developed a clinical trial protocol and tested its feasibility.
Ten participants were accrued. Approximately 25% of eligible participants chose to participate. The consent rate was 55% with 70% of participants completing all MT sessions. All participants completed more than 60% of questionnaires.
Although our protocol could not be considered feasible based on the parameters we originally set, we argue that our study provides enough data to make adjustments to our original trial protocol, which could lead to the collection of reliable evidence related to the effectiveness of MT for seniors at EOL. We recommend future studies to use block randomization and allocation concealment, focus on one primary outcome and conduct intention-to-treat analysis.
Music Therapy (MT); End-of-Life (EOL); Seniors; Clinical trial; Palliative Performance Scale (PPS); Standardized Mini-Mental State Examination (SMMSE); Positive Affect and Negative Affect Schedule (PANAS); Spiritual Health Assessment (SHA).
Postpartum haemorrhage is the leading cause of maternal mortality and morbidity. The significant impact of postpartum haemorrhage (PPH) on maternal mortality can be reduced if timely measures are implemented. Transcatheter arterial embolisation (TAE) is an alternative therapeutic strategy for PPH.
We report a case of postpartum haemorrhage which was managed by transcatheter arterial embolization in lieu of hysterectomy to preserve fertility and menstruation in a 27-year-old patient.
The critical role of obstetrician, anaesthesiologist and interventional radiologist as a team, improve the quality of care and patient safety.
Postpartum hemorrhage (PPH); Peripartum hysterectomy; Transarterial embolisation.
Since the Sarin incident in the subways of Tokyo in 1995, there has been an unprecedented increase in the use of chemical agents on civilian populations internationally. This scourge of chemical terrorism has been relentless worldwide and is likely to continue to be a public health issue that needs to be addressed by the relevant authorities as part of national disaster preparedness and response. One aspect of chemical disasters involves the need for mass decontamination of chemically-contaminated casualties from the scene. The traditional role of hazardous materials civil defence experts in providing such decontamination of victims in the pre-hospital setting is limited by many factors. The presence of congestion in densely populated areas in a highly built up environment of modern-day cities, compounds the timeliness of putting up cordons and crowd control and hence delays the prompt set up of such mobile decontamination facilities close to the incident site. The expected side effect is an almost instantaneous influx of contaminated casualties to the nearest hospital in such situations, which drives the need for public hospitals to be ultimately capable of performing mass casualty decontamination as part of hazardous materials disaster preparedness. This review presents an innovatively designed rapidly deployable hospital-based decontamination facility that has served a tertiary care hospital in Singapore for the last 2 decades in being prepared for managing mass casualties arriving from a chemical disaster in a timely manner.
Decontamination; Chemical incident; Industrial disasters; Toxic industrial chemicals; Hazardous materials preparedness; Disaster contingency plans; Emergency preparedness.
Preconception care improves pregnancy outcomes. The aim of preconception care is to identify situation in which the parents particularly mother or the fetus may be in any additional health risk, and to take steps to minimize the risk before pregnancy is possible. But the concept of preconception care is not as popular as in western countries comparing to India where the number of maternal and newborn morbidity and mortality is high.
To assess the level of knowledge among married women on preconception care by structured knowledge questionnaire; determine the effectiveness of informational booklet in terms of gain in knowledge scores; find the association between pre-test knowledge score and selected variables like age, education, occupation, type of family and parity.
Materials and methods
The study was carried out among married women between the age group of 18-35 residing in a selected village of Udupi District, Karnataka, India. An evaluative approach with one group pre-test and post-test design was used. Frequency, percentage, paired t-test and Chi-square test were used to analyze the data.
Majority (55%) of the women had poor knowledge and 45% women had average knowledge in pre-test. In the post-test 57% of women had good knowledge and 43% had average knowledge. Mean difference between the pre-test and post-test knowledge score was 7.92, p<0.001 which showed an improvement in knowledge scores among women. An association was found between educational status and knowledge among women which can be inferred that the level of knowledge is dependent on the level of education.
Majority of the married women had poor knowledge on preconception care and an informational booklet on preconception care is an effective intervention in improving the knowledge.
Preconception care; Married women; Information booklet; Knowledge level.
Transcriptomics has allowed for a better understanding of disease, and the sequencing of individual genes is becoming a leading approach to discovering novel germ lines. A newly defined cell type, described as transitional cells, was characterized based on their expression of key marker genes that define principle cells (PC) and intercalated cells (IC). Gene expression patterns suggested that a Notch signaling pathway was activated during the transition from IC to PC. An experimental model studying the transition in an inducible transgenic mouse demonstrated that Notch signaling and receptor expression is sufficient to drive cell transition in differentiated adult kidney collecting tubule. The identification of novel cell lines allows for a more accurate diagnosis of kidney disease and precise staging of disease. Molecular profiling and precision therapy will continue to revolutionize the field of medicine and warrants further exploration.
Transcriptomics; Kidney disease; Principle cell; Intercalated cell; Notch signaling; Gene sequencing.
PC: Principle cell; IC: Intercalated cell, DNA: Deoxyribonucleic acid; RNA: Ribonucleic acid; mRNA: Messenger ribonucleic acid.
An incidentally discovered Meckel’s diverticulum while performing radical cystoprostatectomy with neobladder for muscle invasive carcinoma bladder was utilized as the most dependent part of the pouch for anastomosis with the urethral stump leading to a simple tension free anastomosis with very good post-operative results.
Meckel’s diverticulum; Ileal neobladder; Radical cystectomy; Carcinoma bladder.
Pleomorphic adenomas are the most common benign parotid tumours in all populations. Management always consists of a curative superficial parotidectomy. However, rare cases described, in which these histological benign tumors metastasize to distant sites. We present an example of a recurrent parotid pleomorphic adenoma with a contralateral supraclavicular lymph node metastasis after several surgical interventions.
In this case, we reported reported a case of 29-years male with extensive metastasis in submandibular, submental and also very rarely seen contralateral supraclavicular lymph node metastasis. Parotidectomy with preservation of facial nerve and radiotherapy was given to the patient since the lesions were very aggressive.
The patient had several surgical interventions, so it is essential to do meticulous resection in the first surgery to prevent local recurrence and distant metastasis.
Pleomorphic adenoma; Metastasizing pleomorphic adenoma; Salivary gland benign neoplasia.
It is difficult for the elderly, those with complications, and those who live in remote areas to visit the hospital, and as a result, there are limits on the drugs they are able to use. It is therefore effective to prescribe such patients oral medications that have few adverse effects and in regimens that require few hospital visits. Clarithromycin can induce cell death by autophagy and it has a direct antitumor effect. There have been reports of the outcomes of Lenalidomide and Dexamethasone therapy with Clarithromycin which is administered orally and is safe on multiple myeloma. However, in Japan, there have been few studies. Here, we report on Clarithromycin, Lenalidomide and Dexamethasone therapy in our hospital.
We analyzed 7 patients with relapsed refractory or refractory multiple myeloma who were treated at this hospital between January 2012 and December 2014. The Clarithromycin, Lenalidomide and Dexamethasone therapy were administered in a 28-day cycle as follows: Clarithromycin 400 mg/day for 28-days, Lenalidomide 15 mg/day for 21-days, and Dexamethasone was administered in a dose of 20 mg once per week. The response criteria used were standard International Myeloma Working Group (IMWG) Uniform Response Criteria. and adverse events were graded according to the national cancer institute-common terminology criteria for adverse events (NCI-CTCAE) Ver. 4. Statistical analysis was performed using Easy R (EZR).
The response to Clarithromycin, Lenalidomide and Dexamethasone therapy were selective catalytic reduction (sCR) in 2 patients, CR in 1 patient, per rectum (PR) in 3 patients, and standard deviation (SD) in 1 patient. Response rates of PR or better were observed in 86% of the patients. Duration of response was median 316-days (range, 160-522-days). Median oculus sinister (OS) period was 1,907 days. Median OS following discontinuation of the study was 1,385 days. Hematological adverse events were G1-2 anemia in 3 patients and G3-4 anemia in 1 patient. G1-2 thrombocytopenia was observed in 1 patient and G3-4 thrombocytopenia was observed in 1 patient. Leukopenia of G1-2 was observed in 6 patients but G3 was not observed. Non-hematological adverse events were G1-2 liver disorder in 6 patients, G1-2 skin rash in 3 patients, and G1-2 constipation in 2 patients. G4 adverse events were fainting and duodenal ulcer in 1 patient each.
Clarithromycin, Lenalidomide and Dexamethasone can be safely and effectively administered in the relapsed refractory multiple myeloma
Multiple myeloma; Bird; Clarithromycin, lethal dose (Ld).
Historically, natural products played a forceful role in human treatment ailments. Nowadays, natural products include a large part of current pharmaceutical agents, mostly in the field of cancer therapy. The main aim of this review is to provide a comprehensive summary of the most known natural product used as anticancer globally, including various other natural products. Many of these natural product appears to act through an anticancer mechanism. Overall, natural product research is a vigorous tool to discover novel biologically active components with unique mechanisms of action. Given the diversity of nature, it is sensible to indicate that chemical leads can be produced that are able to interact with most therapeutic targets. This review creates a solid foundation for further study these natural products with additional research and study.
Anticancer; Natural product; Plant compounds; Marine flora; Microorganisms; Venom.
A patient-centered approach is reasonable in candidates for carotid revascularization. The patient and their physician should discuss the available treatment options, including revascularization (either carotid artery stenting (CAS) or carotid endarterectomy (CEA)) with their physician. There remains uncertainty regarding the value proposition for revascularization (either CEA or CAS) in asymptomatic patients as a strategy to prevent stroke. Investigation continues into characterizing high-risk carotid plaque subsets, but until that data is available, physicians and patients should continue to strive to achieve the best outcomes with the information that is currently available. The other consideration in asymptomatic patients is that there is a cumulative benefit to revascularization that is dependent on life expectancy. However, the magnitude of the benefit of revascularization, over the longer term in the setting of multifactorial medical therapy, including statins, is not known.
Carotid endarterectomy; Carotid stent; Angioplasty; Embolic protection devices.
Cachexia is a syndrome which is a common feature in more than 80% of patients with advanced cancer and globally accounts for over two million deaths per annum. At present there are no standard treatment guidelines for cancer cachexia management. Previous research conducted with the United Kingdom and Australia has highlighted different understanding and treatment practices of health care professionals in cachexia management, however, no study has elucidated the understanding and current practices of health care professionals in the United States.
The aim of this research was to explore the understanding and current practices of health care professionals in the United States when providing care to an individual with advanced cancer who has cachexia.
This is a qualitative study underpinned by symbolic interactionism. Face-to-face semi-structured interviews were conducted (n=17) with multi-disciplinary oncology staff and thematically analysed. Health care professionals were recruited from one large health care facility in the United States, until data saturation was reached. NVivo was used for data management. Criteria for upholding rigor (credibility, dependability, confirmability, transferability) were adhered to within this qualitative study. Full ethical approval was obtained prior to data collection commencing.
Analysis determined four main themes related to (1) recognizingthe signs and symptoms of cachexia; (2) the multidimensional impact of cachexia on both patients and families; (3) complexities when treating cachexia; and (4) future direction of care delivery for patients with advanced cancer who have cachexia.
Participants within this study recognized the multi-factorial pathophysiology of cachexia and its holistic impact which spanned biological, psychological and social domains. Additionally, they recognized the impact of cachexia on not only patients but also their family carers. In particular the feelings of helplessness family carers experience in trying to stop the progressive and involuntary weight loss associated with cachexia. Further research is required to examine how to best support the needs of patients with advanced cancer who have cachexia and their family carers and equip staff to optimize delivery of this.
Qualitative research; Cancer cachexia; Symbolic interactionism; Multi professional care; Patients and carers.
The obesity epidemic has been largely attributed to changes in lifestyle habits established over the past three decades. These changes are mainly attributed to excessive nutrition and decline in physical activity as well as additional factors such as reduced intestinal microbiota diversity, sleep duration, endocrine disruptors, and reduced variability of the ambient temperature. However, the obesogenic environment is not sufficient to determine the presence of obesity, it is necessary that the lifestyle becomes associated with a personal predisposition for the phenotype to emerge. In this article, we review the main forms of monogenic and syndromic obesity, as well as a historical summary of the search for the genes that add up to confer greater risk for the development of polygenic obesity.
We carried out a PubMed search, along with ExcerptaMedica database (EMBASE)/Cochrane library, Web Sciences for the Medical Subject Headings (MeSH) terms “obesity’’ AND “genetics” for the past 5-years.
We found a total of 14057 articles pertaining to obesity and genetics together of which we selected 92 articles for this review after getting articles after searching cross references.
Studies with twins and adopted children show that 55 to 80% of the variation of body mass index (BMI) is attributed to genetic factors. According to the genetic criteria, obesity can be classified as A) Monogenic – when a mutated gene is responsible for the phenotype; B) Syndromic – when a set of specific symptoms are present and a small group of genes is involved; usually the term is used to describe obese patients with cognitive delay, dysmorphic features, organ-specific abnormalities, hyperphagia, and/or other signs of hypothalamic dysfunction; C) Polygenic – also called “common” obesity, present in up to 95% of cases. Many genes add up to give a greater risk to the individual, and if associated with some habits culminates in obesity. In spite of its great relevance, the search for the genes that raise the risk of obesity has not been easy. It is still a challenge for the scientific community to separate the genetic element from the environmental component in the etiology of this disease. Individuals more susceptible to excessive adiposity may carry risk variants in the genes that influence appetite control, the regulation of cellular machinery, lipid metabolism and adipogenesis, the energy expenditure, insulin signaling, and inflammation.
Obesity; Genetics; Polygenic; Monogenic; Syndromic; Polymorphism.
Severe psoriasis is associated with an enhanced risk of cardiovascular (CV) diseases. The potential impact of psoriasis on the prognosis following coronary revascularization (percutaneous coronary intervention (PCI) or surgical) is not well studied and sparse data available in literature points towards a grim long-term prognosis. The following two cases highlight this phenomenon. We also discuss the plausible reasons responsible for the poor prognosis and propose some possible mechanisms for the same.
This cartographic and analytical study, using the social network analysis method, aims to characterize sheep mobility from breeders producing lambs in the Middle Atlas Mountains to the fattening centers, passing through livestock markets in order to describe the exchange network, to identify the main mobility hubs and to secure the production of fattening lambs by improving the efficiency of the epidemiological surveillance system for “peste des petits ruminants” (PPR) in lambs producers of the Middle Atlas in Morocco.
Descriptive cross-sectional study within the framework of active epidemiological surveillance. It was carried out at a regional level, for mapping the movements of sheep and to analyze the network of exchange relating to this species by the Social Network Analysis (SNA) method in the middle atlas massif and in the zone of sheep fatteners to guide epidemiological surveillance efforts. A total of 807 breeders producing lambs, sheep fatteners and traders were surveyed, including 54 fatteners in fattening workshops (sampling fraction of 48.6%), 150 breeders and traders in livestock markets of Middle Atlas and 603 producing lamb breeders of this massif (sampling fraction at the massif level of 6.64%).
The study revealed a very strong commercial relationship between middle Atlas breeders and fattening zone breeders whose longrange outflows mainly converge towards urban consumption centers. The major strategic livestock markets of the middle Atlas proved to be key points in the articulation of the flows, as was the commune gathering the fatteners. Centrality indicators were used to identify the main trade hubs that contribute to the spread of diseases and to quantify their importance in the influence of sheep movement, while network cohesion parameters have shown that network is vulnerable to the spread of epidemics.
The results of this survey revealed the main commercial hubs at the Middle Atlas level and at the level of the province of fatteners, which represent a great risk of spreading sheep diseases over long distances rather quickly in event of an epizootic, but also representing the ability to control the spread through the control of the movement of animals at their level.
Ovine network; Epizotic of (Peste des Petits Ruminants); Mapping; Social network analysis; Hub; Betweenness; Degree; Strong component; Cutpoint.
The consequence of metastatic carcinoma cervix is regarded to be poor. We present three patients with carcinoma cervix who relapsed in the paraaortic nodes, lungs and vertebra. All of them had oligometastatic disease and were treated with chemotherapy to the lung lesion and radiotherapy to the bone lesion and paraaortic nodes. After more than 5-years they are disease free and on regular follow-up.
Carcinoma; Cervix; Oligometastasis; Paraaortic lymph nodes; Chemoradiation; Chemotherapy.
Prothrombin complex concentrates (PCC) has long been used to reverse vitamin K antagonists (VKA)-induced coagulopathy rapidly and safely. However, its use in trauma-induced coagulopathy (TIC) in patients not using VKA drugs is yet to be elucidated. This article is a narrative review and analysis of the most recent literature to analyse consequences, and intended effects associated with this treatment modality in TIC. Utilization of PCC was addressed in the literature data found by searches of databases. The indications, efficacy and outcomes associated with the use of the product were reviewed in the articles. Some studies point out promising results with respect to PCC use to overcome the VKA-related coagulopathy in victims of trauma. PCC may be a viable option for resuscitation in emergency and critical care in the management of severe hemodynamic deterioration induced by trauma, despite contradictory findings in the literature.
Blood coagulation factor; Trauma; Hemorrhagic shock; Exsanguinating hemorrhage.
Low-levels of gamma globulin are associated with a risk of infection, and complications of hypogammaglobulinemia are often observed in hematologic malignancies. In chronic lymphocytic leukemia (CLL), IgG≤600 mg/dL is reportedly associated with higher risks of infection. The objective was to determine the risks of hypogammaglobulinemia and infection in malignant lymphomas for which rituximab that targets B-cells is used.
A retrospective analysis of data from medical records of patients with malignant lymphomas treated with rituximab-containing therapy at our hospital between April 2014 and March 2016 was performed to assess the risks of infections through an evaluation of IgG levels and hospitalizations for and deaths due to infections in patients hospitalized with infections during this period.
From April 2014 to March 2016, 128 patients with malignant lymphomas received rituximab-containing therapy at our hospital, and 94 (61%) of these patients had IgG levels measured. These 94 patients were included in the analysis. The histological types were as follows: 30 had follicular lymphoma (FL), 17 had indolent non-Hodgkin’s lymphoma (iNHL), 42 had diffuse large B-cell lymphoma (DLBCL), and 5 had mantle cell lymphoma (MCL). The mean minimum immunoglobulin G (IgG) level in patients hospitalized for infection was 546 mg/dL and was 628 mg/dL in those not hospitalized (p=0.6). Although a significant difference was not observed, IgG levels tended to be low in hospitalized patients with infection. In addition, there were 4 patients with mean IgG levels that were 600 mg/dL or less in the 6-months immediately prior to hospitalization. Among these 2 died of infection.
Low-levels of gamma globulin are associated with a risk of mortality due to infections in malignant lymphomas.
Hypogammaglobulinemia; Malignant lymphoma; Rituximab.
CLL: Chronic lymphocytic leukemia; FL: Follicular lymphoma; iNHL: Indolent non-Hodgkin’s lymphoma; DLBCL: Diffuse large B-cell lymphoma; MCL: Mantle cell lymphoma; FN: Febrile neutropenia.
While there are some studies on sleep and physical activity, little is known regarding the associations between sleep and sedentary behavior. This study investigated the associations between sleep, sedentary behavior, and physical activity among young adults.
Cross-sectional data from 124 undergraduate students were included in the analysis (age=21±1 years). Both accelerometer-based and self-report assessments of sleep were included; physical activity and sedentary behavior were assessed by accelerometers. Participants were asked to fill out sleep questionnaires and wear accelerometers for 7 days. Pearson correlations, partial correlations, and analysis of covariance (ANCOVA) analyses were performed to investigate the relationships between sleep, sedentary behavior, and physical activity.
After adjusting for age, gender, percent body fat, educational level, and monthly allowance, prolonged sedentary time was correlated with a shorter sleep onset latency (r=-0.19, p=0.04), shorter time in bed (r=-0.43, p<0.001), and shorter sleep duration (r=-0.38, p<0.001). Moderate-to-vigorous physical activity (MVPA) was positively correlated with sleep onset latency (r=0.43, p<0.001). Sedentary behavior and MVPA were not correlated with sleep quality or daytime sleepiness. After further categorizing sleep duration into three subgroups, individuals with ≤6 hours (p<0.001) of sleep spent more time being sedentary than did those with 6-7 hours (p<0.001) and ≥7 hours (p=0.007) of sleep. Individuals with 6-7 hours of sleep had a higher level of MVPA than did those with ≥7 hours of sleep.
Improving the duration of sleep may be a viable approach to help reduce sedentary behavior among young adults. Future studies with longitudinal designs are needed to further investigate the directionality of these associations and their potential mediators and moderators.
Accelerometer; Sleep; Sedentary; Physical activity.
Nowadays intravitreal drug injection is the most frequent treatment for retinal diseases. Despite widely use endophthalmitis is already most feared complication of every intravitreal injection in each patient. In clinical setting topical antibiotics have been widely used as a precaution to prevent endophthalmitis however recent published evidence showed it to be unnecessary. Furthermore repeated use of topical antibiotics might give rise to antibiotic resistance in conjunctival flora and thus more aggressive endophthalmitis. Strict asepsis has been awarded as the main rule for endophthalmitis prophylaxis intravitreal injection.
Intravitreal injection; Steroid; Anti-vascular endothelial growth factor (VEGF); Topical antibiotic; Enodphthalmitis; Antibiotic resistance.
Low socioeconomic status (SES) is one of the strongest predictors of morbidity and premature mortality worldwide, as well being associated with large increases in cardiovascular disease in both men and women. Uncontrolled hypertension contributes to cardiovascular disparity. Non-adherence to antihypertensive regimens worsens the cardiovascular burden and further widens the health disparity gap. A hierarchical multiple regression study of multiple factors impacting adherence among urban residents in a New York metropolitan region found socioeconomic factors as the strongest factors impacting adherence in this cardiovascular high-risk population..
Secondary analysis of data of a cross-sectional, correlation design study of a dissertation study, with each of the SES variables analyzed against adherence and self-efficacy variables.
Overall, only three SES variables (years with the same provider, work status and income) were significantly related to adherence and/or self-efficacy. Years with the same provider was related to adherence with correlation of rs=0.16 (p=0.048), and to self-efficacy rs=2.0 (p=0.016). Work status was related to adherence with difference in adherence scores between retired and unemployed subjects (KS=38.6, p=0.013 with Bonferroni adjustment; means=3.7 and 3.3, respectively). Work status was not related to selfefficacy scores. Income level was significantly related to the self-efficacy scores, but not the adherence scores. Difference noted between earners<$10,000/year and >$80,000/year (KS=-44.2, p=0.037, with Bonferroni adjustment; means=3.06 and 3.51, respectively).
Low socioeconomic status and non-adherence to antihypertensive regimens remain important factors which worsen cardiovascular health and widen health disparity health gaps. This is evident among the cardiovascular high-risk persons of African descent including those residing in the New York metropolitan regions. Self-efficacy is implicated as a mediating variable between income and adherence. The inverse relationship between fulltime work status and adherence was no longer noted. Further investigation on the associations between income, full time status and adherence among young, hypertensive Blacks/African Americans; as well as self-efficacy mediating effects on income and adherence is recommended.
Socioeconomic status or poverty or low income; Adherence or compliance; Hypertension treatment or hypertension therapy; Blacks or African Americans.
Dehorning or disbudding is the process of removing or stopping the growth of the horns and horn producing tissues after the horns have formed from the bud by different methods which can match to the size of the horn and age. The present case report is aimed to describe and document the surgical procedures, techniques of unilateral horn amputation and its outcome on six years old local breed cow that was referred to the veterinary teaching hospital (VTH), Addis Ababa University from nearby; Hiddi Veterinary Clinic. History stipulated as the cow was treated several times with antibiotics but didn’t respond as the condition was getting worse. Based on the history and clinical findings, the case was diagnosed as suppurative frontal sinusitis. After aseptic preparation of the surgical site, stabilizing the animal and locally desensitizing the incision area; an elliptical skin incision with a distance of approximately (~1 cm wide) around the base of a right horn was performed for successful removal of the corium. Then, skin edge was opposed to assist the skin contraction by using the silk 2-0 size in cross mattress suture pattern. Then the area was properly bandaged with elastic bandages and properly secured to the normal horn and admitted home. Finally, with regular dressing, bandaging and lavaging of the dehorned site, the cow was successfully recovered after two months.
Cow; Dehorning; Horn Injury.
Most anti-bullying programs today are punitive. They rely heavily on schools enforcing procedures based on reporting, investigating, punishing, and labeling bullies. This paper challenges the notion that bullying behavior can be regulated effectively by legislative bodies and policymakers. Schools are communal ecosystems featuring unique social norms and behaviors. For example, in school, a student reporting a classmate to authorities may be labeled a ‘snitch’ because ‘tattling’ violates accepted social norms. Furthermore, the current legal definitions of bullying are confusing and complicated. In many cases, even trained lawyers have difficulty identifying acts of bullying. We suggest, the better approach to preventing bullying in schools, even the workplace, is to ground interventions using psychological frameworks to strengthen children’s social and emotional competence. We contend that social development models provide the psychological frameworks society needs to develop emotionally stable children and
adults while providing them with the internal fortitude to bounce back effectively from adverse situations like bullying.
Bullying prevention; Social-emotional learning (SEL); Social development; Emotional strength; Social aggression; Anti-bullying; Self-awareness; Social-emotional competence; Power imbalance; Intentional; Columbine; Intervention.
Healthcare providers and clinicians such as athletic trainers and physical therapists utilize therapeutic modalities to administer treatment to patients in the clinical setting. It is the responsibility of these healthcare providers to ensure the safe use of therapeutic modalities during treatment sessions, as well as effective delivery of treatment. Thermal-heat, ultrasound, cryotherapy and electrostimulation treatments have the potential for causing harm to patients. Proper care and maintenance of modalities can minimize the risk to patients and avoid legal issues for physical therapists and athletic trainers. This article will explore some of the legal issues, case studies and reports as well as providing information on what healthcare providers can do to protect patients.
Risk management; Negligence; Malpractice; Best practices; Injury prevention; Athletic Trainer; Physical Therapists; Accreditation.
The purpose of this study was to investigate the relationships between pre-season testing performance and playing time within a Division II men’s soccer team over a competitive season.
Data was collected from pre-season athletic performance testing data for 13 male National Collegiate Athletic Association (NCAA) Division II men’s soccer players (age=20±1.5-years; height=180±6 cm; weight=75±7 kg), and was analyzed to determine if relationships existed between physical performance tests (countermovement jump height, peak anaerobic power in watts derived from jump height], change-of-direction performance (505-agility, modified T-test), linear speed (10 m and 30 m sprint intervals), and aerobic fitness (20 m multi-stage fitness test), and playing time over a collegiate season were provided by the University’s coaching staff and retrospectively analyzed.
A Pearson’s moment correlations correlation revealed significant (p<0.05) moderate relationships between playing time and 10 m speed (r=-0.569) only.
These results suggest that linear speed, in particular acceleration over short distance, could be a key characteristic that has some influence on playing time for Division II men’s soccer players.
Pre-season testing of soccer players is commonly used to assess athletic potential. Minimal research has investigated the associations between these tests and playing time over the course of a collegiate season.
Aerobic capacity; Power; Speed; Agility; National Collegiate Athletic Association (NCAA).
To make an account of published implant-related complications (IRC) by a systematic review of the literature.
A systematic search of Pubmed and Scopus databases and Google Scholar engine was performed with selection criteria to detect papers on IRC. We excluded unrelated papers and reviewed selected ones. We considered papers that did not explicitly state about occurrence or not occurrence of IRC as non-IRC reporting. Main outcome measures were the number of papers reporting on complications, IRC, and types of IRC.
After the search, selection, and addition, we studied 109 papers. Incidence of IRC was 4.5%, half required explantation. While 26 implant studies found IRCs (23%), 13 case reports on surgical complications, 8 (61.5%) of them reported IRC. Frequent complications were conjunctival erosion, blockage of the tube, migration to anterior chamber or damage to surrounding tissues.
Most papers did not report on IRC. Length or nature of studies may skew finding IRC. The incidence of IRC was 4.5%. Hard and sharp implants carry a greater risk of IRC and explantation.
Implant-related complications (IRC); Glaucoma surgery; Anterior bleb forming.
To gain insight into the areas that impact women with endometriosis.
A qualitative content analysis of an online survey.
Online questionnaire via Endometriosis UK.
Women diagnosed with endometriosis of any age range.
Free-text online questionnaire through Endometriosis UK completed by women. Results were analysed using NVivo version 9, qualitative analysis software. The software creates links between common words (codes), and these links allow data to be placed in nodes (called themes) which are then developed into categories. Content analysis was used to understand this data.
Main outcome measures
Impact of endometriosis on women’s lives.
In total, 1872 questionnaires were returned but not everyone was able to identify ten separate features that affected them. As such, 1872 women provided at least one area that affected them, 1800 provided two areas, 1770 provided three areas and 1600 provided four areas. The results show that the main areas of concern for these women were pain (53%), heavy menstrual bleeding (11%), low mood (8%) and the perceived lack of understanding displayed by other people (7%). Other important factors were fertility concerns, impact on employment, problems with the medical team and uncertainty. These then impacted on their daily life whereby some women felt “guilty” for not ‘being a normal mother’. A key term that resonated was that endometriosis is an “invisible disease”.
This analysis provides us with insight into the complex psycho-social factors that interact with bio-physical symptoms. Further research is required in sub-population groups such as teenagers and ethnic minority women to explore any differences in impact and how care can be guided accordingly.
Endometriosis; Impact; Qualitative methods; Quantitative methods; Online survey.
The liver is the most common site of uveal melanoma (UM) metastasis with approximately 50% of UM patients being affected. With no proven therapies that mitigate metastases the mortality rate is 85% within the first year after detection of the liver disease. In this study, we provide a mechanistic understanding of the de-regulation of the TP53-MDM2 pathway in UM, which plays a central role in tumor biology.
We investigated the TP53-MDM2 signaling pathway in the microenvironment of liver metastases taken from both a murine orthotopic xenograft and post-mortem metastatic UM human liver. These findings were studied in-depth using both primary and metastatic UM cell lines treated with the MDM2 antagonist Nutlin-3a and the sirtuin inhibitor and transcriptional activator of TP53, Tenovin-6.
De-regulation of the TP53-MDM2 signaling pathway is specific to the liver microenvironment, providing a survival mechanism for UM metastases. Tenovin-6, not Nutlin-3a, reduced UM cell survival by increasing the percentage of cell death and reducing the percentage of proliferating cells. Tenovin-6 increased acetylation of p53, reduced ubiquitination of the protein, and acted as a cell cycle regulator.
Our findings suggest that in patients with metastatic UM de-regulation of TP53-MDM2 signaling pathway promotes growth of the liver metastases and provides pre-clinical information on the potential of targeting of the TP53-MDM2 signaling pathway via Tenovin-6.
Uveal melanoma; Ocular tumors; Nutlin-3a; Tenovin-6; TP53; MDM2.
Pulmonary artery hypertension (PAH) ultimately leads to straining of the right ventricle and increases the risk of heart failure in affected patients. Its clinical presentation is similar to that of many other diseases thus delaying the diagnosis until the disease is far advanced. It remains one of the leading causes of death in adults with sickle cell anaemia (SCA) worldwide. It confers a high risk of death with two-year mortality rates as high as 40-50% even at modest elevation of pulmonary artery pressure. Median survival age after detection of the disease is said to be 25.6-months. Early detection of elevated pulmonary artery pressure in childhood and appropriate intervention by optimization of anti-haemolytic therapy may prevent the progression of this complication. The current writes up is a review of literatures on pulmonary artery hypertension among children with sickle cell anaemia. This will give information which will aid early diagnosis and treatment of pulmonary artery hypertension among children with sickle cell anaemia. This will ultimately improve the quality of life of children with sickle cell anaemia and reduce morbidity and mortality from the disease in adults and children living with sickle cell anaemia.
Sickle cell anaemia; Pulmonary artery hypertension; Children.
Incomplete duplex system is a congenital abnormality, which is often found in children. It corresponds to a doubling of the upper urinary tract with two ureters which join into a common distal portion with a single ureteral orifice. In adults, this infection is fortuitous and often asymptomatic. Therefore, it does not require surgery in the absence of complications. Therefore, we would like to present this new case.
Upper urinary tract; Duplex system; Bifid ureter; Incomplete duplication.
The research was conducted with the aim to develop biscuit and ready-to-eat snack product from cowpea flour incorporated with wheat flour.
The wheat and cowpea flour blends were prepared in five blending ratios including B1 (90:10), B2 (40:60), B3 (65:35), B4 (78:22), and B5 (53:47); respectively. The D-optimal mixture design software was used for flour blend formulation. Biscuit and extrudate products from cowpea and wheat blends were analyzed. Quality characteristics parameter used for value-added products includes physical, functional, proximate, mineral and microbial quality. Furthermore, bioactive components and sensory quality evaluation were also investigated. The biscuit samples were prepared at a baking temperature of 205 °C for 10-minutes holding time. The extrudate samples were also manufactured at feed moisture (18 and 21%), barrel temperature (100, 110 and 120 °C) and screw speed (175 and 220 rpm).
The result for crude protein analysis of biscuit (B3) and extrudate (Ex-3) samples was revealed that 15.972±0.125, and 15.915±0.251; respectively. The result for microbial quality analysis of biscuit (B3) and extrudate (Ex-3) samples was also shown as aerobic bacteria count of 44×10-5, 42×10-5 and yeast and mold (un-detected); respectively. The highest overall sensory evaluation of biscuit (B3) and extrudate (Ex-3) samples score were found 7.6 and 7.14; respectively.
Based on quality evaluation parameters, 35% cowpea flour with 65% of wheat flour blending ratio reveled sensor acceptable for biscuit production and manufacturing of ready-to-eat snack.
Biscuit; Cowpea; D-optimal mixture; Extrudate products; Wheat.
Pancreatic cancer remains a devastating disease with dismal outcomes despite the development of novel chemotherapeutic regimens and radiation techniques. Stereotactic body radiation therapy (SBRT) offers an advantage both in image guidance and radiation dose delivery to direct ablative doses to tumors with acceptable toxicity compared to conventional techniques. Recent literature is clustered with data pertaining to SBRT in patients with resectable, borderline resectable and locally advanced pancreatic tumors. We here present a summary of the current data and highlight the limitations and potential for future growth. Further clinical study in the form of multi-institutional trials is warranted to establish the role of SBRT in combination with new chemotherapeutic agents as well as a non-invasive alternative to surgery.
Pancreatic neoplasms; Pancreas cancer; Radiosurgery; Stereotactic; Stereotactic body radiation therapy (SBRT); Radiation; Radiotherapy.
Beryllium can be found in silver alloy, in costume jewelry and in dental prosthesis. It is also used in aerospace industry and might be also found in precision instruments. Pure contact dermatitis to Beryllium has never been described as in this case associated with allergic contact dermatitis to jewelry. Most reports of Beryllium contact dermatitis are related to dental prosthesis and most of the cases we have seen Beryllium allergic contact dermatitis is associated with other positive allergens. We believe that this metal should be added to the dental screening as according to our findings.
Beryllium; Jewelry; Allergy; Skin allergy; Allergic contact dermatitis.
There are different processes via which a muscle cell can utilize oxygen to make energy that will sustain activity. The type of activity and duration of activity will determine what energy system is used to sustain the activity being done. Aerobic metabolism uses oxygen to sustain the energy demand. Oxygen is obtained from the air we breathe, and then transported to the cells though the myoglobin. Although ambient air only contains 21% oxygen, it is enough to sustain life and energy needs. But what if the muscle cell could instead receive 100% oxygen? The delivery method would be via hyperbaric oxygen therapy (HBO) which supplies oxygen at 100% concentration under a minimum of 1 atmospheric pressure. Atmospheric pressure will affect the outcomes of consuming 100% oxygen. Research supports positive findings on oxygen therapy under pressure and muscle cell recovery but much research still needs to be investigated. One research study revealed detrimental effects of 100% oxygen breathed in consistently for days resulting in comorbidities that did not exist prior to experiment. HBO can pose some risks but if it is applied in a controlled manner, HBO can be a safe option to enhance cellular recovery and cell function.
Oxygen; Hyperbaric oxygen therapy; Muscle recovery; Muscle cells; Pure oxygen.
The purpose of this study was to identify factors that affect the performance of branch sales managers (BSM) of a private bank in India. It also aimed to identify factors that differentiate high performing BSMs from the rest.
A phenomenological methodology known as narrative analysis was used to uncover the lived experiences of Branch sales managers. Open-ended semi-structured interviews were conducted with 50 Branch sales managers situated across the Northern, Western and Southern Regions of India who were pre-classified in two pools of talent–high performers and average performers based on their performance ratings.
Results yielded two distinguishing profiles of high and average performing BSMs known as ‘Bulls’, and ‘Bears’ respectively. Ramifications of individual’s personality, family structure and education profile, birth order, educational and vocational choices, influence of their past work experience, etc., were found to contribute to distinct patters of wok behavior and thereby performance.
Sales organizations will need to hire both “Bull I/Bull II” and “Bears” as each brings a different work ethos that is critical for high and consistent performance within the sales function. Organizations will need to create specific performance levers to engage the “Bull I/Bull II” and “Bears”.
Bears; Bull I; Bull II; Sales performance; Sloths.
The study sought to evaluate the historical surgical-pathological trends in Gynecologic Oncology Group (GOG) 33 in a cohort of patients who underwent robot-assisted staging of uterine carcinomas.
This is a retrospective study from June 2016 through December 2018 at Catholic Health Services Hospitals in Long Island (CHSLI), NY, USA. All patients underwent robotic surgical staging with hysterectomy, bilateral salpingo-oophorectomy, and pelvic and para-aortic lymphadenectomy. Fifty patients were included, and patients were separated into cohorts with endometrioid or non-endometrioid histology for analysis. Patients were staged using the International Federation of Gynecology and Obstetrics (FIGO) 2009 classification.
For all patients undergoing surgical staging, the rate of pelvic and para-aortic nodal metastases occurred at 10% and 8%, respectively. Sixty percent of the grade 1 endometrioid tumors had less than 50% myometrial invasion. No patients had positive paraaortic lymph nodes in the absence of pelvic node involvement. High-risk histologies were associated with nodal disease thirteen percent of the time. A correlation between increasing depth of invasion and positive lymph nodes was demonstrated. Increasing grade of tumors was correlated with the frequency of nodal metastasis. Intraperitoneal spread was highly correlated to metastatic lymph nodes. Deep invasion was positively correlated with nodal disease.
The results of this study validate the trends previously known from GOG 33 in a population undergoing robot-assisted surgical staging for uterine carcinomas.
Gynecologic Oncology Group (GOG) 33; Robotic; Surgery; Uterine cancer; Lymph nodes; Trends.
Non-surgical sterilization technique in animals is an ancient practice and dates back to 7000 BC. Surgical castration in animals has been applied for centuries to control the animal population, advance genetic selection, improve calmness of aggressive animals and mainly to ensure and selectively provide high-quality meat production for human consumption. An ideal method of castration should cause permanent block to spermatogenesis and inhibit androgenetic enzymes with low-cost of treatment and doesn’t affect the welfare of the animal. Even if operative methods are the main methods of castration, hormonal castration and chemical castration are also an alternative and equivalent method of sterilization. Over the past years, non-surgical sterilization has found application in male dogs, cats, monkeys, goats, bulls, hamsters and rabbits. Calcium chloride, lactic acid, sodium chloride, chlorhexidine, formalin, zinc tannate, zinc gluconate, glycerol, glucose, ethanol and silver nitrate are commonly used in chemical
castration. After intratesticular application, degeneration of seminiferous tubules and Leydig cells, decrease in testosterone and sperm production, testicular atrophy is observed. In this review, the approaches of chemical castration were mentioned in different male animals.
Male animal; Non-surgical sterilization; Castration; Chemicals; Testicle.
Foodborne diseases are a public health threat which causes a large economic impact across the worldwide. Escherichia coli (E. coli), Listeria monocytogenes (L. monocytogenes), Salmonella species (S. species), Staphylococcus aureus (S. aureus) and many more other organisms are the leading causes of foodborne illness and death in the world. Increment of antibiotic resistance exhibited by the actions of microbial infectious agents has led to screening of several medicinal plants for their potential antimicrobial activity. Therefore, the aim of this paper is to review on the medicinal value of Croton macrostachyus (C. macrostachyus) and Solanum incanum (S.incanum) against causative agents of foodborne disease. Antimicrobial compounds of medicinal plants differ from antibiotics as they have fewer side effects, better patient tolerance, relatively less expensive, acceptance due to a long history of use and being renewable in nature. There are so many medicinal plants used to treat foodborne diseases which associated with gastroenteritis in humans and animals, among plants S. incanum and C. macrostachyus are the common for treatment of foodborne diseases associated with diarrhea. S. incanum has different bioactive substances which have medicinal importance against skin diseases, abdominal pains, fever, stomachaches and indigestion, treatment of dandruff, wounds, sore throat, angina, ear inflammation, liver disorders, wart and ringworm and treatment of cow driosis, dermatophilosis, foot rot, pasteurellosis, black leg, fasciolosis and snake bite. Bioactive compounds which present in S. incanum are including alkaloids, steroids, saponins, tannins, glycosides, flavonoid and terpenoids. C. macrostachyus is medicinal plant which have bioactive compounds including terpenoids, alkaloids, flavonoids, lignoids, proanthcyanidins, sesquiterpenoids and lupeol, saponnins, resins, crotepeoxide. C. macrostachyus have medicinal value in treatment of malaria, rabies, gonorrhea, wound, diarrhea, hepatitis, jaundice, abdominal pain, cancer, toothache, pneumonia, typhoidand gastrointestinal disorder. Which is also used as abortifacient and uterotonic to expel retained placenta. Therefore, S. incanum and C. Macrostachyus have different medicinal value against foodborne disease and drug-resistance infectious agents. However, an advanced study have not been conducted on the extract of pure bioactive compounds and toxicity analysis. Therefore, further studies should have to be conducted to extract pure compounds from these medicinal plants for pharmaceutics industry.
Bioactive substance; Drug resistance; Food borne disease; Infectious agent; Medicinal plants.
To compare the degree of bacteria dissemination using two currently available operating room (OR) personnel warming devices. The “off-label” use of 3MTM’s Bair HuggerTM vs. a fairly new device, worn around the torso and under a scrub warm-up jacket or surgical gown, the OPERATIONHEATJAC® transformer only (TRO) powered by a transformer and controlled by a 4-level controller, and best for anesthesia providers and perfusionists.
Initially, staff members in scrubs sat in a room for 3 and 6-hours with agar plates placed in various positions throughout the room. Then staff members sat in the same room under the same conditions for 3 and 6-hours, and placed the hose from 3M’s Bair Hugger under their scrubs. Agar plates were positioned in the room in the same positions as in the control. Then staff members sat in the same room under the same conditions for 3 and 6-hours, wearing the OPERATIONHEATJAC® TRO over their scrub shirt and under a scrub warm-up jacket. Agar plates were again positioned in the room in the same positions as in the control. Bacteria colony counts were compared.
The bacteria colony counts were 43.78% and 46.18% higher at 3 and 6-hours respectively from placement of the hose from 3MTM’s Bair HuggerTM under scrubs vs. the control. There was no significant difference in bacteria colony counts with using the OPERATIONHEATJAC® TRO vs. the control.
ORs are maintained cold, mostly for surgeon comfort. In an attempt to keep comfortable in this environment, peripheral OR staff opt for the “off-label” use of 3M’s Bair Hugger hose placed under scrubs. An increased spread of bacteria throughout the OR can result from this practice. Currently, there are now safer OR personnel warming devices available. In addition, this paper reviews the significance and benefits of keeping staff warm and comfortable.
Warming devices; OPERATIONHEATJAC®; surgical site infections (SSIs); Operating room (OR); Temperature.