and join thousands of satisfied authors.
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
NOTE: The DOIs of the In-Press Articles will only function after the final publication of the articles and once they are uploaded to the Current Issues.
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.
letter to the editor
brief research report
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.
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.
Heat treatments are the established food technology for commercial processing of milk. However, degradation of valuable nutrients in milk (as proteins) and its sensory characteristics occur during these processes due to substantial heat exposure. The most important reactions that occur during milk heat treatment are the whey proteins denaturation, its interactions with the casein
micelles and aggregation/dissociation of the casein micelles. Microfiltration represents an emerging food processing technology allowing gentle milk preservation at lower temperatures for similar, or better, nutritive value, microbial removal, and shelf stability. Thus, the aim of this work is to review the existing studies on the effects of microfiltration on milk proteins by comparing with the effects of heating treatments.
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!
The present activity was conducted to execute fruit handling, processing, preservation, dehydration and value addition trainings in Gilgit-Baltistan, to control wastages/losses of fruits and vegetable which is above 60% of total production.
To prepare fruit pulp for fruit preservation using potassium metabisulphite (K2O5S2). To develop household level methods for development of value added products like fruit jam, tomato paste, mix vegetable pickle and dehydrated apricot.
The research work for method development was carried out at Pakistan Council of Scientific & Industrial Research (PCSIR) Skardu, Gilgit-Baltistan, Pakistan. Methods were developed with recommended dosages of chemical preservatives. A total of two days training courses were conducted focusing fruit handling, processing, preservation, dehydration and value addition of fruits and vegetables at 4 different locations in 4 districts of Gilgit-Baltistan (Skardu, Diamer, Hunza and Shigar).
The basic objectives of training were to control wastages/losses of fruits, income generation of fruit growers through sale of fruit, value added products and to contribute to ensure food security issue in Gilgit-Baltistan.
Urocystoliths are difficult to palpate and physical examination findings, complete blood cell count (CBC) and serum biochemical analysis are usually normal and the clinical signs are not definitive. Thus diagnostic imaging is a crucial tool required to confirm the diagnosis of urolithiasis in dogs presented with non-specific clinical signs of urogenital affection.
The aim of this study was to compare the capability of radiography and ultrasonography in detecting uroliths and concurrent urinary system abnormalities and to evaluate clinical, haematological and urinalysis findings of dogs affected with urolithiasis during the presentation.
Findings of signalment, history, physical and laboratory examination of blood and urine were performed and recorded. All dogs presented with complete or partial urinary obstruction, haematuria and renal failure were subjected to both radiographic and ultrasonographic evaluation. Uroliths were retrieved by a cystotomy, urethrotomy, and at necropsy from kidney failure cases confirming urolithiasis.
The result revealed occult clinical haematuria in 56.5%, microscopic haematuria in 78.3% and dysuria/anuria in 34.8% of the affected dogs. Crystalluria is detected in seven (30.4%) of urolithiasis affected dogs. The total leukocyte count was significantly elevated (p≤0.05) in partially and completely obstructed dogs. Radiography diagnosed 19 of 23 urolithiasis cases in the urinary bladder (UB), 2 of 2 in the kidney and 12 of 13 in the urethra while ultrasonography diagnosed 17 of 23 urolithiasis cases in the UB and one in the urethra. From a total of 15 dogs presented with either neoplastic growth and/or cystitis concurrent with urolithiasis, ultrasound detected six while pneumocystogrpahy detected only one.
The study showed haematuria as the leading clinical sign of urolithiasis. Detection of urolithiasis and concurrent cystitis and/or urinary bladder growth increases when ultrasonography and radiography were employed together.
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.
We examined content and expression of Instagram captions of major celebrities who differed according to sex and status, with a focus on determining whether these variables influenced the use of analytic language and cognitive content.
Instagram captions (n=942) were analyzed with the linguistic inquiry and word count (LIWC), which delineated percentage of language reflecting analytical thought and various cognitive mechanisms, such as causality and discrepancy.
Men and low-status persons used more functional analytic language, demonstrating critical thought; in contrast, high-status celebrities showed more causality. Women more than men “qualified” their speech with discrepancy. These findings were not a function of sentence length.
Status increased the tendency to construct and explain, perhaps because higher status celebrities (particularly women) knew that they could hold followers’ attention with complex content. The tendency to write captions that were concrete was seen in those lower-status persons who may have perceived that followers would not wade through a lot of complicated thoughts. Thus, status contributes to the manner in captioning based, perhaps, on having a broader audience willing to read more complex language.
Language use; Status; Instagram; Sex differences in linguistics.
The present study was conducted to extract information about heavy metal pollution in water of Karnaphuli river and to assess the risk to public health occurred from consumption of heavy metal contaminated foodstuff like fish and vegetables collected from the adjacent area of Karnaphuli river which receives a huge amount of industrial and domestic wastes from kalurghat heavy industrial area, Chittagong, Bangladesh.
Energy Dispersive X-ray Fluorescence (EDXRF) Spectrometer (Model: Epsilon 5) was used as major analytical technique for determining elemental concentration. For assessing toxicity level of analyzed foodstuffs and associate health risk problem some indices like metal pollution index (MPI), health risk index (HRI) and hazard index (HI) were also estimated.
The mean value of physicochemical properties like pouvoir hydrogène (pH), electrical conductivity (EC), total dissolved solid (TDS), salinity of river water were found 6.8, 745.5 μS/cm, 458.2 mg/L, 747.4 μS respectively showing that those values are much lower than the Department of Environment (DoE) of Bangladesh suggestive value, indicating safe for irrigation but EC and salinity are higher than the DoE suggestive value for drinking water. In water, the mean concentration of heavy metals in Karnaphuli river was found in the sequence of Fe>K>Cr>Mn>Zn>Cu>As=Ni=Hg>Pb. Chromium, Manganese, Iron, Zinc, and Mercury concentrations are higher than World Health Organization (WHO) standard 2011, United States Environmental Protection Agency
(USEPA) 2009 and Bangladesh Standard for drinking water but other elements are within the safe limit. All metal concentrations in water are below the Bangladesh Standard for Irrigation except Iron (Fe). The decreasing trend of heavy metals (mean) in all the vegetable was Fe>Zn>Cu>Cr>Ni>Pb>Co and for all fish was Fe>Mn>Zn>Cr>Ca>Se>Co>Cu>K. Metal pollution index (MPI) for fish and vegetable is high enough to cause any detrimental effect on human. Estimated daily intake (EDI) value for fish followed a decreasing sequence Fe>Mn>Zn>Cr>Cu>Ni=As>Pb and for vegetable samples Fe>Zn>Cu>Mn>Cr>Ni>Pb>As respectively. Health risk assessment (HRI), and hazard index (HI) value are less than one for fish but HI value is greater than one for most of the vegetable samples analysed.
From the overall study it can be concluded that the mean value of physicochemical parameters (pH, EC, TDS, salinity) in river water were much lower than the DoE of Bangladesh suggestive value, indicating safe for irrigation but not safe for drinking. Fishes are safer for human consumption than vegetables collected from that particular area and hence, suggested to consume those vegetables at lower amount in the diet to reduce any detrimental effect.
Health risk index (HRI); Hazard index (HI); Metal pollution index (MPI); Toxic effect; Vegetables; Fishes.
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).
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.
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.
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.
There is a diversified microbial ecosystem in the rumen for efficient utilization of diet by providing essential nutrient to their host. But there are different factors affecting rumen microbial protein synthesis which are physical factors, chemical factors, dietary factors, biological factors and endogenous factors. Among the details of factors, dietary factors and ruminal pH are the dominant factors influencing rumen microbial protein production. The effects of some dietary factors, on the amount and efficiency of microbial protein synthesis, are discussed in this review. Specifically, these factors include forage quality diets, level of feed and types of feed. It seemed that diets containing a mixture of forages and concentrates increase the efficiency of microbial protein synthesis because of an improved rumen environment for the growth of more diverse bacterial species. This review describes physical and chemical factors which include: pH and buffer system, oxygen concentration, rumen outflow rate and synchronized release of nitrogen and energy from the diet, a nitrogen compound, energy spilling, vitamins and minerals and antimicrobials chemicals, respectively. Age, species, physiological status, sex, and stress are among endogenous factors that mostly affect microbial protein synthesis of a ruminant. Bacteriophages, protozoa predation and bacterial lysis are biological factors affecting the efficiency of microbial protein synthesis. All these factors have a direct effect on the synthesis of microbial protein in the rumen. Therefore, the cumulative effects of the above factors are resulted in the depopulation of rumen microflora and finally reduction of animal product. So, improvement in quantitative aspect of microbial protein synthesis solves many problems from simple to complex so that, the quantitative aspect of rumen microbial biomass are invaluable for health and productivity of ruminants than qualitative aspect hence, maintain health rumen ecosystem means having healthy ruminant.
Rumen; pouvoir hydrogène (pH); Microbial protein; Rumen ecosystem; Ruminant; Rumen microflora; Nutrient; Haematological parameters reference ranges; Healthy status.
MBP: Microbial protein; MCP: Microbial crude protein; NDF: Neutral detergent fiber; NPN: Non-protein pitrogen; NSC: Nonstructural carbohydrate; OM: Organic matter; OMTDR: Organic matter truly digested in rumen; RDP: Rumen degradable protein; RUP: Rumen undegradable protein; SCFA: Short chain fatty acid; TDN: Total digestible nutrient; VFA: Volatile fatty acid; ATP: Adenosine Tri-phosphate; CP: Crude protein; CS: Concentrate supplementation; DM: Dry matter; DOMI: Dry organic matter intake; EMPS: Efficiency of microbial protein synthesis; FOM: Fermented organic matter.
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.
This study examined the impact of insomnia and its psychosocial correlates among young adults in a University in Indian Context.
Sample data were collected from 92 full-time university students (68.3 % females, mean age=19.33 SD=1.032 in Group 0 and in Group 1: 96.6% females, mean age=23.21 and SD=1.146).
Participants completed a self-reported questionnaire that included the pittsburgh sleep quality index (PSQI), and optimism index (OI). A PSQI global score equal to or greater than 5 indicated insomnia.
There is a negative correlation between insomnia and PSQI and OI was found to be (r =-0.342, p<0.01) which means a higher level of optimism is related to better sleep quality and more sleeping difficulties relate to lower level of optimism.
Optimism and sleep quality were both cause and effect of each other a bidirectional causal relationship.
Insomnia symptoms; Sleep duration; Optimism.
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.
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.
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.
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.
The objectives of this study were to assess the prevalence of major gastrointestinal tract (GIT) parasite of cattle’s and associated major risk factor at Jimma municipal abattoir.
A cross-sectional study with a simple random sampling method was conducted from November, 2018 to April, 2019.
Based on the carpological examination, from 400 animals that were presented for slaughter at Jimma municipal abattoir, 46.8% (187) of animals have at least one GIT parasite. The study detected five genera of GIT parasite which were Strongyle-type, Trichuris spp., Monezia spp., Paramphistomum spp. and Eimeria spp. with prevalence of 28.9% (54), 4.8% (9), 3.2% (6), 38.5% (72) and 13.4% (25), respectively while mixed parasites has 11.2% (21) of prevalence. The diversity of those mixed parasite were Strongyle type with Paramphistomum spp., aramphistomum spp. with Eimeria spp., Eimeria spp. with Trichuris spp., Strongyle spp. with Monezia spp., Paramphistomum spp with Monezia spp,, Strongyle type with Emeria spp. and Paramphistomum spp. with Trichuris spp. with the prevalence of 42.9%, 14.3%, 14.3%, 9.5%, 14.3%, 23.8% and 10.0% respectively. The prevalence of gastrointestinal
parasite based on origin of the study animals was recorded and showed statistically significant difference with p-value of 0.001 (p≤0.05) and the prevalence was highest in Seka Chekorsa and followed by Kersa, Mena, Oma Nada and Dedo in decreasing order. The risk factor related to the age showed statistically significant difference (p<0.05) in which GIT parasite has highest prevalence in young and least in old and moderate in adult cattle. This study showed that infection prevalence was highest in animal with poor body condition followed by medium and good body condition scores and difference was statistically significant (p<0.05). In addition, the difference between the season also recorded and found statistically significant (p<0.05).
The finding showed that good management and strategic anthelmintic treatment need to be applied in the area to reduce the
prevalence of the GIT parasites of cattle and their risk factor to lessen economic loss caused by the parasite.
Abattoir; Carpological examination; GIT parasite; Jimma.
ELISA: Enzyme-linked immunosorbent assay; GDP: Gross domestic product; GIT: Gastrointestinal tract; Spp: Species; BW: Body weight.
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).
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.