In order to better understand some neurologic degenerative process is fundamental to use also an evolutionary approach of vertebrates and especially in mammalians. Aim of this work is to verify if an objective measure of brain wasting system can help in this kind of disease. Imaging can help in measuring efficiency of brains wasting system in the various subject. The brain glymphatic systems is well studied today but an accurate measure of the real efficiency of the system is needed. It is relevant so to submit to researcher a working methods strategy to measure this parameter to verify if possible, to use the brain glymphatic system as new therapeutics pathway.
Background: Cyclophosphamide is used for the treatment of malignant and non-malignant diseases, but, it induces oxidative damage and disturbance in the antioxidant defense system. Zinc oxide nanoparticles (ZnO NPs) are used in biomedical applications and consumer products. ZnO-NPs are protected cell membranes against oxidative damage, decrease free radicals and malondialdehyde (MDA) levels, and increase the antioxidant enzyme levels.
Objectives: The present aimed to evaluate the ameliorative effect of Zn-O nano-particles on oxidative damage and disturbance in the antioxidant defense system induced by cyclophosphamide in male albino rats.
Materials and Methods: 24 adult male albino rats were randomly divided into 4 groups (6 rats of each). Group I (Control group): Received 0.2 ml saline /day i.p. injection for 14 days (day by day), group II, (nZnO group): Received nZnO (5 mg/kg/day) b.w., intraperitoneally for 14 days, Group III (CP group): Received CP (20 mg/kg/day) b.w, day by day for 14 days by intraperitoneal injection, Group IV (CP + ZnO NPs group): Received nZnO group: Received nZnO (5 mg/kg/day) b.w., intraperitoneally for 14 days, plus CP (20 mg/kg/day) b.w., day by day for 14 days by intraperitoneal injection. After 24-hr from the last treatment, all animals were anesthetized using light ether. Blood, lungs, and liver samples were taken and prepared for biochemical measurements.
Results: Individual treatment of zinc oxide nanoparticles and CP induced liver cytochrome b5, cytochrome C reductase, and glutathione S-transferase (GST) compared to the control group, while CP increased P450. The combination of nZnO and CP prevents the elevation of cytochrome b5, P450, cytochrome C reductase, and GST compared with the CP treated group. Zinc oxide nanoparticles and CP increased liver thiobarbituric acid reactive substances (TBARS). The combination of nZnO and CP prevents the changes in TBARS concentrations compared with the CP. Injection of CP to rats reduced the activities of serum glutathione reductase (GR) and catalase (CAT) as compared with the control group. However, combination treatment of rats with nZnO and CP increased the activities of these enzymes compared with those treated with CP alone. Zinc oxide nanoparticles and CP increased serum and lung TBARS, while decreased glutathione (GSH) concentration compared to the control group, with more pronounced changes by CP. The combination of nZnO and CP prevents the changes in TBARS and GSH concentrations compared with the CP.
Conclusion: It can be concluded that CP induced oxidative stress and disturbance in the antioxidant defense system. Treatment of rats with zinc oxide nano-particles and CP together attenuated the oxidative damage and disturbance in the antioxidant defense system induced by CP. So, Patients treated with CP advised to take nZnO to prevent the side effects of chemotherapy. Further studies are necessary to evaluate the amelioration effect nZnO and other nano-particles against oxidative stress induced by CP in different doses and experimental models.
Background: Globally, Alzheimer’s disease (AD) affects millions of elderly individuals are affected with AD who suffer from decline in cognitive ability. However, immune system dysfunction has a role in AD pathogenesis. However, pharmacological therapeutic intervention for caring of ADis not available. Therefore there is a need to develop novel therapeutic modalities for AD individual care.
Objective: The objective of the this trial was to detect immune system and quality of life (QOL) response following aerobic versus resisted exercise training among AD subjects.
Methods: Fifty older with AD disease the range of age ranged was 61 to 73 years enrolled in the current study. However, smoking, liver, chest, renal, metabolic and cardiac dysfunction considered as exclusion criteria. Participants were randomly enrolled into group (A) who applied aerobic exercise intervention, while group (B) applied resisted exercise intervention for period of six months.
Results: The SF-36 which measure QOL along with in the immunological parameters (CD3 count, CD4 count, CD8 count and CD4/CD8 ratio) showed significant improvement following aerobic and resisted exercise. However, comparing between both groups showed significant differences with greater significant improvement in all measured parameters following aerobic exercise training (p < 0.05).
Conclusion: Aerobic exercise is the most appropriate exercise to improve immune system and quality of life among elderly Alzheimer’s.
Myocardial infarction without ST segment elevation is one of the most common causes of hospitalization of the elderly patient . Coronarography followed by revascularization, is performed in the vast majority of cases of myocardial infarction without ST segment elevation, in the regions with a well-developed health system. The decision to perform the procedure, the type of approach (early/late) and the selection of the type of myocardial revascularization depend on numerous factors such as: associated comorbidities, clinical presentation, the risk group in which the patient is framed, fragility, cognitive status, life expectancy etc. [2,3]. Older patients often present with various comorbidities, having a higher risk of complications and an unfavorable evolution. Thus, it was observed that invasively treatment is less commonly used in elderly patients with comorbidities, even if, the current guideline recommends that the invasive strategy should be considered in all patients with NSTEMI, regardless of age. At the same time, this subgroup of patients is not so well represented in the studies performed so far, the type of treatment chosen, being most often at the discretion of the attending physician [1,2].
Objective The present study aims to analyze the evolution of a subgroup of patients ≥ 70 years of age, with different comorbidities, with the diagnosis of myocardial infarction without ST segment elevation, according to the type of treatment applied: conservative versus invasive strategy (diagnostic coronarography ± revascularization, if appropriate).
The surgical treatment of prostate cancer (PCa) had as its initial milestone the first prostatectomy, performed by H.H. Young at the Johns Hopkins Hospital, in 1904 , however, the procedure only reached a fundamental role after 1982, based on a better understanding and description of the male pelvic anatomy, by Walsh [2-6] and other [7-11]. Subsequently, minimally invasive approaches emerged: laparoscopic prostatectomy (1992)  and robot- assisted laparoscopic prostatectomy (RALP) (2000) , which modified and optimized the execution of key surgical steps of this procedure, such as bladder neck preservation, nerve-sparing dissection, and prostate apex management .
Inferior vena cava (IVC) involvement by intraluminal extension of tumor is infrequent, occuring in 4% to 10% of patients with renal cell carcinoma (RCC) [1-5]. Based on the cephalic extension of the thrombus, Mayo  described a classification of inferior vena cava thrombi in 4 categories, which has implications on surgical complexity, estimated blood loss (EBL) and peri-operative complications, but not cancer-specific survival [2,7]. Level III IVC thrombus is classified as being located in the retro-hepatic IVC below the diaphragm. Total resection of this tumor is the best chance of cure when no distant metastases are present [4,8]. Actually, open radical nephrectomy with concomitant thrombectomy is still the standard treatment. This procedure is technically challenging and involves a large incision and prolonged convalescence . Recently, the feasibility of robotic IVC thrombectomy has been demonstrated, with potential lower EBL and shorter hospitalization and convalescence [7,10-14]. This surgery requires thorough knowledge of surgical anatomy, detailed pre-operative preparation and meticulous robotic technique . The key point in the surgical management is the correct assessment of the extension of the endocaval thrombus, what is mainly based on radiological examinations . Although Ultrasonography (US) and computerized tomography (CT) are useful in demonstrating the extent of the thrombus, CT is not always accurate in delineating the superior margin of the tumor in the IVC. More precisely, magnetic resonance imaging (MRI) can demonstrate a tumor thrombus and its extension, besides signs of wall invasion, being extremely useful to surgical procedure planning [8,15]. Vena cavography is not additive to US, CT, and MRI, and it increases the risk of contrast-associated renal injury [4,8]. However, new modern image technologies has emerged to help surgical planning, as three-dimensional visualization technique (3DVT) based on routine CT or MRI processed image data [16-20]. Recently, a comparative study showed advantage of 3DVT in management of complex renal tumor during laparoscopic partial nephrectomy . This modality is able to demonstrate anatomy relations, allowing the surgeon to observe the relationship between targeted tumor and peripheral structure before surgery and perform virtual manipulation. This kind of preoperative accurate assessment can enhance surgeons confidence of surgical procedure and decrease surgical risk and incidence of complications . There is no report in the literature of the use of this type of technology in cases of IVC tumor thrombus.
We present the use of 3D holographic interactive reconstruction in a single case of robotic radical nephrectomy with level III IVC thrombectomy.
The phenotypic manifestation of congenital adrenal hyperplasia (CAH) is variable, and this largely depends on the extent of 21-Hydroxylase enzyme deficiency. In non- classic CAH (NCCAH), the clinical features predominantly reflect the androgen excess rather than adrenal insufficiency. In boys, the condition may not present until much later in childhood, where the diagnosis is made following presentation with precocious puberty, features of aldosterone insufficiency, or this condition may be detected during fertility workup Imaging is generally not used in the evaluation of CAH, but may be helpful for the diagnosis, management, and follow-up of these patients. CAH can result in adrenal enlargement in both classic and non-classic forms of adrenal hyperplasia. The so-called adrenal rest tissue may be seen at several sites throughout the body, including the celiac plexus region, broad ligaments, normal ovaries, and testes. Sustained elevation of adrenocorticotropic hormone (ACTH) in patients with CAH has been postulated to cause adrenal rest cells to grow and become functionally active. The discovery of bilateral adrenal enlargement during radiologic evaluation for unrelated disease processes might serve as a mode of presentation for clinically not apparent or non- classical congenital adrenal hyperplasia (NCCAH).
Among all the countries, Yemen is free of corona virus, and no single case has been recorded till today. Yemen is characterized by its mother geographical location on the Red Sea and its population is approximately 30 million people and an area of 555,000 square kilometers.
Introduction: There is increasing published evidence confirming the long-term adult mental and physical health impact of childhood exposure to adverse events including different forms of abuse and family dysfunction. Looked-after Children and young people (LACYP) living in public care are known to be a highly vulnerable group, who have often experienced several pre-care poor socio-economic and family circumstances with subsequent placement instability, as well as inadequate compensatory care within the social care system. We aimed to evaluate the relationship between the adverse socio-emotional risk factors experienced by a cohort of LACYP and their emotional, behavioural and physical health needs within a South-West England Local Authority between Jan and Dec 2018.
Methods: We carried out a retrospective review of the medical records of all looked-after children and young people (LACYP) within one year (Jan to Dec 2018) at the North Somerset Local Authority (NSLA). This was an audit project of the LAC Health team completed as part of the Clinical Governance strategies of the NSLA.
Results: 93% (89/96) of the LACYP experienced at least one or more socio-emotional adverse risk factors. The commonest socio-emotional risk factors recorded were parent-related including poor mental health (67%), neglectful parenting (59%), drugs/alcohol abuse (45%) and domestic violence (47%). Forty-six (48%) of the LACYP had at least one or more emotional problems, 48 (50%) had neurodevelopmental conditions, while 63 (66%) had at least one or more physical problems. The most common emotional needs were behavioural problems (35%), anxiety/ depression (17%), nicotine/substance misuse (10%) and self-harm (6%).
Conclusion: High levels of physical, emotional, behavioral, developmental and neurodisability disorders are prevalent among LACYP due to their high vulnerabilities to adverse life experiences and trauma while living within their biological families. Present and future clinical implications of the socio-emotional risk factors and the need for more integrated multi-agency services for addressing the diverse health needs of the LACYP were discussed.
What is known?
• There is increasing awareness of the relationship between childhood exposure to adverse events and long-term adult mental and physical health
• Looked after children and young people (LACYP) are highly vulnerable to early traumatic and poor socio-economic circumstances exposure
What this study adds:
• Over 90% of LACYP experienced at least one ACE which disproportionately affected the youngest age-group
• Parental factors such as childhood abuse, alcohol/substance abuse and mental health problems were the most common adverse factors experienced by the LACYP
Methods: Experimental phase: Performed a partial nephrectomy off clamp in pig model followed by cauterization of lidocaine gel 2% with different power (control, 30W, 50W and 100W) in the kidney resection bed to evaluate efficacy and deep injury extension.
Clinical phase: 20 patients submitted to laparoscopic or partial nephrectomy for low risk RENAL score were utilized greased lidocaine gel 2% with 50W in cautery scalpel to hemostasis of renal parenchima to validate efficacy and safety.
Results: Experimental study shows that this technique is effective and promote better hemostasis with 50W and 100W, with deep injury of less than 3 mm.
Clinical study confirm efficacy, good control of hemorrage, few complications and no transfusion. Minimal changes in hematocrit, haemoglobin and creatinine were observed.
Conclusion: In this preliminary experience the use of this new alternative to hemostasis for low risk partial nephrectomy was satisfactory and with good intra and postoperative results.
The best advantages were safety in terms of the depth thermal injury, low cost and absence of artifacts over the resection area observed at CT scan postoperatively.
Urinary tract infections are common affection in the general population.
Diagnosis is often easy in the presence of evocative clinical signs.
The diagnosis of urinary tract infection is evoked in the presence of an uropathogenic germ in the urine in sufficient quantity associated with urinary signs. The presence of lower back pain, chills, fever higher than 39° is suggestive of a high urinary tract infection localized in the kidney, the absence of fever associated with dysuria is suggestive of low urinary tract infection localized in the bladder.
Behavioral dentistry is an interdisciplinary science, which needs to be learned, practiced and reinforced in the context of clinical care and within the community oral health care system. The objective of this science is to develop in a dental practitioner an understanding of the interpersonal, intrapersonal, social forces that influence the patients’ behavior. The clinician must acquire knowledge to develop appropriate behavioral skills with an improved quality of communication and management of patients. Behavior dentistry also teaches to develop a recognition and understanding that the body and mind are not separate entities and focuses on patients’ social, emotional and physiological dental experiences.
Behavior is an observable act. It is defined as any change observed in the functioning of an organism. Learning as related to behavior is a process in which experience or practice results in relatively permanent changes in an individual’s behavior. Self-perceptions of dental-facial appearance begin with aesthetic values shared within families and based generally on social norms, but that they may be strongly influenced by peer values and specific experiences of individual children, particularly those involving social responses.
Theories incorporating concepts of social comparison and self-efficacy suggest that individuals evaluate themselves in comparison with others in their social environment. Children who perceive themselves to be attractive will reflect those perceptions in their behaviors and generally will receive confirming social responses. The comparison group may express an attractiveness norm that reflects negatively on the individual’s behavior. This, in turn, can affect the individual perceived sense of self-efficacy or adequacy within that group and lead to behaviors that reflect more negative beliefs about the self, thereby inviting still more negative social responses.
Patient cooperation is the single most important factor every dentist must contend with. Major considerations are
• Regularity in keeping appointments
• Compliance in wearing removable appliances
• Refraining from chewing hard and tenacious substances that are likely to distort or damage the teeth or crowns
• Maintenance of oral hygiene. Laxity in following these instructions may lead not only to compromised treatment but also to slow progress of treatment, loss of chair time and frustration.
What may be more interesting to the Dentist than the shaping of self-perceptions in the shaping of behavior that will ensure a successful result of treatment, that is, the patient’s adherence to prescribed routines for self-care and other regimens during Dental treatment. It is helpful in this regard to know that most patients expect improved dental-facial appearance as an outcome of treatment, but there is much more to know about factors influencing cooperation.
Poor motivation can also contribute to non-compliance. The regulatory loop requires a motivational system to adjust behavior to coincide with the recommended regimen. A patient may recognize that the regimen is not being followed and yet simply not be motivated to correct the discrepancy. Poor motivation can also result from a lack of concern over the long-term health consequences of one’s behavior and/or a lack of belief in the treatment. Cognitive approaches that emphasize the personal relevance of the regimen or address misconceptions about the treatment may enhance motivation. Several approaches may be useful in treating poor compliance. Providing incentives or rewards for compliant behavior might be a useful strategy to enhance motivation. The cause of noncompliance is multifactorial and strategies to improve compliance must be tailored to fit each situation. Current Dental research focuses on a critical aspect of the feedback; specifically, the input received by the comparator that quantifies the actual amount of adherent behavior. Likewise, Patients, parents, and clinicians need a way to ascertain this information.
Obesity is a multifactorial epidemic disease of environmental origin that affects subjects of all countries and whose origin is not in the stomach or intestines. Surgical treatment represents a unique case of surgery for operating healthy organs, which are not the cause of the disease and do not improve after the operation.
Kremen and Linner  and Varco and Buchwald teams of in Minneapolis, MN began the intestinal deviation (ID) of malabsorption in 1954. Payne  and Scott  developed these ID techniques in the 1960s leaving only 14- 4 inches (35 -10 cm) as an absorption zone and were abandoned in the 1970s due to its serious metabolic (malnutrition) and liver complications (liver failure).
The ongoing outbreak of Coronavirus Disease 2019 (COVID-19) originally emerged in China during December 2019 and had become a global pandemic by March 2020. COVID-19 is caused by a novel coronavirus, severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). Two other coronaviruses have caused world-wide outbreaks in the past two decades, namely SARS-CoV (2002–2003) and Middle East respiratory syndrome coronavirus (MERS-CoV) (2012–present). The surface spike glycoprotein (S), which is critical for virus entry through engaging the host receptor and mediating virus host membrane fusion, is the major antigen of coronaviruses. Recent studies provide molecular insights into antibody recognition of SARS-CoV-2. In this review, we discuss the relationship between the spike glycoprotein of SARS-CoV-2 and its receptor, angiotensin converting enzyme 2 (ACE2) including the latest findings.
Background: The REFOCUS intervention was a whole team, complex intervention, designed to increase the recovery support offered by community based, mental health staff. The intervention consisted of two components: Recovery promoting relationships, which focused on how staff work with service users, and Recovery working practices, which focused on what activities and tasks staff and service users could do together.
Aim: We aimed to investigate the experiences of community mental health workers using the REFOCUS intervention to support personal recovery.
Method: In the context of the REFOCUS Trial (ISRCTN02507940), 28 semi-structured individual interviews and 4 staff focus groups, with 24 participants were conducted and thematically analyzed.
Results: Staff valued coaching training and used coaching skills to have tough as well as empowering, motivational conversations with service users. They were positive about the resources within the ‘working practices’ intervention component. The whole team training and reflection sessions helped create team cultures, structures and processes which were conducive to supporting recovery practice.
Conclusion: We recommend the wider use of coaching skills, strengths-based assessments, and approaches to support clinicians to broaden their understanding of service users’ values, treatment preferences and to support striving towards personally-meaningful goals. Staff who used these working practices changed their beliefs about what their service users were capable of, and became more hopeful practitioners. A team-based approach to support recovery creates a learning environment in which staff can support and challenge one another, making sustained practice change more likely.
Coronavirus disease 2019 (COVID-19) which first appeared in China spread gradually all over the world within three months . China was the only country mainly affected by Covid-19 until February 2020, but from the beginning of March, the disease started to spread rapidly to South Korea. It reached Italy in the second week of March and the number of cases increased rapidly in Spain and other European countries in the third week of March then the virus crossed the Atlantic and entered into the United States and other countries in the Americas. WHO declared COVID-19 as a pandemic disease on 11th March 2020 . As of 23rd April 2020, there have been 2,645,785 confirmed cases of COVID-19, with 185,121 deaths and 726,827 recoveries . Slowly, Nepal is also into the scene of the COVID-19 affected countries.
COVID-19 pandemic soon apparently proved to be havoc and a great stressor. During such a stressful time, mental health is in threat. Here, we intend to review the presenting problems/ symptoms as shared in psychiatry helpline of a Teaching Hospital in eastern Nepal during the second week of lockdown and to reflect on to emotional, including mood problems.
It is an institute based period observation noted for all psychiatry helpline calls during 1 week of lockdown days of COVID-19. Their concerns and problems were listened and symptoms clarified by a consultant psychiatrist to help them as far as possible through the telephonic conversation. Maintaining the confidentiality, basic information were noted down in a semi-structured proforma to record certain socio-demographic and clinical information (including mood and other emotional symptoms).
We received 102 helpline calls of 60 clients for psychiatry in 1 week, from 14 districts. More patients being discussed were males (35/60), average age being 34.15 (15 - 70) years. More patients were regular follow-up cases with some new issues (24/60) and 18/60 each were new clients and regular follow-up cases. Majority had exacerbated symptoms in the wake of COVID-19 as: emotional (47/60; mood 24/60, anxiety/worry 23/60) symptoms along with disturbed sleep (32/60); treatment/service issues (31/60) and changed routines. Most common mental problems were Bipolar affective disorder, Psychosis, Anxiety and Depression and advices included Antipsychotics, Benzodiazepines, Antidepressants, along with some Psycho-education. Most common concerns were about OPD service, worsening symptoms and local unavailability of medicines. Many had mood and emotional symptoms in this stressful time, both simple amenable to telephonic advices and severe requiring to be called to emergency service.
Currently brain connectivity modelling, constructed from data acquired by non-invasive technique such as functional magnetic resonance imaging (fMRI), is a well-received approach to illustrate brain function. However, not all connectivity models contains equal amount of information. There are two types of connectivity model that could be constructed from fMRI data, functional and effective connectivity. Effective connectivity includes information about the direction of the connection, while functional connectivity does not. This makes interpretation of effective connectivity more meaningful than functional connectivity. The objective of this study is to show the improvement in interpretability of effective connectivity model in comparison to functional connectivity model. In this study, we show how the difference in the information contained within these two model impacts the interpretation of the resulting connectivity model by analyzing resting-state fMRI data on episodic memory-related cognitive function using CONN Toolbox bivariate correlation measurement for functional connectivity analysis and Tigramite causal discovery framework for effective connectivity analysis on an episodic memory related resting-state fMRI dataset. The comparison between functional and effective connectivity results show that effective connectivity contains more information than the functional connectivity, and the difference in the information contained within these two types of model could significantly impact the intepretation of true brain function. In conclusion, we show that for the connectivity between specific pair of brain regions, effective connectivity analysis reveals more informative characteristic of the connectivity in comparison to functional connectivity where the depicted connectivity lack any additional characteristic information such as the direction of the connection or whether it is a unidirectional or bidirectional. These additional information improve interpretability of brain connectivity study. Thus, we would like to emphasis the important of brain function study using effective connectivity modelling to obtain valid interpretation of true brain function as currently a large body of research in this field focuses only on functional connectivity model.
Objective: The purpose of the study was to evaluate if there is a link between salivary pepsin levels and tooth erosion. Also, to determine if gastroesophageal reflux disease (GERD) is responsible for much of the tooth erosion seen by dentists.
Background: Pepsin is only produced within the stomach. If found within other parts of the body [for example within saliva or sputum samples], the only mechanism by which that would be possible is via the reflux of gastric contents. One of the causes of dental erosion is thought to be due to direct contact between tooth surfaces and acidic substances and digestive enzymes present in gastric refluxate. GERD is a common condition, with its prevalence seemingly trending higher in recent decades. It is reportedly a known cause of tooth erosions. From the hypothesis, there was an expectation to see patients with dental erosions to have pepsin detected [and perhaps at high levels] and to see patients without dental erosions to have no or low levels of pepsin.
Method: Three saliva samples were collected [on waking and 2 post-prandial] from 50 anonymous participating patients (26 females, 24 males) from a single dental practice. Extra information was collected related to lifestyle, Reflux Symptom Index (RSI – reflux questionnaire) and tooth erosions. These samples were analyzed for the stomach enzyme pepsin using the validated medical device Peptest.
Results: There was no correlation between positive pepsin levels and the presence of tooth erosion during this study. There was a statistical difference between the on waking pH vs. positive pepsin levels and post prandial pH vs. positive pepsin levels. The average pH was lower for on waking and post-prandial samples with positive pepsin, suggesting that the saliva was acidic and gastric reflux had occurred. Conversely, the average pH was higher for on waking and post-prandial samples with negative pepsin. There was no statistical difference between pH vs. tooth erosion in the on waking and post- prandial.
Conclusion: Patients identified as having tooth erosion did not have higher levels of pepsin detected, suggesting that pepsin was not associated with dental erosion in these patients.
Typhoid fever is a systemic infection caused by Salmonella enterica serotype typhi. It is of major concern in tropical regions of the world. Highest episodes of typhoid fever occur in Asia i.e.93%. Early diagnosis of the disease is mandatory to lower the mortality rate associated with it as well as to prevent the emergence of antimicrobial drug resistance by Salmonella typhi. Research work was conducted in Immunology Department of the Children’s Hospital, Lahore for the period of one year including a total of 60 patients suspected of having typhoid fever. Serum samples of these patients were tested for typhidot IgG and IgM antibodies as well as for the antibodies against TO and TH antigens using Widal test. Of the total 60 patients, 10 (16.7%) were positive for both typhidot IgG and IgM, 16 (26.7%) were positive for typhidot IgM, 3 (5%) were Positive for typhidot IgG and 31 (51.66%) were negative for both typhidot IgG and IgM. Reading the results of Widal test, 8 (13.33%) were positive for Widal TO and TH antigens, 3 (5%) were positive for Widal TO antigen, 19 (31.7%) were positive for Widal TH antigen and 30 (50%) were negative for Widal TO and TH antigens. IgM is positive at the early stage of acute typhoid fever, IgM along with IgG positive means the middle stage of acute illness. The detection of only IgG cannot discriminate between acute and convalescent phases as it can stay in the serum for at least 2 years or more. The typhidot test is much helpful for the rapid diagnosis of typhoid fever as compared to Widal test which is still being used in some set ups in poor countries, although has become mostly obsolete. By testing the rise of IgM and IgG antibodies against Salmonella typhi, we can detect the infection at early and late stages, respectively
Background: Sudden cardiac death is a major healthcare issue in reduced ejection fraction heart failure (HFrEF) patients. Recently, the new association of sacubitril/valsartan showed a reduction of both ventricular arrhythmias (VA) and mortality even at low dose compared to enalapril in HF patients. The purpose of our study was to assess whether the highest dose of sacubitril/valsartan compared to lower doses may improve the rate of death and VA in a population of patients with HFrEF and with an implantable cardiac defibrillator (ICD).
Methods: 104 HF patients with reduced EF under sacubitril/valsartan with an ICD were divided in 2 groups: the first one with the lower doses of sacubitril/valsartan (24/26 mg or 49 mg/51 mg twice daily) and the second with the maximal dose (97mg/103mg twice daily). The primary outcome was a composite of death or appropriate ICD therapy for VA.
Results: After a median follow-up of 14 months, 39 patients were treated with lower doses and 65 patients with the highest dose. Patients from the lower doses group were older (70 [60-80] vs. 66 [60-70]; p = 0,03), more symptomatic at initiation (NYHA 3: 44% vs. 19%; p < 0,01) and more often in atrial fibrillation (31% vs. 12%; p = 0,04). The primary composite endpoint occurred in 14 patients (36%) in the low doses group versus 7 patients (11%) in high dose group (p < 0,01). This difference was particularly observed in the subgroup of patients with ischemic cardiomyopathy. In a multivariable analysis, the higher dose was independently associated with the primary outcome with an HR = 2,934 [IC 95% 1,147 – 7,504]; p = 0,03. Kaplan-Meier curve showed an early effect of the highest dose of sacubitril/valsartan association.
Conclusion: Patients with HFrEF under the highest dose of sacubitril/valsartan showed better clinical outcomes with a decrease of both mortality or appropriated ICD therapies related to ventricular arrhythmias.
Introduction: Recent research has explored the role that personality traits play in health and weight determination. This study extends current research by evaluating the extent to which behavior mediates the impact of neuroticism and body weight using polygenic risk as a measure of neurotic tendency.
Methods: Structural equation modelling disaggregates the effect of neurotic tendency on BMI into direct and indirect effects. Indirect effects-those transmitted through mediating health behaviors—allow for the simultaneous comparison of multiple behavioral mediators— exercise frequency, smoking intensity, sleep sufficiency and screen time.
Results: While health-related behavior-screen time, sleep, smoking and exercise-directly influence BMI, neurotic tendency showed no direct effect. The strong association between neurotic tendency and behavior, however, indicated that polygenic risk of neuroticism indirectly influenced BMI through two health related behaviors-screen time and smoking. Therefore, the relationship between neurotic disposition and BMI is transmitted through behavioral pathways rather than directly.
Conclusion: This research offers novel insight into the relationship between personality and health outcomes. If behavior manifests through personality disposition, then understanding the relationship between personality, behavior and BMI will help guide weight management interventions to focus on strategies to help manage responses to stress to elicit desired weight outcomes.
Purpose: The purpose of the study was to examine the health status of rural adolescents and young adults in the United States through a comprehensive review of detailed health information, behavior and health awareness. The disparity in health awareness between rural and non-rural residents compared and evaluated.
Methods: Rural-Urban Commuting Area (RUCA) codes were combined with respondent-level data from the Longitudinal Survey of Adolescent to Adult Health (Add Health) to classify individuals as rural/non-rural residents. Health characteristics and perceived health awareness was tested for statistically significant differences using ANOVA. Differences in weight perception accuracy was compared for systematic differences controlling for self-selection into rural areas using a two-stage logistic selection model.
Findings: Analysis revealed that rural residents have a higher incidence of major health conditions including epilepsy, high cholesterol, high blood pressure and diabetes. Additionally, they have a higher prevalence of unhealthy behaviors including drinking and drug use. Rural residents are less likely to be insured, but more likely to be overweight or obese. While rural adolescents are more likely to mis-classify their body weight, this misclassification is a result of the higher incidence of overweight rather than the residential location.
Conclusion: The higher prevalence of chronic conditions combined with the income and education levels suggests the rural environment is a unique and potentially challenging context for adolescent health. Improving rural adolescent health will require innovative solutions appropriate for rural environments and changes in individual health literacy. Solutions must be multisectoral, engaging education, economic development, and other community perspectives to establish key drivers for health equity.
Purpose: The time course of muscle stiffness of muscles around the shoulder joint and the scapula was investigated according to the degree of muscle weakness. This study was conducted to clarify the recovery process of muscle hardness of the muscles surrounding the shoulder joint and the scapula after the shoulder internal and external rotational exercises.
Methods: Participants were 7 healthy men (23.6 ± 1.4 yr), repeated internal and external rotations of the shoulder joint until the mean work of three internal and external rotations each was less than 90%, 80%, or 70% of the standard. Muscle hardness of the supraspinatus muscle, the infraspinatus muscle, and the rhomboideus muscle was measured before, immediately after, and 1to 72 hr after each bout of exercise.
Muscle hardness was measured as Strain ratio using an ultrasound real-time tissue elastography. In addition, the rates of change were calculated using muscle hardness before exercise as the standard, to compare differences in the rate of change after exercise between conditions.
Results: The rates of change of the Strain ratio between measurements taken before and after exercise were compared among conditions for the infraspinatus muscle. Results were -7.1 ± 5.3, -15.2 ± 10.3, and -25.0 ± 8.8, respectively, at 90%, 80%, and 70%, with a significant difference between a decrease to 90% and to 70% (p < 0.05). Significant difference was found in the change over time for the infraspinatus muscle only between values obtained immediately after exercise and after 72 hr at a decrease to 70% (p < 0.05).
Conclusion: Those results described above demonstrated that the infraspinatus muscle and the supraspinatus muscle were harder immediately after exercise when the shoulder joint was at a higher degree of muscle weakness, and demonstrated that the change was likely to be recovered after 72 hr.
The Meckel’s diverticulum (MD) is the most common anomaly of ductus omphaloentericus that surgeon encounters in clinical practice. The accurate incidence is unknown because most patients with the Meckel’s diverticulum are asymptomatic. Most studies report an incidence of about 2%. Approximately 4% of patients with the Meckel’s diverticulum become symptomatic.
A 10 years old boy, was sent from regional hospital. His symptoms started the day before he was hospitalized and represented as gastrointestinal bleeding, lower abdominal pain and four times vomiting, without fever. Ultrasound and X-ray of the abdomen were normal. Blood findings showed: RBC 3,19, hemoglobin 0,95, hematocrit 0,27. During a physical examination abdomen was palpatory soft, with no presence of the pain. Digital rectal examination showed blood. A scintigraphy pathologic scan showed a focal lesion of the right hemi abdomen consistent with the Meckel’s diverticulum.Patient was treated byLaparoscopic-Assisted Transumbilical Extracorporeal Resection of the Meckel’s Diverticulum.
Atherosclerosis is an important promoter of cardiovascular disease potentiating myocardial infarction or stroke. Current demand in biomedical imaging necessitates noninvasive characterization of arterial changes responsible for transition of stable plaque into rupture-prone vulnerable plaque. in vivo contrast enhanced magnetic resonance (MR) imaging (MRI) allows quantitative and functional monitoring of pathomorphological changes through signal differences induced by the contrast agent uptake in the diseased vessel wall, therefore it is the ideal modality toward this goal. However, studies have so far focused on the cellular targets of persisting inflammation, leaving extracellular matrix (ECM) far behind. In this review, we portray ECM remodeling during atherosclerotic plaque progression by summarizing the state of the-art in MRI and current imaging targets. Finally, we aim to discuss glycosaminoglycans (GAGs) and their functional interactions, which might offer potential toward development of novel imaging probes for in vivo contrast-enhanced MRI of atherosclerosis.
Research on psychological risk factors for upper respiratory tract illnesses (URTIs) has been conducted for over fifty years. Early studies failed to control for exposure and also often relied on self-report rather than clinical and virological assessment. A universal policy used in the current COVID-19 pandemic has been to restrict exposure by social isolation. This leads to increased stress and removal of social interaction. In addition, information overload about the disease, and incorrect information, can also reduce wellbeing. Studies of experimentally-induced URTIs have shown that stress increases susceptibility to infection. Other research has shown that stress due to job insecurity and few social contacts are key risk factors for infection. This suggests that while social isolation will reduce exposure, it will also lead to an increased risk of illnesses, due to increased stress and reduced social support, should the person become infected with the virus. Other research has shown that infection and illness lead to changes in behaviour. These effects include greater negative affect and impaired attention and slower speed of response. Such effects are not only present when the person is symptomatic but also occur with sub-clinical infections, during the incubation period and after the illness. People with the illness are also more sensitive to other negative influences such as fatigue, and this has implications for safety critical jobs such as those carried out by healthcare professionals treating those with COVID-19.
An isolate of zucchini yellow mosaic virus (ZYMV) was obtained from naturally infected squash fruits were grown in Abees region, Alexandria governorate. Disease symptoms were Showing mosaic, yellowing and blistering and absis symptoms. The identification was based on the symptoms developed on diagnostic hosts and serological reactions with antisera to cucumber mosaic cucumovirus (CMV), watermelon mosaic potyvirus 2 (WMV-2) and ZYMV. Squash fruit isolate of ZYMV was transmitted by Aphis gossypii, Aphis neri and Myzus persicae in non-persistent manner. The virus was purified by ultra-centrifugation and PEG. The purified virus had an ultraviolet absorption spectrum typical of a nucleoprotein with A260/280 and A280/260 being 1.1 and 0.91 respectively. The yield of purified virus was 1.62 mg/100g infected leaf tissues. Specific antiserum was prepared and found to have a titer of 1:409600 as determined by indirect ELISA.
Managing municipal solid waste correctly is critical to the success of a society. Many regions and countries in the world are behind others in the context of solid waste management. In order to compare three such regions within this context, a meta-analysis was conducted in order to develop a decision matrix. Within this decision matrix, the United States, Europe, and Asia were compared to determine which region is managing municipal solid waste the best. This research design allowed for compiling information from many sources to increase the accuracy of data used in the justifications for the decision matrix. Purposive sampling was used to select and evaluate sources that discuss solid waste management to discern which region’s processes are most favorable in many parameters. The decision matrix consists of nine parameters: main management techniques; finances; landfill taxes; jobs created; waste generation; waste composition; waste storage, collection, and transportation; energy recovery; and environmental health. Each was scored on a scale from zero to ten, ten being the best score and zero being the worst. The final score from the decision matrix suggested that Europe had the most favorable municipal solid waste management (MSWM) system, and the United States had a notably close yet lower score. Asia had the lowest score that was hardly comparable to the other two regions.
On January 19, 2020, a 28-year-old male presented to the hospital with a 2-day history of fever, occasional cough and headache. He disclosed that he worked in Wuhan , China (the center of novel coronavirus outbreak) and flew to Yinchuan on the day of admission.
The effect of the intrinsic lutetium radioactivity on the detection performances of a LYSO based in-beam PET-like prototype used for quality control of hadrontherapy treatments is studied. This radioactivity leads to a background that degrades the measurement of the β+ signal. In particular, it prevents the measurement of faint signals originating from low activity β+ sources. This paper presents a method to estimate the minimum β+ activity that can be measured for any acquisition time taking into account the non-extensible dead time of the detector. This method is illustrated with experimental data collected with the in-beam PET-like prototype. The results presented in this paper are therefore specific to this detector. The method can however be applied in other contexts, either to other lutetium based PET detectors or even to non-PET detectors affected by lutetium radioactivity. The dead time correction formalism can also be used generally to scale signal and background yields in any non-paralizable detector, even those in which the background is not due to the presence of intrinsic radioactivity.
Pulmonary embolism (PE) is an age-related disorder which is potentially fatal, but frequently misdiagnosed. However, the true prevalence of pulmonary embolism is unknown. Inaccurate estimates of PE prevalence might, in part, be attributable to underrecognition of atypical presentations of this disorder. If true prevalence is unknown, the positive predictive values of both typical and atypical symptoms and signs of PE will be unreliable. The negative predictive value of those parameters will, likewise, be unreliable. The aim of this review is to make clinicians more aware of atypical manifestations of PE, thereby increasing the likelihood of correct diagnosis and, hence, ascertainment of the true prevalence of PE. The range of atypical manifestations was explored by a literature search, using MEDLINE from 1946 to February 2019, and EMBASE, from 1947 to February 2019, and Pubmed, from February 2014 to February 2019, using the search terms atypical, uncommon, unusual, pulmonary embolism, lung embolism, pulmonary thromboembolism.
This search revealed atypical presenting features such as non pleuritic retrosternal pain, abdominal pain, atypical breathing patterns, pulmonary oedema, Dressler’s syndrome, atypical radiographic manifestations, atypical electrocardiographic features, manifestations associated with oxygen saturation of 95% or more, coexistence of acute myocardial infarction and pulmonary embolism, coexistence of thoracic aortic dissection and pulmonary embolism, neurological manifestations other than stroke, paradoxical embolism, acute venous thrombosis of atypical location, and pulmonary embolism with normal D-dimer levels.
Anal melanoma is a rare and highly aggressive mucosal melanocytic malignancy. It is the third most common after melanomas of the skin and retina. The peak incidence in seen in the sixth and seventh decades. The clinical symptoms are pain, anal mass, bleeding per rectum, tenesmus or change in the bowel habits. It affects anal canal, rectum or both with a tendency to spread along submucosal planes. It is mostly beyond complete resection at the time of diagnosis and majority of patients die of metastasis. MR imaging significantly increases the diagnosis of anal melanoma in its early stages.
Pines have been discovered to die in the Alps. In any place of skiing, you can find dried pine trees from 2x to 20 meters high. In each zone of visibility of the forest mass of such pines, there are from 1 to 90%. I wonder if science deals with this issue
We know that Corona Virus develops in animals, birds and humans’ body. Now it is a pandemic and many people are dying with each passing day and a number of patients are increasing every hours. If we do not control it then it is dangerous for humanity. As we know that incubation period for COVID-19 is 1 to 14 days and it’s live in the environment for 12 to 14 hours. The only solution to spread of virus is by social distancing. As we know that it affects person with low immunity so it is advised for all people to have balance diet, exercise daily and spend time in meditation for increasing immunity. I want to share a natural method to develop and increase the immunity power by the bile juice of animals, birds and we can try for corona virus too.
Over the last few years, antimicrobial shampoo therapy has been increasingly used to treat skin infections in order to reduce systemic use of antibiotics. This study was aimed to compare the In vitro bactericidal effect of a black currant oil based shampoo (S1) to a chlorhexidine 4% shampoo (S2) against methicillin-sensitive Staphylococcus pseudintermedius (MSSP), methicillin-resistant Staphylococcus pseudintermedius (MRSP), Staphylococcus aureus (SA), Escherichia coli (EC) and Pseudomonas aeruginosa (PA) isolates.
A collection of 50 bacterial strains from skin swabs of dogs with superficial recurrent pyoderma was selected: 10 MSSP, 10 MRSP, 10 SA, 10 EC and 10 PA. The two shampoos were blindly tested in duplicate with a microdilution plate method, with scalar concentrations from 1:2 to 1: 256. The MBC was performed for each dilution. A linear regression was used to detect a statistically significance between the two shampoos.
All isolates were completely killed at 1:2 up to 1:16 dilution of the two antiseptic products. At the 1:32 dilution the first bacterial growths were observed, in particular for 2 and 4 strains of MRSP by S1 and S2 respectively. The first lethal dilution for SA was at 1:64 for S1/S2 and only for S2 against SP. No significant difference was observed between the two shampoos according to the results of linear regression significant for: i) MRSP, PA and EC (p < 0.05); ii) MSSP and SA (p < 0.1).
This study showed that both black currant oil based shampoo and chlorhexidine 4% shampoo have a similar In vitro bactericidal activity.
Aim: This study calculated the effects on serum phosphorus (P) levels, after treatment with either of 2 drugs: the erythropoietin (Epo) and the antioxidant lazaroid (L) drug U-74389G. The calculation was based on the results of 2 preliminary studies, each one of which estimated the certain influence, after the respective drug usage in an induced ischemia reperfusion (IR) animal experiment.
Materials and methods: The 2 main experimental endpoints at which the serum P levels were evaluated was the 60th reperfusion min (for the groups A, C and E) and the 120th reperfusion min (for the groups B, D and F). Specially, the groups A and B were processed without drugs, the groups C and D after Epo administration; whereas the groups E and F after the L administration.
Results: The first preliminary study of Epo presented a non significant hyperphosphoremic effect by 2.46% + 2.02% (p - value = 0.2168). However, the second preliminary study of U-74389G presented a non significant hypophosphoremic effect by 1.09% + 2.01% (p - value = 0.5771). These 2 studies were co-evaluated since they came from the same experimental setting. The outcome of the co-evaluation was that L is at least 0.4455128-fold [0.4445589 - 0.4464687] more hypophosphoremic than Epo (p - value = 0.0000).
Conclusions: The anti-oxidant capacities of U-74389G ascribe at least 0.4455128-fold [0.4445589 - 0.4464687] more effects than Epo (p - value = 0.0000).
We investigated the existence of microalbuminuria in children with corticosteroid-sensitive idiopathic nephrotic syndrome in complete remission. In the study of a series of 18 cases, we noted a clearly different evolution depending on the existence or absence of pathological micro albuminuria.
Microalbuminuria appears to be a prognostic discrimination parameter in idiopathic nephrotic syndrome.
Introduction: Anderson-Hynes pyeloplasty remains the gold standard in the treatment of ureteropelvic junction obstruction. The diagnostic criteria for defining the failure of pyeloplasty are not well-defined or even arbitrary. Likewise, the ideal treatment of persistent hydronephrosis after pyeloplasty is not well established. We tested an innovative endourological procedure, which simultaneously allows a diagnostic definition of failure and treatment when necessary.
Materials and methods: The endourological procedure was applied prospectively to 13 cases from 2006 to 2015. The mean hydronephrosis was 3 cm and all the patients showed an obstructive pattern at scintigraphie. Of these, only 2 patients had symptoms. The procedure consisted in the endoscopic calibration of the pyeloureteral junction. In case of confirmed persistent stenosis, the procedure continued with the high pressure dilation of the junction. The calibration/dilation procedure was carried out with a balloon catheter, previously used for high pressure dilation in the obstructive megaureter. In all patients, a ureteral stent was positioned for 6 - 8 weeks.
The patients were then followed up using ultrasound and renoscintigraphie.
Results: According to the endoscopic balloon procedure, anastomosic stenosis was confirmed in 3 cases, treated with high pressure dilation during the same procedure. In 10 cases no stenosis was found and we followed-up these patients with periodic ultrasound and scintigraphie.
Conclusion: The calibration/dilation of the pyeloureteral junction represents in our opinion a useful diagnostic and therapeutic tool that allows to limit the repetition of open surgery only to symptomatic cases and those non-responders to endoscopic treatment.
Although the classical surgical treatment methods of chronic venous insufficiency are successful to relieve perfectly the cause (reflux) and result (varicose veins), the new ablation techniques such as endogenous laser ablation therapy (EVLT), radiofrequency (RF) and foam ablation come into currency more and more with their advantage of being performed with only local anesthesia. However, these techniques, still have the potential for residual saphenofemoral reflux due to incomplete ablation of all side branches of the saphenofemoral junction. As an alternative technique ligation + foam sclerotherapy is not only comfortable like EVLT or RF but also safe and effective as much as classic stripping.
The global virome: The viruses have a global distribution, phylogenetic diversity and host specificity. They are obligate intracellular parasites with single- or double-stranded DNA or RNA genomes, and afflict bacteria, plants, animals and human population. The viral infection begins when surface proteins bind to receptor proteins on the host cell surface, followed by internalisation, replication and lysis. Further, trans-species interactions of viruses with bacteria, small eukaryotes and host are associated with various zoonotic viral diseases and disease progression.
Virome interface and transmission: The cross-species transmission from their natural reservoir, usually mammalian or avian, hosts to infect human-being is a rare probability, but occurs leading to the zoonotic human viral infection. The factors like increased human settlements and encroachments, expanded travel and trade networks, altered wildlife and livestock practices, modernised and mass-farming practices, compromised ecosystems and habitat destruction, and global climate change have impact on the interactions between virome and its hosts and other species and act as drivers of trans-species viral spill-over and human transmission.
Zoonotic viral diseases and epidemics: The zoonotic viruses have caused various deadly pandemics in human history. They can be further characterized as either newly emerging or re-emerging infectious diseases, caused by pathogens that historically have infected the same host species, but continue to appear in new locations or in drug-resistant forms, or reappear after apparent control or elimination. The prevalence of zoonoses underlines importance of the animal–human–ecosystem interface in disease transmission. The present COVID-19 infection has certain distinct features which suppress the host immune response and promote the disease potential.
Treatment for epidemics like covid-19: It appears that certain nutraceuticals may provide relief in clinical symptoms to patients infected with encapsulated RNA viruses such as influenza and coronavirus. These nutraceuticals appear to reduce the inflammation in the lungs and help to boost type 1 interferon response to these viral infections. The human intestinal microbiota acting in tandem with the host’s defence and immune system, is vital for homeostasis and preservation of health. The integrity and balanced activity of the gut microbes is responsible for the protection from disease states including viral infections. Certain probiotics may help in improving the sensitivity and effectivity of immune system against viral infections. Currently, antiviral therapy is available only for a limited number of zoonotic viral infections. Because viruses are intracellular parasites, antiviral drugs are not able to deactivate or destroy the virus but can reduce the viral load by inhibiting replication and facilitating the host’s innate immune mechanisms to neutralize the virus.
Conclusion: Lessons from recent viral epidemics - Considering that certain nutraceuticals have demonstrated antiviral effects in both clinical and animal studies, further studies are required to establish their therapeutic efficacy. The components of nutraceuticals such as luteolin, apigenin, quercetin and chlorogenic acid may be useful for developing a combo-therapy. The use of probiotics to enhance immunity and immune response against viral infections is a novel possibility. The available antiviral therapy is inefficient in deactivating or destroying the infecting viruses, may help in reducing the viral load by inhibiting replication. The novel efficient antiviral agents are being explored.
Background: Timely starting of breastfeeding is defined as the starting of breastfeeding within one hour after childbirth. Globally mothers who practiced breastfeeding within one hour were less than half in percent. In least developed countries like Eastern and Southern Africa including Ethiopia infant breastfeeding practice within one hour were low. The aim of this study was to assess timely initiation of breastfeeding and associated factors among mothers who have an infant less than six months of age in Gunchire town, Southern Ethiopia.
Methods: The study was conducted from May 1 to 28, 2019 in Gunchire town. Data were collected by using a structured face to face interview questionnaire. The community based cross-sectional study was employed on 333 women. The study participants were selected by Simple random sampling techniques. The data were coded, entered, cleaned and analyzed by SPSS with windows version 21.0. Binary and multivariable logistic regression statistical model was used. Adjusted odds ratio with 95% CI was computed to see the strength of association.
Results: In this study the magnitude of timely initiation of breastfeeding was 80.5%. Governmental employed mothers (AOR=2.914, 95% CI: 1.139, 7.46), Antenatal care follow up (AOR=5.99, 95% CI: 1.29, 27.81), Baby skin to skin contact (AOR=2.4, 95% CI: 1.092, 5.34), Vaginal delivery (AOR=5.82 95% CI: 1.68, 20.14) Institutional delivery (AOR=5.5, 95 CI%: 1.66, 18.3), Good knowledge of breastfeeding (AOR=4.02, 95% CI: 1.04, 15.59) and Breast disease (AOR=0.24, 95% CI: 0.08, 0.73) were significantly associated with timely starting of breastfeeding.
Conclusion: More than two third of the mothers timely initiated breastfeeding within one hour after birth. Being governmentally employed, having Antenatal care follows up, skin to skin contact, mode of delivery, knowledge of mothers about breastfeeding and place of delivery were positively and significantly associated with timely initiation of breast feeding, whereas, breast disease was protective against timely starting of breastfeeding. Therefore, we would like to recommend Enamore woreda health office and Gunchire primary Hospital staffs work at MCH clinic to provide appropriate services and stimulate the mothers to initiate breastfeeding, skin to skin contact enhancing within the first hour of birth.
Amenorrhea is the absence or abnormal cessation of menstrual cycles in a woman of reproductive age. Prolonged cessation of menstrual cycles might results in complications such as infertility, psychosocial developmental delays, Osteoporosis, fractures etc. Better understanding of physiology of menstruation is essential to understand the various causes of primary and secondary amenorrhea. Any disruption or functional abnormality in the hypothalamic-pituitary-ovarian axis can result in abnormal menstruation or amenorrhea. Therefore it is crucial to identify this menstrual distress in women at early age to minimize the risks of reproductive dysfunction in premenstrual and postmenstrual conditions.
Introduction: Diffuse axonal injury (DAI) is a major cause of disability in the pediatric patient. Herein we describe the MRI/DWI findings in a case with DAI. We also discuss the current role of CT and MRI with DWI in the evaluation of DAI.
Aim of the study: To stress the role of diffusion-weighted imaging in diffuse axonal injury.
Methods: A pediatric patient, who was hospitalized in the ICU, was submitted to MRI with DWI for the evaluation of brain lesions. The patient was scanned with T1-weighted images, T2-weighted images, FLAIR, T2*-weighted images and diffusion weighted images.
Result: Brain lesions caused by DAI were more conspicuous on diffusion-weighted images compared to FLAIR images. T2*-weighted images were a helpful adjunct in showing micro-hemorrhages.
Conclusion: T2*-weighted images and FLAIR images alone underestimate the true extent brain lesions in DAI compared to DWI.
The doctor-patient communication and the aging of the patients attended by the general practitioner are two important concepts that constantly impact medical consultations. This article raises some reflections and conceptualizations about the main psychological phenomena that have a special importance in the doctor-elderly patient communication and relationship: 1) Stereotypes and prejudices; 2) Regression; 3) Transference, countertransference and resistance; 4) Rapport; 5) Empathy; and 6) Paternalism. The GP must be alert about what affecting the communication with the old man and he should put the means to get a warm relationship. Consequently, to achieve effective communication with an older adult: The GP have to take it easy; to be patient; avoiding stereotypes and prejudices; allowing the patient to establish a benign regressive relationship, until if it is possible due to the biopsychosocial context of the elderly patient, he can begin the non-regressive relationship again; recognizing fact of transference, which put the doctor in another place, is inevitable, but taking into account that it greatly affects his relationship with the patients; avoiding countertransference; considering that the therapeutic alliance or rapport is particularly fragile in elderly patients with chronic diseases; giving greater importance to empathy; knowing that the elderly patient frequently accepts the authority of the doctor, but avoiding falling into an iatrogenic paternalism; and smile.
Celiac disease affects 1% of the world population; however it is under diagnosed in UAE. The disease has many clinical manifestations, ranging from severe malabsorption to minimally symptomatic or non-symptomatic presentation. Hypocalcaemia is a common finding in celiac disease and could be the only presentation of the disease; however hypercalcemia has been previously reported in patients with celiac disease either due to primary hyperparathyroidism or tertiary hyperparathyroidism due to prolonged hypocalcaemia. A normal calcium level on the other hand in patients with untreated celiac disease who also have primary hyperparathyroidism can be due to interplay of these two conditions and may delay the diagnosis of primary Hyperparathyroidism. We report the very first case from our practice in UAE with untreated celiac disease and normal calcium level at presentation, where a diagnosis of primary hyperparathyroidism was not entertained initially. Patient went on gluten free diet which then caused normalization of intestinal abnormalities and likely calcium absorption manifesting as hypercalcemia on subsequent labs. This led to further work up and finally the diagnosis of Primary hyperparathyroidism due to parathyroid adenoma.
Eliza Miranda Ramos*, Francisco José Mendes dos Reis, Hugo Vieira Ramos, Igor Domingos de Souza, Liliane de Mello Santos Bochenek, Alessandro Carvalho da Fonseca and Valter Aragão do Nascimento
Published on: 7th April, 2020
In the evolutionary journey of humanity, it is possible to verify an analysis of pandemics with high occurrences. This study aims to conduct a critical analysis of the role of Vitamin D as an endogenous vaccine in the main viruses present in humanity over the decades. To construct this text, we used the short review methodology through a critical analysis. This study demonstrated the importance of using Vitamin D as an endogenous vaccine when used frequently in both healthcare professionals and patients. Therefore, it is concluded that Vitamin acts protectively in the innate immune system.
In 2007, Professor Breijo-Márquez described an electrocardiographic pattern, consisting of the presence of a short PR interval (or PQ) together with a short QT interval in the same individual. It was published with the headline “Decrease in cardiac electrical systole” in International Journal of Cardiology (IJC) .
Objective: Currently, Parkinson’s disease (PD) is becoming more common among younger people of ages from 30 – 40 years. The incidence is higher among patients with higher body mass index (BMI), and some reports had it that Obesity is a risk factor for PD while some reported that there is no relationship between obesity and PD. PD patient at the time of diagnosis has an above-normal BMI but which goes below normal as the disease progresses. Therefore, it is essential to explore the relationship between PD and Obesity.
Methods: 349 outpatients and inpatients with PD were selected from Jiangsu University Affiliated People’s Hospital from January 2014 to December 2018, while 74 inpatients with non-cerebrovascular illness in the same period were selected as the control group. According to Hoehn-Yahr grade, Parkinson’s patients were divided into three groups. The height, weight, waist and hip circumference, total cholesterol (TC), Total Glycerol (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were measured and recorded. The relationship between the severity of Parkinson’s disease and blood lipids was evaluated.
Results: The BMI of patients with PD in the early stage was higher than that of the control group, but lower than that of the control group in the late stage, and the level of blood lipid in the patients with early PD was significantly higher than that in the control group and patients with advanced PD, especially in TG. The waist circumference and hip circumference of the patients with early PD were higher than those in the control group, but there was no statistical difference.
Conclusion: i) Obesity may increase the prevalence of PD. ii) The BMI of patients with PD shows two-way changes in different periods. iii) The BMI is higher and cholesterol is more elevated in the early stage of patients with PD, while at the advanced stage of the disease, the BMI and lipid levels of the patients showed a downward trend, which may be associated with a metabolic syndrome associated with dopamine depletion.
Introduction: Pancreatic pseudocysts (PPs) are mostly delayed complications of acute or chronic pancreatitis and trauma. Pancreatic pseudocysts are usually managed by supportive medical treatment without surgical procedure. All the surgical interventions (percutaneous, endoscopic or surgical approaches) are based on the location, size, symptoms, complications of the pancreatic pseudocyst and medical condition of the patients. Recently, laparoscopic cystogastrostomy has become most appropriate approach especially for retrogastric pancreatic pseudocysts. In this study, we would like to report results of laparoscopic anterior transgastric cystogastrostomy by using linear articulated endo GIA stapler (Covidien medium thick purple) and versa-lifter (versa lifter®, laparoscopic retractor, manufactured by protomedlabs, France) in 14 pancreatic pseudocysts patients.
Methods: We retrospectively analyzed data of patients with pancreatic pseudocysts treated by laparoscopic anterior transgastric cystogastrostomy from September 2010 to October 2014. All of the patients were controlled for the recurrence of pancreatic pseudocysts in February 2017.
Results: 14 patients with pancreatic pseudocysts were managed by laparoscopic anterior transgastric cysto-gastrostomy. Conversion was performed in only one patient (7%). There were no symptoms and signs of recurrence of pancreatic pseudocyst during on average 43.6 months follow up time.
Conclusion: Laparoscopic cystogastrostomy by using articulated linear endo-GIA stapler and versa-lifter is a safe and effective method for management of appropriate retro-gastric pancreatic pseudocysts.
Jan Jacques Michiels*, King H Lam, Fibo Ten Kate, Dong-Wook Kim, Myungshin Kim, Vasily Shuvaev, Francisca Valster, Vincent Potters, Wilfried Schroyens, Mihaela Andreescu, Adrian Trifa, Achille Pich and Hendrik De Raeve
The Myeloproliferative Neoplasms (MPN) of trilinear polycythemia vera (PV) and megakaryocytic leukemia (ML = primary megakaryocytic granulocytic myeloproliferation: PMGM) and Essential Thrombocythemia (ET) in the studies of Dameshek and Michiels are caused by the MPN driver mutations JAK2V617F, JAK2exon12, CALR and MPL515 discovered by Constantinescu-Vainchenker, Green and Kralovics. The JAK2V617F mutated trilinear myeloproliferative neoplasms (MPN) include a broad spectrum of clinical laboratory and bone marrow features in essential thrombocythemia (ET), prodromal PV and erythrocythemic PV, classical PV and advanced stages of masked PV and PV complicated by splenomegaly and secondary myelofibrosis (MF). Heterozygous JAK2V617F mutated ET is associated with low JAK2 allele and MPN disease burden and normal life expectance. In combined heterozygous and homozygous or homozygous JAK2V617F mutated trilinear PV, the JAK2 mutation load increases from less than 50% in prodromal PV and classical PV to above 50% up to 100% in hypercellular PV, advanced PV and PV with MF. Bone marrow histology show diagnostic features of eryhrocytic, megakaryocytic and granulocytic (EMG) myeloproliferation in JAK2V617F mutated trilinear MPN, which clearly differs from monolinear megakaryocytic (M) myelproliferation in MPL and CALR thrombocythemia and dual megakaryocytic granulocytic (MG) myeloproliferation in CALR mutated thrombocythemia. The morphology of clustered large pleomorphic megakaryocytes with hyperlobulated nuclei are similar in JAK2V617F thrombocythemia, prodromal PV and classical PV patients. Monolinear megakaryocytic (M) myeloproliferation of large to giant megakaryocytes with hyperlobulated staghorn-like nuclei is the hallmark of MPL515 mutated normocellular thrombocythemia. CALR mutated thrombocythemia usually presents with high platelet count around 1000x109/l and normocellular megakaryocytic (M) proliferation of immature megakaryocytes with cloud-like hyperchromatic nuclei followed by dual megakaryocytic granulocytic (MG) myeloproliferation followed by various degrees of bone marrow fibrosis. Natural history and life expectancy of MPN patients are related to the response to treatment and the degree of anemia, splenomegaly, myelofibrosis and constitutional symptoms. The acquisition of epigenetic mutations at increasing age on top of MPN disease burden independently predict unfavorable outcome in JAK2V617F, MPL515 and CALR mutated myeloproliferative neoplasms (MPNs, which mutually exclude each other).
he presence of bifid mandibu¬lar canals is an unusual but not rare occurrence. The mandibular canal containing the inferior alveolar artery, vein, and nerve, originates from the mandibular foramen and terminates at mental foramen [1-4]. In radiology, mandibular canal’s appearance has been described as “a radiolucent dark ribbon between two white lines”. White and Pharoah defined it as “dark linear shadow with thin radiopaque superior and inferior borders cast by the lamella of bone that bounds the canal” . Understanding of its anatomic variations is very important due to its clinical implications in various oral and maxillofacial treatments like removal of wisdom teeth , mandibular implant placement , in bilateral sagittal split osteotomy procedures and during fixation of mandibular fractures. Presence of bifid or multiple mandibular canals forces the clinician to change the treatment plan. Ignoring this variation can cause several complications intra or postoperatively or even result in failure of treatment. For instance a bifid canal if ignored during surgical removal of third molar or dental implant placement can cause prolonged pain even after administering local anesthesia and also severe bleeding if the accessory canal is encroached .
Bifid mandibular canals may originate from the mandibular foramen independently or might bifurcate from a single canal during its course inside the mandible . Bifid mandibular canals have been by classified by multiple authors according to anatomical location and configuration, on panoramic radiographs and computerized tomography. According to Carter and Keen , inferior alveolar nerve can be arranged as- Type I: single large bony canal, Type II: canal is lower down in the mandible and Type III: canal separates posteriorly into two large branches.
Nortje, et al.  gave patterns of duplication as- Type I: duplicate canals from a single mandibular foramen which can be of same size/ lower canal smaller/ upper canal smaller. Type II: short upper canal up to the second molar areas. Type III: two canals from separate foramina, joining at molar area and Type IV: supplemental canals joining the main canals in the retromolar areas. This report describes a case of a bilateral Bifid Mandibular Canal suspected by a panoramic radiograph and confirmed by a CBCT prior to a dental treatment.
Background: Pulmonary vein isolation (PVI) is the accepted standard nowadays for atrial fibrillation (AF) ablation. The most widespread ablation techniques are cryoballoon (CB) and point-by-point radiofrequency (RF) ablation. Comparative studies between both techniques have shown their equivalence for the first ablation procedure, but no trial has explored the potential incremental benefit of crossing over the ablation technique after AF recurrence.
Objective: To explore the potential incremental benefit of a crossover ablation strategy for AF recurrences, comparatively with repeating the same ablation energy used for the first procedure.
Methods: Retrospective analysis of patients undergoing a second AF ablation procedure after documented AF recurrence. Patients were excluded if all 4 PV were isolated at the beginning of the second procedure or extra-PVI ablation was used for the second procedure. Crossover group (n = 16) included patients in which two different techniques were used for the first and second procedure (CB-RF or RF-CB). Control group (n = 23) for those with same ablation procedure (RF-RF of CB-CB). Acute procedure end-point was PVI of all four pulmonary veins. Patients were followed-up at 3, 6, and 12 months with an electrocardiogram and a 24 h-holter. Arrhythmia-free survival at 1 year after the second ablation procedure was studied, comparing efficiency and safety of the two approaches (crossover vs. same energy). Success was defined as freedom from AF or atrial tachycardia lasting > 30 s off antiarrhythmic drugs (AADs)
Results: A cohort of 39 paroxysmal and persistent AF patients was analyzed. PVI after the second procedure was 100% in all patients in both groups. There were no baseline relevant differences between the two groups. No deaths or hospitalizations occurred during follow up (data censored at 24h moths). At 1 year, arrhythmia free-survival was significantly higher in the crossover group compared to control group [93,3% vs. 47,8%; HR 0.19 (0.06-0.66);p = 0,009].
Conclusion: Crossing the ablation technique (point-by-point radiofrequency or cryoballoon PVI) after AF recurrence significantly improved arrhythmia free-survival at one year, despite no difference in acute success (PVI isolation). Randomized controlled trials with a higher amount of patients are needed to confirm the results and widespread this approach.
The day before yesterday, it was shameful for some politicians, especially President Trump, to label SARS-CoV2 virus as discriminatory “Chinese Virus”. Politicians should be more professional and graceful, and distance themselves from the independence of the academy if something remains unknown to them. Besides, there were two months for President Trump to prepare the Americans for this Virus ; unfortunately, could he have given more attention to his duty of anti-SARS-CoV2 action, despite spending time to defending against the impeachment of his presidency? Besides, in line with this idea, presidential candidate Hillary Clinton wrote: ”The president is turning to racist rhetoric to distract from his failures to take the coronavirus seriously early on, make tests widely available and adequately prepare the country for a period of crisis. Don’t fall for it. Don’t let your friends and family fall for it”.
This paper is an attempt to enrich the literature about the role that can play some economic approaches, such as cost-effectiveness analysis, in order to help medical stuffs to decide about the treatment to adopt in case of a chronic disease such as Haemophilia. Data from morocco were gathered in order to explain the importance of such approaches.
Present paper communicates 42 species of angiosperms depicting characteristics of pollen grains as shape, color, exine ornamentations, and type of apertures. Pollen morphological characters are very important in plant identifications in field. Pollen surface features plays significant role in taxonomy and detection of crud drugs. Firsthand information is gathered from field and provided in this research article.
Thank you for your attitude and support. I am sincerely grateful to you and the entire staff of the magazine for the high professionalism and fast quality work. Thank you very much!
The service is nice and the time of processing the application is fast.
Department of Neurosurgery, Queen Elizabeth Hospital, Hong Kong
I, Muhammad Sarwar Khan, am serving as Editor on Archives of Biotechnology and Biomedicine (ABB). I submitted an editorial titled, 'Edible vaccines to combat Infectious Bursal Disease of poultry' for publication in ABB. After submitting the manuscript; the services rendered by the management and technical personnel to handle and process the manuscript were marvelous. Plagiarism report was shared with me with complements before reviewers' comments, All steps including article processing and service charges were well taken care of keeping in view the author's interest/preference. All together, it was an encouraging and wonderful experience working with ABB personnel.
University of Agriculture, Pakistan
Muhammad Sarwar Khan
We really appreciate your efforts towards our article, the professional way you handle our request for exemption from charges.
It was a great honor for us to publish in your magazine.
It was a great experience publishing through JCICM. The article has reached out to several institutions. Appreciate your professional work. Hope to work with you again
Great, We are too comfortable with the process including the peer review process and quality. But, the journal should be indexed in different databases such scopus.
It has been a fabulous journey writing articles for your journal because of the encouragement you people provide for writers from developing nations like India. Kindly continue the same. Looking forward for a long term association.
The Journal Clinical Nephrology provides a good opportunity for readers to stay updated in the field of clinical nephrology. Additionally - it provides a good opportunity for authors to publish their work.
1. Publication of the accepted manuscripts is sufficiently rapid.
2. The trust factor between the journal and me, as an author, is very important and well preserved.
3. Peer review process very rapid and effective.
Assaf Harofeh Medical Center, Israel
I would like to thank JPRA for taking this decision. I understand the effort it represents for you. I'm truly happy to have the paper published in JPRA. And I'll certainly consider JPRA for my next publications as I was satisfied of the service provided, the efficiency and promptness of the interactions we had.
Archives of Vascular Medicine is one of the top class journal for vascular medicine with highly interesting topics.
You did a professional and great Job!