Laparoscopic approach in emergency theatre is an irreplaceable tool to manage patients with acute surgical pathology. We retrospectively reviewed surgical access records from the Emergency Department for acute right iliac fossa pathology. We considered 51 patients (16 male, 35 female, mean age 23.8 years) access for acute right iliac fossa pathology over the last year. 44 patients underwent laparoscopic approach (86%); 8 patients were treated with an open approach. Outcomes evaluation was based on data comparison from open appendicectomy over 4 year time period.
Variables considered for data analyses were: role of laparoscopic surgery for gangrenous/perforated appendicitis, Conversion rate, Laparoscopy appendicectomy for elderly patients.
Our study demonstrated that a laparoscopic approach at acute right iliac fossa pathology is feasible, safe and can offer a low incidence of infectious complications, less post-operative pain, rapid recovery, and represent a valid diagnostic tool in doubtful cases, at the expense of longer operating time than OA. We suggest that LA should be the initial choice for all patients with acute right iliac fossa pathology.
Atrial septal defect (ASD) is common among adult congenital heart diseases but rarely causes paradoxical cerebral embolism. By sharing the ASD diagnosed after the first ischemic stroke attack at the age of 49 and a case of paradoxical cerebral embolism developing accordingly, we aimed to draw attention to the necessity of detailed cardiac examination in patients with cryptogenic stroke.
Sleep related breathing disorders (SRBD) are among seven well-established major categories of sleep disorders defined in the third edition of The International Classification of Sleep Disorders (ICSD-3), and Obstructive Sleep Apnea (OSA) is the most common SRBD [1,2]. Several studies have demonstrated that obstructive sleep apnea treatment increases the quality of life in OSA patients [3-8]. Indeed, excessive daytime sleepiness (EDS), cognitive impairment (e.g., deficits in attention-concentration, memory, dexterity, and creativity), traffic accidents, and deterioration of social activities are frequently reported in untreated patients [9-11]. Furthermore, an increase in cardiovascular morbidities and mortality (systemic hypertension, stroke, cardiac arrhythmias, pulmonary arterial hypertension, heart failure) , metabolic dysfunction, cerebrovascular ischemic events and chemical/structural central nervous system cellular injuries (gray/white matter) has been reported in OSA patients [13-17].
Continuous positive airway pressure (CPAP) therapy is considered the gold standard for treatment of moderate-severe OSA, nevertheless there is an increasing body of evidence supporting the usefulness of mandibular advancement devices (MADs) for improving quality of life and respiratory parameters even among patients with a high severity of OSA burden [5,10,18,19]. According to the standard of care of the American Academy of Sleep Medicine (AASM), MADs are indicated for mild to moderate OSA particularly in the context of CPAP intolerance or refusal, surgical contraindication, or the need for a short-term substitute therapy [9,15,20-22]. In Cuba, CPAP machines are not readily available; they are expensive and the majority of OSA patients cannot obtain this mode of therapy. Taking into account this problem, our hypothesis was based in the scientific evidences of MAD effectiveness, considering that low cost MADs could offer a reasonable alternative treatment for patients with OSA where CPAP technology are not handy. In this way our purpose was to assess the efficacy of one of the most simple, low cost, manufactured monoblock MAD models (SAS de Zúrich) in terms of improvements in cerebral function, sleep quality and drowsiness reports in a group of Cuban OSA patients with mild to severe disease. Outcome measures included changes in the brain electrical activity, sleep quality, and respiratory parameters, measured by EEG recording with qEEG analysis and polysomnographic studies correspondingly, which were recorded before and during treatment with an MAD, as well as subjective/objective improvements in daytime alertness.
Genetic datasets have a large number of features that may significantly affect the disease classification process, especially datasets related to cancer diseases. Evolutionary algorithms (EA) are used to find the fastest and best way to perform these calculations, such as the bat algorithm (BA) by reducing the dimensions of the search area after changing it from continuous to discrete. In this paper, a method of gene selection was proposed two sequent stages: in the first stage, the fuzzy mutual information (FMI) method is used to choose the most important genes selected through a fuzzy model that was built based on the dataset size. In the second stage, the BBA is used to reduce and determine a fixed number of genes affecting the process of classification, which came from the first stage. The proposed algorithm, FMI_BBA, describes efficiency, by obtaining a higher classification accuracy and a few numbers of selected genes compared to other algorithms.
In general, Erythrocytes may referred to as corpuscle (Red Blood Cells). These erythrocytes will play a significant role in our body. It carries the element round the body and produce dioxide back to lungs. It acquire the element from the lungs then move towards the guts wherever the pure blood is then passed round the body. Erythrocytes covers nearly 1/2 your blood. The mature human erythrocytes is small, Circular, and biconcave; it seems dumbbell-shaped at Look.
The harmattan season, which is a period characterized by low temperature, dry air and increased air pollution leads to widespread airborne disease and exacerbation of pre-existing conditions, should be recognized as a period of potential risk of high COVID-19 infection rates. This period also coincides with the Christmas season which comes with so many festivities and can become a COVID-19 super-spreader. With many Nigerians now abandoning the non-pharmaceutical protection measures against COVID-19, the harmattan season and the forthcoming spike in social gatherings might usher in the second wave of the virus which can potentially be more catastrophic. There is need for the Nigerian government to start planning and instituting new protection measures and guidelines for safe Christmas celebration while also educating and encouraging the populace to adopt the protection measures recommended by experts.
Background: the level of alcohol consumption per capita is an important indicator of the alcohol-related problems. However, it is difficult to estimate the real level of alcohol consumption, since part of the consumption comes from illegal sources.
Aim: an overview of studies estimating the overall level of alcohol consumption in Russia.
Methods: in this review, 9 articles were analyzed estimating the overall level of alcohol consumption in Russia.
Results: in the period from 1956 to 2015 the overall level of alcohol consumption was subject to significant fluctuations: it grew almost linearly in the period from 1965 to 1979; decreased markedly in 1981; declined sharply between 1984 and 1987; rose sharply between 1991 and 1994; decreased significantly between 1995 and 1998; then increased significantly in the period from 1999 to 2003, after which it began to decline. The lowest estimate of the level of alcohol consumption for the entire period under consideration was obtained using the method proposed by Razvodovsky (7.25 litres - 1987), and the highest - using the method proposed by Norstrom (19.64 litres - 1994).
Conclusion: despite a significant decrease in the level of alcohol consumption in Russia over the past decade, this level remains high.
A mucoso-respiratory highly contagious disease; COVID-19, has led to tremendous global health and economy damages. This virus could be dampened through home use of fermented bio food material. Fermented millet flour (ibyer) is an indigenous non-alcoholic gruel made from cereals either (maize, sorghum and millet). It is prepared by cooking reconstituted cereal flour or wet milled paste with water. In this study, fermented millet fl our supplemented with ginger powder blends were formulated in the ratio 100:0, 95:5, 90:10, 85:15, 80:20, 75:25 and 70:30 for the production of gruel. The blends were subjected to feeding trial experiment using wistar albino rat. Results analysis revealed that Serum cholesterol was less than 200 mg/dl. The fasting blood glucose was also within the recommended range (67.7 - 125.0 mg/dl). The biochemical parameters were within recommended range, total serum protein ranged from 5.82-7.06 g/L, Alanine aminotransferase ranged from 28.53 to 41.13 iu/L, Aspartate aminotransferase ranged from 28.50 to 48.66 iu/L. The albino rats showed slight increase in body weight throughout the experimental period, ranging from 78.67 -103.80 g. The experiment shows that the diet did not have any adverse effect on the experimental animals and were within the recommended range hence a good anti diabetic blend and has excellent biochemical profile properties for homes use.
COVID-19 emergency requests a new definition of security procedures adopted in Child and Adolescence Neuropsychiatric Services (CANS).
The WHO recommends using Personal Protective Equipment (PPE) for preventing inter-human transmission of viral diseases . These recommendations regard primarily hospitalized patients and ambulatory medical services for adults.
Ventricular assist device is a portable machine which is also called an artificial heart for the patients who have terminal heart failure. The device maintains the heart’s vital functions until the suitable donor is found for the heart transplantation. It can be applied to either ventricles or both (biventricular). Although the device provides independence for the patient, it also has life-threatening complications. Such as infection, stroke secondary to thromboembolism, hemorrhage depending on anticoagulant use, right heart failure… and most of the time it is really hard to manage those complications. We will present a case, who had ischemic stroke as a complication of VAD even though he has been using aspirin, warfarin and had effective INR value.
Introduction: One of the major complications among COVID-19 patients include cardiac arrhythmias. Commonest arrhythmia is sinus tachycardia which is usually associated with palpitation causing discomfort to patients. In this study, we present a comparative study of use of Ivabradine vs. Carvedilol for sinus tachycardia in post-COVID-19 infected patients.
Method: 50 consecutive recovered COVID-19 patients with sinus tachycardia were included in this open labelled RCT. 25 patients received Ivabradine and remaining 25 received Carvedilol. Single therapy non-responders were treated with Ivabradine with Atorvastatin.
Results: The mean age of all patients is 48.8±7.66 years (Males 49.5 ± 7.21 years; Females 47.68 ± 8.23 years). The mean heart rate (MHR) of all patients is 125.52 ± 9.07/min (Males 125.67 ± 8.78/min; Females 125.26 ± 9.5/min). After five days of single drug therapy the mean drop in the heart rate was 35.04 ± 10.55/min (Males 34.41 ± 9.71/min; Females 36.05 ± 11.72/min), resulting in 27.88 ± 8.11% (Males 27.38 ± 7.56%; Females 28.69 ± 8.89%) reduction in MHR. Among the two groups, the Carvedilol group showed improvement of MHR in 14(56%) patients; whereas in Ivabradine group 18(72%) patients improved out of 25 patients each (p: 0.2385). In the Carvedilol group the MHR reduced from 128.6 ± 8.44 to 95.68 ± 10.63 (p < 0.001), which is statistically significant; similarly, the Ivabradine group showed a MHR from 122.44 ± 8.62 to 85.28 ± 10.52 (p < 0.001). The monotherapy therapy non-responders were treated with dual-therapy of (Ivabradine + Atorvastatin).
Discussion: Ivabradine is more effective in controlling heart rate compared to Carvedilol. Also, Ivabradine group scores very well in ‘patient-satisfaction’ with regards to symptom (palpitation) relief.
Conclusion: The COVID-19 sequelae of sinus tachycardia can be better controlled with Ivabradine when compared to Carvedilol.
Ranitidine is a widely used drug in Europe and its intake is usually well tolerated. Hypersensitivity reactions due to ranitidine are uncommon. The immediate mild reactions type are the most prevalent. In some special cases a delayed type reaction such as contact dermatitis or severe reactions with systemic involvement have been reported.
In the present paper, a case report of a 78-year old patient who experienced a maculopapular eruption after 7 days of oral treatment with ranitidine is described. Patch tests were performed twice with ranitidine with positive results confirming the diagnosis. In order to discard a double sensitization and a possible cross-reactivity phenomenon, patch test was performed once with famotidine, with a negative result. This is the first maculopapular exanthema reported as type IV hypersensitivity reaction to ranitidine confirmed by patch testing.
Moreover, there are only two reported cases showing a double sensitization to ranitidine and to other H2-receptor antagonists by patch testing after a delayed reaction due to ranitidine, the other being H2-receptor antagonists involving cimetidine and nizatidine, not famotidine.
Background: Oral cancer accounts for 30% of all types of cancer in India. Surgery is the mainstay of treatment but due to the recent outbreak of COVID-19, there is a partial or complete disruption of health services in the country. The initial delay in the treatment was due to cancellations of planned surgeries as per government regulations and reduction in public transportation. In the latter half of the initial relaxation of the lockdown, we formulated our institutional protocol for the surgical treatment of oral cancer patients. On admission, all patients were kept in isolated wards followed by RT-PCR (Reverse Transcriptase-Polymerase Chain Reaction) testing on the same day. RT-PCR negative patients are subjected to HRCT Thorax (High-resolution Computer Tomography). This ensured the safety of health care workers, patients, and patient attendees. Keeping this in mind, we did an observational study on the role of HRCT in the pre-operative screening of asymptomatic oral cancer patients.
Materials and methods: Retrospective analysis of prospectively collected data of 150 patients was done. HRCT reporting was done by two experienced senior radiologists of the Department of Radiology at our hospital.
Results: The number of patients under the CO-RADS 1 category was 121 and CO-RADS 2 category was 29, according to CO-RADS classification. The results of RT-PCR and HRCT were compared and there was a 100% positive correlation between RT-PCR and HRCT Thorax.
Conclusion: Our study supported the use of HRCT Thorax as a diagnostic tool in pre-operative screening of oral cancer patients for COVID 19, particularly in RT-PCR negative cases.
A knee arthroscopy in spinal anaesthesia was performed on a 67 years old male patient. During the procedure the patient was hemodynamically stable, until he suddenly turned pale and started complaining of severe pain in lower abdomen with signs of guarding. The procedure was finished as urgently as possible and after releasing the tourniquet we noticed significant difference in volume of the leg, with redness distal to tourniquet. Urgent lab results were essentially unremarkable and the patient was sent for the urgent radiological diagnostics.
CD of the left leg described fluid in the soft tissues of the thigh, scrotum, and abdomen; and the unenhanced CT of the abdomen showed free fluid along the entire femoral shaft of the left thigh, extending towards pelvis and abdomen to perihepatic and perisplenic space, and retroperitoneum, with gas bubbles tracking along anterior aspect of the left thigh into the left retroperitoneum.
He was admitted to the ICU, and within few hours all symptoms have resolved and his further recovery was without complications.
Background: Intensive care patients are often in need of sedation to endure being intubated. Light sedation is increasingly common since it has been proved to offer benefits such as faster recovery to patients.
Aim: The aim of this study was to describe critical care nurses’ experiences of nursing patients lightly sedated with dexmedetomidine.
Research Methodology: Qualitative personal interviews were conducted during 2015 with 10 critical care nurses in Sweden. Interview transcripts were analysed using inductive qualitative thematic analysis.
Results: Light sedation of the patient facilitated communication and interaction with him or her, and the relationship between the patient and his or her family members. Dexmedetomidine was described as a fairly new drug, and the critical care nurses stated that they needed more knowledge about it and about sedation scales in order to learn more about the drug’s mechanism of action and its potential side effects on patients.
Conclusion: It is important to critical care nurses to learn more about dexmedetomidine and about sedation scales to assess levels of sedation, as light sedation has been shown to benefit the patient as opposed to deep sedation that can increase recovery time.
The nemesis: SARS-CoV-2 pandemic: Leaving in its wake millions of infections, accompanied by an immense magnitude of morbidity and multitude of mortality, and an unfathomable economic toll, the COVID-19 pandemic has led to a global calamity. An effective and safe COVID-19 vaccine is urgently needed to prevent the disease, thwart the complications and avert deaths resulting from unrestrained transmission of the infection.
The hubris: Vaccine development: While most of the platforms of vaccine candidates have focused on the spike (S) protein and its variants as the primary antigen of COVID-19 infection, various techniques involved include nucleic acid technologies (RNA and DNA), non-replicating viral vectors, peptides, recombinant proteins, live attenuated and inactivated viruses. There are novel vaccine technologies being developed using next-generation strategies for precision and flexibility for antigen manipulation relating to SARS-CoV-2 infection mechanisms.
The elpis: Updates and prospects: There were nine different technology platforms under research and development to create an effective vaccine against COVID 19. Although there are no licensed vaccines against COVID-19 yet, there are various potential vaccine candidates under development and advanced clinical trials. Out of them, one having undergone phase III clinical trials, has become available in some countries for use among the high-risk groups following emergency use authorization. Other COVID-19 vaccines may soon follow the suit.
Conclusion: Hopes and concerns: The hope of benefiting from the vaccine to the extent that it may be the only way to tide over and control the COVID-19 pandemic, is accompanied by the likely fear of adverse effects and opposition in public for COVID-19 vaccination, including the vaccine hesitancy. Further, there is concern among scientific circles that vaccine may have opposite of the desired effect by causing antibody-dependent disease enhancement.
Japan enjoys the longest expectation of life at birth among major developed countries, and one possible reason for this is that obesity is rare in Japan. Further, COVID-19 death rate is extremely low in South Korea and Japan compared to the other developed countries, and low obesity rate may be related to this phenomenon.
Diane Gillooly*, Ganga Mahat and Patricia Paradiso
Published on: 21st December, 2020
Background: School nurses possess an essential role in treating and helping children maintain health. However, the full scope of their role has not been identified by parents. Therefore, the purpose of this study was to explore parents’ perceptions of the role of the school nurse.
Methods: Descriptive statistics were used to analyze the data. One hundred eighty parents participated in the study. The perception of the roles of school nurses was assessed by a 16-item questionnaire, which was adapted from a study by Kirchofer, et al. 2007.
Results: The four most important school nurses’ roles perceived by the parents were providing first aid and emergency care to children, communicating with parents and health care providers in the presence of a problem, providing medical treatment, and preventing and controlling diseases.
Conclusion: School nurses have many important roles, and while parents identified some essential roles, they did not recognize other vital roles as being very important. Increasing awareness of school nurses’ multifaceted roles among parents is essential so that they can utilize nurses’ expertise in maintaining their student’s health as well as tap into a key resource in the coordination of care for their child.
Background: Hypertension is the leading cause of cardiovascular diseases and premature deaths. Hypertension plays a striking role in mortality and morbidity in case of Coronavirus Disease 2019 (COVID-19) infection; however, numerous studies have reported contradictory findings.
Objective: To assess the relationship of hypertensive disease and mortality of COVID-19 infection and to assess the sex and age differentials on the association.
Methods: We have conducted a systematic review of published literatures that identified the relationship between hypertension and mortality of COVID-19 infections. Nineteen articles were selected following structured inclusion and exclusion criteria for systematic review and analyses. A total of 21,684 hospital admitted COVID-19 patients were included in this review and meta-analysis from 19 studies. The studies covered the six months of the pandemic from December 2019 to May 2020.
Results: In the pooled analysis, the median age of patients was 58 years, and the proportion of male patients was 58.8%. In contrast, we estimated 33.26% of hypertensive and 19.16% of diabetes mellitus patients in the studies. Hypertension was found to be associated with COVID-19 mortality (“Risk ratio (RR) = 1.45, [95% confidence interval (CI): 1.35 - 1.55]; I2 = 77.1%, p - value < 0.001”). The association in the meta-regression was affected by sex (p - value = 0.050). The association was found to be stronger in the studies with males ≥ 55% and age ≥ 55 years (“RR = 1.65, [95% CI: 1.52 - 1.78]; I2 = 77.1%, p - value < 0.001”) compared to male < 55% or age < 55 years (“RR = 1.11, [95% CI: 0.94 - 1.28]; I2 = 72.2%, p - value < 0.001”).
Conclusion: Hypertension was significantly strong associated with COVID-19 mortality which may account for the contradiction in the many studies. The association between hypertension and mortality was affected by sex and there were significantly higher fatalities among older male patients.
Post-extrasystolic potentiation (PESP) is a marker of contractile reserve and refers to the augmentation of left ventricular contractility due to preload recruitment and rise in intracellular calcium following a premature beat. In this case report we show that PESP might be a safe and helpful aid to evaluate low flow, low gradient aortic stenosis and contractile reserve in the cathlab, thereby reducing the potential risk of complications associated with intravenous dobutamine evaluation and reducing unnecessary testing.
Pieces of evidence have continued to emerge, demonstrating the extensive efficiency and effectiveness of the DNA database in assisting criminal investigations around the world. Therefore, the present study aimed to determine the awareness level on the prominent role of Forensic DNA Database on Crime Investigation in Nigeria: a case study of Benin City. In conducting this research, a total of 458 questionnaires were distributed around Benin City between the periods of 12th January 2020 to 21st March 2020, with a particular focus on security agents and students. The questionnaire comprised of three main categories: Socio-demographic characteristics, Information about the National Forensic DNA Database, and Information about DNA evidence, and Nigeria Criminal Justice system. For the analysis of data collected; the statistical tool used was also Statistical Package for Social Sciences, version 22 for windows. Responses were compared using chi-square and presented as counts and percentages. In determining the level of awareness, the following responses were obtained. Of the total population: 53.28% had no idea about forensics, 19.21% were uncertain and 27.54% knew about forensics. The same trend was observed with Forensic DNA profiling, 42.14% did not know, 22.27% were uncertain and 35.59% demonstrated good knowledge of Forensic DNA profiling. On the knowledge about the National Forensic DNA Database, 48.47% had no knowledge, 22.27% were uncertain and 29.26% were knowledgeable about it. The result of the present study revealed that the awareness level of the forensic DNA Database was found to be inadequate.
Luca Riccioni*, Anna Maria Cremonini and Manlio Gessaroli
Published on: 15th December, 2020
We report a case of 30-year-old immunocompetent man, with a previous history of cranial-facial trauma, who presented with progressive left exophthalmos due to an intracranial left frontal-ethmoidal-orbital mass. Histology of the resected tumor revealed a classical Hodgkin’s Lymphoma (HL). Epstein-Barr virus encoded RNA/EBER was detected in typical Hodgkin and Reed-Sternberg cells. After postoperative radiotherapy and chemotherapy administration, the patient remains free of systemic disease or recurrence on 4 years of follow-up.
Intracranial involvement by HL has rarely been described, mostly as a late localization or as a recurrence of a disseminated disease, in a setting of immunosuppression. Primary HL of the central nervous system occurring as an isolated disease is even more uncommon, with only 16 reported cases documented to date. The prognosis of these rare cases appears comforting with appropriate treatment. Tumor resection and, in appropriate cases, treatment with radiation and/or chemotherapy seem to warrant a durable response. For this reason a systemic disease should be excluded in all cases intracranial HL by a comprehensive work-up.
To the best of our knowledge, this case represents the first report that documents the association of intracranial HL and local trauma with subsequent intracranial infection.
Diarrheal diseases continue to be the major cause of morbidity and mortality among children under 5 years. This study aimed to isolate, identify and determining the prevalence, antimicrobial susceptibility profile of Shigella sp associated with acute diarrhea among children in Kano, Northern Nigeria. A cross sectional study was conducted among children less than 5 years diagnosed with acute diarrhea and admitted to paediatric ward of Murtala Muhammad Specialist Hospital Kano. Stool samples from a total of 37 (20 male and 17 female) subjects were used to isolate and identified the pathogen. Antimicrobial susceptibility test was conducted using disc diffusion method. The result showed 12 out of 37 samples were positive for Shigella sp which accounted for 32.4%. Higher incidence of Shigella sp was found among subjects of age between 2 – 3 years. The isolates were 100% resistant to Ampicillin. High resistance was also observed in Amoxicillin (83.33%), Chloramphenicol (58.33%) and Tetracycline (25%). The isolates are 100% sensitive to ciprofloxacin, 66.7% to Levofloxacin and Gentamicin each and 58.33% to Erythromycin. Three (3) isolates were resistance to Ampicillin and Amoxicillin, 5 isolates were resistance to Ampicillin, Chloramphenicol and Amoxicillin while 2 isolates were resistance to Ampicillin, Chloramphenicol, Tetracycline and Amoxicillin. It is concluded that Shigella sp is one of the etiological agent of diarrhea in children. Ciprofloxacin, levofloxacin and Gentamicin are drugs of choice for treating diarrhea caused by Shigella sp.
Lipoma arborescens is an exceptional condition comprised of frond-like excrescences of mature adipose tissue. The condition was originally described by Albert Hoffa in 1904 with characteristic morphology of macroscopic, villous, frond- like excrescences recapitulating a tree-like appearance, as denominated by the term “arborescens” . Lipoma arborescens is additionally designated as “diffuse articular lipomatosis”, “villous lipomatous proliferation of synovial membrane” or “diffuse lipoma of joint”. The essentially benign condition appears within large joints and typically exhibits adipose tissue infiltration of sub-synovial connective tissue. Synovial sheaths of tendons are infrequently incriminated [1,2].
COVID-19 is a mucoso-respiratory highly contagious disease that has leaded to a tremendous global pandemic wide spreading throughout nations of all continents with successive waves of high morbidities and mortalities. However, several independent vaccine production projects are working ahead for combatting the pandemic, but it is obvious they cannot create a sufficient umbrella that could protect billions of humans in a short term. Indeed, the current approved protocols including frequent cleaning of hands, social distancing and covering face mask are disappointing for their claimed capabilities to efficiently control of the pandemic. As they failed to highlight the critical determining role of air refreshing into indoors that 90 percent of infected people at least involved in enclosed spaces. Instead, Outdoor Access Approach (OAA) can be promising according veterinary medical successful experiences in control of air-borne contagious diseases as control of highly pathogenic avian influenza to become a global pandemic (One Health integration). Along with the above-mentioned protocols. Adaptation of all aspects of ordinary life activities in human societies to guarantee an efficient fresh air flow into enclosed spaces and prevention of the most dangerous air stagnation in them is the core stone of the OAA. This article discusses practical suggestions to attain such situation which can provide a kind of symbiosis with COVID-19` infection major threatening.
Uterine sections from 6 patients with incidental nodal lymphangioleiomyomatosis (LAM) were examined for LAM lesions by screening these sections with cathepsin K immunohistochemistry (IHC) stains. The hysterectomy specimens were all concurrent with the lymph node dissections in which the nodal LAM was discovered. In 4 of 6 patients microscopic lesions of pre-LAM were identified and confirmed by IHC staining for HMB-45 and beta-catenin. All lesions were grossly inapparent and also inapparent by routine hematoxylin and eosin stains. Three variants of pre-LAM lesions were identified. None of the pre-LAM lesions had an associated lymphatic proliferation. It is proposed that these pre-LAM lesions gave rise to the incidental nodal LAM lesions. Furthermore, it is suggested that the absence of an associated lymphatic proliferation associated with these lesions may be a factor in the attenuated potential for spread and the only rare association of these nodal lesions with pulmonary LAM.
The well recognized white adipose tissue is an endocrinal organ secreting various hormones and this article simply indicates to the physiologic concepts brown fat tissues (BAT) which are extremely active endocrine organs and play various metabolic active roles in intermediate metabolism. The physiologic function of Brown adipose tissues contributes to energy-producing parts of the cell. Its amount is rare up to approximately one hundred and thirty gram and implies important characteristics for mammals. An increase in energy expenditure could be an aim by activation of BAT, seems futurity to reduce body weight that needs a vast majority of fundamental research to facilitate its occurrence . Brown fat tissue generates heat and has valuable importance for human metabolism [2,3]. Brown fat tissue is decreased in overweight and obese people and possibly activating brown fat tissue might help for reducing weight and weight-related metabolic disorders like insulin resistance.
The nurse in Poland may have a secondary level of education (secondary school or post-secondary) or high level (BSc and MSc). She can have a specialization of one the parts of medicine. After the MSc studies she can take the doctor’s degree. But we must take as a fact that with the high level of education and specialization she can be the Court Expert i.e. in nursing anesthesiology, intensive therapy, nursing first aid, palliative medicine as well as in many other cases. As about nursing we should remember that woman and man can practice this specific profession .
In 2013, the World Health Organization (WHO) reported that small, pet turtles had caused multistate Salmonella outbreaks in the United States, from where small turtles were subsequently exported into the Republic of Korea. We investigated cases of salmonellosis in South Korea associated with domestic small turtles and analysed genetic characteristics of Salmonella isolates in commercially-available small turtles. We traced six Salmonella serovars, known to have caused human infection in the United States (S. Sandiego, S. Pomona, S. Poona, S. Newport, I 4,(5),12:i:-, and S. Typhimurium), in isolates from suspected Salmonella infection cases in Korea from 2006 to 2015. Additionally, we conducted a pilot study of isolates from small turtles being sold in Korean markets, and performed molecular genetic analysis on the identified strains. S. Pomona was identified in one Salmonella infection case, while all strains isolated from small turtles belonged to either subspecies I (enterica, n = 10, 71.4%) or subspecies IIIb (diarizonae, n = 4, 28.6%). Two serovars (S. Pomona and S. Sandiego) that were highly associated with turtle-to-human transmission were identified with 100% homology to human isolates. Previous to this study, turtle-associated human S. Pomona infections were not well reported in Korea. We report Salmonella infection in small turtles in Korea, and confirm that small turtles should be considered the first infectious agent in S. Pomona infection. We therefore suggest quarantine measures for importing small turtles be enhanced in Korea.
The paper is dedicated to the consideration of the metal-carbon mesocomposites application possibilities for the medicine magnetic transport. This trend is determined by correspondent peculiarities of content and structure of mesoscopic composites. The main peculiarities of these nanosized particles are the following: a) the presence of unpaired electrons on the carbon shell; b) the structure of carbon shell from poly acetylene and carbine fragments; c) the atomic magnetic moment of inner metal is equaled to more than 1–3 μB. The creation of reactive mesoscopic materials with regulated magnetic characteristics which can find application as medicine magnetic transport within an organism is very topical. The present investigation has fundamental character. It’s based on the ideas concerning to the change of metal-carbon mesocomposites reactivity. The use is possible as metal-carbon mesocomposites both and they are modified analogously.
Juvenile xanthogranuloma (JXG) is a rare form of non-Langherans cell histiocytosis (non-LCH) observed almost exclusively in infants and young children. It is rarely systemic, involving extracutaneous sites, such as the liver, lungs, spleen, kidney, pancreas, bone or central nervous system. Systemic JXG may be associated with significant complications requiring aggressive medical or surgery care; especially, central nervous system lesions are difficult to treat and reported to be possibly fatal. Clinical presentation of JXG of central nervous system is not specific and is related to the involved site while magnetic resonance imaging examination remains the first choice for localizing the lesions. If no other system is involved, surgical excision could be sufficient.
The diagnosis of acute necrotising pancreatitis is a rare event in the Paediatric Emergency Department (ED).
We report a case of acute pancreatitis in a paediatric patient, diagnosed in our ED, a tertiary level paediatric hospital.
This child presented with vague symptoms of constipation, abdominal pain and back pain, and on clinical examination had a distended abdomen with peritonism. She rapidly deteriorated and needed aggressive fluid resuscitation in the ED for treatment of septic shock. The diagnosis of acute pancreatitis (AP) was only considered once elevated amylase levels were apparent.
Whilst AP is an important differential diagnosis in a patient who is presenting with acute abdominal symptoms, the diagnosis in children in particular is seldom and thus easily overlooked in the previously healthy child.
Background: Corona virus disease is a highly infectious disease caused by the newly innovated corona virus. An emerging respiratory disease was abbreviated as COVID-19, after it has been first reported in December 2019 in Wuhan city of China. Ethiopia Ministry of health initiated multidisciplinary approach to tackle COVID-19 of which awareness creation is the main. The aim of this study is to assess knowledge, practice and associated factors towards prevention of novel corona virus among clients in Debre Tabor general hospital, Northwest Ethiopia, 2020.
Methods: Institution based cross sectional study design was conducted in Debre Tabor General hospital from May 15 to May 30, 2020. A structured questionnaire was used for data collection. The data were entered into epi data version 4.4 and exported to SPSS window version 25 for analysis. Binary and multivariable logistic regression was fitted. Odds Ratios with 95% Confidence interval and p - value ≤ 0.05 were considered to assert significance.
Result: A total of 345 clients were analyzed and the response rate was 96.4%. The mean age was 32.95 with S.D ± 13.18 years. Majority of the respondents were male (75.7%). Among the study participants 54.2% with (95% CI: [49.0, 59.2%]) and 49.0% with (95% CI: [43.5, 53.4%]) have good knowledge and god practice on COVID-19 preventions respectively. Sex AOR: 4.33 (2.06, 9.09), family size AOR: 2.49 (1.01, 6.15 and heard from social media AOR: 2.78 (1.21, 6.39) were significantly associated with knowledge of respondents. Knowledge AOR: 3.11 (1.59, 6.10) was significantly associated with practice of clients. Residency and those heard from TV were significant variables for both.
Conclusion and recommendation: In this study the overall knowledge and preventive practices of the respondents were found to be low. Sex, family size, residency and sources of information were associated factors for knowledge. In addition to this knowledge was significant factor for practice. Health education programs aimed at mobilizing and improving COVID-19 related knowledge and practice intend to be strengthened.
Maternal mortality accounts for most deaths in agrarian communities of Nigeria due to poor access to midwives services and inadequate Skilled Birth Attendants (SBAs). The Midwives Service Scheme (MSS) was established to engage more SBAs and advocate better utilization of pre and post-natal care services. Studies have focused on maternal mortality reduction, however, information on underlying factors that predispose MSS target beneficiaries to its utilization is scarce. Therefore, utilization of MSS among women farmers in southwestern Nigeria was investigated. A four-stage sampling procedure was used. Three states from southwestern states (Oyo, Ogun and Ekiti) were randomly selected. Thereafter, ten Local Government Areas (LGAs) from eighteen LGAs that adopted MSS programme in the selected states were sampled. Also, 30% of the MSS facilities in the sampled LGAs were selected, resulting in 13 MSS facilities. Proportionate sampling technique was used to select 20% of registered women farmers in the selected 13 MSS facilities to give 207 respondents. Interview schedule was used to collect data on respondents’ socioeconomic characteristics, Maternal Health Information Sources (MHIS), Maternal Health Information Seeking Behavior (MHISB) and utilization of MSS. Data were analyzed using descriptive and inferential statistics. About (55.6%) of the respondents had formal education. MHISB and effectiveness of MSS was rated low by 53.2% and 55.6% of the respondents, respectively. MSS was moderately utilized by 64.7% of the respondents. The MSS utilization was 49.24 ± 11.39 (Oyo), 45.08 ± 9.28 (Ogun) and 44.00 ± 10.71 (Ekiti). Respondents’ education (χ2 = 12.85), family size (r = 0.02), monthly income (r = 0.48) related positively and significantly (r = 0.27) to MSS utilization.
Industrial control systems (ICS) are critical, as in these systems, cyber threats have the potential to affect, disorganize, change their mode of operation, act as an information extraction vehicle, and ultimately turn against itself. Creating risks to the system itself, infrastructure, downtime, leakage of sensitive data, and even loss of human life. Industrial control systems (ICS) are vital to the operation of all the modern automated infrastructure in the western world, such as power plant and power stations. Industrial control systems (ICS) differ from the traditional information systems and infrastructures of organizations and companies, a standard cyber security strategy cannot be implemented but part of it adapting to the real facts and needs of each country, legislation and infrastructure. These systems require continuous operation, reliability and rapid recovery when attacked electronically with automated control, isolation and attack management processes. Incorrect settings and lack of strategic planning can lead to unprotected operation of critical installations, as they do not meet the cyber security requirements. Industrial control systems (ICS) require special protection in their networks, as they should be considered vulnerable in all their areas, they need protection from cyber attacks against ICS, SCADA servers, workstations, PLC automations, etc. Security policies to be implemented should provide protection against cyber threats, and systems recovery without affecting the operation and reliability of operating processes. Security policies such as security assessment, smart reporting, vulnerability and threat simulation, integrity control analysis, apply security policy to shared systems, intrusion detection and prevention, and finally firewall with integrated antivirus and sandbox services should be considered essential entities.
Cissus quadrangularis a succulent vine belongs to Vitaceae family is widely distributed throughout tropical and subtropical regions of the world and used frequently to various disorders. The plant has been reported to contain flavonoids, triterpenoids, phytosterols, glycosides and rich source of calcium. This study aims to bring a systematic review of C. quadrangularis in various pharmacological mechanisms. Evidence from the previous studies suggested the efficacy of C. quadrangularis with antimicrobial, anti-diabetic, anti-inflammatory, anti-obesity, anti-oxidant, bone turnover, cardiovascular and hepatoprotective activities. In conclusion, Cissus quadrangularis appears worthy of pharmacological investigations for new drug formulations.
The present study was designed to measure the relationship between the consumption of Information Technology (IT) and anxiety among Pakistani youth. The inquiry included 200 conveniently selected Pakistani youth aged 16 to 24 years from 4 cities. The anxiety subscale of Depression Anxiety and Stress Scale was administered along with a demographic information questionnaire. It was hypothesized that higher use of IT would be positively correlated with higher levels of anxiety among Pakistani youth. The results significantly supported the hypothesis, and it was established that the excessive use of IT is positively and significantly correlated with anxiety. The results are consistent with similar studies carried out in countries other than Pakistan.
Introduction: High proportion of stroke survivors have impaired functional mobility and decrease in overall quality of life (QoL). Transcranial direct current stimulation (tDCS) (non-invasive brain stimulation) and over-ground walking task (OGWT) (functional task-oriented training) have been suggested to improve functional mobility and QoL of stroke survivors. Hence, this study determined the efficacy of tDCS (anodal and cathodal) with OGWT on functional mobility and QoL of stroke survivors.
Materials and methods: Seventy eight (78) stroke survivors were randomised into three groups: anodal group (anodal tDCS with OGWT); cathodal group (cathodal tDCS with OGWT) and control group (OGWT only). Participants had two sessions of intervention per week for six weeks. Functional mobility was assessed using 10 meter walk test (10MWT) measuring steps, time and velocity while QoL was measured using Stroke Specific QoL (SSQoL) scale. Significance level was set at p < 0.05.
Results: Participants (46 males) were aged 56.78 ± 10.24 years. The groups were matched for functional mobility and QoL at baseline and only work/productivity domain of SSQoL showed statistically significant difference (p = 0.028). Each group showed statistically significant improvement between baseline and post-intervention scores of items in functional mobility (p ≤ 0.001) and total SSQoL (p ≤ 0.001). Anodal group showed better statistically significant improvement in step (p = 0.008), time (p = 0.024), velocity (p = 0.001) and total SSQoL (p = 0.016) among the groups when the mean differences were compared.
Conclusion: tDCS with OGWT is efficacious in improving functional mobility and QoL of stroke survivors. Specifically anodal tDCS with OGWT showed better clinical improvement in step, time, velocity and QoL in stroke survivors.
A balance response is the point at which a corrosive and a base respond to shape water and a salt and includes the mix of H+ particles and OH-particles to produce water. The balance of a solid corrosive and solid base has a pH equivalent to 7.
Trans-radial uterine artery embolization (UAE) is acknowledged as a non- invasive, cost-effective and safe procedure for the treatment of symptomatic fibroids. However, it is associated with the recurrence of symptoms like abnormal uterine bleeding and pressure symptom in some patients. This is a comparative study of our data with other international data, in the context of percentage reduction in fibroid size, accompanying controlling factors, short and long term follow up data analysis of the first two years was done. Careful pre-procedural counseling of future possibility of fibroid recurrence and means of management should be stressed.
Materials and methods: A retrospective cohort study at the Security Forces Hospital in Riyadh, Saudi Arabia, was conducted. The study was done from 1st November 2017-31st October 2019, on symptomatic patients diagnosed with fibroids, who refused surgical treatment.
The outcomes included: fibroid site, size and anatomical position, patients’ symptoms, general condition, and early and delayed complications. These data were compared with those from other international studies.
Results: The study involved 23 patients (mean age: 39 years). The average percentage reduction in fibroid volume was 49%. There were no major complications and no recurrence of symptoms during the covered period. Data analysis revealed a poor correlation between the overall percentage reduction of fibroid size with fibroid number, age of patients’, and body mass indices.
Conclusion: Despite poor correlation, we provided preliminary data of the first two years out of the total five-year projected period of the study where it showed effectiveness and relative safety of radial - UAE for fibroid.
Introduction: Chronic endometritis (CE) is a common cause of infertility in asymptomatic patients and its diagnosis and treatments improved assisted reproduction technique outcome in most of the specialized centers. Diagnosis of CE in endometrial biopsy by Hematoxylin and Eosin (H&E) stain is hard to identify chronic inflammatory cells from the stroma and the use of plasma cells-specific stains is helpful.
Aim of the work: Evaluation of the use of CD138 in the identification of plasma cells in endometrial biopsy of patients with previous IVF trial failure.
Material and methods: Hysteroscopic and curettage endometrial biopsies from fifty-five females with previous IVF trial failure were stained with H&E and CD138 immunostaining for detection of plasma cells.
Results: Plasma cells were identified in 52.7% of cases by H&E and in 6/55 by CD138 immunostaining. CD138 is more sensitive in detecting plasma cells in endometrial biopsy than H&E stain. There was a significant statistical correlation between CE and abnormal uterine bleeding, abortion and primary infertility (p > 0.5).
Conclusion: Diagnosis of CE is helpful in infertility patients with IVF trial failure to improve the outcome of the maneuver. CD138 is more sensitive for plasma cells specially in endometrial biopsies than H&E.
A 44-year-old G4P2+1 presented to the emergency department on the 10th day following embryo transfer (with two fresh, day 5, blastocysts transferred in a hospital abroad) with the complaints of difficulty breathing, chest discomfort and cough for one day. These symptoms increased on lying on her side and were not related to exertion. She also mentioned having had abdominal discomfort over the preceding few days. On taking a past history, the patient revealed that all her prior pregnancies were the result of IVF treatment and she suffered OHSS with each. Her first pregnancy was a triplet gestation through IVF and complicated by OHSS; followed by her second pregnancy which was an IVF twin gestation also complicated by OHSS with ascites requiring paracentesis. With her third IVF treatment she conceived, had OHSS and miscarried spontaneously. However, these IVF treatments and pregnancies were all managed abroad and no medical records were available.
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