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Rationale: Blood Pressure measurement has transitioned to the oscillometric method in most hospitals in the United States, however out-patient offices mainly use the auscultatory technique. Objective: To determine time taken to measure blood pressure by an automatic oscillometric device compared to an auscultatory measurement device and to determine what each measurement costs. Methods: Blood Pressures were measured in a single primary care office by medical assistants (MA) for patients seen for office visits. Timed measurements were performed using an automated oscillometric Welch Allyn Connex Vital Signs Monitor (WA) and manually using a Tycos device. A minimum of 400 readings were taken with each method. Results: The average time to manually measure BP was 58.6 seconds, whereas the WA average was 39.8 seconds, 18.8 seconds faster (p<0.05). There was an improvement in measurement time with MA experience with the WA device (p<0.05). The average MA cost to measure a single BP using the manual method was $0.35 vs. the WA method ($0.24) or a savings of $0.11 per measurement. The improvement with experience of WA method reduced cost to $0.17 per measurement. Conclusion: The oscillometric method saved 17cents per measurement potentially saving $1,119 per year for our primary care practice.

Background and Purpose: Injuries for the pre-adolescent female Irish Dancer (FID) are not well recognized. The purpose of this case study is to report imaging assisted diagnosis and management of atypical medial and plantar foot pain (MPFP) in an 8-year-old FID. Description: The patient presented with chief complaint of diffuse left MPFP. The patient was initially evaluated by a Physical Therapist for persistent foot pain. The patient experienced minimal pain in non-weightbearing (NWB). Pain intensified in weightbearing (WB) escalating with a heel raise. The patient experienced pain with resistance testing, ankle passive range of motion (PROM) and first metatarsophalangeal joint (MTPJ) PROM. Diffuse tenderness with palpation over the medial column of the left foot was noted. The patient was unable to complete single leg dynamic activity on the left foot. There was suspicion for a metatarsal stress fracture (MSF). Radiographs were ordered and read as negative. The patient was treated with immobilization in a walking boot, WB as tolerated and relative rest including cessation of dance. The patient returned for re-evaluation 2 weeks after reporting no change in symptoms. Magnetic Resonance Imaging (MRI) was then ordered. Outcome: Results of the MRI identified 2 stress fractures in the first metatarsal. The treatment plan changed to NWB status with immobilization for an additional 6 weeks. The patient returned to full WB status and participated in all dance activity 15 weeks after the initial presentation to the Physician and 27 weeks after the initial onset of MPFP. Discussion/Conclusion: In this pre-adolescent FID, the presentation of MPFP can be misinterpreted as a soft tissue injury. It is important to consider the diagnosis of first MSF in a pre-adolescent FID to allow appropriate management.

Introduction: The rise in cesarean section rates globally has led to a growing population of women with uterine scars, necessitating more targeted obstetric care in subsequent pregnancies. These women are faced with the decision of attempting vaginal delivery after cesarean section (VBAC) or opting for an elective repeat cesarean section. The likelihood of a VBAC depends on various factors both maternal and fetal, gathered in two known scores Grobman and Zhang, utilizing them could make VBAC successful and more widely attempted.  This study aims to validate the prognostic of these scores in a Moroccan population.Objectives:•    Validate the international predictive scores (Grobman and Zhang) for the probability of a successful VBAC in the Moroccan population.•    Explore additional criteria specific to the Moroccan population and develop a simplified VBAC score.  Results:•    Out of 2,973 women with a cesarean history, 313 attempted  TOLAC, 79% of these attempts were successful VBAC.•    The characteristics of successful VBAC included lower BMI, previous vaginal birth, lower estimated fetal weight, younger maternal age, and more favorable cervical conditions at admission.•    The Grobman and Zhang scores showed good predictive accuracy, with both models achieving 82.2% accuracy.•    When dividing women into groups based on predicted success (using both Grobman and Zhang scores), significant differences were found in success rates across different probability categories.Conclusion: Both Grobman and Zhang’s models were effective in predicting VBAC success in the Moroccan population, with a slight preference for the Zhang model. However, further research is needed to validate these models in clinical practice. It could involve developing a more population-specific model.

Environmental electromagnetic fields are nowadays available in all environments today. These areas affect the biological system. Controlled interactions with elecrtomagnetic fields can have positive effects when unrestricted interactions have negative effects. Uncontrolled exposure to low-frequency electromagnetic fields can cause adverse effects such as signal transduction in cells and tissues, cell membrane structure, ion channels, molecular interactions, DNA damage. But contrary to controlled exposure, it positively affects tissues. The most obvious example of this is seen in the bone and cartilaginous tissue. Repairing fractures and damage in bone and cartilage. This has been shown in many studies. Below is a summary of the relevant information.

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.

Today, there is a considerable increase in localizing adrenal bulks with the bringing radiologic diagnosis methods having high technology into use and improvement in diagnostic tests. Adrenal glands are vital tissues for the organism due to the hormones they secrete. Death is a natural result in the absence of adrenal cortex. Adrenal bulks can be seen with different clinical, laboratory and radiological data. These bulks are often benign and rarely malign. They can be functional or non-functional. Major treatment methods used fort he treatment of adrenal gland primary tumors or metastases are surgery, arterial embolisation, chemical ablation, radiofrequency ablation and radiotherapy [1-4]. Adrenal glands are one of the metastatic fields. In wide autopsy series, adrenal metastasis has been determined between the rates of 13-17% [5]. While unilateral metastasis is common, bilateral metastasis’ rate of incidence is between 4-20%. It has been stated that lung (35%), gastric (14%), esophageal (12%) and hepatobiliary (10%) primary carcinomas adrenal metastasis are prevalent most frequently [2]. Curative treatments are tested on patients having cancer with oligo metastasis limited with adrenal gland and primary source is under control because of the expectation of long-term survival, and the surgery is the first choice. These bulks can be treated with open and laparoscopic surrenalectomy in a curative way. It was reported in studies that overall survival was longer in resection of clinically isolated adrenal metastases when compared with nonsurgical therapy (including RFA, external beam radiotherapy, arterial embolization, radioembolization, chemical ablation, and cryoablation) [1,2,5,7]. Lo et al., found one-year survival as 73% and two-year survival as 40% in their study conducted on 52 patients having curative resection for solitary adrenal metastasis [3]. Tanvetyanon et al., demonstrated 5-year survival rates of 25% following resection of isolated synchronous adrenal metastases and reported 26% after resection of metachronous adrenal metastases in their study conducted on NSCLC patients developing solitary adrenal metastasis [4]. Conducted studies revealed that the rate of complication was 9-20% in patients having adrenalectomy for solitary adrenal metastasis [2-4,7]. In recent years, the use of radiotherapy, which is a treatment modality as effective as surgical resection, has become prevalent for the management of oligometastases. Today, three different modalities have been tested in the radiotherapy treatment of adrenal gland metastases. In the first one, total 50 Gy treatment dose with 3D-CRT as daily 2 Gy fraction dose is given [8]. The second one is IMRT implementations for adrenal gland metastases but it isn’t thought as suitable according to Practice Guidelines for Neuroendocrine Tumors published by NCCN in 2010. The third radiotherapy modality is stereotactic body radiotherapy (SBRT). SBRT implementations have started to be preferred today since they are completed in a few fractions in addition to that they show close results to surgery for primary tumors and metastases. Holy et al., implemented SBRT to patients having 13 solitary adrenal metastases with NSCLC at 5 fractions and between 20 and 40 Gy total doses. They found disease-free survival as median 12 months, overall survival as median 23 months and local control rate as 77% [9]. In SBRT implementations for different cancer types determined 30 adrenal metastases, Chawla et al., reported the rates of one-year survival, local control and distant metastasis as 44%, 55% and 13% respectively [10]. In Casamassima et al.,’s study on this issue, the rate of two-year local control was found as 90% [11]. Second degree toxicity was seen in none of the above mentioned studies according to the RTOG toxicity classification. Wardak et al., reported that the patient having lung cancer that they implemented SBRT for bilateral adrenal metastases developed adrenal insufficiency depending on SBRT [6]. Ippolito et al., Reported that adrenal insuffiency may be due to both the tumor and the local treatment [12]. Incidence of symptomatic adrenal insufficiency were reported 4% [2,13]. Casamassima et al and Onishi et al studies, two grade 2 adrenal insuffiencies were reported [11,14]. Consequently, when all these data were evaluated, it is seen that SBRT use has gradually become prevalent for patients not suitable for surgery because of comorbid disease, for patients having oligometastatic cancer that are not suitable for surgery since it has vital risk to resect or that refuse surgery. However, it hasn’t been clear yet that local control will be provided with how many total doses and which fraction schema. There is no agreement on the examination of the adrenal hormone axes because of the short length of life. Besides, it should be kept in mind that adrenal insufficiency can develop in patients implemented SBRT because of bilateral adrenal metastasis developing as synchronous or metachronous. The hormone levels of these patients need to be followed. More researches should be done to lighten this matter.  

It is quite alarming the increasing rate of antibacterial resistance all over the world considering the public health threat and the re-emergence of multi-drug resistant Enterobacteriaceae. The aim of this study is Antibacterial resistance and phenotypic detection of Extended Spectrum Beta-Lactamase (ESBL) producing Enterobacteriaceae isolated from human and animal fecal samples in selected local government areas of Nasarawa state, Nigeria was carried out in the study. Hundred (100) samples comprising human and animal (goats, cattle, and chicken) were collected and 55 samples were multidrug resistant. A commercial biochemical kit (Eneterosystem 18R) was used for the isolation and identification of Enterobacteriaceae. Kirby Bauer Disk Diffusion Method was used for antibacterial susceptibility testing of Enterobacteriaceae isolates. The Double Disc Synergy Test (DDST) method was also used for the phenotypic confirmation test of Extended Spectrum Beta Lactamase (ESBL). The occurrence of multidrug-resistant isolates shows that Escherichia coli (100.00%) which is the highest, Proteus mirabilis (14.54%), Klebsiella pneumoniae, and Salmonella enterica (10.90%), while the occurrence of Shigella flexneri (9.09%) was the lowest. The Enterobacteriaceae isolates were more resistant to Cefuroxime, Cefexime, Amoxicillin Clavulanate, and Imipenem/Cilastatin with percentage resistance ranges from 66.6% - 100%. The occurrence of ESBL producers shows that Escherichia coli (60.00%) and Proteus mirabilis (62.5%) were high while Shigella flexneri (20.0%) had a low occurrence of ESBL. The sale and in-discriminate use of antibiotics without a prescription is an important regulatory issue in the abuse of antibiotics for both humans and animals. The Beta-Lactam and gentamycin antibiotics were not effective against the Multi-Drug Resistant (MDR) isolates and most of the isolates were ESBL producers.

Sunflower (Helianthus annuus L.) is one of the most important vegetable oil sources in the world and in our country. The preference for sunflower oil in the consumption of vegetable oil increases the importance of sunflowers in our country. Rust, downy mildew, Verticillium wilt, Sclerotinia stalk and head rot, charcoal rot, blight, and leaf spot are some of the important diseases most commonly seen in sunflowers. In some years, depending on the climatic conditions, Downy mildew (Plasmopara halstedii) is widely observed and it causes an epidemic in sunflower-planted areas in the Adana province. Genetically resistant hybrids have started to be grown in Turkey in recent years due to the resistance of downy mildew disease to fungicides. The aim of the study was to determine the status of sunflower diseases and Downy Mildew disease in Adana.

In this investigation, solid dispersions were prepared and characterized to improve the solubility and dissolution of poorly water soluble drug Ketoprofen, using glucosamine HCl as a carrier. For the improvement of the solubility and dissolution rate of poorly water soluble drugs different techniques are used such as solubilization, salt formation, particle size reduction and solid dispersion etc, but in the present study, solid dispersions (SDs) of poorly water soluble NSAID Ketoprofen were prepared to improve its solubility and dissolution rate, using solvent evaporation method with drug-carrier ratio of 1:1, 1:2 and 1:3. Our results indicate that all solid dispersions of Ketoprofen and Glucosamine HCl exhibited more enhancements in solubility and dissolution rates than corresponding physical mixtures. The DSC thermograms and X-ray diffraction patterns showed a slight reduction in crystallinity in solid dispersions which were further verified by FT-IR and SEM. It is concluded that solid dispersion is an effective technique for enhancing the solubility and dissolution rate of poorly water-soluble drug Ketoprofen using Glucosamine HCl as a carrier. This amino sugar (Glucosamine HCl) could be used as a novel potential carrier for preparation and formulation of SDs and would have potential commercial benefits.

Introduction: Chronic low back pain is one of the most prevalent musculoskeletal disorders. Studies have shown certain relations between physical fitness and chronic low back pain (CLBP) by examine some measures of physical fitness. The aim of study was to measure lung function using winspiro PRO in patient with CLBP versus normal healthy individual, and relation of lung function with duration and intensity of CLBP. Methodology: The study population is comprised of a total of 120 adult persons. 60 subjects with chronic low back pain (41 male and 19 female) with a mean age of 30.69 years (+4.34) and 60 normal individual (39 male and 21 female) with mean age of 29.00 years (+5.34). Results:The result of comparison of the respiratory parameter forced vital capacity (FVC), and maximal voluntary ventilation (MVV) of individual with CLBP show a significant difference as compare to the normal healthy population. In unrelated ‘t’ test the patient with CLBP (N=60) of age 30.51(SD±4.33), height 169cm (SD±1.23), weight 57.86(SD±7.73) and body mass index (BMI) 20.46 (SD±2.54) show a significant difference in respiratory parameter FVC ( t=17.244, P=0.000), and MVV ( t=11.048, P=0.000) as compare to the normal healthy persons (N=60) of age 29.79 (SD±5.28), height 170cm (SD±1.13), weight 59.40(SD±6.97) and BMI 21.59 (SD±3.29).In patient group- FVC range is 34.0% to 75.00% (52.85%±9.30). MVV range is 45.0% to 86.80%. (63.11%±12.06)In control group FVC range is 63.90% to 98.83% (83.63%±7.59). MVV range is 63.00% to 98.00% (78.96%±7.86). Conclusions:The overall result of the study show that there is a significant difference in the respiratory parameter that is FVC (forced vital capacity), and the MVV (maximum voluntary ventilation) in persons with chronic low back pain as compare to the healthy person of same age, height, weight and body mass index (BMI).