Search results for: prospective registry

Authors: Muhammad Ali Khan

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Education is a word has been derived from Latin word "Educare", means to train. Therefore, the harmonious growth of the potentialities for achieving the qualities desirable and useful in the human society is called education. It is claimed that by educating women we can develop our economy, family health and decrease population growth. To explore the socio-economic impact of education on urban women. A prospective study design was used. Over a period of six months 50 respondents were randomly selected from Hayat Abad, an urban city in the North West of Pakistan. A questionnaire was used to explore marital, educational, occupational, social, economical and political status of urban women. Of the total, 50% (25) were employed, where 56% were married and 44% unmarried. Of the employed participants, 56% were teachers fallowed by social worker 16%. Monthly income was significantly high (p=001) of women with master degree. Understanding between wife and husband was also very significant in women with masters. . 78% of employed women replied that Parda (Hija) should be on choice not imposed. 52% of educated women replied participation in social activates, such as parties, shopping etc. Education has a high impact on urban women because it is directly related to employment, decision of power, economy and social life. Urban women with high education have significant political awareness and empowerment. Improving women educational level in rural areas of Pakistan is the key for economic growth and political empowerment

Keywords: women, urban, Pakistan, socio economic

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Authors: Anand K. Patel

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Background: Patients with COPD have decreased pulmonary functions, which in turn reflect on their day-to-day activities. Objectives: To assess the correlation between functional vital capacity (FVC) and forced expiratory volume in one second (FEV1) with 6 minutes walk test (6MWT). To correlate the Borg rating for perceived exertion scale (Borg scale) and Modified medical research council (MMRC) dyspnea scale with the 6MWT, FVC and FEV1. Method: In this prospective study total 72 patients with COPD diagnosed by the GOLD guidelines were enrolled after taking written consent. They were first asked to rate physical exertion on the Borg scale as well as the modified medical research council dyspnea scale and then were subjected to perform pre and post bronchodilator spirometry followed by 6 minute walk test. The findings were correlated by calculating the Pearson coefficient for each set and obtaining the p-values, with a p < 0.05 being clinically significant. Result: There was a significant correlation between spirometry and 6MWT suggesting that patients with lower measurements were unable to walk for longer distances. However, FVC had the stronger correlation than FEV1. MMRC scale had a stronger correlation with 6MWT as compared to the Borg scale. Conclusion: The study suggests that 6MWT is a better test for monitoring the patients of COPD. In spirometry, FVC should be used in monitoring patients with COPD, instead of FEV1. MMRC scale shows a stronger correlation than the Borg scale, and we should use it more often.

Keywords: spirometry, 6 minute walk test, MMRC, Borg scale

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Authors: S. alireza Mirghasemi, Shervin Rashidinia, Mohammadsaleh Sadeghi, Mohsen Talebizadeh, Narges Rahimi Gabaran, S. Shahin Eftekhari, Sara Shahmoradi

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Purpose: There are various pin-in-plaster methods for treating distal radius fractures. This study is meant to introduce a modified technique of pin-in-plaster. Materials and methods: Fifty-four patients with distal radius fractures were followed up for one year. Patients were excluded if they had type B fractures according to AO classification, multiple injuries or pathological fractures, and were treated more than 7 days after injury. Range of motion and functional results were evaluated. Radiographic parameters including radial inclination, tilt, and height, were measured preoperatively and postoperatively. Results: The average radial tilt was 10.6° and radial height was 10.2 mm at the sixth month postoperatively. Three cases of pin tract infection were recorded, who were treated totally with oral antibiotics. There was no case of pin loosening. Of total 73 patients underwent surgery, three cases of radial nerve irritation were recorded at the time of cast removal. All of them resolved at the 6th month follow up. No median nerve compression and carpal tunnel syndrome have found. We also had no case of tendon injury. Conclusion: Our modified technique is effective to restore anatomic congruity and maintain reduction.

Keywords: distal radius fracture, percutaneous pinning, pin-in-plaster, modified method of pin-in-plaster, operative treatment

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Authors: Elvira Loibl

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In Western countries, the demand for adoptable children, especially healthy babies, has been considerably high for several years. Rising infertility rates, liberal abortion politics, the widespread use of contraception, and the increasing acceptance of unmarried motherhood are factors that have decreased the number of infants available for domestic adoption in the U.S. and Europe. As a consequence, many involuntarily childless couples turn to intercountry adoption as a viable alternative to have a child of their own. However, the demand for children far outpaces the supply of orphans with the desired characteristics. The imbalance between the number of prospective adopters and the children available for intercountry adoption results in long waiting lists and high prices. The inordinate sums of money involved in the international adoption system have created a commercial ‘underbelly’ where unethical and illicit practices are employed to provide the adoption market with adoptable children. Children are being purchased or abducted from their families, hospitals or child care institutions and then trafficked to receiving countries as ‘orphans’. This paper aims to uncover and explain the factors of the German adoption system that are conducive to child trafficking for adoption purposes. It explains that the tension between money and integrity as experienced by German adoption agencies, blind trust in the authorities in the sending countries as well as a lenient control system encourage and facilitate the trafficking in children to Germany.

Keywords: child trafficking, intercountry adoption, market in adoptable babies, German adoption system

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Authors: J. B. Sharma, Vivek Kakkar, Sunesh Kumar, K. K. Roy, Rajesh Kumari, Kavita Pandey, Smriti Hari

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Background: Stress urinary incontinence (SUI) is a common problem affecting the quality of life of women. Methods: It is a prospective study conducted over 40 women of SUI by endovaginal ultrasound on rest and Valsalva preoperatively and six months postoperatively for levator hiatus, pubovisceral thickness, urethral length, and bladder neck position. A 24-hour pad test was also performed on all women at the same time for grading of SUI. Treatment given was medical in 4 (10%), Burch colposuspension in 18 (45%), and tension-free obturator tape in 18 (45%). Results: Mean age, parity, and body mass index in the study were 41.60 years, 2.73, and 24.2 kg/m², respectively. All 40 (100%) patients had SUI, with the mean duration of symptoms being 4.04 years. On the 24-hour pad test, mild SUI was in 4 (10%), moderate SUI in 33 (82.5%), and severe SUI in 3 (7.5%), with mean preoperative 24-hour pad test being 36.69 gm which significantly reduced to 9.79 gm postoperatively (p 0.001). There was a significant change in levator hiatus and pubovisceral thickness with the treatment of SUI. Overall urethral length increased, but there was a significant decrease in urethral length on Valsalva after the treatment (0.40 versus 0.28 cm, p 0.04) and a significant reduction in bladder neck descent after Valsalva after treatment (0.41 cm versus 0.27 cm, p 0.001). Conclusion: Endovaginal ultrasound and 24-hour pad test are useful diagnostic modalities for SUI diagnosis and to see the impact of treatment.

Keywords: stress urinary incontinence, endovaginal ultrasound, 24-hours pad test, pubovisceral muscle thickness

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Authors: A. Fordham, A. Hudson

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Background: Studies have suggested 16-25% of normotensive trauma patients with no clinical signs of shock have abnormal lactate and BD readings evidencing shock; a phenomenon known as occult hypoperfusion (OH). In light of the scarce quantity of evidence currently documenting OH, this study aimed to identify the prevalence of OH in the pre-hospital setting and explore ways to improve its identification and management. Methods: A quantitative retrospective data analysis was carried out on 75 sets of patient records for trauma patients treated by Kent Surrey Sussex Air Ambulance Trust between November 2013 and October 2014. The KSS HEMS notes and subsequent ED notes were collected. Trends between patients’ SBP on the scene, whether or not they received PRBCs on the scene as well as lactate and BD readings in the ED were assessed. Patients’ KSS HEMS notes written by the HEMS crew were also reviewed and recorded. Results: -Suspected OH was identified in 7% of the patients who did not receive PRBCs in the pre-hospital phase. -SBP heavily influences the physicians’ decision of whether or not to transfuse PRBCs in the pre-hospital phase. Preliminary conclusions: OH is an under-studied and underestimated phenomenon. We suggest a prospective trial is carried out to evaluate whether detecting trauma patients’ tissue perfusion status in the pre-hospital phase using portable devices capable of measuring serum BD and/or lactate could aid more accurate detection and management of all haemorrhaging trauma patients, including patients with OH.

Keywords: occult hypoperfusion, PRBC transfusion, point of care testing, pre-hospital emergency medicine, trauma

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Authors: Elena G. Salina, Laurent R. Chiarelli, Maria R. Pasca, Vadim A. Makarov

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Tuberculosis is one of the most challenging threats to human health, confronted by the problem of drug resistance. Evidently, new drugs for tuberculosis are urgently needed. Thienopyrimidine TP053 is one of the most promising new antitubercular prodrugs. Mycothiol-dependent reductase Mrx2, encoded by rv2466c, is known to be a TP053 activator; however, the precise mode of action of this compound remained unclear. Being highly active against both replicating and non-replicating tuberculosis bacilli, TP053 also revealed dose-escalating activity for M. tuberculosis-infected murine macrophages. The chemical structure of TP053 is characterized by the presence of NO₂ group which was suggested to be responsible for the toxic effects of the activated compound. Reduction of a nitroaromatic moiety of TP53 by Mrx2 was hypothesized to result in NO release. Analysis of the products of enzymatic activation of TP053 by Mrx2 by the Greiss reagent clearly demonstrated production of nitric oxide in a time-dependent manner. Mass-spectra of cell lysates of TP-treated M. tuberculosis bacilli demonstrated the transformation of TP053 to its non-active metabolite with Mw=261 that corresponds NO release. The mechanism of NO toxicity for bacteria includes DNA damage and degradation of iron-sulfur centers, especially under oxygen depletion. Thus, TP-053 drug-like scaffold is prospective for further development of novel anti-TB drug. This work was financially supported by the Russian Foundation for Basic Research (Grant 17-04-00342).

Keywords: drug discovery, M. tuberculosis, nitric oxide, NO donors

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Authors: Ana Maria De Azevedo

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We are living a remarkable period, responsible for the thriving of the human population to unprecedented levels. Still, it is empirically obvious that sustaining such a huge population puts a tremendous pressure on our planet. Once Land resources grow scarcer, there is a mounting pressure to find alternatives to support basic human needs elsewhere. Occupying most of our planet, it’s therefore natural that, is not a so distant future, humankind look for such basic subsistence means at the Ocean. Thus, once the Ocean becomes essential to Human subsistence, it is predictable it's moving to the foreground of Geopolitics. Both future technologies and uses of the Ocean, as bidding for the exploration of its resources away from the natural territory of influence of a Country, are susceptible of raising the risk of conflict between traditional political adversaries and/or the dilemma of having to balance economic interests, with various security and defense concerns. Those empirical observations suggest the need to further research on this perspective shift of the main Geopolitical axis to the Ocean, the new sources of conflict that can result thereon, and how to address them. The author suggests a systematic analysis of this problematic, to attain a political and legal international consensus, namely on what concerns updating of the 'United Nations Convention on the Law of the Sea' of 10 December 1982, and/or its annexes. To proceed with the present research, the primary analysis was based on a quantitative observation, but reasoning thereon relied essentially on a qualitative process of prospective scenarios assessment.

Keywords: marine resources, ocean geopolitics, security and defense, sustainable development

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Authors: Chao Hsing Yeh, Wei Chun Lin

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Background: Current management of aromatase inhibitor-induced arthralgia (AIA) in postmenopausal breast cancer survivors (PBCS) has limited effect. Method: In this prospective randomized clinical trial (RCT), a 4-week APA treatment was used to manage AIA. Twenty PBCS participated. After baseline data was collected, participants were waited for a month before they receive APA at a convenient time once a week for 4 weeks. Blood samples from participants in both groups were collected at baseline and after 4 weeks of treatment. The primary outcomes included: pain intensity, pain interference, stiffness, and physical function. Results: After the 4-week APA treatment, the pro-inflammatory cytokines and chemokines display a trend of mean percentage reduction (i.e., -22% in IL-1α, -4% in IL-1β, -1% in IL-2, -3% in IL-6, -19% in IL-12, -9% in Eotaxin, and -2% in MCP-1). The anti-inflammatory cytokine IL-10 and IL-13 (i.e., 5% in IL-10 and 29% in IL-13) increased from pre- to post-APA treatment. Significant positive correlation of percentage mean change was observed between symptom severity and eotaxin (ρ = 0.56; p < 0.01) & MCP-1 (ρ = 0.65; p < 0.01). Interference and chemokines (eotaxin & MIP-1) also shows positive correlation (ρ = 0.48; p < 0.01 & ρ = 0.39; p < 0.05). Another positive correlation was found between worst pain and chemokines (eotaxin, ρ = 0.48; p < 0.01 & MIP-1, ρ = 0.39; p < 0.05). Additionally, interference also shows positive correlation among IL-1α (ρ = 0.36; p < 0.05) and IL-β (ρ = 0.33; p < 0.05). Conclusion: These findings suggest that APA intervention may inhibit inflammation of AIA patients and chemokine could be one of the key factors of AIA symptom improvement.

Keywords: acupressure, cytokine, pain management, breast cancer survivors

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Authors: Mohammed G. Alotaibi, Sameer Albahkaly, Salwa M. Bahkali, Abdullah M. Alghamdi, Raseel S. Alswidan, Maha Bin Shafi, Sarah Almaiman

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Introduction: Rhinitis is common in Saudi Arabia. Therefore, our study was designed to evaluate the prevalence, triggering factors, severity and progression of rhinitis during pregnancy. Methods: Prospective cross-sectional study was conducted in eight governmental and private medical centers in Riyadh, Saudi Arabia, during June and July 2014. Validated Arabic language self-administered questionnaire was used. Sample size of 260 Saudi pregnant women was calculated by Raosoft sample size calculator. Random sampling was achieved by choosing one and skipping every five patients in the clinic list. Data were coded and entered manually into spreadsheets then transferred to SPSS statistical package version 16.0 for Windows. Consent, Privacy and confidentiality of information were assured. Results: Pregnancy rhinitis was reported 31.2% (CI 25.6 - 37.2%). Symptoms arising in first trimester appeared in 79.2% of PR cases and mostly worsen. The most prevalent symptoms were nasal pruritis (67.5%), followed by sneezing (57.1%), congestion (50.6%), and post nasal drip (46.7%). The major triggering factor was dust (71.4%), followed by Tobacco/Shisha smoke (57.6%) and perfume(47%). Preexisting allergic diseases were markedly associated with developing pregnancy rhinitis. Conclusion: Rhinitis during pregnancy manifested in one third of Saudi pregnant ladies. Nasal pruritus was the most common symptom and dust was the widespread triggering factor.

Keywords: allergy, pregnancy, Rhinitis, sneezing

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Authors: Aruha Khan, Brynn E. Kankel, Paraskevi Papadopoulou

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In recent years, extensive research upon ‘stress’ has provided insight into its two distinct guises, namely the short–term (fight–or–flight) response versus the long–term (chronic) response. Specifically, the long–term or chronic response is associated with the suppression or dysregulation of immune function. It is also widely noted that the occurrence of cancer is greatly correlated to the suppression of the immune system. It is thus necessary to explore the impact of long–term or chronic stress upon the prevalence and risk of cancer. To what extent can the dysregulation of immune function caused by long–term exposure to stress be controlled or minimized? This study focuses explicitly upon immunosuppression due to its ability to increase disease susceptibility, including cancer itself. Based upon an analysis of the literature relating to the fundamental structure of the immune system alongside the prospective linkage of chronic stress and the development of cancer, immunosuppression may not necessarily correlate directly to the acquisition of cancer—although it remains a contributing factor. A cross-sectional analysis of the survey data from the University of Tennessee Medical Center (UTMC) and Harvard Medical School (HMS) will provide additional supporting evidence (or otherwise) for the hypothesis of the study about whether immunosuppression (caused by the chronic stress response) notably impacts the prevalence of cancer. Finally, a multidimensional framework related to education on chronic stress and its effects is proposed.

Keywords: immune system, immunosuppression, long–term (chronic) stress, risk of cancer

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Authors: Irene Perez Lopez

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Delta and estuary cities are spaces constantly evolving, incessantly altered by the ever-changing actions of water transformation. Strategies that incorporate comprehensive and integrated approaches to planning and design with water will play a powerful role in defining new types of flood defense. These strategies will encourage more resilient and active urban environments, allowing for new spatial and functional programs. This abstract presents the undergoing research in Newcastle, the first urbanized delta in New South Wales (Australia), and the region's second-biggest catchment and estuary. The research methodology is organized in three phases: 1) a projective cartography that analyses maps and data across the region's recorded history, identifying past and present constraints, and predicting future conditions. The cartography aids to identify worst-case scenarios, revealing the implications of land reclamation that have not considered the confronting evolution of climate change and its conflicts with inhabitation; 2) the cartographic studies identify the areas under threat and form the basis for further interdisciplinary research, complimented by community consultation, to reduce flood risk and increase urban resilience and livability; 3) a speculative or prospective phase of design with water to generate evidence-based guidelines that strengthen urban resilience of shorelines and flood prone areas.

Keywords: coastal defense, design, urban resilience, mapping

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Authors: K. Amanzoui, A. Erragh, M. Elharit, A. Afif, K. Elfakhr, S. Kalouch, A. Chlilek

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Orthopedic surgery is a provider of pre and postoperative bleeding; patients are exposed to several risks, and different measures are proposed to reduce bleeding during surgery, called the transfusion-sparing method, including tranexamic acid, which has shown its effectiveness in numerous studies. A prospective analytical study in 50 children was carried out in the orthopedic traumatology operating room of the EL HAROUCHI hospital of the CHU IBN ROCHD in Casablanca over a period of six months (April to October 2022). Two groups were randomized: one receiving tranexamic acid (Group A) and a non-receiving control group (Group B). The average age was 10.3 years, of which 58.8% were female. The first type of surgery was thoracolumbar scoliosis (52%). The average preoperative hemoglobin was 12.28 g/dl in group A, against 12.67 g/dl in the control group. There was no significant difference between the two groups (p=0.148). Mean intraoperative bleeding was 396.29 ml in group A versus 412 ml in the control group. No significant difference was observed for this parameter (p=0.632). The average hemoglobin level in the immediate postoperative period in our patients is 10.2 g/dl. In group A, it was 10.95 g/dl versus 10.93 g/dl in group B. At H24 postoperative, the mean hemoglobin value was 10.29 g/dl in group A against 9.5 g/dl in group B. For group A, the blood loss recorded during the first 24 hours was 209.43 ml, against 372 ml in group B, with a significant difference between the two groups (p=0.001). There is no statistically significant difference between the 2 groups in terms of the use of fillers, ephedrine or intraoperative transfusion. While for postoperative transfusion, we note the existence of a statistically significant difference between group A and group B. It is suggested that the use of tranexamic acid is an effective, simple, and low-cost way to limit postoperative blood loss and the need for transfusion.

Keywords: tranexamic acid, blood loss, orthopedic surgery, children

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Authors: Amin Davoudi

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Aim: New approaches have been introduced to improve soft tissue indices of the dental implants. This systematic review aimed to investigate the effect of computer-aided design and computer-assisted manufacture (CAD/CAM) zirconia (Zr) implant abutments on periodontal aspects. Materials and Methods: Five electronic databases were searched thoroughly based on prior defined MeSH and non-MeSH keywords. Clinical studies were collected via hand searches in English language journals up to September 2020. Interproximal papilla stability, papilla recession, pink and white esthetic score (PES, WES), bone and gingival margin levels, color, and contour of soft tissue were reviewed. Results: The initial literature search yielded 412 articles. After the evaluation of abstracts and full texts, six studies were eligible to be screened. The study design of the included studies was a prospective cohort (n=3) and randomized clinical trial (n=3). The outcome was found to be significantly better for Zr than titanium abutments, however, the studies did not show significant differences between stock and CAD/CAM abutments. Conclusion: Papilla fill, WES, PES, and the distance from the contact point to dental crest bone of adjacent tooth and inter-tooth–implant distance were not significantly different between Zr CAD/CAM and Zr stock abutments. However, soft tissue stability and recession index were better in Zr CAD/CAM abutments.

Keywords: zirconia, CADCAM, periodental, implant

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Authors: Md. Toufiq Hasan

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This research set out to explore the source of stress and coping strategies of undergraduate Occupational Therapy students’ of Bangladesh Health Professions Institute (BHPI) in Bangladesh. For that reason, a quantitative and prospective type survey has been conducted by the researcher with 27 student participants of BHPI Occupational Therapy department whose stress scores were ≥40 according to Zung’s self-rating depression scale. Data was collected by using Bengali and English joined questionnaire of Inventory of College Students’ Recent Life Experience and Ways of Coping Scale. The researcher followed ‘Comprehensive sampling’ procedure to study the entire group of population. From the in-depth analysis to data found some source of stress and coping strategies of the students’. Stress was found significantly more in 2nd year students rather than other years. Female students were more vulnerable for stress rather than male. The age ranges 18-20 years of students are more vulnerable for stress. The main sources of stresses are found that, a lot of responsibilities and too many things to do at once and not enough time to meet their obligation or duties. The important coping strategies are found that, they criticized or lectured their selves, tried not to burn their bridges, but leave things open somewhat and inspired to do something creative. Findings of the study highlighted the need for teachers-students interactive relationship for better academic performance. The study also discloses some important recommendations for the students and teachers. At last the findings of the study will help the Occupational Therapy students and teachers of BHPI.

Keywords: BHPI undergraduate occupational therapy students, stress, source of stress, coping strategies

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Authors: Tapas Acharya, Monalisa Mitra

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Overlay modeling is the most widely used conventional analysis for spatial decision support system. Overlay modeling requires a set of themes with different weightage computed in varied manners, which gives a resultant input for further integrated analysis. In spite of the popularity and most widely used technique; it gives inconsistent and erroneous results for similar inputs while processed in various GIS overlay techniques. This study is an attempt to compare and analyse the differences in the outputs of different overlay methods using GIS platform with same set of themes of the Precambrian metamorphic to obtain groundwater prospecting in Precambrian metamorphic rocks. The objective of the study is to emphasize the most suitable overlay method for groundwater prospecting in older Precambrian metamorphics. Seven input thematic layers like slope, Digital Elevation Model (DEM), soil thickness, lineament intersection density, average groundwater table fluctuation, stream density and lithology have been used in the spatial overlay models of fuzzy overlay, weighted overlay and weighted sum overlay methods to yield the suitable groundwater prospective zones. Spatial concurrence analysis with high yielding wells of the study area and the statistical comparative studies among the outputs of various overlay models using RStudio reveal that the Weighted Overlay model is the most efficient GIS overlay model to delineate the groundwater prospecting zones in the Precambrian metamorphic rocks.

Keywords: fuzzy overlay, GIS overlay model, groundwater prospecting, Precambrian metamorphics, weighted overlay, weighted sum overlay

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Authors: Sanjaya N. Munasinghe, R. Gnanasekeram, Dimuthu Tennakoon

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During the last few years there has been a dramatic increase in the number of motorcyclists in Sri Lankan roads and thus an increase of motorcycle accidents (MCAs) with a heavy death and casualty toll. Extremity injuries due to MCAs cause a heavy burden on government hospitals. However, data on MCA injuries are limited. This study tries to determine the relationship between extremity injuries with protective gears and clothing motorcycle riders were wearing at the time of the accident. Data were collected from 410 motorcycle riders and passengers involved with MCAs and admitted to orthopedic and emergency observation wards in Teaching Hospital Kurunegala with extremity injuries between 1st February 2015 and 31st July 2015 using an interviewer administered questioner. Data were analyzed using SPSS version 17.0. Distal radial fracture is the most common upper extremity injury (12%), and Tibial fracture is the most common and severe lower extremity injury (23%). Very few participants were wearing safety gloves (2%) and jackets (10%). Most of the participants were wearing slippers (66%), short sleeved upper clothing (96%) and light cloth trousers (49%). According to Chi-square test associations were found between footwear and foot injuries (p-value - 0.001, Cramer's v-value - 0.203) and safety jacket and upper extremity injuries (p-value - 0.002, Cramer's v-value - 0.177). The results indicate that using safety gear can minimize the number of injuries in MCA victims. Thus it is necessary to ensure that motorcycle riders and pillion riders use proper safety gear.

Keywords: extremity injuries, fractures, motorcycle accidents, safety gear

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Authors: Andrew Tan Hwee Chye, Yeo Zhen Ning

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This study aims to meta-analyse clinical studies comparing femoral tunnel position (FTP), femoral tunnel length (FTL) and graft bending angle (GBA) of single-bundle Anterior Cruciate Ligament (ACL) reconstruction using Transtibial (TT), Anteromedial (AM) and Outside-in (OI) techniques. A meta-analysis comparing the FTP, FTL and GBA of single-bundle ACL reconstruction utilising the TT, AM and OI was performed. Prospective Comparative Studies (PCS) and Retrospective Comparative Studies (RCS) from PubMed, Cochrane Library, and Embase were included. A total of 17 studies were included in this study. TT had the longest FTL, when compared to AM (Mean difference = 7.38, 95% CI: 3.76 to 11.00, P < 0.001) and OI (Mean difference = 9.47, 95% CI: 4.89 to 14.05, P < 0.001). In the deep-to-shallow direction, the OI resulted in a significantly deeper femoral tunnel as compared to the TT (Mean difference = 4.36, 95% CI: 1.39 to 7.33, P = 0.004) (Figure 6B). The AM technique also contributed to a significantly lower tunnel position as compared to the OI technique (Mean difference = 2.34, 95% CI: 0.76 to 3.92, P = 0.004). There were no significant differences in the graft bending angle between TT, AM and OI techniques. AM and OI techniques provide a more anatomical position as compared to the TT. Although FTL in the TT is longer than the AM and OI, all three techniques exceed the critical length of 25mm. There are no differences in the GBA between the three techniques.

Keywords: femoral tunnel position, femoral tunnel length, anterior cruciate ligament, transtibial, graft bending angle, anteromedial, outside-in

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Authors: Aminu Musa Audu

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This paper examines the human resources management issues of the Nigeria Police and how it is impacting the community policing policy transfer. Nigeria Police Force is the organisation in the country with the constitutional responsibility of maintaining law and order. The high level of crime and other forms of insecurity called for the introduction of ‘police-community partnership’ strategy in 2003. The trend of events has suggested that the effort is not yielding result, partly because the police in Nigeria are facing human resources management challenges. For instance, the prospective candidates for the police jobs are usually not vetted a situation which provides the possibility of recruiting persons of low academic background and questionable character, or even criminal records. Moreover, the existing training, development infrastructure and other logistics for the job of policing are not in good condition. Consequently, the implementation of the ‘community policing’ policy for crime prevention and control in Nigeria stands to suffer setbacks. Adopting qualitative methods and with focus groups discussions and individual in-depth interviews for data collections, the findings from the views and perspectives of the participants were suggestive of poor handlings of human resources management of the Nigeria police organisation and with negative effect on the implementation of community policing policy. The paper therefore recommends that a total overhaul of the human resources component of the police organisation is necessary in the community policing policy transfer process for crime prevention and control in Nigeria.

Keywords: Nigeria Police Force, community policing policy transfer, human resources management, police-community partnership

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Authors: Sherif Sabri, Nael Samir, Mohamed Ali, Ahmed ElSakhawy

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Introduction: There is growing evidence to support the hypothesis that serum matrix metalloproteinase -9 in could be an early predictor of mortality in septic patients. Aim of the work: Study the relationship of matrix metalloproteinase 9 in patients with SIRS in comparison to septic patients in day 0 and day 2. Patients and Methods: This is a prospective observational study conducted on 40 adult critically ill patients staying more than 24 hours in ICU either surgical or medical department, El Fayoum General Hospital in the period from November 2014 to March 2015. Patients met at least two of the criteria for severe inflammatory response syndrome (SIRS). Diagnostic criteria include several clinical and laboratory findings of sepsis induced tissue hypoperfusion or organ dysfunction. Samples were grouped as drawn either at admission, or at day 2 after admission. Results: Patients were divided into two groups: The non-sepsis (SIRS) group, which included 15 (37.5%) patients with no later evidence of sepsis were enrolled as controls. The Sepsis group, which included 25 patients diagnosed to have SIRS with later evidence of sepsis with positive culture. Exploring serum level of MMP-9 in non-survivors and survivors, there was significant increase in non-survivors if compared to survivors at admission p-value 0.001 (mean value in survivors 4.4mg/dl±4.1mg/dl at admission versus mean value in non-survivors 11.9mg/dl±5.8mg/dl) and after two days of admission was also significant increase p-value 0.001 (mean value in survivors 10.9mg/dl ±9.4mg/dl versus mean value in non-survivors 22.6mg/dl±10.4). Conclusion: MMP-9 levels in septic patients have a beneficial role in ICU for high-risk stratification as it is an independent marker of mortality in severe sepsis.

Keywords: matrix metalloproteinase (MMP-9), sepsis, septic shock, systemic inflamatory response syndrome

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Authors: Rana Praween Kumar

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Preterm-low birth weight delivery is a major cause of infant morbidity and mortality in developing countries and has been linked to poor periodontal health during pregnancy. Gingivitis and chronic periodontitis are highly prevalent chronic inflammatory oral diseases. The detection and diagnosis of these common diseases is a fundamentally important component of oral health care. This study is intended to investigate predisposing and enabling factors as determinants of oral health indicators in pregnancy as well as the association between periodontal problems during pregnancy with age and socio economic status of the individual. A community –based prospective cohort study will be conducted in Jamshedpur, Jharkhand, India among pregnant women using completed interviews and a full mouth oral clinical examination using the CPITN (Community Periodontal Index of Treatment Need) and OHI-S (Simplified Oral Hygiene) indices with adequate sample size and informed consent to the patient following proper inclusion and exclusion criteria. Multiple logistic regression analyses will be used to identify independent determinants of periodontal problems and use of dental services during pregnancy. Analysis of covariance (ANCOVA) will be used to investigate the relationship between periodontal problems with the age and socioeconomic status. The result will help in proper monitoring of periodontal health during pregnancy encouraging the delivery of healthy child and the maintenance of proper health of the mother.

Keywords: infant, periodontal problems, pregnancy, pre-term-low birth weight delivery

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Authors: Sushma Ghogale

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With a surge in user-generated content or feedback or reviews on the internet, it has become possible and important to know consumers' opinions about products and services. This data is important for both potential customers and businesses providing the services. Data from social media is attracting significant attention and has become the most prominent channel of expressing an unregulated opinion. Prospective customers look for reviews from experienced customers before deciding to buy a product or service. Several websites provide a platform for users to post their feedback for the provider and potential customers. However, the biggest challenge in analyzing such data is in extracting latent features and providing term-level analysis of the data. This paper proposes an approach to use topic modeling to classify the reviews into topics and conduct sentiment analysis to mine the opinions. This approach can analyse and classify latent topics mentioned by reviewers on business sites or review sites, or social media using topic modeling to identify the importance of each topic. It is followed by sentiment analysis to assess the satisfaction level of each topic. This approach provides a classification of hotel reviews using multiple machine learning techniques and comparing different classifiers to mine the opinions of user reviews through sentiment analysis. This experiment concludes that Multinomial Naïve Bayes classifier produces higher accuracy than other classifiers.

Keywords: latent Dirichlet allocation, topic modeling, text classification, sentiment analysis

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Authors: Azza Gaber Antar Farag, Eman Abd El Fatah Badr, Wesam Ahmed Tawfik Hasssan Abdel Aal, Mustafa Elsayed Elshaib

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Background: Female Sexual Dysfunction (FSD) represents recurrent and persistent problems that distress women and/or strain their relationships with their partners. Dopamine can affect sexual function and interacts with ovarian hormones in the ventromedial area in the hypothalamus. Objective: To investigate the possible role of dopamine in FSD. Method: This prospective case-control study was carried on 100 women having FSD and 100 healthy volunteer females. They were recruited from the Al-Menoufia governorate. All included women were subjected to the questionnaire to assess their demographic and gynecological data as well as sexual function. They were investigated for serum levels of dopamine, estradiol, progesterone and DHEA hormones. Results: Dopamine serum levels were significantly lower in females having sexual dysfunction (6.68±4.14) than controls (57.97±26.26) (P>0.001). This decreased dopamine level was of a significant positive correlation with the arousal domain and significant negative correlation regarding the pain domain (r=-0.19, p=0.01). Also, estradiol serum levels were significantly lower (P>0.001), but progesterone and DHEA serum levels were significantly higher in the FSD group than controls (P>0.001). There was a significant negative correlation between dopamine and DHEA serum levels (r= -0.45, p <0.001). Conclusions: Decreased dopamine serum levels may have an active role in the pathophysiology of FSD, impacting mainly arousal and pain domains, and its targeting should be considered during FSD management.

Keywords: dopamine, estradiol, progesterone, DHEA, females sexual dysfunction

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Authors: Ammar Ali Saleh Jaber, Amer Hayat Khan, Syed Azhar Syed Sulaiman

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Tuberculosis (TB) is considered as a major disease that affects daily activities and impairs health-related quality of life (HRQoL). The impact of TB on HRQoL can affect treatment outcome and may lead to treatment defaulting. Therefore, this study aims to evaluate the HRQoL of TB treatment lost to follow-up during and after treatment in Yemen. For this aim, this prospective study enrolled a total of 399 TB lost to follow-up patients between January 2011 and December 2015. By applying HRQoL criteria, only 136 fill the survey during treatment. Moreover, 96 were traced and fill out the HRQoL survey. All eight HRQol domains were categorized into the physical component score (PCS) and mental component score (MCS), which were calculated using QM scoring software. Results show that all lost to follow-up TB patients reported a score less than 47 for all eight domains, except general health (67.3) during their treatment period. Low scores of 27.9 and 29.8 were reported for emotional role limitation (RE) and mental health (MH), respectively. Moreover, the mental component score (MCS) was found to be only 28.9. The trace lost follow-up shows a significant improvement in all eight domains and a mental component score of 43.1. The low scores of 27.9 and 29.8 for role emotion and mental health, respectively, in addition to the MCS score of 28.9, show that severe emotional condition and reflect the higher depression during treatment period that can result to lost to follow-up. The low MH, RE, and MCS can be used as a clue for predicting future TB treatment lost to follow-up.

Keywords: Yemen, tuberculosis, health-related quality of life, Khat

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Authors: Mohhamed El Habib Labdouni

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Introduction: Co-infection with VIH and tuberculosis poses one of the major ongoing challenges for global TB and AIDS prevention and control. The objective of this study is to raise the issue of the resurgence of TB, in People living with VIH supported in a referent center in western Algeria. Its epidemiological, clinical, biological and radiological new trends, and to compare the mortality rate between early and delayed ART. Methods: It was a prospective study, during 36 months from the 01st/01/2012 to 31st/12/2014, by identifying and analyzing cases of TB-VIH co-infection. Our population was devised in two groups/ early ART and delayed ART. The primary and secondary endpoints were analyzed with Kaplan-Meier curves and log-rank test the period of follow up, which was fixed at 300 weeks. Results: Sixty cases of co-infection TB -VIH were enrolled in our study: 78.3% had pulmonary tuberculosis associated with extra-pulmonary, 13.3% had only pulmonary tuberculosis and 08.3% presented strictly extra-pulmonary TB. The clinical particularity of this co-infection is the frequency of serious localization such us: pleural 23.3%, peritoneal 31.7%, and meningeal suffusion 13.3%.y-.biologicaly we notice the predominance both of pancytopenia and leucoanemia, hyponatremia in 38,6% and hypokalemia in 19,3%. By analyzing Kaplan-Meier survival curves, we notice that early ART initiation is associated with a significant reduction of all-cause mortality (p = 0,000), and we have identified several prognostic factors such as hypokalemia hyponatremia, leukocytosis thrombopenemia leucothrombopenia (p = 0,005). Conclusion: Our study confirms most of the results reported in the literature. Early ART initiation reduces the rate of all-cause mortality, despite the probability of the occurrence of TB-IRIS.

Keywords: TB-HIV co-infection, early ART, hyponatremia, extrapulmonary tuberculosis

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Authors: Gehan Hussein, Hams Ahmad, Baher Matta, Yasmeen Mansi, Mohamad Fawzi

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Background: Congenital heart disease (CHD) is a common problem worldwide with variable incidence in different countries. The exact etiology is unknown, suggested to be multifactorial. We aimed to study the incidence of various CHD in a neonatal intensive care unit (NICU) in a tertiary care hospital in Egypt and the possible associations with variable risk factors. Methods: Prospective study was conducted over a period of one year (2013 /2014) at NICU KasrAlAini School of Medicine, Cairo University. Questionnaire about possible maternal and/or paternal risk factors for CHD, clinical examination, bedside echocardiography were done. Cases were classified into groups: group 1 without CHD and group 2 with CHD. Results: from 723 neonates admitted to NICU, 180 cases were proved to have CHD, 58 % of them were males. patent ductus arteriosus(PDA) was the most common CHD (70%), followed by an atrial septal defect (ASD8%), while Fallot tetralogy and single ventricle were the least common (0.45 %) for each. CHD was found in 30 % of consanguineous parents Maternal age ≥ 35 years at the time of conception was associated with increased incidence of PDA (p= 0.45 %). Maternal diabetes and insulin intake were significantly associated with cases of CHD (p=0.02 &0.001 respectively), maternal hypertension and hypothyroidism were both associated with VSD, but the difference did not reach statistical significance (P=0.36 &0.44respectively). Maternal passive smoking was significantly associated with PDA (p=0.03). Conclusion: The most frequent CHD in the studied population was PDA, followed by ASD. Maternal conditions as diabetes was associated with VSD occurrence.

Keywords: NICU, risk factors, congenital heart disease, echocardiography

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Authors: Kalyan Koganti

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Background: In India, platelet transfusions are given to large no. of patients suffering from dengue due to the fear of bleeding especially when the platelet counts are low. Though many patients do not bleed when the platelet count falls to less than 20,000, certain patients bleed even if the platelet counts are more than 20,000 without any comorbid condition (like gastrointestinal ulcer) in the past. This fear has led to huge amounts of unnecessary platelet transfusions which cause significant economic burden to low and middle-income countries like India and also sometimes these transfusions end with transfusion-related adverse reactions. Objective: To identify the role of Activated Partial Thromboplastin Time (APTT) in comparison with thrombocytoenia as an indicator to assess the real need of platelet transfusions. Method: A prospective study was conducted at a hospital in South India which included 176 admitted cases of dengue confirmed by immunochromatography. APTT was performed in all these patients along with platelet count. Cut off values of > 60 seconds for APTT and < 20,000 for platelet count were considered to assess the bleeding manifestations. Results: Among the total 176 patients, 56 patients had bleeding manifestations like malena, hematuria, bleeding gums etc. APTT > 60 seconds had a sensitivity and specificity of 93% and 90% respectively in identifying bleeding manifestations where as platelet count of < 20,000 had a sensitivity and specificity of 64% and 73% respectively. Conclusion: Elevated APTT levels can be considered as an indicator to assess the need of platelet transfusion in dengue. As there is a significant variation among patients who bleed with respect to platelet count, APTT can be considered to avoid unnecessary transfusions.

Keywords: activated partial thromboplastin time, dengue, platelet transfusion, thrombocytopenia

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Authors: Michael W. Markowitz, Jeffrey Gingerich

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The landscape of higher education in the United States has undergone significant changes in the last 25 years. What was once a domain of competition among prospective students for a limited number of college and university seats has become a marketplace in which institutions vie for the enrollment of educational consumers. A central figure in this paradigm shift has been the Chief Academic Officer (CAO), whose institutional role has also evolved beyond academics to include such disparate responsibilities as strategic planning, fiscal oversight, student recruitment, fundraising and personnel management. This paper explores the scope and impact of this transition by, first, explaining its context: the intersection of key social, economic and political factors in neo-conservative, late 20th Century America that redefined the value and accountability of institutions of higher learning. This context, in turn, is shown to have redefined the role and function of the CAO from a traditional academic leader to one centered on the successful application of corporate principles of organizational and fiscal management. Information gathered from a number of sitting Provosts, Vice-Presidents of Academic Affairs and Deans of Faculty is presented to illustrate the parameters of this change, as well as the extent to which today’s academic officers feel prepared and equipped to fulfill this broader institutional role. The paper concludes with a discussion of the impact of this transition on the American academy and whether it serves as a portend of change to come in higher education systems around the globe.

Keywords: academic administration, higher education, leadership, organizational management

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Authors: Pitchaporn Purngpiputtrakul, Suttasinee Petsakul, Sunisa Chatmongkolchart

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Nasogastric tube (NGT) insertion in anaesthetized and intubated patients can be challenging even for experienced anesthesiologists. Various techniques have been proposed to facilitate NGT insertion in these patients. This study aimed to compare the success rate and time required for NGT insertion between the GlideScope visualization and neck flexion with lateral neck pressure techniques. This randomized clinical trial was performed at a teaching hospital on 86 adult patients undergoing abdominal surgery under relaxant general anaesthesia who required intraoperative NGT insertion. The patients were randomized into two groups, the GlideScope group (group G) and the neck flexion with lateral neck pressure group (group F). The success rate of first and second attempts, duration of insertion, and complications were recorded. The total success rate was 79.1% in Group G compared with 76.7% in Group F (P=1) The median time required for NGT insertion was significantly longer in Group G, for both first and second attempts (97 vs 42 seconds P<0.001) and (70 vs 48.5 seconds P=0.015), respectively. Complications were reported in 23 patients (53.5%) in group G and 13 patients (30.2%) in group F. Bleeding and kinking were the most common complications in both techniques. Using GlideScope visualization to facilitate NGT insertion was comparable to neck flexion with lateral neck pressure technique in degree of success rate of insertion, while neck flexion with lateral neck pressure technique had fewer complications and was less time-consuming.

Keywords: anaesthesia, nasogastric tube, GlideScope, intubation

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Authors: Shikha Gupta, Suneet Kathuria, Supriya Sampley, Sunil Katyal

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Opioids are being increasingly used these days as adjuvants to local anesthetics in spinal anesthesia. The aim of this prospective, randomized, double‑blind study is to compare the effects of adding sufentanil or fentanyl to low dose bupivacaine in spinal anesthesia for endoscopic urological procedures. A total of 90 elective endoscopic urological surgery patients, 40‑80 years old, received spinal anesthesia with 7.5 mg hyperbaric bupivacaine 0.5% (Group A) or by adding sufentanil 10 μg (Group B) or fentanyl 25 μg (Group C) to 5 mg hyperbaric bupivacaine 0.5%. These groups were compared in terms of the quality of spinal anesthesia as well as analgesia. Analysis of variance and Chi‑square test were used for Statistical analysis. The onset of sensory and motor blockade was significantly rapid in Group A as compared with Groups B and C. The maximum upper level of sensory block was higher in Group A patients than Groups B and C patients. Quality of analgesia was significantly better and prolonged in sufentanil group as compared with other two groups. Motor block was more intense and prolonged in Group A as compared with Groups B and C patients. Request for post‑operative analgesic was significantly delayed in Group B patients. Hence in conclusions, spinal anesthesia for endoscopic urological procedures in elderly patients using low dose bupivacaine (5 mg) combined with 10 μg sufentanil is associated with a lower incidence of hemodynamic instability, better quality and prolonged duration as compared to that by adding 25 μg fentanyl.

Keywords: adjuvants, bupivacaine, fentanyl, intrathecal, low dose spinal, sufentanil

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