Search results for: classical instrumental background music

Authors: Theresa Ukamaka Nwagha, Angela Ogechukwu Ugwu, Martins Nweke

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Background and Objectives: Blood transfusion is an effective and proven treatment for some severe complications of sickle cell disease. Recurrent transfusions have put patients with sickle cell disease at risk of developing antibodies against the various antigens they were exposed to. This study aims to investigate the frequency of red blood cell alloimmunization in patients with sickle disease in Africa. Materials and Methods: This is a systematic review of peer-reviewed literature published in English. The review was conducted consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Data sources for the review include MEDLINE, PubMed, CINAHL, and Academic Search Complete. Included in this review are articles that reported the frequency/prevalence of red blood cell alloimmunization in sickle cell disease patients in Africa. Eligible studies were subjected to independent full-text screening and data extraction. Risk of bias assessment was conducted with the aid of the mixed method appraisal tool. We employed a random-effects model of meta-analysis to estimate the pooled prevalence. We computed Cochrane’s Q statistics and I2 and prediction interval to quantify heterogeneity in effect size. Results: The prevalence estimates range from 2.6% to 29%. Pooled prevalence was estimated to be 10.4% (CI 7.7.–13.8); PI = 3.0 – 34.0%), with significant heterogeneity (I2 = 84.62; PI = 2.0-32.0%) and publication bias (Egger’s t-test = 1.744, p = 0.0965). Conclusion: The frequency of red cell alloantibody varies considerably in Africa. The alloantibodies appeared frequent in this order: the Rhesus, Kell, Lewis, Duffy, MNS, and Lutheran

Keywords: frequency, red blood cell, alloimmunization, sickle cell disease, Africa

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Authors: Eglė Bilevičiūtė, Vidmantas Egidijus Kurapka, Snieguolė Matulienė, Sigutė Stankevičiūtė

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The Council of European Union (EU Council) has stressed on several occasions the need for a concerted, comprehensive and effective solution to delinquency problems in EU communities. In the context of establishing a European Forensic Science Area and the development of forensic science infrastructure in Europe, EU Council believes that forensic science can significantly contribute to the efficiency of law enforcement, crime prevention and combating crimes. Lithuanian scientists have consolidated to implement a project named “Conception of the vision for European Forensic Science 2020 implementation in Lithuania” (the project is funded for the period of 1 March 2014 - 31 December 2016) with the objective to create a conception of implementation of the vision for European Forensic Science 2020 in Lithuania by 1) evaluating the current status of Lithuania’s forensic system and opportunities for its improvement; 2) analysing achievements and knowledge in investigation of crimes listed in conclusions of EU Council on the vision for European Forensic Science 2020 including creation of a European Forensic Science Area and the development of forensic science infrastructure in Europe: trafficking in human beings, organised crime and terrorism; 3) analysing conceptions of criminalistics, which differ in different EU member states due to the variety of forensic schools, and finding means for their harmonization. Apart from the conception of implementation of the vision for European Forensic Science 2020 in Lithuania, the project is expected to suggest provisions that will be relevant to other EU countries as well. Consequently, the presented conception of implementation of vision for European Forensic Science 2020 in Lithuania could initiate a project for a common vision of European Forensic Science and contribute to the development of the EU as an area of freedom, security and justice. The article presents main ideas of the project of the conception of the vision for European Forensic Science 2020 of EU Council and analyses its legal background, as well as prospects of and challenges for its implementation in Lithuania and the EU.

Keywords: EUROVIFOR, standardization, vision for European Forensic Science 2020, Lithuania

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Authors: William Cheng, Rini Sekartini

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Background: Sleep is essential for children because it provides enhancement for the neural system activities that give physiologic effects for the body to support growth and development. One of the modifiable factors that relates with sleep is nutrition, which includes nutritional status, iron intake, and magnesium intake. Nutritional status represents the balance between nutritional intake and expenditure, while iron and magnesium are micronutrients that are related to sleep regulation. The aim of this study is to identify prevalence of sleep disturbance among Indonesian children and to evaluate its relation with aspect to nutrition. Methods : A cross-sectional study involving children aged 5 to 7-years-old in an urban primary health care between 2012 and 2013 was carried out. Related data includes anthropometric status, iron intake, and magnesium intake. Iron and magnesium intake was obtained by 24-hours food recall procedure. Sleep Disturbance Scale for Children (SDSC) was used as the diagnostic tool for sleep disturbance, with score under 39 indicating presence of problem. Results: Out of 128 school-aged children included in this study, 28 (23,1%) of them were found to have sleep disturbance. The majority of children had good nutritional status, with only 15,7% that were severely underweight or underweight, and 12,4% that were identified as stunted. On the contrary, 99 children (81,8%) were identified to have inadequate magnesium intake and 56 children (46,3%) with inadequate iron intake. Our analysis showed there was no significant relation between all of the nutritional status indicators and sleep disturbance (p>0,05%). Moreover, inadequate iron and magnesium intake also failed to prove significant relation with sleep disturbance in this population. Conclusion: Almost fourth of school-aged children in Indonesia were found to have sleep disturbance and further study are needed to overcome this problem. According to our finding, there is no correlation between nutritional status, iron intake, magnesium intake, and sleep disturbance.

Keywords: iron intake, magnesium intake, nutritional status, school-aged children, sleep disturbance

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Authors: Mathumalar Loganathan, Lina Syazana, Bryony Dean Franklin

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Background: The therapeutic benefit of self-administered medication for long-term use is limited by an average 50% non-adherence rate. Patient forgetfulness is a common factor in unintentional non-adherence. With a growing ageing population, strategies to improve self-administration of medication adherence are essential. Our aim was to review systematically the effects of interventions to optimise self-administration of medication. Method: Database searched were MEDLINE, EMBASE, PsynINFO, CINAHL from 1980 to 31 October 2013. Search terms included were ‘self-administration’, ‘self-care’, ‘medication adherence’, and ‘intervention’. Two independent reviewers undertook screening and methodological quality assessment, using the Downs and Black rating scale. Results: The search strategy retrieved 6 studies that met the inclusion and exclusion criteria. Three intervention strategies were identified: self-administration medication programme (SAMP), nursing education and medication packaging (pill calendar). A nursing education programme focused on improving patients’ behavioural self-management of drug prescribing. This was the most studied area and three studies highlighting an improvement in self-administration of medication. Conclusion: Results are mixed and there is no one interventional strategy that has proved to be effective. Nevertheless, self-administration of medication programme seems to show most promise. A multi-faceted approach and clearer policy guideline are likely to be required to improve prescribing for these vulnerable patients. Mixed results were found for SAMP. Medication packaging (pill calendar) was evaluated in one study showing a significant improvement in self-administration of medication. A meta-analysis could not be performed due to heterogeneity in the outcome measures.

Keywords: self-administered medication, intervention, prescribing, older patients

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Authors: C. G. Shashi Kumar, G. Arun Maiya, H. Manjunath Hande, K. V. Rajagopal

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Background: Diabetes mellitus (DM) is a metabolic disorder with involvement of neurovascular and muscular system. Studies have documented that the gait parameter is altered in type 2 diabetes mellitus with peripheral neuropathy. However, there is a dearth of literature regarding the gait characteristics in type 2 diabetes mellitus (T2DM) without peripheral neuropathy. Therefore, the present study is focused on identifying gait changes in early type 2 diabetes mellitus without peripheral neuropathy. Objective: To analyze the gait characteristics in Type 2 diabetes mellitus without peripheral neuropathy. Methods: After obtaining ethical clearance from Institutional Ethical Committee (IEC), 36 T2DM without peripheral neuropathy and 32 matched healthy subjects were recruited. Gait characteristics (step duration, gait cycle length, gait cycle duration, stride duration, step length, double stance duration) of all the subjects were analyzed using Windtrack dynamic foot scanner. Data were analyzed using Independent‘t’ test to find the difference between the groups (step duration, gait cycle length, gait cycle duration) and Mann-Whitney test was used to analyze the step length and double stance duration to find difference between the groups. Level of significance was kept at P<0.05. Results: Result analysis showed significant decrease in step duration, gait cycle length, gait cycle duration, step length, double stance duration in T2DM subjects as compared to healthy subjects. We also observed a mean increase in stride duration in T2DM subjects compared to healthy subjects.

Keywords: type 2 diabetes mellitus, dynamic foot scan, gait characteristics, medical and health sciences

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Authors: Deependra Prasad Sarraf, Ashish Shrestha, Mehul Rajesh Jaisani, Gajendra Prasad Rauniar

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Background: Honey is the worlds’ oldest known wound dressing. Its wound healing properties are not fully established till today. Concerns about antibiotic resistance, and a renewed interest in natural remedies have prompted the resurgence in the antimicrobial and wound healing properties of Honey. Evidence from animal studies and some trials has suggested that honey may accelerate wound healing in burns, infected wounds and open wounds. None of these reports have documented the effect of honey on the healing of socket after tooth extraction. Therefore, the present experimental study was planned to evaluate the efficacy of honey on the healing of socket after tooth extraction in rabbits. Materials and Methods: An experimental study was conducted in six New Zealand White rabbits. Extraction of first premolar tooth on both sides of the lower jaw was done under anesthesia produced by Ketamine and Xylazine followed by application of honey on one socket (test group) and normal saline (control group) in the opposite socket. The intervention was continued for two more days. On the 7th day, the biopsy was taken from the extraction site, and histopathological examination was done. Student’s t-test was used for comparison between the groups and differences were considered to be statistically significant at p-value less than 0.05. Results: There was a significant difference between control group and test group in terms of fibroblast proliferation (p = 0.0019) and bony trabeculae formation (p=0.0003). Inflammatory cells were also observed in both groups, and it was not significant (p=1.0). Overlying epithelium was hyperplastic in both the groups. Conclusion: The study showed that local application of honey promoted the rapid healing process particularly by increasing fibroblast proliferation and bony trabeculae.

Keywords: honey, extraction wound, Nepal, healing

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Authors: Marcelus U. Ajonina, Deodata B. Ngonga, Kenric B. Ware, Carine K. Nfor

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Background: Lack of knowledge of rational use of antimalarial drugs among dispensers is a serious problem, especially in areas of intense transmission, thus increasing the risk of resistance and adverse drug reactions. This study was aimed at assessing the knowledge of malaria as well as perception and dispensing practices of antimalarials among vendors in Buea community. Methods: A community-based cross-sectional survey of a random sample of 140 drug vendors living within the Buea community was conducted between March and June 2017. A questionnaire was designed to obtain information from drug vendors on the general knowledge of malaria as well as dispensing practices. Data were analyzed using SPSS Statistics 20.0 and were considered significant at p ≤ 0.05. Results: Knowledge of malaria symptoms, transmission, and prevention was reasonable among 55.8% (77) of the respondents. Only 33.6% (47) of the respondents could attribute the cause of malaria to protozoan of genus Plasmodium species. Of the 140 vendors, 115 (82.7%) prescribe antimalarial drugs. The knowledge of the national protocol was malaria case management among dispensers was 35.0%. Vendors in hospital/community pharmacies were 2.4 times (OR = 3.14, 95% CI: 4.14 - 8.74, p < 0.001) more knowledgeable about malaria treatment protocol than those of in drugstores. The prevalence of self-prescription of antimalarials was 39.3%. Self-prescription was significantly higher in drugstores than hospital/community pharmacies (p=0.004). In all, 56 (40.6%) of vendors showed good practices regarding antimalarial drug dispensing with the majority (51.7%) from community pharmacies (OR=2.27,95% CI: 1.13-4.56). Conclusion: Findings reveal moderate knowledge of malaria but poor prescription and dispensing practices of antimalarial drugs among vendors, thus indicating a need for routine monitoring and evaluation to prevent the emergence of resistant strains to current efficacious antimalarials.

Keywords: antimalarials, drug retail outlets, dispensing, drug resistance, prescription

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Authors: Rosy Chaudhary, Pushpa Parajuli

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Background and Objectives: Informational support to family members has a significant potential for reducing this distress related to hospitalization of their patient into the critical care unit, enabling them to cope better and support the patient. The objective of the study is to assess family members’ perception of informational support, anxiety, satisfaction with care and to reveal the association with selected socio-demographic variables and to investigate the correlation between informational support, anxiety and satisfaction with care. Materials and Methods: A descriptive cross-sectional study was conducted in 39 family caregivers of patients admitted in critical care unit of BPKIHS(B.P. Koirala Institute of Health Sciences). Consecutive sampling technique was used wherein data was collected over duration of one month using interview schedule. Descriptive and inferential statistics were used. Results: The mean age of the respondents was 34.97 ± 10.64 and two third (66.70%) were male. Mean score for informational support was 25.72(SD = 5.66; theoretical range of 10 - 40). Mean anxiety was 10.41 (SD = 5.02; theoretical range of 7 - 21). Mean score for satisfaction with care was 40.77 (SD = 6.77; theoretical range of 14 - 64). A moderate positive correlation was found between informational support and satisfaction with care (r = 0.551, p < .001) and a moderate negative correlation was found between anxiety and satisfaction with care (r = -0.590; p = 0.000). No relationship was noted between informational support and anxiety. Conclusion: The informational support and satisfaction of the family caregivers with the care provided to their patients was satisfactory. More than three fourth of the family caregivers had anxiety; the factors associated being educational status of the caregivers, the family income and duration of visiting hours. There was positive correlation between informational support and satisfaction with care provided justifying the need for comprehensive information to the family caregivers by the health personnel. There was negative correlation between anxiety and satisfaction with care.

Keywords: anxiety, caregivers, critical care unit, informational support, family

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Authors: Adela Penesova, Zofia Radikova, Boris Bajer, Andrea Havranova, Miroslav Vlcek

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Background: The aim of our study was to compare the effect of intensified lifestyle intervention on insulin resistance (HOMA-IR), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and Fibroblast growth factor (FGF) 21 after 8 weeks of lifestyle intervention. Methods: A group of 43 obese patients (13M/30F; 43.0±12.4 years; BMI (body mass index) 31.2±6.3 kg/m2 participated in a weight loss interventional program (NCT02325804) following an 8-week hypocaloric diet (-30% energy expenditure) and physical activity 150 minutes/week. Insulin sensitivity was evaluated according to the homeostasis model assessment of insulin resistance (HOMA-IR) and insulin sensitivity indices according to Matsuda and Cederholm were calculated (ISImat and ISIced). Plasma ALT, AST, Fetuin-A, FGF 21, and physical fitness were measured. Results: The average reduction of body weight was 6.8±4.9 kg (0-15 kg; p=0.0006), accompanied with a significant reduction of body fat amount of fat mass (p=0.03), and waist circumference (p=0.02). Insulin sensitivity has been improved (IR HOMA 2.71±3.90 vs 1.24±0.83; p=0.01; ISIMat 6.64±4.38 vs 8.93±5.36 p ≤ 0.001). Total, LDL cholesterol, and triglycerides decreased (p=0.05, p=0.04, p=0.04, respectively). Physical fitness significantly improved after intervention (as measure VO2 max (maximal oxygen uptake) (p ≤ 0.001). ALT decreased significantly (0.44±0.26 vs post 0.33±0.18 ukat/l, p=0.004); however, AST not (pre 0.40±0.15 vs 0.35±0.09 ukat/l, p=0.07). Hepatokine Fetuin-A significantly decreased after intervention (43.1±10.8 vs 32.6±8.6 ng/ml, p < 0.001); however, FGF 21 levels tended to decrease (146±152 vs 132±164 pg/ml, p=0.07). Conclusion: 8-weeks of diet and physical activity intervention program in obese otherwise healthy subjects led to an improvement of insulin resistance parameters and liver marker profiles, as well as increased physical fitness. This study was supported by grants APVV 15-0228; VEGA 2/0161/16.

Keywords: obesity, diet, exercice, insulin sensitivity

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Authors: Daniela Velichová

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Plenty of ideas on how to adopt active learning methods in education are available nowadays. Mathematics is a subject where the active involvement of students is required in particular in order to achieve desirable results regarding sustainable knowledge and deep understanding. The present article is based on the outcomes of an Erasmus+ project DrIVE-MATH, that was aimed at developing a novel and integrated framework to teach maths classes in engineering courses at the university level. It is fundamental for students from the early years of their academic life to have agile minds. They must be prepared to adapt to their future working environments, where enterprises’ views are always evolving, where all collaborate in teams, and relations between peers are thought for the well-being of the whole - workers and company profit. This reality imposes new requirements on higher education in terms of adaptation of different pedagogical methods, such as project-based and active-learning methods used within the course curricula. Active learning methodologies are regarded as an effective way to prepare students to meet the challenges posed by enterprises and to help them in building critical thinking, analytic reasoning, and insight to the solved complex problems from different perspectives. Fostering learning-by-doing activities in the pedagogical process can help students to achieve learning independence, as they could acquire deeper conceptual understanding by experimenting with the abstract concept in a more interesting, useful, and meaningful way. Clear information about learning outcomes and goals might help students to take more responsibility for their learning results. Active learning methods implemented by the project team members in their teaching practice, eduScrum and Jigsaw in particular, proved to provide better scientific and soft skills support to students than classical teaching methods. EduScrum method enables teachers to generate a working environment that stimulates students' working habits and self-initiative as they become aware of their responsibilities within the team, their own acquired knowledge, and their abilities to solve problems independently, though in collaboration with other team members. This method enhances collaborative learning, as students are working in teams towards a common goal - knowledge acquisition, while they are interacting with each other and evaluated individually. Teams consisting of 4-5 students work together on a list of problems - sprint; each member is responsible for solving one of them, while the group leader – a master, is responsible for the whole team. A similar principle is behind the Jigsaw technique, where the classroom activity makes students dependent on each other to succeed. Students are divided into groups, and assignments are split into pieces, which need to be assembled by the whole group to complete the (Jigsaw) puzzle. In this paper, analysis of students’ perceptions concerning the achievement of deeper conceptual understanding in mathematics and the development of soft skills, such as self-motivation, critical thinking, flexibility, leadership, responsibility, teamwork, negotiation, and conflict management, is presented. Some new challenges are discussed as brought by introducing active learning methods in the basic mathematics courses. A few examples of sprints developed and used in teaching basic maths courses at technical universities are presented in addition.

Keywords: active learning methods, collaborative learning, conceptual understanding, eduScrum, Jigsaw, soft skills

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Authors: Taslim Khan, Ray Hua Horng, Rajendra Singh

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This study presents a comprehensive analysis of the design, fabrication, and performance evaluation of a solar-blind Schottky photodetector based on ZnGa₂O₄ grown via MOCVD, utilizing Ni/Au as the Schottky electrode. ZnGa₂O₄, with its wide bandgap of 5.2 eV, is well-suited for high-performance solar-blind photodetection applications. The photodetector demonstrates an impressive responsivity of 280 A/W, indicating its exceptional sensitivity within the solar-blind ultraviolet band. One of the device's notable attributes is its high rejection ratio of 10⁵, which effectively filters out unwanted background signals, enhancing its reliability in various environments. The photodetector also boasts a photodetector responsivity contrast ratio (PDCR) of 10⁷, showcasing its ability to detect even minor changes in incident UV light. Additionally, the device features an outstanding detective of 10¹⁸ Jones, underscoring its capability to precisely detect faint UV signals. It exhibits a fast response time of 80 ms and an ON/OFF ratio of 10⁵, making it suitable for real-time UV sensing applications. The noise-equivalent power (NEP) of 10^-17 W/Hz further highlights its efficiency in detecting low-intensity UV signals. The photodetector also achieves a high forward-to-backward current rejection ratio of 10⁶, ensuring high selectivity. Furthermore, the device maintains an extremely low dark current of approximately 0.1 pA. These findings position the ZnGa₂O₄-based Schottky photodetector as a leading candidate for solar-blind UV detection applications. It offers a compelling combination of sensitivity, selectivity, and operational efficiency, making it a highly promising tool for environments requiring precise and reliable UV detection.

Keywords: wideband gap, solar blind photodetector, MOCVD, zinc gallate

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Authors: Tali Capua, Karin Hermon, Miguel Glatstein, Oren Tavor, Ayelet Rimon

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Background: Electric bicycles (E-bikes) are one of a wide range of light electric vehicles that provide convenient local transportation and attractive recreational opportunities. Along with their growing use worldwide, the E-bike related injury rate increases. To the best of our knowledge, this study is the first to specifically compare E-bike with classic bicycle related injuries in children. Methods: Data of all pediatric ( < 16 years of age) bicycle related injuries presenting to an urban level I trauma center between 2014 and 2015 were collected and analyzed. The recorded data included age, gender, details of the accident, as well severity of injury, medical diagnosis, and the outcome. Abbreviated Injury Score (AIS) and Injury Severity Score (ISS) were calculated for each patient. Data of E-bike related injuries and classic bicycle were then compared. Results: A total of 124 bicycle related injuries and 97 E-bike related injuries presented to the emergency department. Once pedestrians and bicycle passengers were removed, the groups of riders consisted of 111 bikers and 85 E-bikers. The mean age of bikers was 9.9 years (range 3-16 years) and of E-bikers was 13.7 years (range 7.5-16 years). Injuries to the head and the extremities were common in both groups. Compared to bikers, E-bikers had significantly more injuries to intra-abdominal organs (p = 0.04). Twenty patients (16%) with bicycle related injuries were admitted, and 13 (15%) patients with E-bike related injuries, of the latter group four underwent surgical intervention. ISS scores were low overall, but the injuries of higher severity (ISS > 9) were among the E-bikers. Conclusions: This study provides unique information which suggests that injuries in E-bikers tend to be more severe than in classic bikers. There is a need for regulation regarding the use of E-bikes to enhance the safety of both bikers and other road and pavement users.

Keywords: bicycle, electric bicycle, injury, pediatric, trauma

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Authors: Lucile Soudani, Hervé Illy, Rémi Bouchié

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Mould growth in living environments has been widely reported for decades all throughout the world. A higher level of moisture in housings can lead to building degradation, chemical component emissions from construction materials as well as enhancing mould growth within the envelope elements or on the internal surfaces. Moreover, a significant number of studies have highlighted the link between mould presence and the prevalence of respiratory diseases. In recent years, the proportion of biobased materials used in construction has been increasing, as seen as an effective lever to reduce the environmental impact of the building sector. Besides, bio-based materials are also hygroscopic materials: when in contact with the wet air of a surrounding environment, their porous structures enable a better capture of water molecules, thus providing a more suitable background for mould growth. Many studies have been conducted to develop reliable models to be able to predict mould appearance, growth, and decay over many building materials and external exposures. Some of them require information about temperature and/or relative humidity, exposure times, material sensitivities, etc. Nevertheless, several studies have highlighted a large disparity between predictions and actual mould growth in experimental settings as well as in occupied buildings. The difficulty of considering the influence of all parameters appears to be the most challenging issue. As many complex phenomena take place simultaneously, a preliminary study has been carried out to evaluate the feasibility to sadopt a reliability approach rather than a deterministic approach. Both epistemic and random uncertainties were identified specifically for the prediction of mould appearance and growth. Several studies published in the literature were selected and analysed, from the agri-food or automotive sectors, as the deployed methodology appeared promising.

Keywords: bio-based materials, mould growth, numerical prediction, reliability approach

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Authors: Seyed Saeid Nabavi

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Background: Many infants with intrauterine growth disorder are screened for TORCH infections. This action has no economic justification in terms of the imposed costs. In this regard, due to the research gap in this field, this study aimed to investigate the relationship between intrauterine growth disorder and TORCH infection in neonates referred to Milad hospital in 2019 and 2020. Materials and Methods: In this cross-sectional study, 41IUGR newborns were selected and evaluated based on diagnostic and clinical studies in Milad Hospital in 2019 and 2020. TORCH results found in IgG and IgM antibody titer assay were tested in mother and infant. Antibody titers of toxoplasmosis, rubella, cytomegalovirus, herpes, and syphilis were determined in cases, and other variables were compared. The collected data were entered in SPSS software 25 and analyzed at a significant level of 0.05 using the statistical tests of Kolmogorov–Smirnov, Shapiro–Wilk, chi-square, and Mann–Whitney. Results: Most of the IUGR infants studied were girls (68.3%), Gravida and Parity were reported to be 68.3% and 80%, respectively, in the study. Mean weight, APGAR score, and neonatal gestational age are reported as 1710.62±334.43 g, 7.71±1.47, and 35.7+ 1.98 weeks, respectively. Most of the newborns were born by cesarean section (92.7%). TORCH infection was reported in three patients, 7.3%. The mean gestational age of IUGR infants with TORCH infection was reported to be less than other babies with IUGR. Therefore, the mean gestational age of subjects with TORCH infection was 33±1.4 weeks and in others 35.94±1.91 weeks (p-value = 0.038). No significant relationship between TORCH infection and gender, gravidity, and parity of newborns was found (p-value > 0.05). Conclusion: TORCH infection was reported in 3 patients( 7.3%). No significant relationship between TORCH infection and gender, gravidity, and parity of newborns was found. p-value > 0.05

Keywords: congenital infection, intrauterine growth restriction, TORCH infections, neonates

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Authors: Eric Beyegue, Boris Azantza, Judith Laure Ngondi, Julius E. Oben

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Background: Dietary supplement may potentially help to fight obesity and other metabolic disorders such as adipogenesis, insulin resistance, and inflammation. The present study aimed to test whether supplementation with African walnuts (Aw) could have an effect on adipogenesis and others dysfunctions associated with obesity in rats. Methods: Wistar rats were fed with standard diet (SD) or high-fat high-sucrose diet (HFS) and HFS with supplemented (HFS-Aw) for eight weeks. Results: HFS diet-induced body weight gain and increased fat mass compared to SD. In addition HFS-fed rats developed fasting hyperglycaemia and insulinaemia as well as insulin resistance. Aw supplementation in HFS rats had a protective effect against adipose tissues weigh gain but slightly against body weight gain and major study related disorders. This could be mainly due to decreased food intake dependently of effect in food intake in central nervous system, which decreased in HFS rats supplemented with African walnut compared to the HFS-diet group. Interestingly, African walnut supplementation induced a slight decrease of fasting glycaemia, insulinaemia and Nitric Oxide which could partially explain its minor protective effect against diet-induced insulin resistance. Additionally a decrease in hepatic TG and transaminases levels suggesting a protective effect against liver injury. Conclusion: Taken together these data suggested that supplementation of African walnut could be used to prevent adipose weight gain and related disorders on the other hand, minimally reduced insulin resistance.

Keywords: African walnut, dietary fiber, insulin resistance, oxidative stress

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Authors: Walaa H. Salama, Azza M. Abdel-Aty, Afaf S. Fahmy

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Background: Egyptian Cobra; Naja haje (Elapidae) is one of most common snakes, widely distributed in Egypt and its envenomation causes multi-organ failure leading to rapid death. Thus, Different medicinal plants showed a protective effect against venom toxicity and may complement the conventional antivenom therapy. Aim: The present study was designed to assess both the antioxidant capacity of methanolic extract of rosemary leaves and evaluate the neutralizing ability of the extract against hepatotoxicity induced by Naja haje venom. Methods: The total phenolic and flavonoid contents and the antioxidant capacity of the methanolic rosemary extract were estimated by DPPH and ABTS Scavenging methods. In addition, the rosemary extract were assessed for anti-venom properties under in vitro and in vivo standard assays. Results: The rosemary extract had high total phenolic and flavonoid content as 12 ± 2 g of gallic acid equivalent per 100 gram of dry weight (g GAE/100g dw) and 5.5 ± 0.8 g of catechin equivalent per 100 grams of dry weight (g CE/100g dw), respectively. In addition, the rosemary extract showed high antioxidant capacity. Furthermore, The rosemary extract were inhibited in vitro the enzymatic activities of phospholipase A₂, L-amino acid oxidase, and hyaluronidase of the venom in a dose-dependent manner. Moreover, indirect hemolytic activity, hepatotoxicity induced by venom were completely neutralized as shown by histological studies. Conclusion: The phenolic compounds of rosemary extract with potential antioxidant activity may be considered as a promising candidate for future therapeutics in snakebite therapy.

Keywords: antioxidant activity, neutralization, phospholipase A₂ enzyme, snake venom

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Authors: Lian Tong, Yan Ye, Qiong Yan

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Background: Children with attention-deficit/hyperactivity disorder (ADHD) often experience sleep problems, but the comorbidity mechanism has not been sufficiently studied. This study aimed to determine the comorbidity of ADHD and sleep problems as well as the moderating effects of bedtime activities and depression/anxiety symptoms on the relationship between ADHD and sleep problems. Methods: We recruited 934 primary students from third to fifth grade and their parents by stratified random sampling from three primary schools in Shanghai, China. This study used parent-reported versions of the ADHD Rating Scale-IV, Children’s Sleep Habits Questionnaire, and Achenbach Child Behavior Checklist. We used hierarchical linear regression analysis to clarify the moderating effects of bedtime activities and depression/anxiety symptoms. Results: We found that children with more ADHD symptoms had shorter sleep durations and more sleep problems on weekdays. Screen time before bedtime strengthened the relationship between ADHD and sleep-disordered breathing. Children with more screen time were more likely to have sleep onset delay, while those with less screen time had more sleep onset problems with increasing ADHD symptoms. The high bedtime eating group experienced more night waking with increasing ADHD symptoms compared with the low bedtime eating group. Anxiety/depression exacerbated total sleep problems and further interacted with ADHD symptoms to predict sleep length and sleep duration problems. Conclusions: Bedtime activities and emotional problems had important moderating effects on the relationship between ADHD and sleep problems. These findings indicate that appropriate bedtime management and emotional management may reduce sleep problems and improve sleep duration for children with ADHD symptoms.

Keywords: ADHD, sleep problems, anxiety/depression, bedtime activities, children

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Authors: Lingxia Li, Frédéric Schnell, Shuzhe Ding, Solène Le Douairon Lahaye

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Background: The prevalence of cardiovascular diseases (CVD) in different triathlon sports disciplines has not been determined. Purpose: The present study aimed to determine the prevalence of CVD in world-class triathletes according to their sex, sports disciplines (aquathlon, duathlon, triathlon…), and formats (short/medium, long, and ultra-long distance). Methods: Male and female elite athletes from eleven triathlon sport disciplines, ranked in the internationally yearly top 10 between 2006 and 2019, were included. The athlete’s name was associated in a Google search with selected key terms related to heart disease and/or cardiac abnormalities. The prevalence and the hazard function of the variation were calculated, and the differences were then compared. Results: From 1329 athletes (male 639, female 690), 13 cases of CVD (0.98%, 95% CI: [0.45-1.51]) were identified, and the mean age of their occurrence was 29±6 years. Although no sex differences were found in each sport discipline/format (p > 0.05), severe outcomes (sudden cardiac arrest/death and those who had to stop their sports practice) were only observed in males. Short-distance triathlon (5.08%, 95% CI: [1.12-9.05]) was more affected than other disciplines in short/medium, long, and ultra-long formats. The prevalence of CVD in athletes who participated in multi-type of sports disciplines (4.14%, 95% CI: [1.14-7.15]) was higher than in those who participated in one type (0.52%, 95% CI: [0.10-0.93]) (p = 0.0004). Conclusion: Athletes in short-distance triathlon were more affected than other disciplines in short/medium, long and ultra-long formats. Athletes who participate in short/medium distances and those who participate in multi-type of sports disciplines should be closely monitored regardless of sex.

Keywords: cardiovascular diseases, sudden cardiac death, triathlon sport disciplines, world-class athletes

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Authors: Md Tareq Ferdous Khan, Shrabanti Mazumder, MB Rao

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Background: Substance use during pregnancy is a longstanding public health problem that results in severe consequences for pregnant women and fetuses. Methods: Eight (2011-2018) datasets on pregnant women’s admissions are extracted from TEDS-A. Distributions of sociodemographic, substance abuse behaviors, and clinical characteristics are constructed and compared over the years for trends by the Cochran-Armitage test. Market basket analysis is used in mining the association among polysubstance abuse. Results: Over the years, pregnant woman admissions as the percentage of total and female admissions remain stable, where total annual admissions range from 1.54 to about 2 million with the female share of 33.30% to 35.61%. Pregnant women aged 21-29, 12 or more years of education, white race, unemployed, holding independent living status are among the most vulnerable. Concerns prevail on a significant number of polysubstance users, young age at first use, frequency of daily users, and records of prior admissions (60%). Trends of abused primary substances show a significant rise in heroin (66%) and methamphetamine (46%) over the years, although the latest year shows a considerable downturn. On the other hand, significant decreasing patterns are evident for alcohol (43%), marijuana or hashish (24%), cocaine or crack (23%), other opiates or synthetics (36%), and benzodiazepines (29%). Basket analysis reveals some patterns of co-occurrence of substances consistent over the years. Conclusions: This comprehensive study can work as a reference to identify the most vulnerable groups based on their characteristics and deal with the most hazardous substances from their evidence of co-occurrence.

Keywords: basket analysis, pregnant women, substance abuse, trend analysis

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Authors: Alejandro Rodríguez-Molinero, Carlos Pérez-López, Jorge Hernández-Vara, Àngels Bayes-Rusiñol, Juan Carlos Martínez-Castrillo, David A. Pérez-Martínez

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Background: Monitoring motor symptoms in Parkinson's patients is often a complex and time-consuming task for clinicians, as Hauser's diaries are often poorly completed by patients. Recently, new automatic devices (Parkinson's holter: STAT-ON®) have been developed capable of monitoring patients' motor fluctuations. The MoMoPa-EC clinical trial (NCT04176302) investigates which of the two methods produces better clinical results. In this sub-analysis, the concordance between both methods is analyzed. Methods: In the MoMoPa-EC clinical trial, 164 patients with moderate-severe Parkinson's disease and at least two hours a day of Off will be included. At the time of patient recruitment, all of them completed a seven-day motor fluctuation diary at home (Hauser’s diary) while wearing the Parkinson's holter. In this sub-analysis, 71 patients with complete data for the purpose of this comparison were included. The intraclass correlation coefficient was calculated between the patient diary entries and the Parkinson's holter data in terms of time On, Off, and time with dyskinesias. Results: The intra-class correlation coefficient of both methods was 0.57 (95% CI: 0.3-0.74) for daily time in Off (%), 0.48 (95% CI: 0.14-0.68) for daily time in On (%), and 0.37 (95% CI %: -0.04-0.62) for daily time with dyskinesias (%). Conclusions: Both methods have a moderate agreement with each other. We will have to wait for the results of the MoMoPa-EC project to estimate which of them has the greatest clinical benefits. Acknowledgment: This work is supported by AbbVie S.L.U, the Instituto de Salud Carlos III [DTS17/00195], and the European Fund for Regional Development, 'A way to make Europe'.

Keywords: Parkinson, sensor, motor fluctuations, dyskinesia

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Authors: Thelma Mort

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This empirical, qualitative research uses interviews of four intermediate phase English language student teachers at one university in South Africa and is an exploration of student teacher learning on their teaching practicum in their penultimate year of the initial teacher education course. The country’s post-apartheid language in education policy provides a context to this study in that children move from mother tongue language of instruction in foundation phase to English as a language of instruction in Intermediate phase. There is another layer of context informing this study which is the school context; the student teachers’ reflections are from their teaching practicum in resource constrained schools, which make up more than 75% of schools in South Africa. The findings were that in these schools, deep biases existed to local languages, that language was being used as a proxy for social class, and that conditions necessary for language acquisition were absent. The student teachers’ attitudes were in contrast to those found in the schools, namely that they had various pragmatic approaches to overcoming obstacles and that they saw language as enabling interdisciplinary work. This study describes language issues, tensions created by policy in South African schools and also supplies a regional account of learning to teach in resource constrained schools in Cape Town, where such language tensions are more inflated. The central findings in this research illuminate attitudes to language and language education in these teaching practicum schools and the complexity of learning to be a language teacher in these contexts. This study is one of the few local empirical studies regarding language teaching in the classroom and language teacher education; as such it offers some background to the country’s poor performance in both international and national literacy assessments.

Keywords: language teaching, narrative, post apartheid, South Africa, student teacher

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Authors: Hannah S. Waldron

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Background: The government has proposed sugar reduction targets in an effort to tackle childhood obesity, focussing on those of low socioeconomic status (SES). Supermarkets are a key location for reducing the amount of sugar purchased, but success so far in this environment has been limited. Building on previous research, this study will assess the impact of restricting the availability of higher sugar biscuits as a strategy to encourage lower sugar biscuit purchasing, and whether the effects vary by customer SES. Method: 14 supermarket convenience stores were divided between control (n=7) and intervention (n=7) groups. In the intervention stores, biscuits with sugar above the government’s target (26.2g/100g) were removed from sale and replaced with lower sugar ( < 26.2g sugar/100g) alternatives. Sales and customer demographic information were collected using loyalty card data and point-of-sale transaction data for 8-weeks pre and post the intervention for lower sugar biscuits, total biscuits, alternative higher sugar products, and all products. Results were analysed using three-way and two-way mixed ANOVAs. Results: The intervention resulted in a significant increase in lower sugar biscuit purchasing (p < 0.001) and a significant decline in overall biscuit sales (p < 0.001) between the time periods compared to control stores. Sales of higher sugar products and all products increased significantly between the two time periods in both the intervention and control stores (p < 0.05). SES showed no significant effect on any of the reported outcomes (p > 0.05). Conclusion: Restricting the availability of higher sugar products may be a successful strategy for encouraging lower sugar purchasing across all SES groups. However, larger-scale interventions are required in additional categories to assess the long term implications for both consumers and retailers.

Keywords: biscuits, nudging, sugar, supermarket

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Authors: Khulood Zahran

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Background and Purpose: The effects of backpack on 'school-age' children (Age 9–12) years, have been a critical subject of discussion throughout the past years. It has been one of the factors that contribute to a bad posture for 40% to 70% of developed countries. A child carrying a heavy backpack for a prolonged period, on a daily base has shown significant changes in the child's spinal posture, foot shape, and gait. The back pain caused by the compensatory posture, or "Backpack syndrome", is also known for its headaches, fatigue, cervical and lumber pain caused by the abnormal body posture. The child tends to balance himself by bending forward to match the heavy backpack, moving his Centre of Gravity forward, resulting in decreased lumber lordosis and increased thoracic kyphosis. Since currently available bags have not addressed the weight distribution issue till now. Therefore, KZ bag is believed to prevent the huge backward shift of COG due to the load, and hence all the symptoms accompanied. This is thought to be possible by combining the design of a normal backpack with a messenger bag. The purpose of this study is to investigate the improvement of the child's spine and to minimize the compensatory posture after using the KZ bag. Materials and Methods: KZ bag would compromise the pros of a messenger bag (keeping the COG in place) by a diagonal load strap and of a backpack (distributing the load on both shoulders) by connecting another load strap parallel to the sagittal plane of the body. The design would be made adjustable to match the child's height, and the bag load kept within limits, (10-15%) of the child's body weight. Measurements of Postural angles (Cervical, shoulders, and Trunk) would be taken after the use of KZ bag for a specified period. Conclusion: KZ bag will prove an improved distribution of weight of the bag on the child's body, and reduce the degree of the compensatory posture, that occurs in the attempt to balance the external weight of the bag.

Keywords: backpack, backpack syndrome, posture, spine

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Authors: Pinal Patel

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The study defines the problems and issues of women in Maoist groups, also referred as ‘Naxalites’, in Chhattisgarh, India. It analyses the causes and consequences of increasing number of women joining Maoists groups and measures taken by the central and state government to retreat them. The main aspect of the study is, how to counter the challenges to resolve the issues and restore normalcy in the life of women Maoists to resettle them in mainstream once they become physically inactive and wish to become part of the society. The rationale behind this study is that women Maoists once inactive, has no place either with Maoist camps/rebel groups or particularly in society. The problems faced by the women Maoists, in society as well as in Maoists camps, can be studied through social, economic, cultural, political and humanitarian aspects. The methodology of the study is dependent on primary sources of information which includes a research survey in majorly affected areas, statistical analysis. Secondary sources of information are helpful for understanding the background of the problem. Government’s strategy of rewarding with cash and providing resettlement and rehabilitation benefits including houses and jobs to ex-women Maoists and their families is a well formulated and feasible policy and effectively implemented by the concerned authorities. But, the survey results show that the policy has not been able to have impacts as it was intended. Because inactive and physically disabled women are still left deserted in deep forests to die and police or authorities are not able to reach them and bring them back. The difficult terrain and dense forest areas are major hurdles to reach to Maoists camps. Moreover, to make people aware of government’s surrendering and rehabilitation schemes and policies as communication networks are very poor due to the lack of development in the state.

Keywords: maoists, women, government, policy

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Authors: Ni Luh Putu Harta Wedari

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Background: Clostridium difficile has two main virulence factors, namely TcdA and TcdB. TcdA encoded by the tcdA gene acts as an enterotoxin, pro-inflammatory and fluid accumulation, while TcdB encoded by the tcdB gene is cytotoxic, causes disruption of the actin cytoskeleton, and causes disruption of tight junctions in colon cells. This study aims to explore the relationship between the tcdA and tcdB genes and the duration of diarrhea in elderly patients. Method: This research was an observational analytic with a prospective cross-sectional with samples of elderly diarrhea patients who met the inclusion criteria in Denpasar City health service facilities from 1 December 2022 until 30 June 2023, and then their feces were analyzed using the real-time PCR method. Results: In this study, 40 elderly diarrhea patients met the inclusion criteria and in accordance with the minimum sample size, 28 (70%) men and 12 (30%) women. 5 patients (12.5%) had a history of azithromycin, 4 (10%) levofloxacin, 17 (42.5%) ciprofloxacin, 8 (20%) metronidazole, 1 (2.5%) cefoperazone, 5 (12, 5%) doxycycline. Comorbids, namely 13 (32.5%) type II diabetes mellitus, 4 (10%) chronic kidney disease, 10 (25%) malignancies, 7 (17.5%) urinary tract infections, 3 (7.5%) %) immunocompromised, 2 (5%) cardiac heart failure, and 1 (2.5%) acute on chronic kidney disease. The overall diarrhea duration average was 5 days. 8 samples (20%) were positive for 16s rRNA, and there was no significant difference in diarrhea duration with negative samples (p=0.166). The relationship between the tcdA gene and the duration of diarrhea could not be performed because all samples were negative. Likewise, relationship analysis between the coexistence of tcdA and tcdB could not be performed. There was no significant difference between tcdB positive 3 (7.5%) and negative with diarrhea duration (p=0.739). Conclusion: There is no significant relationship between the presence of the 16s rRNA and tcdB C. difficile genes with the duration of diarrhea in elderly patients.

Keywords: clostridium, difficile, diarrhea, elderly, tcdA, tcdB

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Authors: Fergus Wade, Jasmine Makker, Matthew Jankinson, Aminah Qamar, Gemma Morrelli, Shayan Shah

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Background: Ambulance offload delays (AODs) affect patient outcomes. At baseline, the average AOD at Princess Royal University Hospital (PRUH) was 41 minutes, in breach of the 15-minute target. Aims: By February 2023, we aimed to reduce: the average AOD to 30 minutes percentage of AOD >30 minutes (PA30) to 25% and >60 minutes (PA60) to 10% Methods: Following a root-cause analysis, we implemented 2 Plan, Do, Study, Act (PDSA) cycles. PDSA-1 ‘Drop-and-run’: ambulances waiting >15 minutes for a handover left the patients in the Emergency Department (ED) and returned to the community. PDSA-2: Booking in the patients before the handover, allowing direct updates to online records, eliminating the need for handwritten notes. Outcome measures: AOD, PA30, and PA60, and process measures: total ambulances and patients in the ED were recorded for 16 weeks. Results: In PDSA-1, all parameters increased slightly despite unvarying ED crowding. In PDSA-2, two shifts in data were seen: initially, a sharp increase in the outcome measures consistent with increased ED crowding, followed by a downward shift when crowding returned to baseline (p<0.01). Within this interval, the AOD reduced to 29.9 minutes, and PA30 and PA60 were 31.2% and 9.2% respectively. Discussion/conclusion: PDSA-1 didn’t result in any significant changes; lack of compliance was a key cause. The initial upward shift in PDSA-2 is likely associated with NHS staff strikes. However, during the second interval, the AOD and the PA60 met our targets of 30 minutes and 10%, respectively, improving patient flow in the ED. This was sustained without further input and if maintained, saves 2 paramedic shifts every 3 days.

Keywords: ambulance offload, district general hospital, handover, quality improvement

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Authors: Bekan Bogale, Tsegaye Girma Asere, Tilahun Yai, Fekadu Melak

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Aims: To study photocatalytic degradation of methylene blue dye on cuprous oxide/graphene nanocomposite. Background: Cuprous oxide (Cu2O) nanoparticles are among the metal oxides that demonstrated photocatalytic activity. However, the stability of Cu2O nanoparticles due to the fast recombination rate of electron/hole pairs remains a significant challenge in their photocatalytic applications. This, in turn, leads to mismatching of the effective bandgap separation, tending to reduce the photocatalytic activity of the desired organic waste (MB). To overcome these limitations, graphene has been combined with cuprous oxides, resulting in cuprous oxide/graphene nanocomposite as a promising photocatalyst. Objective: In this study, Cu2O/graphene nanocomposite was synthesized and evaluated for its photocatalytic performance of methylene blue (MB) dye degradation. Method: Cu2O/graphene nanocomposites were synthesized from graphite powder and copper nitrate using the facile sol-gel method. Batch experiments have been conducted to assess the applications of the nanocomposites for MB degradation. Parameters such as contact time, catalyst dosage, and pH of the solution were optimized for maximum MB degradation. The prepared nanocomposites were characterized by using UV-Vis, FTIR, XRD, and SEM. The photocatalytic performance of Cu2O/graphene nanocomposites was compared against Cu2O nanoparticles for cationic MB dye degradation. Results: Cu2O/graphene nanocomposite exhibits higher photocatalytic activity for MB degradation (with a degradation efficiency of 94%) than pure Cu2O nanoparticles (67%). This has been accomplished after 180 min of irradiation under visible light. The kinetics of MB degradation by Cu2O/graphene composites can be demonstrated by the second-order kinetic model. The synthesized nanocomposite can be used for more than three cycles of photocatalytic MB degradation. Conclusion: This work indicated new insights into Cu2O/graphene nanocomposite as high-performance in photocatalysis to degrade MB, playing a great role in environmental protection in relation to MB dye.

Keywords: methylene blue, photocatalysis, cuprous oxide, graphene nanocomposite

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Authors: Amare Nigatu, Mågne Bratveit, Bente E. Moen

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Background: Pesticide exposure is an important public health concern in Ethiopia, but there is limited information on pesticide intoxications. Residents may have an increased risk of pesticide exposure through proximity of their homes to farms using pesticides. Also the pesticide exposure might be related to employment at these farms. This study investigated the prevalence of acute pesticide intoxications (API) by residence proximity to a nearby flower farm and assessed if intoxications are related to working there or not. Methods: A cross-sectional survey involving 516 persons was conducted. Participants were grouped according to their residence proximity from a large flower farm; living within 5 kilometers and 5-12 kilometers away, respectively. In a structured interview, participants were asked if they had health symptoms within 48 hours of pesticide exposure in the past year. Those, who had experienced this and reported two or more typical pesticide intoxication symptoms, were considered as having had API. Chi-square and independent t-tests were used to compare categorical and continuous variables, respectively. Confounding variables were adjusted by using binomial regression model. Results: The prevalence of API in the past year among the residents in the study area was 26%, and it was higher in the population living close to the flower farm (42%) compared to those living far away (11%), prevalence ratio (PR) = 3.2, 95% CI: 2.2-4.8, adjusted for age, gender & education. A subgroup living close to the farm & working there had significantly more API (56%) than those living close & did not work there (16%), adjusted PR = 3.0, 95% CI: 1.8-4.9. Flower farm workers reported more API (56%) than those not working there (13%,), adjusted PR = 4.0, 95% CI: 2.9-5.6. Conclusion: The residents living closer than 5 kilometers to the flower farm reported significantly higher prevalence of API than those living 5-12 kilometers away. This increased risk of API was associated with work at the flower farm.

Keywords: acute pesticide intoxications, self-reported symptoms, flower farm workers, living proximity

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Authors: Mitchell Stanton

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Background: Endovascular management is well established as a mainstay treatment option for cerebral aneurysms. It is also well established that immediate post procedural imaging can be difficult to interpret due to the presence of contrast material. However, through the use of Dual-Energy computed tomography, it has become possible to differentiate contrast extravasation and intracranial haemorrhage. This case illustrates the importance of this technology following endovascular treatment of an unruptured cerebral aneurysm. Case Presentation: A 79-year-old female was found to have an unruptured large intracavernous ICA fusiform aneurysm on CT Brain Angiogram after presenting with acute ophthalmoplegia. This ophthalmoplegia was caused by mass effect from the aneurysm and subsequently the aneurysm was treated with an endovascular flow diverting stent. CT brain was performed post operatively due to a reduced level of consciousness and this showed diffuse subarachnoid hyperdensity of the left hemisphere. The use of Dual-Energy CT allowed accurate differentiation and illustrated diffuse contrast material extravasation, allowing patient to continue on dual-antiplatelets and therapeutic anticoagulation to reduce the risk of ischaemic injury post endovascular stent. Conclusion: Endovascular treatment options for management of intracranial aneurysms are constantly evolving. The use of Dual-Energy CT therefore has an integral role in accurately diagnosing any post-operative complications. Specifically, differentiating between subarachnoid haemorrhage and contrast extravasation is vital in these patients due to the significant consequences to their ongoing management in regards to continuation or cessation of antiplatelets or anticoagulation. With increasing access to this technology, its use should become standard practice in the post-operative investigation of these patients undergoing endovascular treatment.

Keywords: aneurysm, computed tomography, contrast extravasation, dual-energy CT, endovascular, subarachnoid haemorrhage

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Authors: K. D. Candido, A. Lissounov, I. Knezevic, N. Knezevic

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Background: The most commonly performed pain procedures in the USA is Lumbar Epidural Steroid Injections (LESI). There are three main types of these procedures: transforaminal (TF), interlaminar (IL) and caudal injections. It is expected for TF injections to have better outcomes than IL injections, based on the recently published systematic review. The studies presented in that review used a midline IL approach, but those with parasagittal IL approach were not taken into consideration. Our aim is to emphasize the efficacy of the lateral parasagittal (paramedian) IL approach in this review. Methods: We included five studies in this systematic review, which compared Parasagittal-IL (PIL) with either Midline-IL (MIL) or TF LESI. Total of 296 patients who had undergone different types of LESI were observed across the five studies, and the average pain and functional improvements were calculated and compared among groups. Results: Pain and function improvements with PIL approach is superior on 12 months follow up to MIL approach (53.4% vs. 14.7%) and (55% vs. 27.7%), respectively. A 12 months follow-up results between PIL and TF shows a near equivalent effectiveness for pain (58.9% vs. 63.2%) and function improvement (47.3% vs. 48.1%). An average follow-up of 17.1 days have shown better short-term pain relief for PIL than TF approach (45.8% vs. 19.2%), respectively. Number of repeated injections is lower for PIL injections than MIL. Number of weeks between 1st and 2nd injections: PIL averaged 15.8 weeks and MIL averaged 9.7 weeks. Third LESI injection is more common in TF group (30%) than PIL group (18.8%). Conclusion: Higher complication rates are associated with TF injections for which FDA7 issued an official warning. We have recorded better outcomes in pain and function improvement of Parasagittal-IL LESI as compared to midline-IL injection, in the presented systematic review. Parasagittal and TF injections have equivalent efficacy in Pain and Function improvements thus we advocate for Parasagittal-IL approach consideration as an alternative for TF injections.

Keywords: parasagital approach, lumbar, back pain, epidural steroid injection

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