Search results for: clinical care

Authors: Katalin Gombos, Bence Gálik, Krisztina Ildikó Kalács, Krisztina Gödöny, Ákos Várnagy, József Bódis, Attila Gyenesei, Gábor L. Kovács

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Although non-invasive pre-implantation genetic testing for aneuploidy (NIPGT-A) is potentially appropriate to assess chromosomal ploidy of the embryo, practical application of it in a routine IVF center has not been started in the absence of a recommendation. We developed a comprehensive workflow for a clinically applicable strategy for NIPGT-A based on next-generation sequencing (NGS) technology. We performed MALBAC whole genome amplification and NGS on spent blastocyst culture media of Day 3 embryos fertilized with intra-cytoplasmic sperm injection (ICSI). Spent embryonic culture media of morphologically good quality score embryos were enrolled in further analysis with the blank culture media as background control. Chromosomal abnormalities were identified by an optimized bioinformatics pipeline applying a copy number variation (CNV) detecting algorithm. We demonstrate a comprehensive workflow covering both wet- and dry-lab procedures supporting a clinically applicable strategy for NIPGT-A. It can be carried out within 48 h which is critical for the same-cycle blastocyst transfer, but also suitable for “freeze all” and “elective frozen embryo” strategies. The described integrated approach of non-invasive evaluation of embryonic DNA content of the culture media can potentially supplement existing pre-implantation genetic screening methods.

Keywords: next generation sequencing, in vitro fertilization, embryo assessment, non-invasive pre-implantation genetic testing

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Authors: Maha Saliba Foster

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Speech perception has been recognized as a bi-sensory process involving the auditory and visual channels. Compared to the auditory modality, the contribution of the visual signal to speech perception is not very well understood. Studying how the visual modality affects speech recognition can have pedagogical implications in second language learning, as well as clinical application in speech therapy. The current investigation explores the potential effect of speech visual cues on the perception of Arabic emphatics (AEs). The corpus consists of 36 minimal pairs each containing two contrasting consonants, an AE versus a non-emphatic (NE). Movies of four Lebanese speakers were edited to allow perceivers to have partial view of facial regions: lips only, lips-cheeks, lips-chin, lips-cheeks-chin, lips-cheeks-chin-neck. In the absence of any auditory information and relying solely on visual speech, perceivers were above chance at correctly identifying AEs or NEs across vowel contexts; moreover, the models were able to predict the probability of perceivers’ accuracy in identifying some of the COIs produced by certain speakers; additionally, results showed an overlap between the measurements selected by the computer and those selected by human perceivers. The lack of significant face effect on the perception of AEs seems to point to the lips, present in all of the videos, as the most important and often sufficient facial feature for emphasis recognition. Future investigations will aim at refining the analyses of visual cues used by perceivers by using Principal Component Analysis and including time evolution of facial feature measurements.

Keywords: Arabic emphatics, machine learning, speech perception, visual speech perception

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Authors: Sonila Robo, Ilma Robo, Eduart Kapaj, Saimir Heta

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Background: Early birth is 37 weeks or less, pregnancy maturity! Clinically active presence, or positive culture of vaginal secretions, means excessive production of cytokines and prostaglandins also encountered in amniotic fluid. Bacterial vaginosis appears with their clinical outbreak in a combination of bacteria. Some of these bacteria are basic members in the creation of bacterial plaque. Objective: The purpose of this study is to find the link between the presence of specific bacteria in the mouth, bacterial vaginosis as one of the causes of premature birth, and the latter. Methods: The study was applied to 30 pregnant women in the burden pathology ward at Fier maternity, divided into two groups. The first group consisting of 20 women in the 2-month period, August-September. The number of women in the ward was 10 days maximum! All women were treated with cortisone and serum IV, magnesium sulphate, antibiotic prophylaxis! Results: 55% of women were under the age of 25 and 45% of women were over the age of 25. The age effect is mentioned for classifying the diseases that causes Actinomyces. Under the age of 25, a teenager and a 25-year-old are chronically ill. The final index was G2! All females were positive for the presence of salicylic acid in saliva and vaginal secretions. Conclusions:Premature birth is a complex process with some gynecological reasons, but in high percentage of cases there is coverage with the presence of infection by Actinomyces Actinomycetemcomitans in the oral cavity, which depending on the age causes two different types of periodontitis with special characteristics.

Keywords: early birth, periodontal status, bacterial vaginosis, actinomyces actinomycetemcomitans

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Authors: Fatima M. Jadu, Asmaa A. Alzahrani, Maha A. Almutairi, Salma O. Al-Amoudi, Mawya A. Khafaji

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Introduction: Estimating the potential radiation risk for a widely used imaging technique such as cone beam CT (CBCT) is crucial. The aim of this study was to examine the effect of varying two CBCT technical factors, the voxel size (VOX) and the Field-of-View (FOV) centralization, on the radiation dose. Methodology: The head and neck slices of a RANDO® man phantom (Alderson Research Laboratories) were used with nanoDot™ OSLD dosimeters to measure the absorbed radiation dose at 25 predetermined sites. Imaging was done using the i-CAT® (Imaging Science International, Hatfield, PA, USA) CBCT unit. The VOX was changed for every three cycles of exposures from 0.2mm to 0.3mm and then 0.4mm. Then the FOV was centered on the maxilla and mandible alternatively while holding all other factors constant. Finally, the effective radiation dose was calculated for each view and voxel setting. Results: The effective radiation dose was greatest when the smallest VOX was chosen. When the FOV was centered on the maxilla, the highest radiation doses were recorded in the eyes and parotid glands. While on the mandible, the highest radiation doses were recorded in the sublingual and submandibular glands. Conclusion: Minor variations in the CBCT exposure factors significantly affect the effective radiation dose and thus the radiation risk to the patient. Therefore, extreme care must be taken when choosing these parameters especially for vulnerable patients such as children.

Keywords: CBCT, cone beam CT, effective dose, field of view, mandible, maxilla, resolution, voxel

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Authors: Fauzik Lendriyono, Isbandi Rukminto Adi

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Muhammadiyah is an Islamic-based organization taking care to human suffering. The existence of Muhammadiyah organization is strong supported by its members. Muhammadiyah as the oldest Islamic organization in Indonesia, since its establishment has had main activities, such as in the fields of education, health, and social services, one of the form is Orphanage. However, at present, Muhammadiyah orphanage was in a dilemma because of differences in orientation and commitment of the caretaker-managers. This research on Muhammadiyah orphanage is very important because it is able to know the problem identification and to find the ideal concept for the better management of an orphanage in Muhammadiyah. This research is a phenomenology study by research subjects: caretaker of the orphanage in Muhammadiyah at Great Malang. The research data was obtained after the observation, in-depth interviews, review of documentation and the discussion focused. Data were analyzed with interpretative phenomenological analysis. Basic problems for causes of differences in orientation and commitment administrators of Muhammadiyah orphanage is the influence of organizational culture and organizational environment factors. Organizational culture factors include the Islamic-based value and organization ideology, so that the Islamic values and the values of Muhammadiyah are used as guidelines in the orphanage. Environmental factors include the demand for its organization sustainability as characterized by economically productive activities organized by Orphanage and a program to produce a cadre of Muhammadiyah. To support the social welfare of Muhammadiyah, the ideal Orphanage concept for Muhammadiyah is a missionary and self-sufficient orphanage.

Keywords: orphanage, Muhammadiyah, misionary, Great Malang

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Authors: Irina S. Burashnikova, Dmitriy A. Sychev, Ruslan Y. Kazakov

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Сytochrome P450 CYP2D6 activity affects antipsychotic therapy safety. CYP2D6*4 polymorphism frequency varies among different ethnic groups. We studied CYP2D6*4 polymorphism frequency in Tatar and Russian schizophrenic patients and association of CYP2D6*4 polymorphism and extrapyramidal disorders (EPD) frequency in schizophrenic patients on haloperidol monotherapy in daily doses up to 20 mg. Results: Heterozygous CYP2D6*4 allele carrier frequency among Tatars was lower (23.8% vs 32.4% in Russians), but the differences did not reach statistical significance. CYP2D6*4 allele frequency among Tatars was also lower (11.9% vs 24.3% in Russians), but the difference was not quite significant (p=0.0592). Average daily haloperidol dose in the group without EPD was significantly higher than in the group with EPD (11.35±4.6 vs 13.87±3.3 mg, p=0.0252), but average daily haloperidol dose/weight ratios in the compared groups had no significant differences. Statistically significant association between EPD development and heterozygous CYP2D6*1/*4 genotype and CYP2D6*4 allele carrier frequency was revealed among all schizophrenic patients and among those of Tatar nationality. Further well designed pharmacogenetic studies in different Russian regions are needed to improve psychotropic therapy safety and to establish evidence-based indications for pharmacogenetic testing in clinical practice.

Keywords: antipsychotic, CYP2D6 polymorphism, ethnic differences of CYP2D6*4 allele frequency, extrapyramidal side effects/disorder, schizophrenia, pharmacogenetics, Russians, Tatars

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Authors: Osama M. Ahmed, Walaa G. Hozayen, Haidy Tamer Abo Sree

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Doxorubicin (DOX), an anthracycline antibiotic is a broad-spectrum antineoplastic agent, which is commonly used in the treatment of uterine, ovarian, breast and lung cancers, Hodgkin's disease and soft tissue sarcomas as well as in several other cancer types. The effect of doxorubicin (4 mg/kg b.w.week) without or with oral administration of ethanolic purslane (Portulaca oleracea) shoot (leaves and stems) extract (50 mg/kg b.w. day) or ethanolic purslane seeds extract (50 mg/kg b.w.day) co-treatments for 6 weeks was evaluated in adult male rats. Serum ALT, AST, ALP, GGT, total bilirubin, total protein, and albumin levels were assayed. Lipid peroxidation (indexed by MDA) and antioxidants like hepatic glutathine, glutathione transferase, peroxidase, SOD, and CAT were assessed. There was an increase in serum levels of ALT, AST, ALP, GGT and total bilirubin. In addition, hepatic glutathine, glutathione transferase, peroxidase, SOD, and CAT activities were decreased while lipid peroxidation in the liver was increased. Co-administration of ethanolic purslane and seed extracts successfully improved the adverse changes in the liver functions with an increase in antioxidants activities and reduction of lipid peroxidation. In conclusion, it can be supposed that dietary purslane extract supplementation may provide a cushion for a prolonged therapeutic option against DOX hepatopathy without harmful side effects. However, further clinical studies are required to assess the safety and efficacy of these extract in human beings.

Keywords: doxorubicin, purslane, hepatotoxicity, antioxidants

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Authors: Z. S. Haidar

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Millions of teeth are removed annually, and dental extraction is one of the most commonly performed surgical procedures globally. Whether due to caries, periodontal disease, or trauma, exodontia and the ensuing wound healing and bone remodeling processes of the resultant socket (hole in the jaw bone) usually result in serious deformities of the residual alveolar osseous ridge and surrounding soft tissues (reduced height/width). Such voluminous changes render the placement of a proper conventional bridge, denture, or even an implant-supported prosthesis extremely challenging. Further, most extractions continue to be performed with no regard for preventing the onset of alveolar osteitis (also known as dry socket, a painful and difficult-to-treat/-manage condition post-exodontia). Hence, such serious resorptive morphological changes often result in significant facial deformities and a negative impact on the overall Quality of Life (QoL) of patients (and oral health-related QoL); alarming, particularly for the geriatric with compromised healing and in light of the thriving longevity statistics. Despite advances in tissue/wound grafting, serious limitations continue to exist, including efficacy and clinical outcome predictability, cost, treatment time, expertise, and risk of immune reactions. For cases of dry socket, specifically, the commercially available and often-prescribed home remedies are highly-lacking. Indeed, most are not recommended for use anymore. Alveogyl is a fine example. Hence, there is a great market demand and need for alternative solutions. Herein, SockGEL/PLUG (patent pending), an innovative, all-natural, drug-free, and injectable thermo-responsive hydrogel, was designed, formulated, characterized, and evaluated as an osteogenic, angiogenic, anti-microbial, and pain-soothing suture-free intra-alveolar dressing, safe and efficacious for use in fresh extraction sockets, immediately post-exodontia. It is composed of FDA-approved, biocompatible and biodegradable polymers, self-assembled electro-statically to formulate a scaffolding matrix to (1) prevent the on-set of alveolar osteitis via securing the fibrin-clot in situ and protecting/sealing the socket from contamination/infection; and (2) endogenously promote/accelerate wound healing and bone remodeling to preserve the volume of the alveolus. The intrinsic properties of the SockGEL/PLUG hydrogel were evaluated physical-chemical-mechanically for safety (cell viability), viscosity, rheology, bio-distribution, and essentially, capacity to induce wound healing and osteogenesis (small defect, in vivo) without any signaling cues from exogenous cells, growth factors or drugs. The proposed animal model of cranial critical-sized and non-vascularized bone defects shall provide new and critical insights into the role and mechanism of the employed natural bio-polymer blend and gel product in endogenous reparative regeneration of soft tissues and bone morphogenesis. Alongside, the fine-tuning of our modified formulation method will further tackle appropriateness, reproducibility, scalability, ease, and speed in producing stable, biodegradable, and sterilizable thermo-sensitive matrices (3-dimensional interpenetrating yet porous polymeric network) suitable for the intra-socket application. Findings are anticipated to provide sufficient evidence to translate into pilot clinical trials and validate the innovation before engaging the market for feasibility, acceptance, and cost-effectiveness studies.

Keywords: hydrogel, nanotechnology, bioengineering, bone regeneration, nanogel, drug delivery

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Authors: Bang Haeyong

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Purpose: The objectives of this study were to determine the prevalence, incidence, and risk factors for postoperative fever after lumbar fusion. Methods: This study was a retrospective chart review of 291 patients who underwent lumbar fusion between March 2015 and February 2016 at the Asan Medical Center. Information was extracted from electronic medical records. Postoperative fever was measured at Tmax > 37.7 ℃ and Tmax > 38.3 ℃. The presence of postoperative fever, blood culture, urinary excretion, and/or chest x-ray were evaluated. Patients were evaluated for infection after lumbar fusion. Results: We found 222 patients (76.3%) had a postoperative temperature of 37.7 ℃, and 162 patients (55.7%) had a postoperative temperature of 38.3 ℃ or higher. The percentage of febrile patients trended down following the mean 1.8days (from the first postoperative day to seventh postoperative day). Infection rate was 9 patients (3.1%), respiratory virus (1.7%), urinary tract infection (0.3%), phlebitis (0.3%), and surgical site infection (1.4%). There was no correlation between Tmax > 37.7℃ or Tmax > 38.3℃, and timing of fever, positive blood or urine cultures, pneumonia, or surgical site infection. Risk factors for increased postoperative fever following surgery were confirmed to be delay of defecation (OR=1.37, p=.046), and shorten of remove drainage (OR=0.66, p=.037). Conclusions: The incidence of fever was 76.3% after lumbar fusion and the drainage time was faster in the case of fever. It was thought that the bleeding was absorbed at the operation site and fever occurred. The prevalence of febrile septicemia was higher in patients with long bowel movements before surgery than after surgery. Clinical symptoms should be considered because postoperative fever cannot be determined by fever alone because fever and infection are not significant.

Keywords: lumbar surgery, fever, postoperative, risk factor

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Authors: Jitpisute Chunthorng-Orn, Thana Juckmeta, Onmanee Prajuabjinda, Arunporn Itharat

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Inflammation and oxidative stress work together to produce symptoms in cancer patients. The whole part of it is used as a preparation to treat cancer patients in Khampramong temple which has been a place of treatment and palliative care for cancer patients since 2005. Thus, the objective of this study was to investigate anti-inflammatory and antioxidant activities of Heliotropium indicum extracts. Dried plant materials were extracted in a similar manner to those practiced by the Khampramong Temple i.e. maceration in 95% ethanol and boiling in water. For anti-inflammation activity, both extracts were tested for suppression of nitric oxide (NO) production in LPS-induced RAW 264.7 cells. They were also tested for antioxidant activity by DPPH radical scavenging assay. This study found that the ethanolic extract of Heliotropium indicum exhibited higher inhibitory activity of NO release than Indomethacin as a positive control (IC50 value of 24.17±2.12 and 34.67±6.23 μg/mL, respectively). For DPPH radical scavenging assay, the ethanolic extract also exhibited antioxidant activity but less than BHT as a antioxidant compound (EC50 values = 28.91±4.26 and 13.08±0.29 μg/mL, respectively). In contrast, its water extract had no inhibitory activity on NO release (IC50 > 100 μg/mL) and no inhibitory activity on DPPH radicals (EC50 values > 100 μg/mL). The results showed correlation between anti-inflammation and antioxidant activity and these results also support using this plant to treat cancer patients.

Keywords: Heliotropium indicum, RAW 264.7, DPPH, Khampramong Temple

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Authors: Atul Khurana, Rajul Rastogi, Hans-Joachim Gamperl

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The pharmaceutical companies are getting more inclined towards patient support programs (PSPs) which assist patients and/or healthcare professionals (HCPs) in more desirable disease management and cost-effective treatment. The utmost objective of these programs is patient care. The PSPs may include financial assistance to patients, medicine compliance programs, access to HCPs via phone or online chat centers, etc. The PSP has a crucial role in terms of customer acquisition and retention strategies. During the conduct of these programs, Marketing Authorisation Holder (MAH) may receive information related to concerned medicinal products, which is usually reported by patients or involved HCPs. This information may include suspected adverse reaction(s) during/after administration of medicinal products. Hence, the MAH should design PSP to comply with regulatory reporting requirements and avoid non-compliance during PV inspection. The emergence of wireless health devices is lowering the burden on patients to manually incorporate safety data, and building a significant option for patients to observe major swings in reference to drug safety. Therefore, to enhance the adoption of these programs, MAH not only needs to aware patients about advantages of the program, but also recognizes the importance of time of patients and commitments made in a constructive manner. It is indispensable that strengthening the public health is considered as the topmost priority in such programs, and the MAH is compliant to Pharmacovigilance (PV) requirements along with regulatory obligations.

Keywords: drug safety, good pharmacovigilance practice, patient support program, pharmacovigilance

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Authors: Angelika Magiera, Weronika Penar, Czesław Klocek

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Intellectual disability (ID) affects approximately 1.55% of children and adults in the society of developed countries. Depending on the ID degree, the patient is burdened with additional disease entities. Intellectual disability does not only limits a person’s opportunities to participate in social life but also affects whole families. People with ID belong to the group of risk of mental illnesses, they are less emotionally stable, while families are predisposed to depression. The study was held in a day care center for people with intellectual disabilities (of various degrees of disability) on 26 people. Nurses and carers also took part. The age range of study groups ranged from 22 to 67 years. Therapeutic classes were held for four independent mixed groups (sex and intellectual disability degree) from 6 to 7 people each, lasting no more than 30 minutes. They were created by the facility's staff to make sure that a group is stable. The animal assisted activity took place with a 2.5-year-old Ragdoll cat. The animal has passed the exam (certificate entitling her to take part in felinotherapy) and had 1.5 years of work experience. Due to the different degrees of ID, an individual emotional state survey was conducted among the caregivers of those who were involved in the activity, to assess the impact of animal assisted activity with a cat on patients. A positive effect on the emotional state of people with different types of intellectual disability was observed. Caregivers and nurses of those participating in the study express willingness to continue these types of classes and consider them necessary for this group of people.

Keywords: intellectual disabilities, animal-assisted activity, cat, feline, emotions

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Authors: Chih-I. Tsai, Yu-Chien. Lin

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Through experiences of clinical practices, it is discovered that locations on the body at a level of four fingerbreadth above and below the joints are the points at which muscles connect to tendons, and since the muscles and tendons possess opposite characteristics, muscles are full of blood but lack qi, while tendons are full of qi but lack blood, these points on our body become easily blocked. It is proposed that through doing acupuncture or creating localized pressure to the areas four fingerbreadths above and below our joints, with an elastic bandage, we could help the energy, also known as qi, to flow smoothly in our body and further improve our health. Based on the Four Fingers Theory, we understand that human height is 22 four fingerbreadths. In addition, qi and blood travel through 24 meridians, 50 times each day, and they flow through 6 cun with every human breath. We can also understand the average number of human heartbeats is 75 times per minute. And the function of qi-blood circulation system in Traditional Chinese Medicine is the same as the blood circulation in Western Medical Science. Informed by Four Fingers Theory, this study further examined its applications in acupuncture practices. The research question is how Four Fingers Theory proves what has been mentioned in Nei Jing that there are 66 acupoints under a human’s elbow and knee. In responding to the research question, there are 66 acupoints under a human’s elbow and knee. Four Fingers Theory facilitated the creation of the acupuncture naming and teaching system. It is expected to serve as an approachable and effective way to deliver knowledge of acupuncture to the public worldwide.

Keywords: four fingers theory, meridians circulation, 66 acupoints under human elbow and knee, acupuncture

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Authors: H. Yousefnia, S. Zolghadri

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An early diagnosis of bone metastases is very important for providing a profound decision on a subsequent therapy. A prerequisite for the clinical application of new diagnostic radiopharmaceutical is the measurement of organ radiation exposure dose from biodistribution data in animals. In this study, the dosimetric studies of a novel agent for SPECT-imaging of bone methastases, 111In-(4-{[(bis(phosphonomethyl))carbamoyl]methyl}-7,10-bis(carboxymethyl)-1,4,7,10-tetraazacyclododec-1-yl) acetic acid (111In-BPAMD) complex, have been estimated in human organs based on mice data. The radiolabeled complex was prepared with high radiochemical purity at the optimal conditions. Biodistribution studies of the complex were investigated in male Syrian mice at selected times after injection (2, 4, 24 and 48 h). The human absorbed dose estimation of the complex was performed based on mice data by the radiation absorbed dose assessment resource (RADAR) method. 111In-BPAMD complex was prepared with high radiochemical purity >95% (ITLC) and specific activities of 2.85 TBq/mmol. Total body effective absorbed dose for 111In-BPAMD was 0.205 mSv/MBq. This value is comparable to the other 111In clinically used complexes. The results show that the dose to critical organs the complex is well within the acceptable considered range for diagnostic nuclear medicine procedures. Generally, 111In-BPAMD has interesting characteristics and can be considered as a viable agent for SPECT-imaging of the bone metastases in the near future.

Keywords: In-111, BPAMD, absorbed dose, RADAR

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Authors: Rebecca Oakes

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In the New Zealand public health system, work has been taking place to use electronic systems to convey data from the ‘floor to the board’ that makes patient needs, and therefore nursing work, visible. For nurses, these developments in health information technology puts us in a very new and exciting position of being able to articulate the work of nursing through a language understood at all levels of an organisation, the language of acuity. Nurses increasingly have a considerable stake-hold in patient acuity data. Patient acuity systems, when used well, can assist greatly in demonstrating how much work is required, the type of work, and when it will be required. The New Zealand Safe Staffing Unit is supporting New Zealand nurses to create a culture of shared governance, where nursing data is informing policies, staffing methodologies and forecasting within their organisations. Assisting organisations to understand their acuity data, strengthening user confidence in using electronic patient acuity systems, and ensuring nursing and midwifery workload is accurately reflected is critical to the success of the safe staffing programme. Nurses and midwives have the capacity via an acuity tool to become key informers of organisational planning. Quality patient care, best use of health resources and a quality work environment are essential components of a safe, resilient and well resourced organisation. Nurses are the key informers of this information. In New Zealand a national level approach is paving the way for significant changes to the understanding and use of patient acuity and nursing workload information.

Keywords: nursing workload, patient acuity, safe staffing, New Zealand

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Authors: R. Hassan, J. Duncombe, E. Darke, A. Dias, K. Anderson, R. G. Middleton

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Background: NHS England has set itself the task of delivering a “Net Zero” National Health service by 2040. It is incumbent upon all health care practioners to work towards this goal. Orthopaedic surgeons are no exception. Distal radial fractures are the most common fractures sustained by the adult population. However, studiesare shortcoming on individual patient experience. The aim of this study was to assess the patient’ssatisfaction and outcomes with woodcast used in the conservative management of distal radius fractures. Methods: For all patients managed with woodcast in our unit, we undertook a structured questionnairethat included the Patient Rated Wrist Evaluation (PRWE) score, The EQ-5D-5L score, and the pain numerical score at the time of injury and six weeks after. Results: 30 patients were initially managed with woodcast.80% of patients tolerated woodcast for the full duration of their treatment. Of these, 20% didn’t tolerate woodcast and had their casts removed within 48 hours. Of the remaining, 79.1% were satisfied about woodcast comfort, 66% were very satisfied about woodcast weight, 70% were satisfied with temperature and sweatiness, 62.5% were very satisfied about the smell/odour, and 75% were satisfied about the level of support woodcast provided. During their treatment, 83.3% of patients rated their pain as five or less. Conclusion: For those who completed their treatment in woodcast, none required any further intervention or utilised the open appointment because of ongoing wrist problems. In conclusion, when woodcast is tolerated, patients’ satisfaction and outcome levels were good. However, we acknowledged 20% of patients in our series were not able to tolerate woodacst, Therefore, we suggest a comparison between the widely used synthetic plaster of Pariscasting and woodcast to come in order.

Keywords: distal radius fractures, ecological cast, sustainability, woodcast

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Authors: Manjunath Attibele, Alsawafi Manal, Al Dughaishi Tamima

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Introduction: The purpose of this study was to describe the clinical characteristics and types of mechanisms of injuries caused by Motor vehicle accidents (MVA) during pregnancy. To analyze the patterns of accidents during pregnancy and its adverse consequences on both maternal and fetal outcome. Methods: This was a retrospective cohort study on pregnant patients who met with MVAs The study period was from January 1, 2010, to December 31, 2019. All relevant data were retrieved from electronic patients’ records from the hospital information system and from the antenatal ward admission register Results: Out of 168 women who had motor vehicle accidents during the study period, of which, 39 (23.2%) women during pregnancy. Twenty-one (53.8%) women were over 30 years old. Thirty-five (89.7%) women were Omanis, and 27 (69.2%) were in their third trimester. Twenty-three (59%) of accidents happened at night, and 31 (79.5%) of them happened on a weekday. Twenty-two (56.4%) of women were driving themselves, and 24 (61.5%) of them were not using any seatbelt. Accident related abdominal & back pain was seen in 23(59%) women. Regarding the outcome of pregnancy, 23 (74.2%) had a normal vaginal delivery. The mean accident to delivery interval was 7 weeks. Thirty (96.7%) of involved newborns were relatively healthy. One woman (3.2%) had a ruptured uterusleading to fetal death (3.2%). Conclusion: This study showed that the incidence of motor vehicle accidents during pregnancy is around 23.2% . Majority had trauma-associated pain. One serious injury to a woman causing a ruptured uterus which lead to fetal death. Majority of involved newborns were relatively healthy. No reported maternal death.

Keywords: motor vehicle accidents, pregnancy, maternal outcome, fetal outcome

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Authors: B. Nageshwar Rao

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Urinary tract infection (UTI) represents the most commonly acquired bacterial infection worldwide, with substantial morbidity, mortality, and economic burden. The objective of the study is to characterize the microbial profiles of uropathogenic in the obstetric population by RTPCR. Study design: An observational cross-sectional study was performed at a single tertiary health care hospital among 50 pregnant women with UTIs, including asymptomatic and symptomatic patients attending the outpatient department and inpatient department of Obstetrics and Gynaecology.Methods: Serotyping and genes detection of various uropathogens were studied using RTPCR. Pulse filed gel electrophoresis methods were used to determine the various genetic profiles. Results: The present study shows that CsgD protein, involved in biofilm formation in Escherichia coli, VIM1, IMP1 genes for Klebsiella were identified by using the RTPCR method. Our results showed that the prevalence of VIM1 and IMP1 genes and CsgD protein in E.coli showed a significant relationship between strong biofilm formation, and this may be due to the prevalence of specific genes. Finally, the genetic identification of RTPCR results for both bacteria was correlated with each other and concluded that the above uropathogens were common isolates in producing Biofilm in the pregnant woman suffering from urinary tract infection in our hospital observational study.

Keywords: biofilms, Klebsiella, E.coli, urinary tract infection

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Authors: Abraham J. Rizkalla, Joanne F. Irons, Christopher Q. Cao

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Purpose: Lobectomy was considered the standard of care for early-stage non-small lung cancer (NSCLC) after the Lung Cancer Study Group trial demonstrated increased locoregional recurrence for sublobar resections. However, there has been heightened interest in segmentectomies for selected patients with peripheral lesions ≤2cm, as investigated by the JCOG0802 and CALGB140503 trials. Minimally invasive robotic surgery facilitates segmentectomies with improved maneuverability and visualization of intersegmental planes using indocyanine green. We hereby present a patient who underwent robotic lingulectomy for an undiagnosed ground-glass opacity. Methodology: This video demonstrates a robotic portal lingulectomy using three 8mm ports and a 12mm port. Stereoscopic direct vision facilitated the identification of the lingula artery and vein, and intra-operative bronchoscopy was performed to confirm the lingula bronchus. The intersegmental plane was identified by indocyanine green and a near-infrared camera. Thorough lymph node sampling was performed in accordance with international standards. Results: The 18mm lesion was successfully excised with clear margins to achieve R0 resection with no evidence of malignancy in the 8 lymph nodes sampled. Histopathological examination revealed lepidic predominant adenocarcinoma, pathological stage IA. Conclusion: This video presentation exemplifies the standard approach for robotic portal lingulectomy in appropriately selected patients.

Keywords: lung cancer, robotic segmentectomy, indocyanine green, lingulectomy

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Authors: Yogesh Karunakar, Praveen Kandaswamy

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Mother’s milk provides the most superior source of nutrition to a child. There is no other substitute to the mother’s milk. Postpartum secretions like breast milk can be analyzed on the go for testing the presence of any harmful pathogen before a mother can feed the child or donate the milk for the milk bank. Since breast feeding is one of the main causes for transmission of diseases to the newborn, it is mandatory to test the secretions. In this paper, we describe the detection of pathogens like E-coli, Human Immunodeficiency Virus (HIV), Hepatitis B (HBV), Hepatitis C (HCV), Cytomegalovirus (CMV), Zika and Ebola virus through an innovative method, in which we are developing a unique chip for testing the mother’s milk sample. The chip will contain an antibody specific to the target pathogen that will show a color change if there are enough pathogens present in the fluid that will be considered dangerous. A smart-phone camera will then be acquiring the image of the strip and using various image processing techniques we will detect the color development due to antigen antibody interaction within 5 minutes, thereby not adding to any delay, before the newborn is fed or prior to the collection of the milk for the milk bank. If the target pathogen comes positive through this method, then the health care provider can provide adequate treatment to bring down the number of pathogens. This will reduce the postpartum related mortality and morbidity which arises due to feeding infectious breast milk to own child.

Keywords: postpartum, fluids, camera, HIV, HCV, CMV, Zika, Ebola, smart-phones, breast milk, pathogens, image processing techniques

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Authors: Vinicius Marzall, Jussanã Milograna

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The urban drainwatering remains a major challenge for most of the Brazilian cities. Not so different of the most part, Goiania, a state capital located in Midwest of the country has few legislations about the subject matter and only one registered solution of compensative techniques for drainwater. This paper clam to show some solutions which are adopted in other Brazilian cities with consolidated legislation, suggesting technics about detention tanks in a building sit. This study analyzed and compared the legislation of Curitiba, Porto Alegre e Sao Paulo, with the actual legislation and politics of Goiania. After this, were created models with adopted data for dimensioning the size of detention tanks using the envelope curve method considering synthetic series for intense precipitations and building sits between 250 m² and 600 m², with an impermeabilization tax of 50%. The results showed great differences between the legislation of Goiania and the documentation of the others cities analyzed, like the number of techniques for drainwatering applied to the reality of the cities, educational actions to awareness the population about care the water courses and political management by having a specified funds for drainwater subjects, for example. Besides, the use of detention tank showed itself practicable, have seen that the occupation of the tank is minor than 3% of the building sit, whatever the size of the terrain, granting the exit flow to pre-occupational taxes in extreme rainfall events. Also, was developed a linear equation to measure the detention tank based in the size of the building sit in Goiania, making simpler the calculation and implementation for non-specialized people.

Keywords: clean technology, legislation, rainwater management, urban drainwater

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Authors: Alisha Akya, Afsaneh salami

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Background and Objective: Pseudomonas aeruginosa is an opportunistic pathogen associated with nosocomial infections. One of the major concerns for the treatment of P. aeruginosa infections is its resistant to a variety of antibiotics. The purpose of this study was to assess the dissemination of p. aeruginosa isolates obtained from major hospitals in Kermanshah, west of Iran. Materials and Methods: Antibiotic susceptibility testing was performed using the minimal inhibitory concentrations. Mettalo-beta-lactamase was investigated using the double disk diffusion (DDST) test and PCR. Molecular typing was performed by pulsed-field gel electrophoresis (PFGE). Results: The 60 P. aeruginosa isolates, 30 (50%) were resistant to gentamicin, 38 (63/3%) to piperacilin, 42 (70%) to ceftazidime, and 45 (75%) to cefepime. Twenty-nine (48/3%) isolates were MBLs producer based on the DDST test. Five (8/3%) isolates were positive for VIM gene and 4 of them were from burn specimens. PFGE analysis among MBLs producers revealed 12 distinct genotype patterns. A pattern covering the highest number of strains was determined as the dominant clone. Conclusions: Our study showed that P. aeruginosa strains can be spread between patients in hospitals or acquired from different environmental sources. P. aeruginosa isolates were highly resistant to antibiotics and, therefore, the susceptibility of isolates to antibiotics should be tested before treatment. Given the clinical significance of MBLs producing isolates, identification of these organisms is essential in the hospitals in order to get a better therapeutic response and control of bacterial dissemination.

Keywords: clonal dissemination, mettalo-beta-lactamase, Pseudomonas aeruginosa, PFGE

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Authors: Daphine Namara, Jeremy I. Schwartz, Andrew K. Tusubira, Willi McFarland, Caroline Birungi, Fred C. Semitala, Martin Muddu

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Emerging evidence suggests a possible association between hyperglycemia and dolutegravir (DTG), a preferred first-line antiretroviral agent in sub-Saharan Africa (SSA). There is a need for rigorous studies to validate this association in the face of increasing DTG use and the burden of non-communicable diseases among people living with HIV (PLHIV). We conducted a case-control study to assess the risk of hyperglycemia associated with the use of DTG among PLHIV attending Mulago ISS Clinic in Kampala. Cases had hyperglycemia, while controls had no hyperglycemia, as confirmed by fasting plasma glucose and oral glucose tolerance tests. Demographic, laboratory, and clinical data were collected using interviewer-administered questionnaires and medical record abstraction. The analysis compared cases and controls on DTG use prior to diagnosis of hyperglycemia while controlling for potential confounders using multivariable logistic regression. We included 204 cases and 231 controls. In multivariable analysis, patients with prior DTG use had seven times greater odds of subsequent diagnosis of hyperglycemia compared to those who had non-DTG-based regimens (adjusted odds ratio [aOR] 7.01, 95% CI 1.96-25.09). The odds of hyperglycemia also increased with age (56 years and above vs. 18-35, aOR 12.38, 95% CI 3.79-40.50) and hypertension (aOR 5.78, 95% CI 2.53-13.21). Our study demonstrates a strong association between prior DTG exposure and subsequent diagnosis of hyperglycemia. Given the benefits of DTG, wide-scale use, and the growing burden of diabetes mellitus (DM) in SSA, there is a need for systematic screening for hyperglycemia and consideration of alternate regimens for those at risk for DM.

Keywords: HIV, hyperglycemia, doluteravir, diabetes

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Authors: Viktoriia Malinovska, Iryna Kuklina, Katerina Grabicova, Milos Buric, Pavel Kozak

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Personal care products, including organic UV filters, are considered emerging contaminants and their toxic effects have been a concern for the last decades. Sunscreen compounds continually enter the surface waters via sewage water treatment due to incomplete removal and during human recreational and laundry activities. Despite the environmental occurrence of organic UV filters in the freshwater environment, little is known about their impacts on aquatic biota. In this study, environmentally relevant concentrations of 5-Benzoyl-4-hydroxy-2-methoxybenzenesulfonic acid (BP-4, 2.5 µg/L) and 2-Phenylbenzimidazole-5-sulfonic acid (PBSA, 3 µg/L) were used to evaluate the cardiac and locomotor responses of signal crayfish Pacifastacus leniusculus during a short time period. The effects of these compounds were evident in experimental animals. Specimens exposed to both tested compounds exhibited significantly bigger changes in distance moved and time movement than controls. Significant differences in changes in mean heart rate were detected in both PBSA and BP-4 experimental groups compared to control groups. Such behavioral and physiological alterations demonstrate the ecological effects of selected sunscreen compounds during a short time period. Since the evidence of the impacts of sunscreen compounds is scarce, the knowledge of how organic UV filters influence aquatic organisms is of key importance for future research.

Keywords: aquatic pollutants, behavior, freshwaters, heart rate, invertebrate

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Authors: Artsiom Zinchanka

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The world faces now one of the largest migration crisis and the European Union meets challenges in accepting the flow of migrants that could not be handled finally at this step. This crisis is complicated with many factors, such as military conflict in the Middle East; absence of the appropriate conditions in the refugees’ camps; but also with the complicity of the migration flow consisting of the Sub-Saharan migrants. This type of migrants leave their homelands for many reasons including poverty, not appropriate level of social and economic conditions, absence of infrastructure and access to the education and medical care. In practice, when the restrictive approach directed to limit the flow of illicit migration and to send illicit migrants back to their homelands is not always working, the approach directed to the root causes of the migration crisis can be more effective in settling the crisis. The Cotonou Agreement and the following treaties concluded between the European Union, and Sub-Saharan states show that the European Union considers the development of human rights and appropriate social and economic conditions in the Sub-Saharan states as one of the most important factors addressing the migration crisis. The preventive approach as the efforts of the European Union to develop appropriate social and economic conditions in Sub-Saharan states is considered in this article, as well as its evolution and current condition. This article also considers pros and cons of this approach and the obstacles that this approach faces. The research methods include review of literature and documents, analytical and descriptive methods.

Keywords: migration crisis, preventive approach, Sub-Saharan States, the European Union

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Authors: Chengbin Wang, Li Lu, Luodan Suo, Qinghai Wang, Fan Yang, Xu Wang, Mona Marin

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Background: Two-dose varicella vaccination has been recommended in Beijing since November 2012. We investigated a varicella outbreak in a highly vaccinated elementary school population to examine transmission patterns and risk factors for vaccine failure. Methods: A varicella case was defined as an acute generalized maculopapulovesicular rash without other apparent cause in a student attending the school from March 28 to May 17, 2015. Breakthrough varicella was defined as varicella >42 days after last vaccine dose. Vaccination information was collected from immunization records. Information on prior disease and clinical presentation was collected via survey of students’ parents. Results: Of the 1056 school students, 1028 (97.3%) reported no varicella history, of whom 364 (35.4%) had received 1-dose and 650 (63.2%) had received 2-dose varicella vaccine, for 98.6% school-wide vaccination coverage with ≥ 1 dose before the outbreak. A total of 20 cases were identified for an overall attack rate of 1.9%. The index case was in a 2-dose vaccinated student who was not isolated. The majority of cases were breakthrough (19/20, 95%) with attack rates of 7.1% (1/14), 1.6% (6/364) and 2.0% (13/650) among unvaccinated, 1-dose, and 2-dose students, respectively. Most cases had < 50 lesions (18/20, 90%). No difference was found between 1-dose and 2-dose breakthrough cases in disease severity or sociodemographic factors. Conclusion: Moderate 2-dose varicella vaccine coverage was insufficient to prevent a varicella outbreak. Two-dose breakthrough varicella is still contagious. High 2-dose varicella vaccine coverage and timely isolation of ill persons might be needed for varicella outbreak control in the 2-dose era.

Keywords: varicella, outbreak, breakthrough varicella, vaccination

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Authors: Merav Rabinovich

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Background: Psychoanalytic and cognitive therapy attend problems from a different point of view. At the recent decade the integrating movement gaining momentum. However only little has been studied regarding the theoretical interrelationship among these therapy approaches. Method: 33 transference case-studies that were published in peer-reviewed academic journals were coded by Luborsky's Core Conflictual Relationship Theme (CCRT) method (components of wish, response from other – real or imaginal - and the response of self). CCRT analysis was conducted through tailor-made method, a valid tool to identify transference patterns. Rabinovich and Kacen's (2010, 2013) Relationship Between Categories (RBC) method was used to analyze the relationship among these transference patterns with cognitive and behavior components appearing at those psychoanalytic case-studies. Result: 30 of 33 cases (90%) were found to connect the transference themes with cognitive overgeneralization. In these cases, overgeneralizations were organized around Luborsky's transference themes of response from other and response of self. Additionally, overgeneralization was found to be an antithesis of the wish component, and the tension between them found to be linked with powerful behavioral and emotional reactions. Conclusion: The findings indicate that thinking distortions of overgeneralization (cognitive therapy) are the actual expressions of transference patterns. These findings point to a theoretical junction, a platform for clinical integration. Awareness to this junction can help therapists to promote well psychotherapy outcomes relying on the accumulative wisdom of the different therapies.

Keywords: transference, overgeneralization, theoretical integration, case-study metasynthesis, CCRT method, RBC method

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Authors: Fatima U. Maigari, Musa Halilu, M. Maryam Umar, Rabiu Zainab

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Plants as therapeutic agents are used as drug in many parts of the world. Medicinal plants are mostly used in developing countries due to culture acceptability, belief or due to lack of easy access to primary health care services. Jatropha curcas is a plant from the Euphorbiaceae family which is widely used in Northern Nigeria as an anti-diarrheal agent. This study was conducted to determine the anti-diarrheal effect of the leaf extract on castor oil induced diarrhea in albino rats. The leaves of J. curcas were collected from Balanga Local government in Gombe State, north-eastern Nigeria; due to its bioavailability. The leaves were air-dried at room temperature and ground to powder. Phytochemical screening was done and different concentrations of the extract was prepared and administered to the different categories of experimental animals. From the results, aqueous leaf extract of Jatropha curcas at doses of 200mg/Kg and 400mg/Kg was found to reduce the mean stool score as compared to control rats, however, maximum reduction was achieved with the standard drug of Loperamide (5mg/Kg). Treatment of diarrhea with 200mg/Kg of the extract did not produce any significant decrease in stool fluid content but was found to be significant in those rats that were treated with 400mg/Kg of the extract at 2hours (0.05±0.02) and 4hours (0.01±0.01). A significant reduction of diarrhea in the experimental animals signifies it to possess some anti-diarrheal activity.

Keywords: anti-diarrhea, diarrhea, Jatropha curcas, loperamide

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Authors: Yagahira E. Castro-Sesquen, Chloe Kim, Robert H. Gilman, David J. Sullivan, Peter C. Searson

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Diagnosis of severe malaria is particularly important in highly endemic regions since most patients are positive for parasitemia and treatment differs from non-severe malaria. Diagnosis can be challenging due to the prevalence of diseases with similar symptoms. Accurate diagnosis is increasingly important to avoid overprescribing antimalarial drugs, minimize drug resistance, and minimize costs. A nanoparticle-based assay for detection and quantification of Plasmodium falciparum histidine-rich protein 2 (HRP2) in urine and serum is reported. The assay uses magnetic beads conjugated with anti-HRP2 antibody for protein capture and concentration, and antibody-conjugated quantum dots for optical detection. Western Blot analysis demonstrated that magnetic beads allows the concentration of HRP2 protein in urine by 20-fold. The concentration effect was achieved because large volume of urine can be incubated with beads, and magnetic separation can be easily performed in minutes to isolate beads containing HRP2 protein. Magnetic beads and Quantum Dots 525 conjugated to anti-HRP2 antibodies allows the detection of low concentration of HRP2 protein (0.5 ng mL-1), and quantification in the range of 33 to 2,000 ng mL-1 corresponding to the range associated with non-severe to severe malaria. This assay can be easily adapted to a non-invasive point-of-care test for classification of severe malaria.

Keywords: HRP2 protein, malaria, magnetic beads, Quantum dots

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Authors: William Cheng, Yuni Astria, Rini Sekartini

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Background: Prevalence of anemia among school-aged children is relatively high (25.4%). This condition can affect children’s life, including cognitive function. One of the most common factors that is associated with anemia in children is nutritional status. This simple indicator will be very helpful in identifying more population at risk. The aim of this study is to correlate the clinical implication of nutritional status to the prevalence of anemia in children, with intention to determine a more effective nutritional status indicator in detecting anemia. Method: Anthropometric and haemoglobin status were gathered from children between 5 to 7-years-old in one of the urban areas in Jakarta in 2012. We identified children with haemoglobin level under 11.5 as anemia and correlated them to their WHO z-score from each of these indicators: Body Weight for Age (normal weight and underweight), Height for Age (not stunted and stunted), and Body Mass Index for Age (not wasted and wasted). Results: A total of 195 children were included in this research and 57 of them (29,2%) were diagnosed as anemia. The majority of the children had good nutritional status, however, 30 (15,4%) of them were found to be underweight, 33 (16,9%) were stunted, and 1 children (0,5%) was wasted. There were no overweight result found in this population. From the three nutritional status indicators, none proved to be statistically significant in relation to the incidence of anemia (p>0.05). Out of 33 children who were diagnosed as stunted, 36.36 % were found to have anemia, in comparison to 27,7% of children who were not stunted. Meanwhile, among 30 children who were diagnosed as underweight, 33,3 % of them were anemic whereas only 28,4% of the normal weight group were anemic. Conclusion: In this study, there is no significant correlation between anemia with any nutritional status indicator. However, more than a third of the stunted children are proven to have low haemoglobin status. The finding of stunting in children should be given more attention to further investigate for anemia.

Keywords: school-aged children, nutritional status, anemia, pediatrics

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