Search results for: neurological complications

Authors: Morgane Chatard, Clémentine Puech, Nathalie Perek, Frédéric Roche

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Several neurological disorders are linked to repeated hypoxia. The impact of such repeated hypoxic stress, on endothelial cells function of the blood-brain barrier (BBB) is little studied in the literature. Indeed, the study of hypoxic stress in cellular pathways is complex using hypoxia exposure because HIF 1α (factor induced by hypoxia) has a short half life. Our study presents an innovative induction method of repeated hypoxic stress, more reproducible, which allows us to study its impacts on an in vitro contact co-culture BBB model. Repeated hypoxic stress was induced by hydralazine (a mimetic agent of hypoxia pathway) during two hours and repeated during 24 hours. Then, BBB integrity was assessed by permeability measurements (transendothelial electrical resistance and membrane permeability), tight junction protein expressions (cell-ELISA and confocal microscopy) and by studying expression and activity of efflux transporters. First, this study showed that repeated hypoxic stress leads to a BBB’s dysfunction illustrated by a significant increase in permeability. This loss of membrane integrity was linked to a significant decrease of tight junctions’ protein expressions, facilitating a possible transfer of potential cytotoxic compounds in the brain. Secondly, we demonstrated that brain microvascular endothelial cells had set-up defence mechanism. These endothelial cells significantly increased the activity of their efflux transporters which was associated with a significant increase in their expression. In conclusion, repeated hypoxic stress lead to a loss of BBB integrity with a decrease of tight junction proteins. In contrast, endothelial cells increased the expression of their efflux transporters to fight against cytotoxic compounds brain crossing. Unfortunately, enhanced efflux activity could also lead to reducing pharmacological drugs delivering to the brain in such hypoxic conditions.

Keywords: BBB model, efflux transporters, repeated hypoxic stress, tigh junction proteins

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Authors: Ismail Okur, Betul Taspinar, Turkan Pasali Kilit, Eda O. Okur, Ferruh Taspinar

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Type 2 Diabetes Mellitus (T2DM) is one of the most important global health emergencies and every year more and more people are affected by T2DM. T2DM causes life-changing complications by affecting organ and systems. Although diet and exercise are the best way to treat patients with T2DM, those patients generally have a sedentary life style. This study was planned to determine whether patients with T2DM have kinesiophobia (fear of movement). A controlled trial was conducted on 87 adults. Forty-one individuals with T2DM (study group, 34 female and 7 male) and 46 nondiabetic individuals (control group, 39 female and 7 male) were included in the study. Patients were screened for fear of movement using the Tampa Scale for Kinesiophobia (TSK). The data including age, sex, weight, height, and TSK scores were obtained. Mann Whitney U test were used to analyse the data. The mean ages and BMI of study and control groups were 51.98 ± 6.03 year and 49.52 ± 5.61 year and 31.82 ± 2.88 kg/m2 and 30.22 ± 2.91 kg/m2, respectively. The groups have similar demographic properties. The kinesiophobia scores of study and control groups were 42.78 ± 5.50 and 39.48 ± 5.05, respectively and the difference was statistically significant (p=0.05). This study showed that patients with T2DM had high kinesiophobia scores rather than nondiabetics. Those patients might avoid to do exercise. In other words, patients with T2DM might have lower physical activity level. Therefore the authors suggest that to evaluate and interfere with kinesiophobia before conducting exercise therapy will be useful for diabetes care.

Keywords: diabetes, fear of movement, kinesiophobia, type 2 diabetes mellitus

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Authors: Adnan Sahin, Ufuk Uylas, Ercument Pasaoglu, Tarik Caga, Enver Ihtiyar, Serdar Erkasap, Ersin Ates, Fatih Yasar

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Background: In this study, it was evaluated the demographic features, etiological factors and the management of acute pancreatitis. Methods: 106 patient hospitalized due to acute pancreatitis were retrospectively examined from 1 January 2015 to 31 December 2015 in Department of General Surgery of ESOGUMF. The data of gender, signs and symptoms, etiological factors, WBC, AST, ALT, Amilase, USG and CT findings treatment options ERCP, and complications, mortality rate were analysed. Results: The mean age of patients were 58.8 (53 men and 53 women). The causes of acute pancreatitis were as follows: gallbladder stone was 89, hyperlipidemia was 5 and idiopathic were 16 patients. Severe pancreatitis was developed in 16 patients in the biliary pancreatitis group and ERCP was performed. Cholecystectomy was performed to all biliary pancreatitis group patients after acute pancreatitis subside. The mean hospital stay period was 9.33 (2-37) day. Discussion and conclusion: Severe acute pancreatitis is a mortal disease. The most common etiological cause of acute pancreatitis is biliary origin. The first line treatment modality of acute pancreatitis is medical. Cholecystectomy should be planned to the all-biliary caused acute pancreatitis patients after the attack subside. ERCP is a useful treatment modality in the case of clinical worsening and suspicion of acute cholangitis. ERCP procedure used 16 patients in our series and these patients have a good morbidity and mean hospital period is lower than the others. We suppose that ERCP procedure should be planned selectively and conservatively.

Keywords: acute pancreatitis, ERCP, morbidity, treatment

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Authors: Selina Doncevic, Lisa Perla, Angela Kindvall

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The Global War on Terror which began after September 11, 2011, increased survivability of severe injuries requiring varying trajectories of rehabilitation and recovery. The costs encompass physiologic, functional, social, emotional, psychological, vocational and scholastic domains of life. The purpose of this poster is to inform private sector health care practitioners and clinicians at various levels of the unique and long term dynamics of healthcare recovery for polytrauma, and traumatic brain injured service members and veterans in the United States of America. Challenges include care delivery between the private sector, the department of defense, and veterans affairs healthcare systems while simultaneously supporting the dynamics of acute as well as latent complications associated with severe injury and illness. Clinical relevance, subtleties of protracted recovery, and overwhelmed systems of care are discussed in the context of lessons learned and in reflection on previous wars. Additional concerns for consideration and discussion include: the cost of protracted healthcare, various U.S. healthcare payer systems, lingering community reintegration challenges, ongoing care giver support, the rise of veterans support groups and the development of private sector clinical partnerships.

Keywords: brain injury, future, polytrauma, rehabilitation

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Authors: Bin Mohamed Ebrahim, Aminesh Singla, Henry Pleass

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Aim: There is an ongoing gap in renal transplantation between organs available for donation and recipients on the waiting list. Live donors with pre-existing or a history of renal calculi were thought to be a relative contraindication due to safety concerns for donors. We aim to review current literature assessing outcomes of donors who were found to have a history of renal calculi. Methods: Ovid and Embase were searched between 1960 to 2021 using key terms and Medical Subject Headings (MeSH) – nephrolithiasis, renal stones, renal transplantation and renal graft. Articles included conference proceedings and journal articles and were not excluded based on patient numbers. Studies were excluded if the specific organ was not identified, duplicated reports found or if post-transplant outcomes were not recorded. Outcomes were donor’s renal function or renal calculi recurrence postoperatively. Results: Upon reviewing 344 articles, 14 manuscripts met inclusion criteria. A total of 152 live donors were identified as having pre-existing or with a history of renal calculi at pre-operative workup. The mean stone size was 2.6 4mm (1 – 16) with a mean follow-up duration of 31.8 months (1 – 96). Seven studies had both outcomes. None showed renal complications or stone recurrence. The remaining studies contained 2 out of 84 patients having recurrent nephrolithiasis. Conclusion: Data suggests minimal morbidity involved for live renal donors with a history of nephrolithiasis. This should encourage surgeons to continue recruiting such donors for kidney transplantation.

Keywords: renal transplantation, renal graft, nephrolithiasis, renal calculi, live donor

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Authors: Jihene Bettaieb, Ghassen kharroubi, Rym mallekh, Ines Cherif, Taoufik Atawa, Kaouther Harrabech

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Brucellosis is a major worldwide zoonosis. It is a reportable condition in Tunisia where the disease remains endemic, especially in rural areas. The aim of this study was to describe the epidemiological, clinical, and bacteriological profile of human brucellosis cases notified in the district of Tunis. It was a retrospective descriptive study of cases reported in the district of Tunis through the national surveillance system between the 1st January and 31th December 2017. During the study period, 133 brucellosis confirmed cases were notified. The mean age was 37.5 ± 18.0 years, and 54.9% of cases were males. More than four-fifths (82.7%) of cases were reported in spring and summer with a peak in the month of May (36 cases). Fever and sweats were the most common symptoms; they occurred in 95% and 72% of cases, respectively. Osteoarticular complications occurred in 10 cases, meningitis in one case and endocarditis in one other case. Wright agglutination test and Rose Bengale test were positive in 100% and 91% of cases, respectively. While blood culture was positive in 9 cases and PCR in 2 cases. Brucella melitensis was the only identified specie (9 cases). Almost all cases (99.2%) reported the habit of consuming raw dairy products. Only 5 cases had a suspect contact with animals; among them, 3 persons were livestock breeders. The transmission was essentially due to raw dairy product consumption. It is important to enhance preventive measures to control animal Brucellosis and to educate the population regarding the risk factors of the disease.

Keywords: brucellosis, risk factors, surveillance system, Tunisia

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Authors: Fadhl Qutaish

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This paper examines the pharyngealization spread in one of the Yemeni Arabic dialects, namely, Ibbi Arabic (IA). It investigates how pharyngealized sounds spread their acoustic features onto the neighboring vowels and change their default features. This feature has been investigated quietly well in MSA but still has to be deeply studied in the different dialect of Arabic which will bring about a clearer picture of the similarities and the differences among these dialects and help in mapping them based on the way this feature is utilized. Though the studies are numerous, no one of them has illustrated how far in the multi-syllabic word the spread can be and whether it takes a steady or gradient manner. This study tries to fill this gap and give a satisfactory explanation of the pharyngealization spread in Ibbi Dialect. This study is the first step towards a larger investigation of the different dialects of Yemeni Arabic in the future. The data recorded are represented in minimal pairs in which the trigger (pharyngealized or the non-pharyngealized sound) is in the initial or final position of monosyllabic and multisyllabic words. A group of 24 words were divided into four groups and repeated three times by three subjects which will yield 216 tokens that are tested and analyzed. The subjects are three male speakers aged between 28 and 31 with no history of neurological, speaking or hearing problems. All of them are bilingual speakers of Arabic and English and native speakers of Ibbi-Dialect. Recordings were done in a sound-proof room and praat software was used for the analysis and coding of the trajectories of F1 and F2 for the low vowel /a/ to see the effect of pharyngealization on the formant trajectory within the same syllable and in other syllables of the same word by comparing the F1 and F2 formants to the non-pharyngealized environment. The results show that pharyngealization spread is gradient (progressively and regressively). The spread is reflected in the gradual raising of F1 as we move closer towards the trigger and the gradual lowering of F2 as well. The results of the F1 mean values in tri-syllabic words when the trigger is word initially show that there is a raise of 37.9 HZ in the first syllable, 26.8HZ in the second syllable and 14.2HZ in the third syllable. F2 mean values undergo a lowering of 239 HZ in the first syllable, 211.7 HZ in the second syllable and 176.5 in the third syllable. This gradual decrease in the difference of F2 values in the non-pharyngealized and pharyngealized context illustrates that the spread is gradient. A similar result was found when the trigger is word-final which proves that the spread is gradient (progressively and regressively.

Keywords: pharyngealization, Yemeni Arabic, Ibbi dialect, pharyngealization spread

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Authors: Mohammad Mosaddik Rahman

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This study embarks on an exploratory journey to assess the pervasive issue of heavy metal contamination in the water bodies along Chittagong Coast, Bangladesh. Situated along the mesmerizing Bay of Bengal, known for its potential as an emerging tourist haven, economic zone, ship breaking yard, confronts significant environmental hurdles. The core of these challenges lies in the contamination from heavy metals such as lead, cadmium, chromium, and mercury, which detrimentally impact both the ecological integrity and public health of the region. This contamination primarily stems from industrial activities, particularly those involving metallurgical and chemical processes, which release these metals into the environment, leading to their accumulation in soil and water bodies. The study's primary aim is to conduct a thorough assessment of heavy metal pollution levels, alongside an analysis of nutrient variations, focusing on nitrates and nitrites. Methodologically, the study leverages systematic sampling and advanced analytical tools like the Hach 3900 spectrophotometer to ensure precise and reliable data collection. The implications of heavy metal presence are multifaceted, affecting microbial and aquatic life, and posing severe health risks to the local population, including respiratory problems, neurological disorders, and an increased risk of cancer. The results of this study highlight the urgent need for effective mitigation strategies and regulatory measures to address this critical issue. By providing a comprehensive understanding of the environmental and public health implications of heavy metal contamination in Chittagong Coast, this research endeavours to serve as a catalyst for change, emphasising the need for pollution control and advancements in water management policies. It is envisioned that the outcomes of this study will guide stakeholders in collaborating to develop and implement sustainable solutions, ultimately safeguarding the region’s environment and public health.

Keywords: heavy metal, environmental health, pollution control policies, shipbreaking yard

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Authors: Nazmul Haque, Syeda Tasnuva Maria

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Sheehan's Syndrome (SS), also known as postpartum hypopituitarism, is a rare but potentially serious condition resulting from ischemic necrosis of the pituitary gland, often occurring during or after childbirth. This syndrome is characterized by hypopituitarism, leading to deficiencies in various hormones produced by the pituitary gland. The primary cause is typically severe postpartum hemorrhage, leading to inadequate blood supply and subsequent necrosis of the pituitary tissue. This chronic hypopituitarism sometimes plays the role of premature atherosclerosis, which may lead to cardiovascular disease. This abstract provides a comprehensive overview of Sheehan's Syndrome with ischaemic heart disease, encompassing its pathophysiology, clinical manifestations, and current management strategies. The disorder presents a wide spectrum of symptoms, including chest pain, fatigue, amenorrhea, lactation failure, hypothyroidism, and adrenal insufficiency. Timely diagnosis is crucial, as delayed recognition can lead to complications and long-term health consequences. We herein report a patient complaining of chronic fatigue symptoms, aggressiveness, chest pain, and breathlessness with repeated LOC that were diagnosed with SS with IHD. The patient was treated with antiplatelet, antianginal, steroids, and hormone replacement with marked improvement in his overall condition.

Keywords: ischaemic heart disease, Sheehan's syndrome, post-partum haemorrhage, pituitary gland

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Authors: David Mafullul, Jiang Lei, Edward Goacher, Jibin Francis

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PURPOSE: Timely decompressive surgery for cauda equina syndrome (CES) is dependent on efficient referral pathways for patients presenting at local primary or secondary centres to tertiary spinal centres in the United Kingdom (UK). Identifying modifiable points of delay within this process is important as minimising time between presentation and surgery may improve patient outcomes. This study aims to analyse whether adequacy of referral impacts on time to surgery in CES. MATERIALS AND METHODS: Data from all cases of confirmed CES referred to a single tertiary UK hospital between August 2017 to December 2019, via a suspected CES e-referral pathway, were obtained retrospectively. Referral adequacy was defined by the inclusion of sufficient information to determine the presence or absence of several NICE ‘red flags’. Correlation between referral adequacy and delay from referral-to-surgery was then analysed. RESULTS: In total, 118 confirmed CES cases were included. Adequate documentation for saddle anaesthesia was associated with reduced delays of more than 48 hours from referral-to-surgery [X2(1, N=116)=7.12, p=.024], an effect partly attributable to these referrals being accepted sooner [U=16.5; n1=27, n2=4, p=.029, r=.39]. Other red flags had poor association with delay. Referral adequacy was better for somatic red flags [bilateral sciatica (97.5%); severe or progressive bilateral neurological deficit of the legs (95.8%); saddle anaesthesia (91.5%)] compared to autonomic red flags [loss of anal tone (80.5%); urinary retention (79.7%); faecal incontinence or lost sensation of rectal fullness (57.6%)]. Although referral adequacy for urinary retention was 79.7%, only 47.5% of referrals documented a post-void residual numerical value. CONCLUSIONS: Adequate documentation of saddle anaesthesia in e-referrals is associated with reduced delay-to-surgery for confirmed CES, partly attributable to these referrals being accepted sooner. Other red flags had poor association with delay to surgery. Referral adequacy for autonomic red flags, including documentation for post-void residuals, has significant room for improvement.

Keywords: cauda equina, cauda equina syndrome, neurosurgery, spinal surgery, decompression, delay, referral, referral adequacy

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Authors: Majid Khan

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Introduction: In this era of microsurgery, free flap holds a remarkable spot in reconstructive surgery. A free flap is well suited for composite defects as it provides sufficient and well-vascularized tissue for coverage. We report our experience with the use of the free flaps for the reconstruction of composite defects. Methods: This is a retrospective case series (chart review) of patients who underwent reconstruction of composite defects with a free flap at Aga Khan University Hospital, Karachi (Pakistan) from January 01, 2015, to December 31, 2019. Data were collected for patient demographics, size of the defect, size of flap, recipient vessels, postoperative complications, and outcome of the free flap. Results: Over this period, 532 free flaps are included in this study. The overall success rate is 95.5%. The mean age of the patient was 44.86 years. In 532 procedures, there were 448 defects from tumor ablation of head and neck cancer. The most frequent free flap was the anterolateral thigh flap in 232 procedures. In this study, the risk factor hypertension (p=0.004) was found significant for wound dehiscence, preop radiation/chemotherapy (p=0.003), and malnutrition (p=0.005) were found significant for fistula formation. Malnutrition (p=0.02) and use of vein grafts (p=0.025) were significant factors for flap failure. Conclusion: Free tissue transfer is a reliable option for the reconstruction of large and composite defects. Hypertension, malnutrition, and preoperative radiotherapy can cause significant morbidity.

Keywords: free flap, free flap failure, risk factors for flap failure, free flap outcome

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Authors: Moetazza M. Al-Shafei, Hala Abdel Karim, Eitedal M. Daoud, Hassan Zaki Hassuna

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Epilepsy is a common neurological disorder affecting all age groups. It is one of the world's most prevalent non-communicable diseases. Increased evidence suggesting that long term usage of anti-epileptic drugs can have adverse effects on bone mineralization and bone molding .Aiming to study these effects and to give guide lines to support bone health through early intervention. From Neurology Out-Patient Clinic kaser Elaini University Hospital, 60 Patients were enrolled, 40 patients on antiepileptic drugs for at least two years and 20 controls matched with age and sex, epileptic but before starting treatment both chosen under specific criteria. Patients were divided into four groups, three groups with monotherapy treated with either Phynetoin, Valporic acid or Carbamazipine and fourth group treated with both Valporic acid and Carbamazipine. Estimation of serum Carboxy-Terminal Telopeptide of Type I- Collagen(ICTP) bone resorption marker, serum 25(OH )vit D3, calcium ,magnesium and phosphorus were done .Results showed that all patients on AED had significant low levels of 25(OH) vit D3 (p<0.001) ,with significant elevation of ICTP (P<0.05) versus controls. In group treated with Phynotoin highly significant elevation of (ICTP) marker and decrease of both serum 25(OH) vit D3 (P<0, 0001) and serum calcium(P<0.05)versus control. Double drug group showed significant decrease of serum 25(OH) vit D3 (P<0.0001) and decrease in Phosphorus (P<0.05) versus controls. Serum magnesium showed no significant differences between studied groups. We concluded that Anti- epileptic drugs appears to be an aggravating factor on bone mineralization ,so therapeutically it can be worth wile to supplement calcium and vitamin D even before initiation of antiepileptic therapy. ICTP marker can be used to evaluate change in bone resorption before and during AED therapy.

Keywords: antiepileptic drugs, bone minerals, carboxy teminal telopeptidetype-1-collagen bone resorption marker, vitamin D

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Authors: Li-Ting Kung, Hui-Zhu Chen, Hsin-Tzu Lee, Wan-Yin Hsu

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Patients with spinal cord injury combined with diabetic nephropathy may under a lot of painful conditions due to complications related to the illness itself or treatments, such as recurrent pressure ulcers, autonomic and peripheral neuropathy, as well as dialysis, for long term. This case report illustrated the nursing experience of transferring a spine cord injure patient who received hemodialysis due to adverse lifestyle-induced diabetic nephropathy to the hospice ward. Nursing care was provided in this patient from July 25th to August 30th, 2015. The tool of 'Gordon’s 11-item functional health assessment' and clinical observation, interviews as well as physical examination were used as data collections. Based on results of health assessment as above, the patient’s health problems were identified as the following: impaired skin integrity, chronic pain, and hopeless. Besides to relieve the symptom of pain due to disease or the treatment of hemodialysis and provide wound care, the first author also played a role to assist the patient to achieve his goal of receiving the hospice palliative care. Finally, with much effort of nurses to communicate with medical teams between the surgical and hospice wards, the patient was transferred to the hospice ward to have fulfilled his last wish of having a good death. We hope this nursing experience can be applied to other similar cases in the future.

Keywords: diabetic nephropathy, hospice care, palliative care, spinal cord injury

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Authors: Yuri Seu, Hyun Jin Park, Jin Seo Park, Yong-Suk Moon, HongtaeKim, Mi-Sun Hur

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The present case report describes bifid ureters arising directly from the separate calyces and renal pelvis of the kidney. It was a single common ureter leading away from the bladder, which was separated into incompletely duplicated ureters near the level of the anterior superior iliac supine. These two branches then entered the left kidney through their own courses. Each ureter traveled anterior and posterior to the renal vein, respectively. These two ureters formed a Y-shaped pattern. One ureter coursed anterior to the renal vein with shorter length, and it terminated at the renal pelvis that was divided into major calices in approximately lower two thirds of the kidney. The other ureter coursed posterior to the renal vein with longer length, terminating at approximately the upper third of the kidney. The renal calices in the upper third of the kidney were directly connected to the posterior ureter, whereas the other major calices in the lower two thirds of the kidney formed the renal pelvis connecting to the anterior ureter. Thus, convergence of the major calices was separated according to the terminations of two ureters. These anomalous ureters were traced to the calices of the kidney, thereby providing a reference of a rare variation of the ureter. The bifid ureters arising from the separate calyces and renal pelvis should be considered by radiologists when evaluating images and diagnosing possible complications of these anomalies.

Keywords: bifid ureters, kidney, major calices, renal pelvis

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Authors: Aamna Tufail, Catherine Anyanwu

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Introduction/Aims: Neurosensory deficits following third molar removal affect the quality of life markedly. The purpose of this audit was to evaluate the incidence of IDN and LN damage and to compare departmental rates to an established standard. A secondary objective was to provide a descriptive summary of identified cases for clinical learning. Materials and Methods: A retrospective audit was conducted by a telephone survey of 101 patients who had third molar extractions performed under LA, IVS, or GA from January 2019 to June 2020 at a District General Hospital. The results were compared to a clinical standard identified as Cheng et al1. Data collection included mode of surgery, mode of anaesthesia, grade of clinician, assessment of difficulty, severity, and duration of symptoms. Results/Statistics: A total of 101 patients had 136 third molars extracted. Age range was 18-84 years. 44% extractions were under LA, 52% under GA, and 4% under IV sedation. 30% were simple extractions, 68% were surgical removals, 2% were unspecified. 89% extractions were performed by an Associate Specialist, 5% by a consultant, and 6% by unspecified grade of clinician. The rate of IDN injuries was 2.9% (n=4), higher than standard (0.3%). The rate of LN injuries was 0.7% (n=1), same as standard (0.7%). The 5 cases of neurosensory deficits are discussed in detail. Conclusions/Clinical Relevance: The rate of ID nerve injuries was higher than the standard. The rate of LN complications was lower than the standard.

Keywords: inferior dental nerve, lingual nerve, nerve injuries, third molars

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Authors: Hamidreza Torabi, Mohsen Moghtaderi

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Introduction: Currently, deep vitrectomy with silicone oil tamponade is the standard treatment method for patients with Rhegmatogenous Retinal Detachment (RRD). After retinal repair, it is necessary to remove silicone oil from the eye, but the appropriate time to remove the oil and complications related to that time has been less studied. The aim of this study was to compare the results of the early removal of silicone oil with the delayed removal of silicone oil in patients with RRD. Method & material: Patients who were referred to the Ophthalmology Clinic of Baqiyatallah Hospital, Tehran, Iran, due to RRD with detached macula in 2021 & 2022 were evaluated. These patients were treated with deep vitrectomy and silicone oil tamponade. Patients whose retinas were attached after the passage of time were candidates for silicone oil removal (SOR) surgery. For patients in the early SOR group, SOR surgery was performed 3-6 months after the initial vitrectomy surgery, and for the late SOR group, SOR was performed after 6 months after the initial vitrectomy surgery. Results: In this study, 60 patients with RRD were evaluated. 23 (38.3%) patients were in the early group, and 37 (61.7%) patients were in the late group. Based on our findings, it was seen that the mean visual acuity of patients based on the Snellen chart in the early group (0.48 ± 0.23 Decimal) was better than the late group (0.33 ± 0.18 Decimal) (P-value=0.009). Retinal re-detachment has happened only in one patient with early SOR. Conclusion: Early removal of silicone oil (less than 6 months) from the eyes of patients undergoing RRD surgery has been associated with better vision results compared to late removal.

Keywords: retinal detachment, vitrectomy, silicone oil, silicone oil removal, visual acuity

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Authors: Swarnali Chakma, Akihiko Hokugo

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Research on three case studies reviewed here explains many aspects and complications of evacuation behavior during an emergency period. The scenario and phenomenon of the disaster were different, but the similarities are that after receiving the warning peoples does not take it seriously. Many individuals evacuated after taking some kind of action, for example; return to home, searching for family members, prepared valuable things etc. Based on a review of the literature, the data identified a number of factors that help explain evacuation behavior during the disaster. In the case of Japan, cultural inhibitors impact people’s behavior; for example, following the traffic rules, some people lost their time to skip because of the slow-moving car makes overcrowded traffic and some of them were washed away by the tsunami. In terms of Bangladeshi culture, women did not want to evacuate without men because staying men and women who do not know each other under the same roof together is not regular practice or comfortable. From these three case studies, it is observed that early warning plays an important role in cyclones, typhoons and earthquakes. A high level of trust from residents in the warning system is important to real evacuation. It is necessary to raise awareness of disaster and provide information on the vulnerability to cyclones, typhoons and earthquakes hazards at community levels. The local level may help decision makers and other stakeholders to make a better decision regarding an effective disaster management.

Keywords: disaster management, emergency period, evacuation, shelter, typhoon

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Authors: Ecem Deniz Kırkpantur, Ozge Ecmel Onur, Tuba Cimilli Ozturk, Ebru Unal Akoglu

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Moyamoya disease is a unique chronic progressive cerebrovascular disease characterized by bilateral stenosis or occlusion of the arteries around the circle of Willis with prominent arterial collateral circulation. The occurrence of Moyamoya disease is related to immune, genetic and other factors. There is no curative treatment for Moyamoya disease. Secondary prevention for patients with symptomatic Moyamoya disease is largely centered on surgical revascularization techniques. We present here a 62-year old male presented with headache and vision loss for 2 days. He was previously diagnosed with hypertension and glaucoma. On physical examination, left eye movements were restricted medially, both eyes were hyperemic and their movements were painful. Other neurological and physical examination were normal. His vital signs and laboratory results were within normal limits. Computed tomography (CT) showed dilated vascular structures around both lateral ventricles and atherosclerotic changes inside the walls of internal carotid artery (ICA). Magnetic resonance imaging (MRI) and angiography (MRA) revealed dilated venous vascular structures around lateral ventricles and hyper-intense gliosis in periventricular white matter. Ischemic gliosis around the lateral ventricles were present in the Digital Subtracted Angiography (DSA). After the neurology, ophthalmology and neurosurgery consultation, the patient was diagnosed with Moyamoya disease, pulse steroid therapy was started for vision loss, and super-selective DSA was planned for further investigation. Moyamoya disease is a rare condition, but it can be an important cause of stroke in both children and adults. It generally affects anterior circulation, but posterior cerebral circulation may also be affected, as well. In the differential diagnosis of acute vision loss, occipital stroke related to Moyamoya disease should be considered. Direct and indirect surgical revascularization surgeries may be used to effectively revascularize affected brain areas, and have been shown to reduce risk of stroke.

Keywords: headache, Moyamoya disease, stroke, visual loss

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Authors: Mohaya Farzin, Parvin Babaei, Mohammad Rostampour

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Ghrelin plays a considerable role in important neurological effects related to food intake and energy homeostasis. As was found, regular physical activity may make available significant improvements to cognitive functions in various behavioral situations. Anxiety is one of the main concerns of the modern world, affecting millions of individuals’ health. There are contradictory results regarding ghrelin's effects on anxiety-like behavior, and the plasma level of this peptide is increased during physical activity. Here we aimed to evaluate the coincident effects of exogenous ghrelin and aerobic exercise on anxiety-like behavior and passive avoidance memory in Wistar rats. Forty-five male Wistar rats (250 ± 20 g) were divided into 9 groups (n=5) and received intra-hippocampal injections of 3.0 nmol ghrelin and performed aerobic exercise training for 8 weeks. Control groups received the same volume of saline and diazepam as negative and positive control groups, respectively. Learning and memory were estimated using a shuttle box apparatus, and anxiety-like behavior was recorded by an elevated plus-maze test (EPM). Data were analyzed by ANOVA test, and p<0.05 was considered significant. Our findings showed that the combined effect of ghrelin and aerobic exercise improves the acquisition, consolidation, and retrieval of passive avoidance memory in Wistar rats. Furthermore, it is supposed that the ghrelin receiving group spent less time in open arms and fewer open arms entries compared with the control group (p<0.05). However, exercising Wistar rats spent more time in the open arm zone in comparison with the control group (p<0.05). The exercise + Ghrelin administration established reduced anxiety (p<0.05). The results of this study demonstrate that aerobic exercise contributes to an increase in the endogenous production of ghrelin, and physical activity alleviates anxiety-related behaviors induced by intra-hippocampal injection of ghrelin. In general, exercise and ghrelin can reduce anxiety and improve memory.

Keywords: anxiety, ghrelin, aerobic exercise, learning, passive avoidance memory

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Authors: Elif Ates, Naile Bilgili

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Background: One of the most important medical complications that individuals with spinal cord injury (SCI) face are the neurogenic bladder. Objectives: To review methods used for management of neurogenic bladder and their effects. Methods: The study was conducted by searching CINAHL, Ebscohost, MEDLINE, Science Direct, Ovid, ProQuest, Web of Science, and ULAKBİM National Databases for studies published between 2005 and 2015. Key words used during the search included ‘spinal cord injury’, ‘bladder injury’, ‘nursing care’, ‘catheterization’ and ‘intermittent urinary catheter’. After examination of 551 studies, 21 studies which met inclusion criteria were included in the review. Results: Mean age of individuals in all study samples was 42 years. The most commonly used bladder management method was clean intermittent catheterization (CIC). Compliance with CIC was found to be significantly related to spasticity, maximum cystometric capacity, and the person performing catheterization (p < .05). The main reason for changing the existing bladder management method was urinary tract infections (UTI). Individuals who performed CIC by themselves and who voided spontaneously had better life quality. Patient age, occupation status and whether they performed CIC by themselves or not were found to be significantly associated with depression level (p ≤ .05). Conclusion: As the most commonly used method for bladder management, CIC is a reliable and effective method, and reduces the risk of UTI development. Individuals with neurogenic bladder have a higher prevalence of depression symptoms than the normal population.

Keywords: bladder management, catheterization, nursing, spinal cord injury

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Authors: Maryam Risla Shahul Hameed, Tharsiga Yogarajah, Fritzy Mathew, Tayyaba Syed, Shalin Shaunak

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Aim: Auditing the adherence of Trauma and Orthopaedics Operative notes to the RCS Good Surgical Practice Guidelines. Method: Clinical audit conducted on 150 operative notes over a period of 2 months April- May 2023, including emergency and elective surgeries performed in Ashford and St. Peter’s Hospital. The RCS Good Practice Surgical Guidelines for an ideal operative note were used to compare.Results: Date of the procedure and signature of the surgeon were mentioned in all the notes by default in the electronic template being used. Title of the operation performed and whether elective or emergency were mentioned by 92% and 45%, respectively. Name of theatre anaesthetist and operating surgeons were mentioned by 73% and 93% respectively. Time of surgery mentioned by 26%. Operative findings and operative diagnosis mentioned by 83% and 53% respectively. Incision and complications of surgery mentioned in 80% and 53%, respectively. Details of tissue added/ altered/ removed mentioned by 46%. Information on prosthesis or implant used is mentioned by 54%. Details of closure and anticipated blood loss mentioned in 91% and 45% respectively. Antibiotic prophylaxis was mentioned by 63%, out of which only 23% mentioned the name and duration of the antibiotic. VTE prophylaxis was mentioned by 84%, out of which only 23% and 29% mentioned the name and duration of the prophylaxis, respectively. Conclusion: There is more for improvement in the operative notes for better continuity of care between the operating surgeons and other doctors in the wards taking care of the patients post operatively. We recommend to follow a standardized guidelines by all the nationwide and a standard template to be followed by all.

Keywords: surgery, notes, RCS, guidelines

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Authors: A. Haddick, A. Soltan

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Background: During the period of recovery from an operative obstetric procedure, a woman is not only at risk of the life-threatening complications accompanying labour but also those associated with surgery and anaesthesia. It is speculated that women in the recovery area may receive a lower standard of care over a night shift. Thus obstetric recovery room care should be evaluated regularly to ensure all women receive an equally high standard of care 24/7. Aim: The aim of this audit was to undertake an audit in the Liverpool Women’s Hospital on the care in recovery, and to ascertain the extent to which the standards were met. This audit included the full audit cycle. Method: Standards were taken from the AAGBI, RCOA, NICE and CNST guidelines. There were 12 standards including appropriate documentation of vital signs and appropriate length of stay after surgery. Notes from 100 patients were analysed from March 2011-March 2012. There were 52 day notes and 48 night notes; these were accessed to gain the relevant data. In the re audit 35 notes were accessed from March 14-September 14. Results: The Liverpool Women’s Hospital met in total 10 of these standards. 10 were met during the day shift (83%) and 0 met during the night shift. In the re audit, there was a significant improvement in the standards met at night. 9 of the standards were met during the day and 7 of the standards were met at night. Clearly there are still improvements to be made. Conclusions: In the original audit, an audit action plan was formulated. This was following discussion of the results of this audit in an MDT meeting and presentation with a consultant Obstetrician, the head of Midwifery, the head of Obstetrics theatres and a recovery nurse. This audit will be further discussed in the Liverpool Woman's Hospital in July 2015 for further implementation for improvement.

Keywords: care, recovery, room, women

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Authors: Suk Kyoon Song, Myung-Rae Cho

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Purpose: Paralytic ileus occurs in up to 18% of patients with pelvic bone fractures. The aim of this study is to determine if massive bleeding requiring arterial angioembolization is related to the duration of ileus in patients with traumatic pelvic ring injuries. Methods: This retrospective study included 25 patients who underwent arterial angioembolization for traumatic pelvic ring injuries. Data were collected from prospectively maintained databases of two independent hospitals. Results: Demographic characteristics (such as age, sex, body mass index, and Charlson Comorbidity Index), cause of trauma, and severity of pelvic injuries were similar in the non-prolonged and prolonged ileus groups. As expected, the prolonged ileus group had a significantly longer duration of ileus than the non-prolonged ileus group (8.0 ± 4.2 days vs. 1.2 ± 0.4 days, respectively, P < 0.001). The mortality rate was higher in the prolonged ileus group (20% vs. 0%), but it was not significantly different (P = 0.13). Interestingly, the prolonged ileus group received significantly higher amounts of packed red blood cell (PRBC) transfusions (6.1 ± 2.1 units vs. 3.8 ± 2.5 units; P = 0.02). The amount of PRBC transfusions was associated with a greater risk of prolonged ileus development (P = 0.03, OR = 2.04, 95% CI = 1.08-3.88). Conclusion: This study supports the idea that the duration of the ileus is related to the amount of bleeding caused by the traumatic pelvic ring injury. In order to prevent further complications, conservative treatments of the ileus should be considered.

Keywords: pelvic ring injury, bleeding, ileus, arterial angioembolization

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Authors: Ghada A. Gamea, Nabila A. Yaseen, Ahmed A. Othman, Ahmed S. Tawfik

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Infection with Toxoplasma gondii can cause serious complications in pregnant women, leading to abortion, stillbirth, and congenital anomalies in the fetus. Definitive diagnosis of T. gondii acute infection is therefore critical for the clinical management of a mother and her fetus. This study was conducted on 250 pregnant females in the first trimester who were inpatients or outpatients at Obstetrics and Gynaecology Department at Tanta University Hospital. Screening of the selected females was done for the detection of immunoglobulin (IgG and IgM), and all subjects were submitted to history taking through a questionnaire including personal data, risk factors for Toxoplasma, complaint and history of the present illness. Thirty-eight samples, including 18 IgM +ve and 20 IgM-ve cases were further investigated by the avidity and IgE ELISA tests. The seroprevalence of toxoplasmosis in pregnant women was (42.8%) based on the presence of IgG antibodies in their sera. Contact with cats and consumption of raw or undercooked meat are important risk factors that were associated with toxoplasmosis in pregnant women. By serology, it could be observed that in the IgM +ve group, only one case (5.6%) showed an acute pattern by using the avidity test, though 10 (55.6%) cases were found to be acute by the IgE assay. On the other hand, in the IgM –ve group, 3 (15%) showed low avidity, but none of them was positive by using the IgE assay. In conclusion, there is no single serological test that can be used to confirm whether T. gondii infection is recent or was acquired in the distant past. A panel of tests for detection of toxoplasmosis will certainly have higher discriminatory power than any test alone.

Keywords: diagnosis, serology, seroprevalence, toxoplasmosis

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Authors: M. Yadegari

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The thyroid gland is the largest classic endocrine organ that effects many organs of the body and plays a significant role in the process of Metabolism in animals. The aim of this study was to investigate the prevalence of thyroid disorders diagnosed by ultrasound and microscopic Lesions of the thyroid during the slaughter of apparently healthy One Humped Camels (Camelus dromedarius) in Iran. Randomly, 520 male camels (With an age range of 4 to 8 years), were studied in 2012 to 2013. The Camels’ thyroid glands were evaluated by sonographic examination. In both longitudinal and transverse view and then tissue sections were provide and stained with H & E and finally examined by light microscopy. The results obtained indicated the following: hyperplastic goiter (21%), degenerative changes (12%), follicular cysts (8%), follicular atrophy (4%), nodular hyperplasia (3%), adenoma (1%), carcinoma (1%) and simple goiter colloid (1%). Ultrasound evaluation of thyroid gland in adenoma and carcinoma showed enlargement and irregular of the gland, decreased echogenicity, and the heterogeneous thyroid parenchyma. Also, in follicular cysts were observed in the enlarged gland with no echo structures of different sizes and decreased echogenicity as a local or general. In nodular hyperplasia, increase echogenicity and heterogeneous parenchymal were seen. These findings suggest the use of Ultrasound as a screening test in the diagnosis of complications of thyroid disorders. Pathology also to be used for the diagnosis of thyroid problems and other side effects.

Keywords: thyroid gland, one humped camel, sonography, pathology

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Authors: Pheeraphat Ussadamongkol, Suthasinee Sinawat

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Objective: The purpose of this study is to evaluate the anatomical and visual outcomes associated with the use of heavy silicone oil (HSO) during pars plana vitrectomy (PPV) in patients with rhegmatogenous retinal detachment (RRD). Materials and methods: A Total of 66 eyes of 66 patients with RRD patients who underwent PPV with HSO from 2018-2023 were included in this retrospective study. Risk factors of surgical outcomes were also investigated. Results: The mean age of the recruited patients was 55.26 ± 13.05 years. The most common diagnosis was recurrent RRD, with 43 patients (65.15%), and the majority of these patients (81.39%) had a history of multiple vitreoretinal surgeries. Inferior breaks and PVR grade ≧ C were present in 65.15% and 42.42% of cases, respectively. The mean duration of HSO tamponade was 7.77+5.19 months. The retinal attachment rate after surgery was 71.21%, with a final attachment rate of 87.88%. The mean final VA was 1.62 ± 1.11 logMAR. 54.54% of patients could achieve a final visual acuity (VA)  6/60. Multivariate analysis revealed that proliferative vitreoretinopathy (PVR) and multiple breaks were significantly associated with retinal redetachment, while initial good VA (  6/60) was associated with good visual outcome ( 6/60). The most common complications were glaucoma (30.3%) and epimacular membrane (7.58%). Conclusion: The use of heavy silicone oil in pars plana vitrectomy for rhegmatogenous retinal detachment yields favorable anatomical and visual outcomes. Factors associated with retinal redetachment are proliferative vitreoretinopathy and multiple breaks. Good initial VA can predict good visual outcomes.

Keywords: rhegmatogenous retinal detachment, heavy silicone oil, surgical outcome, visual outcome, risk factors

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Authors: Mehdi Mirzaei Alavijeh, Farzad Jalilian

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Background: Marijuana is the most widely used illicit drug worldwide, especially among adolescents and young adults, which can cause numerous complications. The aim of this study was to determine the pattern, motivation use, and factors related to marijuana use among Iranian youths based on the integrative model of behavioral prediction Methods: A cross-sectional study was conducted among 174 youths marijuana user in Kermanshah County and Isfahan County, during summer 2014 which was selected with the convenience sampling for participation in this study. A self-reporting questionnaire was applied for collecting data. Data were analyzed by SPSS version 21 using bivariate correlations and linear regression statistical tests. Results: The mean marijuana use of respondents was 4.60 times at during week [95% CI: 4.06, 5.15]. Linear regression statistical showed, the structures of integrative model of behavioral prediction accounted for 36% of the variation in the outcome measure of the marijuana use at during week (R2 = 36% & P < 0.001); and among them attitude, marijuana refuse, and subjective norms were a stronger predictors. Conclusion: Comprehensive health education and prevention programs need to emphasize on cognitive factors that predict youth’s health-related behaviors. Based on our findings it seems, designing educational and behavioral intervention for reducing positive belief about marijuana, marijuana self-efficacy refuse promotion and reduce subjective norms encourage marijuana use has an effective potential to protect youths marijuana use.

Keywords: marijuana, youth, integrative model of behavioral prediction, Iran

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Authors: Surena V.

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Background and Aim: Periodontal diseases are among the most common infectious diseases all around the world, even in developed countries. Considering the increased rate of microbial resistance to antibiotics and the chemical side effects of antibiotics and antiseptics used for the treatment of periodontal disease, there is a need for an alternative antimicrobial agent with fewer complications. Medicinal herbs have recently become popular as antimicrobial and preventive agents. This study aimed to assess the antibacterial effects of hydroalcoholic extracts of Lawsonia inermis, Malva sylvestris and Boswellia serrata on Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans). Materials and Methods: Hydroalcoholic extracts of the three medicinal plants were obtained by the maceration technique and A. actinomycetemcomitans was cultured. The antimicrobial efficacy of the three medicinal plants was compared with that of 0.2% chlorhexidine (CHX) according to the CLSI protocol using agar disc diffusion and broth microdilution techniques. All tests were repeated three times. Results: Hydroalcoholic extracts of all three plants had antimicrobial activity against A. actinomycetemcomitans. The minimum inhibitory concentration (MIC) of Lawsonia inermis, Malva sylvestris, and Boswellia serrata was 78.1, 156.2, and 1666 µg/mL with no significant difference between them. The MIC of CHX was 3.33 µg/mL, which was significantly higher than that of Boswellia serrata extract. Conclusion: Given that, further in vivo studies confirm other properties of these extracts and their safety in terms of cytotoxicity and mutagenicity, hydroalcoholic extracts of Lawsonia inermis and Malva sylvestris may be used in mouthwashes or local delivery systems to affect periodontal biofilm.

Keywords: actinobacilus actinomycetem commitans, lawsonia inermis, malva sylvestris, boswellia serrata

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Authors: H. Noureddine, P. Rao, R. Guru, A. Chandratreya

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The nice guidance for elective total knee replacements states that patients should be given mechanical thrombo-prophylaxis, and if no contraindications chemical thromboprophylaxis in the form of Dabigatran etexilate, Rivaroxiban, UFH, LMWH, or Fondaparinux sodium (CG92, 1.5.14, January 2010). In Practice administering oral agents has been the dominant practice as it reduces the nursing needs, and shortens hospital stay and is generally received better by patients. However, there are well documented associated bleeding risks, and their effects are difficult to reverse in case of major bleeding. Our experience with oral factor 10 inhibitors used for thromboprophylaxis was marked with several patients developing complications necessitating return to the theatre for wound washouts. This has led us to try a different protocol for thromboprophylaxis that we applied on our patients undergoing total and unicondylar knee replacements. We applied mechanical thromboprophylaxis in the form of intermittent pneumatic pressure devices, and chemical thromboprophylaxis in the form of a dose of prophylactic LMWH pre-op, then 150 mg of Aspirin to start 24 hours after the surgery and to continue for 6 weeks, alongside GI cover with PPIs or antihistamines. We also administered local anaesthetics intra-operatively in line with the ERAS protocol thus encouraging early mobilization. We have identified a cohort of 133 patients who underwent one of the aforementioned procedures in the same trust, and by the same surgeon, where this protocol was applied and examined their medical notes retrospectively with a mean follow-up period of 14 months, to identify the rate and percentage of patients who had thrombo-embolic events in the post-operative period.

Keywords: aspirin, heparin, knee arthroplasty, thromboprophylaxis

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Authors: Alireza Pishgahi, Mohammad Rahbar, Javad Shokri, Shahla Dareshiri, Yaghoub Salekzamani, Fariba Eslamian

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Background and Objectives: Hypertrophic scars are one of the complications following a burn injury. Intralesional corticosteroid injection is an invasive method for treatment of this complication. We had design a single blinded randomized control trial to deliver dexamethasone by phonophoresis and evaluate its efficacy on hypertrophic burn scars characteristics. Material and Methods: 56 cases of hypertrophic burn scar due to burn injury allocated randomly to dexamethasone and control group. Individuals in case group received 10 sessions of dexamethasone 0.4% phonophoresis. Patients in control group had placebo phonophoresis (ultrasound with normal routine aquatic gel without any dexamethasone) with the same protocol. At the beginning of study and one week after last session, hypertrophic scar characteristics and pruritus were measured by ‘Vancouver Scar Scale’, and ‘5-D Pruritus Scale’ respectively in both groups. Results: Despite mild improvement in Vancouver Scar Scale score one week after intervention in dexamethasone phonophoresis group in comparison to control subjects, but this difference was not significant (p=0.08). Pruritus score perceived subjectively were significantly lower one week after intervention in dexamethasone groups in comparison to control subjects (p=0.00). Conclusion: Dexamethasone phonophoresis is a safe and effective treatment method for burn hypertrophic scar pruritus, but its efficacy for scar characteristics improvement needs to be evaluated by larger studies with long-term follow-up period.

Keywords: dexamethasone, hypertrophic scar, phonophoresis, pruritus

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