Search results for: shoulder pain

Authors: Melliti Rihab, Zaeid Sonia, Khechine Wiem, Daldoul Amira

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Introduction: Lung cancer is the leading cause of cancer death. Its incidence is increasing, and its prognosis remains pejorative. We present the clinical, pathological, and therapeutic characteristics of bronchopulmonary cancer (BPC) in Tunisia. Methods: Retrospective study including patients followed in the oncology department of the University Hospital of Monastir between April 2014 and December 2021 suffering from lung cancer. Results: These are 117 patients, including 86.3% men and 13.7% women (sex ratio 6.3). The average age was 64 years ± 9 (37-83), with 95.7% being over 50 years old. Patients were smokers in 82% of cases. The clinical signs were dominated by chest pain (27.5%) and dyspnea in 21.1% of cases. In 6 patients, an episode of COVID-19 infection revealed the diagnosis. Half of the patients had a PS between 0 and 1. Small cell lung cancer was present in 18 patients (15.4%). The majority of non small cell lung cancer was of the adenocarcinoma type (68.7%). The diagnosis was late (stage IV) in 62.4% of cases. BPC was metastatic to bone (52%), contralateral lung (25.9%), and brain (27.3%). Patients were oligometastatic in 26% of cases. Surgery and radiotherapy were performed respectively in 14.5% and 23.1% of cases. Three-quarters of the patients had had nutrition (75.2%). The ROS1 mutation was present in 1 patient. PDL-1 expression was >40% in 2 patients. Survival was mean eight months ± 7.4. Conclusion: Lung cancer is diagnosed at a late stage in Tunisia. The lack of molecular study for non-small cell PBC and the lack of marketing authorization for tyrosine kinase inhibitors in Tunisia make the management incomplete.

Keywords: SCLC, NCSLC, ROS1, PDL1

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Authors: Mohammed Fakehy, Mohammed Haggag

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The problem of test anxiety considered as one of the most important and most complex psychological problems faced by students of King Saud University, where university students in a need to bring their reassurance and psychological comfort, relieves feeling pain and difficulties of the study. Recently, there are programs and science that help human to change, including the science Linguistic Programming this neural science stems from not just the tips of the need to make the effort or continue to work, but provides the keys in which one can be controlled in the internal environment. Even human potential energy is extracted seeking to achieve success and happiness and excellence. Through the work of the researchers as members of the teaching staff at King Saud University and specialists in the field of psychology noticed the suffering of some students of King Saud University, test anxiety. In an attempt by the researchers to mitigate as much as possible of the unity of this concern, students will have a training program in Neuro Linguistic Programming. The main Question of this study is What is the effectiveness of the impact of a training program using NLP to reduce test anxiety by using a biological feedback. Therefore, the results of this study might serve as a good announcement about the usefulness of NLP programs which influence future research to significant effect of NLP on test anxiety.

Keywords: neuro linguistic programming, test anxiety, biological feedback, king saud

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Authors: Laila Shikaki

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‘Writings about Home’ discusses the poetry of Palestinian American female poets, especially ones who write about their homelands, living away from home, as well as their family ties to the land. This is a paper about poetry, but it is also about Palestinian American women who use English to convey issues pertaining to homesickness, family, and language. She study poems by Naomi Shihab Nye and Natalie Hanal. In ‘My Father and the Fig Tree,’ for example, Nye depicts her father’s life away from Palestine and his attachment to a tree that represents his homeland and nostalgia. Nye’s style is diverse and unified, and her attention is to details and images. While her words and imagery are usually simple, they are always rich in meaning. Nathalie Handal’s poetry, on the other hand, has a more complicated, multi-layered, and nuanced style as the poet herself lived in many areas and spoke multiple languages. ‘Bethlehem,’ for instance, depicts her city of origin, recalling her grandfather. Her poem ‘Blue Hours’ illustrates a persona’s difficulty in belonging, switching from one language to the next, and feeling a betrayal in both. This paper pays attention to language and how being bilingual adds another level of exile and pain to those who have fled or were forced to leave Palestine. This paper is very timely as the issue of Palestinian freedom and its right to autonomy and self-determination is the central stage for many Americans, seen in their protests, university encampments, and graduation ceremonies, not forgetting its effect on voters’ decisions for president and elected officials.

Keywords: Palestinian American, poetry, homeland, Nye, Handal

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Authors: Dganit Sharon, Raghda Alnabilsy

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The goal of this qualitative research was to sound the voices of Jewish and Arab women in Israel who had experienced obstetric violence, to learn the consequences of the violence to them on different levels and over time, and to present their coping strategies from their perspective. Another goal was to expand the research knowledge on an issue that has not been studied among Arab and Jewish women in Israel. The premise of this study is the feminist approach that aims to promote human rights, and to eradicate phenomena related to cultural, structural, gender and patriarchal structures of women, their bodies, and their health. The research was based on the qualitative-constructivist methodology, by means of thematic analysis of 20 in-depth semi-structured interviews. Two main themes emerged from the analysis. First, the physical and emotional consequences of obstetric violence, consequences to spousal relationships, and mistrust of the health system and service providers. Second, women’s coping strategies with obstetric violence that included repression and avoidance as a way of coping with the pain and trauma of the abuse; garnering inner strengths, resilience, knowledge and awareness of the delivery process; recruiting and relying on external help; sharing on social media, and discussions with other women who had similar experiences; or reaching out to therapists / legal aid / public complaints.

Keywords: obstetric violence, Jewish and arab women in israel, consequences, coping strategies, gender-related perspective

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Authors: Dielle Martins

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A 45-year-old female, Manju Devi, presented with a 6-month history of progressively changing voice, difficulty breathing for the past month, and worsening dysphagia for the past two weeks, particularly with solids. Direct laryngoscopy revealed an ulceroproliferative mass arising from the left aryepiglottic fold, obscuring the glottic opening. Imaging with contrast-enhanced CT of the neck showed a lobulated, heterogeneous mass in the hypo-pharyngeal region, encroaching into the airway and involving the aryepiglottic fold and pyriform sinus, raising concerns for a malignant lesion. Small reactive lymph nodes were identified in the left submandibular region and along the carotid sheath. Due to the location of the mass near the glottis and the risk of complete airway obstruction, securing the airway was a critical concern. An awake fiberoptic bronchoscopy for endotracheal intubation was chosen as the safest approach. The patient was prepped with local anesthesia to the airway using nebulized 10% lignocaine and 4% lignocaine spray to the oral mucosa. After obtaining informed consent, the patient was positioned supine on the operating table. To facilitate the fiberoptic intubation, the patient’s neck was extended, and the head was laterally rotated 30 degrees to the left. This positioning helped optimize the visualization of the glottic opening, which was obscured by the mass. The fiberoptic scope was carefully passed through the oral cavity, past the uvula, and into the laryngeal area. As the scope advanced, the ulceroproliferative mass was observed covering most of the glottis, with only the anterior commissure visible. After further gentle manipulation, including the use of a shoulder roll for additional neck extension and rotation, a clearer view of the anterior two-thirds of the glottis was achieved. A 6.5mm internal diameter endotracheal tube was advanced over the fiberoptic scope and successfully positioned just above the carina. General anesthesia was then induced, and an excision biopsy of the growth was performed. This case underscores the importance of careful preoperative airway evaluation and the role of awake fiberoptic intubation in managing complex airway obstructions. Proper patient positioning, including neck extension and lateral rotation, proved crucial for successful intubation in the presence of a mass obstructing the glottic opening. This case emphasizes the techniques used in the fiberoptic intubation and the careful positioning of the patient, which were critical for the success of the procedure.

Keywords: awake fiberoptic bronchoscopy in laryngeal growth, Difficult intubation in glottic cancer, glottic cancer, difficult airway

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Authors: Isa Naina Mohamed, Mazliadiyana Mazlan, Ahmad Nazrun Shuid

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Stichopus chloronotus (Black Knobby or green fish) is a sea cucumber species commonly found along Malaysia’s coastline. In Malaysia, it is believed that sea cucumber can expedite healing of wounds, provide extra energy and used as an ointment to relieve pain. The aim of this study is to determine the best concentration of Stichopus chlronotus extract to promote wound healing. 12 male Sprague-Dawley rats with wounds created using 6mm disposable punch biopsy were divided into 6 treatment groups. The normal control group (untreated), positive control group (flavin treated only), negative control group (emulsifying ointment only), and group 0.1, group 0.5, group 1 were each treated with 0.1%, 0.5% and 1% of Stichopus chlronotus water extract mixed in emulsifying ointment, respectively. Treatments were administered topically for 10 days. Changes in wound area were measured using caliper and photographs were taken on day 2, 4, 6, 8, and 10 after index wound. Results showed that wound reduction of group 0.5 on day 4, 6, and 8 was significantly higher compared to normal control group and positive control group. Group 0.5 also had higher wound reduction from day 6 until day 10 compared to all other groups. In conclusion, Sea Cucumber (Stichopus chloronotus) extract demonstrated the best minor wound healing properties at concentration 0.5%. The potential of Stichopus chlronotus extract ointment for wound healing shall be investigated further.

Keywords: minor wound healing, expedite wound healing, sea cucumber, Stichopus chloronotus

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Authors: Naso Isaiah Thanavisuth

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Medical cannabis can be used for treatment including pain, multiple sclerosis, Parkinson's disease, and cancer. However, medical cannabis leads to adverse effects (AEs), which is delta-9-tetrahydrocannabinol (THC). In previous studies, the major of THC metabolism enzymes are CYP2C9. Especially, the variation of CYP2C9 gene consist of CYP2C9*2 on exon 3 and CYP2C9*3 on exon 7 to decrease enzyme activity. Notwithstanding, there is no data describing whether the variant of CYP2C9 genes are apharmacogenetics marker for the prediction of THC-induced AEs in Thai patients. We want to investigate the association between CYP2C9 gene and THC-induced AEs in Thai patients. We enrolled 39 Thai patients with medical cannabis treatment who were classified by clinical data. The CYP2C9*2 and *3 genotyping were conducted using the TaqMan real time PCR assay. All Thai patients who received the medical cannabis consist of twenty-four (61.54%) patients were female, and fifteen (38.46%) were male, with age range 27- 87 years. Moreover, the most AEs in Thai patients who were treated with medical cannabis between cases and controls were tachycardia, arrhythmia, dry mouth, and nausea. Particularly, thirteen (72.22%) medical cannabis-induced AEs were female and age range 33 – 69 years. In this study, none of the medical cannabis groups carried CYP2C9*2 variants in Thai patients. The CYP2C9*3 variants (*1/*3, intermediate metabolizer, IM) and (*3/*3, poor metabolizer, PM) were found, three of thirty-nine (7.69%) and one of thirty-nine (2.56%), respectively. Although, our results indicate that there is no found the CYP2C9*2. However, the variation of CYP2C9 allele might serve as a pharmacogenetics marker for screening before initiating the therapy with medical cannabis for the prevention of medical cannabis-induced AEs.

Keywords: CYP2C9, medical cannabis, adverse effects, THC, P450

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Authors: Michael Stevens

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David Hunter, a musicologist, has suggested that both Beethoven and Handel had chronic lead poisoning from the wine that they drank. These two eminent musical composers had some striking similarities. Beethoven had alcohol dependency and preferred wine, to which lead had been added to improve the taste. Handel was obese due to an eating disorder that included drinking tainted wine after large meals. They both had paresthesia of their extremities that they interpreted as rheumatism. This is a common sensory symptom from chronic lead poisoning. Their differences are marked in that Beethoven was profoundly deaf by the end of his life, whereas Handel had remarkably good hearing. Handel had paresis of three fingers of his right hand, whereas Beethoven lacked any motor symptoms. Beethoven reported recurrent abdominal pain suggestive of lead colic, whereas it can only be inferred that this symptom was present in Handel. Lead poisoning is likely in Handel because his paralysis was consistent with radial nerve involvement in the dominant hand. In addition, it was cured by hot baths, which have been shown to reduce total body lead content by exchanging with iron and calcium ions in water. Although lead produces predominantly motor symptoms in classic or subacute lead poisoning, and sensory symptoms in chronic lead poisoning, lead poisoning causes a variety of symptoms that depending on duration and level of exposure, are extremely variable from person to person. It therefore seems likely that Handel had lead poisoning, but extremely likely that Beethoven did because of the confirmatory finding of high levels of lead deep in his skull bone, which is a good measure of total body burden.

Keywords: beethoven, handel, lead, poisoning

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Authors: En Hyung Kim

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Partial unilateral lentiginosis (PUL) is an unusual pigmentary disorder characterized by numerous lentigines grouped within an area of normal skin. Although treatment is not necessary, many patients with facial PUL seek medical help for cosmetic reasons. There is no established standard treatment for PUL. Conventional lasers may cause postinflammatory hyperpigmentation because keratinocytes are injured during the process. Also scarring, long downtime and pain are important issues. Case: A 19-year-old patient with facial PUL was treated with 1064-nm Q-Switched Neodymium-Doped Yttrium Aluminum Garnet (QS Nd:YAG) laser. The patient was treated at one-week intervals starting with a spot size of 6 mm, a fluence of 2.5 J/cm2 and a pulse rate of 10 Hz with 1-2 passes of slow sliding technique with approximately 5-15 % overlap. The fluence was elevated to 3 J/cm2 after the 4th session according to treatment response and patient tolerance. After 10 treatment sessions the lesions were remarkably improved. Discussion: Although the exact mechanism by which low fluence 1,064-nm QS Nd:YAG laser improves pigmentary lesions is unclear, the term ‘subcellular selective photothermolysis’ and ‘melanocyte apoptosis and replacement’ have been proposed. If appropriate measures are taken to monitor patient response during and after the procedure, low fluence 1064-nm QS Nd:YAG laser may achieve good cosmetic result in the treatment of PUL with a very safe and effective profile.

Keywords: laser toning, low fluence, 1064-nm Q-switched neodymium-doped yttrium aluminum garnet laser, partial unilateral lentiginosis

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Authors: Isabel Moscol, Carlos J. Díaz, Ciro Rodríguez

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Hip replacement becomes necessary when a person suffers severe pain or considerable functional limitations and the best option to enhance their quality of life is through the replacement of the damaged joint. One of the main components in femoral prostheses is the stem which distributes the loads from the joint to the proximal femur. To preserve more bone stock and avoid weakening of the diaphysis, a short starting stem was selected, generated from the intramedullary morphology of the patient's femur. It ensures the implantability of the design and leads to geometric delimitation for personalized optimization with machine learning (ML) and metaheuristic algorithms. The present study attempts to design a cementless short stem to make the strain deviation before and after implantation close to zero, promoting its fixation and durability. Regression models developed to estimate the percentage change of maximum principal stresses were used as objective optimization functions by the metaheuristic algorithm. The latter evaluated different geometries of the short stem with the modification of certain parameters in oblique sections from the osteotomy plane. The optimized geometry reached a global stress shielding (SS) of 18.37% with a determination factor (R²) of 0.667. The predicted results favour implantability integration in the short stem optimization to effectively reduce SS in the proximal femur.

Keywords: machine learning techniques, metaheuristic algorithms, short-stem design, stress shielding, hip replacement

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Authors: Neena Kanojia, R. K. Kanojia

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Background: Osteoarthritis OA of the knee is one of the leading causes of disability characterized by degeneration of hyaline cartilage combined with reparative processes. Its strong association with metabolic syndrome is postulated to be due to both mechanical and biochemical factors. Our study aims to study differential effect of metabolic risk factors on cartilage degeneration and regeneration at biomarker level. Design: After screening 281 patients presenting with knee pain, 41 patients who met the selection criteria were included and were divided into metabolic MetS OA and non-metabolic Non-MetS OA phenotypes using National Cholesterol Education Programme-Adult Treatment Panel-III NCEP ATP III criteria for metabolic syndrome. Serum Cartilage Oligomeric Matrix Protein COMP and Procollagen type IIA N terminal Propeptide PIIANP levels were used as tools to assess cartilage degeneration and regeneration, respectively. Results: 22 among 41 patients 53.66% had metabolic syndrome. Covariates like age, gender, Kellgren Lawrence KL grades were comparable in both groups. MetS OA group showed significant increase in serum COMP levels (p 0.03 with no significant effect on serum PIIANP levels (p 0.46. Hypertriglyceridemia showed independent association with both cartilage anabolism (p 0.03 and catabolism (p 0.03. Conclusion: Metabolic syndrome, though has no effect on cartilage regeneration tends to shift cartilage homeostasis towards degeneration with hypertriglyceridemia showing significant independent effect on cartilage metabolism.

Keywords: metabolic, syndrome, cartilage, degernation

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Authors: Kwanputtha Arunprasert, Chaiyakarn Pornpitchanarong, Praneet Opanasopit, , Prasopchai Patrojanasophon

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Capsaicin, a recently FDA-approved drug for the topical treatment of neuropathic pain, is associated with several side effects like burning sensation and erythema leading to severe skin irritation and poor patient compliance. These unwanted side effects are due to the rapid penetration of capsaicin into the epidermis and low permeation to the dermis layer. The purpose of this study was to develop nanostructured lipid carriers (NLCs) that entrapped capsaicin for reducing dermal irritation. Solid lipid (glyceryl monostearate (GM), cetyl palmitate (CP), cetyl alcohol (COH), stearic acid (SA), and stearyl alcohol (SOH)) and surfactant (Tween®80, Tween®20, and Span®20) were varied to obtained optimal capsaicin-loaded NLCs. The formulation using CP as solid lipid and Tween®80 as a surfactant (F2) demonstrated the smallest size, excellent colloidal stability, and narrow range distribution of the particles as being analyzed using Zetasizer. The obtained capsaicin-loaded NLCs were then characterized by entrapment efficiency (EE) and loading capacity (LC). The release characteristics followed Higuchi kinetics, and the prolonged capsaicin release may result in the reduction in skin irritation. These results could demonstrate the potentials of capsaicinloaded lipid-based nanoparticles for topical drug delivery.

Keywords: capsaicin, lipid-based nanoparticles, nanostructured lipid carriers, topical drug delivery system

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Authors: Xiaoyun Hui, Fiona Gentle, Clemens Engelke, Margaret C. Graham

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Although past work has shown that phosphorus (P), an important nutrient, may form complexes with aqueous humic substances (HS), the principal component of natural organic matter, the nature of such interactions is poorly understood. Humic complexation may not only enhance P concentrations but it may change its bioavailability within such waters and, in addition, influence its transport within catchment settings. This project is examining the relationships and associations of P, HS, and iron (Fe) in Loch Meadie, Sutherland, North Scotland, a mesohumic freshwater loch which has been assessed as reference condition with respect to P. The aim is to identify characteristic spectroscopic parameters which can enhance the performance of the model currently used to predict reference condition TP levels for highly-coloured Scottish lochs under the Water Framework Directive. In addition to Loch Meadie, samples from other reference condition lochs in north Scotland and Shetland were analysed. By including different types of reference condition lochs (clear water, mesohumic and polyhumic water) this allowed the relationship between total phosphorus (TP) and HS to be more fully explored. The pH, [TP], [Fe], UV/Vis absorbance/spectra, [TOC] and [DOC] for loch water samples have been obtained using accredited methods. Loch waters were neutral to slightly acidic/alkaline (pH 6-8). [TP] in loch waters were lower than 50 µg L-1, and in Loch Meadie waters were typically <10 µg L-1. [Fe] in loch waters were mainly <0.6 mg L-1, but for some loch water samples, [Fe] were in the range 1.0-1.8 mg L-1and there was a positive correlation with [TOC] (r2=0.61). Lochs were classified as clear water, mesohumic or polyhumic based on water colour. The range of colour values of sampled lochs in each category were 0.2–0.3, 0.2–0.5 and 0.5–0.8 a.u. (10 mm pathlength), respectively. There was also a strong positive correlation between [DOC] and water colour (R2=0.84). The UV/Vis spectra (200-700 nm) for water samples were featureless with only a slight “shoulder” observed in the 270–290 nm region. Ultrafiltration was then used to separate colloidal and truly dissolved components from the loch waters and, since it contained the majority of aqueous P and Fe, the colloidal component was fractionated by gel filtration chromatography method. Gel filtration chromatographic fractionation of the colloids revealed two brown-coloured bands which had distinctive UV/Vis spectral features. The first eluting band had larger and more aromatic HS molecules than the second band, and in addition both P and Fe were primarily associated with the larger, more aromatic HS. This result demonstrated that P was able to form complexes with Fe-rich components of HS, and thus provided a scientific basis for the significant correlation between [Fe] and [TP] that the previous monitoring data of reference condition lochs from Scottish Environment Protection Agency (SEPA) showed. The distinctive features of the HS will be used as the basis for an improved spectroscopic tool.

Keywords: total phosphorus, humic substances, Scottish loch water, WFD model

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Authors: Yamani Amal, Lazaae Jamila, Elachouri Mostafa

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Plants and their active agents – especially polyphenols – may have a principal role in the treatment of diseases that result from the defect of physiological antioxidant mechanisms. Bryonia dioica is well known in Moroccan traditional medicine for alleviatin pain and traiting many diseases. We have focused on plant belonging to Cucurbitaceae Family from around the world to understand their therapeutic uses and their potential antioxidant activities Although several biological activities and Chemical composition of Bryonia dioica are well characterized, no direct, in vitro study, of this natural product examined the antioxydant effect of the extract from the roots of Bryonia dioica. The aim of this study was to determine in vitro antioxidant activity of the B.dioica root, using antioxidant analysis methods based on determination of Hydroxyradical Scavenging, 1,1-diphenyl-2-picrylhydrazine (DPPH) radical scavenging, Hydrogenperoxide Scavenging and Nitric Oxide Scavenging. In this study, it was demonstrated, that, B. dioica root extract showed excellent antioxidant properties. This investigation showed that the roots of this plant contain potent natural scavengers R. It may represent an interesting source of antioxidant phenolics that may favour the extension of their cultivation as new source of natural antioxidants in addition to containing high quality proteins for human or animal nutrition. Therefore, there is need for all stakeholders on the Morocco to strive towards taking advantage of our enormous biodiversity resources to free our people from diseases, abject poverty and stagnation.

Keywords: Morocco, bryoniadioica, in vitro, antioxydant

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Authors: Ezgiamn Abraha Hagos

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The primary objective of this study was to assess the existential concerns and related manifestations of higher learning students by investigating their perception of meaningful life and evaluating their purpose in life. In addition, this study was aimed at assessing the manifestations of existential pain among the students. Data was procured using Purpose in Life test (PIL), Well-being Manifestation Measure Scale (WBMMS), and focus group discussion. The total numbers of participants was 478, of which 299 were males and the remaining 179 females. They were selected using a simple random sampling technique. Data was analyzed using two ways. SPSS-version 20 was used to analyze the quantitative part, and narrative modes were utilized to analyze the qualitative data. The research finding revealed that students are involved in risk taking behaviors like alcohol ingestion, drug use, Khat (chat) chewing, and unsafe sex. In line with this it is found out that life in campus was perceived as temporary and as a result the sense of hedonism was prevalent at any cost. Of course, the most important thing for the majority of the students was to know about the purpose of life. Regarding WBMMS, there was no statistically significant difference among males and females and with the exception of the sub-scale of happiness; in all the sub-scales the mean is low. At last, assisting adolescents to develop holistically in terms of body, mind, and spirit is recommended.

Keywords: existential concerns, higher learning institutions, Ethiopia, Aksum University

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Authors: Siavash Azarbani

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Background and Objective: The side effects of NSAIDS drugs have caused the increasing interest of scientists in herbal medicines as alternative treatment. In this study, the effect of anti inflammatory of seed and fruit of date palm hydroalcolic extracts, due to having antioxidants, was studied. Materials and Methods: In this study, the extraxts of date palm seed and fruit were prepared by the maceration method in 70% alcohol. Eighty male rats Wistar, divided into 10 groups of eight in each, 4 groups received different doses (100, 200, 400, and 600 mg/kg) of seed extract, and 4 other groups different doses (100, 200, 400, and 600 mg/kg) of fruits extract of the palm, and the positive control aspirin (300mg/kg) and the negative control group saline (5ml/kg) via injection intraperitoneally. Half an hour later, all animals received 100 µl of 1% carrageenan into the rats hind paw subcutaneous. The changes in rats paw edema was measured by plethysmometer every hour for five hours. Results: The effect of all of the doses of date palm seed extract on edema were less than aspirine (P<0.05). But there was no significant difference between the group that received 400 and 600 mg/kg of date palm fruit extract when compared with the aspirin group. The Dose 400 mg/kg of fruit extract showed the most anti-inflammatory effect, and it was assignded as the best dose. Conclusion: It is likely that with further studies on different model of animals and also on the human model, the palm fruit extract could be used for pain treatment.

Keywords: palm, inflamentory, date, aspirin, karageenan

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Authors: Deok Hyun Han

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Objective: To explore outcomes of UventaTM metallic ureteral stent between malignant and benign ureteral obstruction. Methods: We reviewed the medical records of 90 consecutive patients who underwent Uventa stent placement for benign or malignant ureteral obstruction from December 2009 to June 2013. We evaluated the clinical outcomes, complications, and reasons and results for unexpected stent removals. Results: The median follow-up was 10.7 (0.9 – 41) months. From a total of 125 ureter units, there were 24 units with benign obstructions and 101 units with malignant obstructions. Initial technical successes were achieved in all patients. The overall success rate was 70.8% with benign obstructions and 84.2% with malignant obstructions. The major reasons for treatment failure were stent migration (12.5%) in benign and tumor progression (11.9%) in malignant obstructions. The overall complication rate was similar between benign and malignant obstructions (58.3% and 42.6%), but severe complications, which are Clavien grade 3 or more, occurred in 41.7% of benign and 6.9% of malignant obstructions. The most common complications were stent migration (25.0%) in benign obstructions and persistent pain (14.9%) in malignant obstructions. The stent removal was done in 16 units; nine units that were removed by endoscopy and seven units were by open surgery. Conclusions: In malignant ureteral obstructions, the Uventa stent showed favorable outcomes with high success rate and acceptable complication rate. However, in benign ureteral obstructions, overall success rate and complication rate were less favorable. Malignant ureteral obstruction seems to be appropriate indication of Uventa stent placement. However, in chronic diffuse benign ureteral obstructions the decision of placement of Uventa stent has to be careful.

Keywords: cause, complication, ureteral obstruction, metal stent

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Authors: Emma Carr, Jennifer Morrison, Peter Walker

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Background: Due to COVID-19, there was a significant reduction in the number of children being treated under general anaesthetic (GA) within the health board, which led to a backlog of referrals. The referrals were being triaged and added to a waiting list in order of priority -determined by the information given. By implementing a checklist, it is anticipated that at least 70% of referrals will have the majority of the information required to effectively prioritise patients. The gold standard, as defined in ‘Guidelines For The Management Of Children Referred For Dental Extractions Under General Anaesthesia’, indicates that all referrals should mention: (i) Inability of the child to cooperate, (ii) Previously tried anxiety management techniques, (iii) Existence of psychological disorders, (iv) Presence of acute dental infection, (v) Requirement for extractions in multiple quadrants. Method: 130 referrals were examined over three months and compared to the recommended standard. A letter was emailed to referring dentists within Ayrshire & Arran outlining the recommended information to be included within the referral. The second round of data collection was then carried out, which involved an examination of 105 referrals. Results: The first round revealed that only 28% of referrals mentioned at least four defined standards outlined above. Following issuing a checklist to all dentists, this increased to 72%. Conclusion: As many of the children referred for extractions under GA have suffered pain and infection because of dental caries, it is important that delay of treatment is minimised, where possible. The implementation of a standardised checklist has enabled more effective prioritisation of patients.

Keywords: caries, dentistry, general anaesthetic, paediatrics

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Authors: Thomas Geninatti, Bruno Giacomo, Alessandro Grattoni

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Nanofluidic devices have been investigated for over a decade as promising platforms for the controlled release of therapeutics. The nanochannel drug delivery system (nDS), a membrane fabricated with high precision silicon techniques, capable of zero-order release of drugs by exploiting diffusion transport at the nanoscale originated from the interactions between molecules with nanochannel surfaces, showed the flexibility of the sustained release in vitro and in vivo, over periods of time ranging from weeks to months. To improve the implantable bio nanotechnology, in order to create a system that possesses the key features for achieve the suitable release of therapeutics, the next generation of nDS has been created. Platinum electrodes are integrated by e-beam deposition onto both surfaces of the membrane allowing low voltage (<2 V) and active temporal control of drug release through modulation of electrostatic potentials at the inlet and outlet of the membrane’s fluidic channels. Hence, a tunable administration of drugs is ensured from the nanochannel drug delivery system. The membrane will be incorporated into a peek implantable capsule, which will include drug reservoir, control hardware and RF system to allow suitable therapeutic regimens in real-time. Therefore, this new nanotechnology offers tremendous potential solutions to manage chronic disease such as cancer, heart disease, circadian dysfunction, pain and stress.

Keywords: nanochannel membrane, drug delivery, tunable release, personalized administration, nanoscale transport, biomems

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Authors: Mina Dabirinezhad, Mohsen Bayat Pour, Amin Dabirinejad

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This paper is intended to introduce the technology to solve some of the deficiencies of the direct digital radiology. Nowadays, digital radiology is the latest progression in dental imaging, which has become an essential part of dentistry. There are two main parts of the direct digital radiology comprised of an intraoral X-ray machine and a sensor (digital image receptor). The dentists and the dental nurses experience afflictions during the taking image process by the direct digital X-ray machine. For instance, sometimes they need to readjust the sensor in the mouth of the patient to take the X-ray image again due to the low quality of that. Another problem is, the position of the sensor may move in the mouth of the patient and it triggers off an inappropriate image for the dentists. It means that it is a time-consuming process for dentists or dental nurses. On the other hand, taking several the X-ray images brings some problems for the patient such as being harmful to their health and feeling pain in their mouth due to the pressure of the sensor to the jaw. The author provides a technology to solve the above-mentioned issues that is called “Self-Recognition Direct Digital Radiology” (SDDR). This technology is based on the principle that the intraoral X-ray machine is capable to diagnose the location of the sensor in the mouth of the patient automatically. In addition, to solve the aforementioned problems, SDDR technology brings out fewer environmental impacts in comparison to the previous version.

Keywords: Dental direct digital imaging, digital image receptor, digital x-ray machine, and environmental impacts

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Authors: Hanan Bishara

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This study deals with the subject of Popular Arabic Proverbs and the stereotypical roles and images that they create about the woman in general and Arab woman in particular. Popular proverbs in general are considered to be essence of experiences of society and the extract of its collective thought establish wisdom in a distinguished concise tight mold or style that affects the majority of people and keep them alive by virtue of constant use and oral currency through which they are transmitted from one generation to another. Proverbs deal with different aspects and types of people, different social relations, including the society's attitude about the woman. Proverbs about women in the human heritage in general and the Arab heritage in particular are considered of a special characteristics and remarkable in their being dynamic ones that move in all directions of life. Most of them carry the essence of the social issues and are distributed in such a way that they have become part of the private life of the general public. This distribution covers all periods and fields of the woman's life, the social, the economic and psychological ones. The woman occupies a major space in the Popular Proverbs because she is the center of social life inside and outside the house. The woman's statuses and images in the provers are numerous and she is often described in parallel images but each one differs from the other. These images intertwine due to their varieties and multiplicity and ultimately, they constitute a general stereotypical image of the woman, which degrades her status as a woman, a mother and a wife. The study shows how Popular Proverbs in Arabic reflect the Arab woman's position and status in her society.

Keywords: Arab, proverb, popular, society, woman

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Authors: Priyanka Sharma, Tarkewshwar Dubey, Hemalatha Siva

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Hemorrhoids are one of the most common anorectal diseases around the world. Severalfactors are involved in causing hemorrhoids including irregularbowel function (constipation, diarrhea), exercise, gravity, low fiberdiet, pregnancy, obesity, high abdominal pressure, prolongedsitting, genetic factors, and aging. Pain, bleeding, itching,swelling and anal discharge are the symptoms of the disease. Due to limitedmodern pharmacotherapeutic options available for treatment, theherbal medicines remain the choice of therapy. Blumea lacera (Burm f.) DC. belonging to the Asteraceae family is a common plain land weed of Bangladesh. Traditionally it has been used for treatment of hemorrhoids.Considering the above fact, present study was aimed to validate the ethnomedicinal use of B. lacera leaves on experimental hemorrhoids in rats. The anti-hemorrhoid activity was performed by using croton oil induced rat models. The parameters studied were assessment of TNF-α and IL-6, Evans blue exudation, macroscopic severity score, recto-anal coefficient, histomorphological scores. Also, in vivo antioxidant parameters and histopathological studies were also performed. All paramaters exhibited significant anti-hemorrhoid activity. Moreover ethanolic extract of B. lacera (EBL) leaves 400mg/kg showed ameliorative effect oncroton oil induced hemorrhoids.In conclusion, EBL exhibitedbeneficial effect on croton oil- induced hemorrhoids and validates its ethnomedicinal use in treatment of piles.

Keywords: haemorrhoids, IL-6, piles, TNF-α

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Authors: Disaphon Boobpachat, Nuttaset Manimmanakorn, Apiwan Manimmanakorn, Worrawut Thuwakum, Michael J. Hamlin

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Objectives: To evaluate effect of kinesio tape compared to placebo tape and static stretching on recovery of anaerobic power and maximal oxygen uptake (Vo₂max) after intensive exercise. Methods: Thirty nine untrained healthy volunteers were randomized to 3 groups for each intervention: elastic tape, placebo tape and stretching. The participants performed intensive exercise on the dominant quadriceps by using isokinetic dynamometry machine. The recovery process was evaluated by creatine kinase (CK), pressure pain threshold (PPT), muscle soreness scale (MSS), maximum voluntary contraction (MVC), jump height, anaerobic power and Vo₂max at baseline, immediately post-exercise and post-exercise day 1, 2, 3 and 7. Results: The kinesio tape, placebo tape and stretching groups had significant changes of PPT, MVC, jump height at immediately post-exercise compared to baseline (p < 0.05), and changes of MSS, CK, anaerobic power and Vo₂max at day 1 post-exercise compared to baseline (p < 0.05). There was no significant difference of those outcomes among three groups. Additionally, all experimental groups had little effects on anaerobic power and Vo₂max compared to baseline and compared among three groups (p > 0.05). Conclusion: Kinesio tape and stretching did not improve recovery of anaerobic power and Vo₂max after eccentric exercise compared to placebo tape.

Keywords: stretching, eccentric exercise, Wingate test, muscle soreness

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Authors: Anupam Sibal

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Whatever is measured tends to improve. With a view to objectively measuring and improving clinical quality across the Apollo Group Hospitals, the initiative of ACE @ 25 (Apollo Clinical Excellence@25) was launched on Jan 09. ACE @ 25 is a clinically balanced scorecard incorporating 25 clinical quality parameters involving complication rates, mortality rates, one-year survival rates and average length of stay after major procedures like liver and renal transplant, CABG, TKR, THR, TURP, PTCA, endoscopy, large bowel resection and MRM covering all major specialties. Also included are hospital acquired infection rates, pain satisfaction and medication errors. Benchmarks have been chosen from the world’s best hospitals. There are weighted scores for outcomes color coded green, orange and red. The cumulative score is 100. Data is reported monthly by 43 Group Hospitals online on the Lighthouse platform. Action taken reports for parameters falling in red are submitted quarterly and reviewed by the board. An audit team audits the data at all locations every six months. Scores are linked to appraisal of the medical head and there is an “ACE @ 25” Champion Award for the highest scorer. Scores for different parameters were variable from green to red at the start of the initiative. Most hospitals showed an improvement in scores over the last four years for parameters where they had showed scores in red or orange at the start of the initiative. The overall scores for the group have shown an increase from 72 in 2010 to 81 in 2015.

Keywords: benchmarks, clinical quality, lighthouse, platform, scores

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Authors: Yu Wen Wang, Shyh Ming Kuo, Hsia Ying Cheng, Yu Chiuan Wu

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Liver fibrosis is caused by the activation of hepatic stellate cells in the liver to secrete excessive and deposition of extracellular matrix. In recent years, many treatment strategies have been developed to reduce the activation of hepatic stellate cells and therefore to increase the decomposition of extracellular matrix. Bacopa monnieri, an herbaceous plant of the scrophulariaceae, containing saponins and glycosides, which with antioxidant, anti-inflammation, pain relief and free radical scavenging characteristics. This study was to evaluate the inhibition of hepatic stellate cell activity by Bacopa monnieri extract and its therapeutic potential in treating thioacetamide-induced liver fibrosis in rats. The results showed that the IC50 of Bacopa monnieri extract was 0.39 mg/mL. Bacopa monnieri extract could effectively reduce H2O2-induced hepatic stellate cells inflammation. In the TAA-induced liver fibrosis animal studies, albumin secretion recovered to normal level after treated with Bacopa monnieri extract for 2-w, and fibrosis related proteins, α-SMA and TGF-1levels decreased indicating the extract exerted therapeutic effect on the liver fibrosis. However, inflammatory factors TNF- obviously decreased after 4-w treatment. In summary, we could successfully extract the main component-Bacopaside I from the plant and acquired a potential therapy using this component in treating TAA-induced liver fibrosis in rat.

Keywords: anti-inflammatory, Bacopa monnieri, fibrosis, hepatic stellate cells, water extract

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Authors: Muhammad Saad Aslam

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In 2021, our organization has launched our proprietary mobile App i.e. Farm Intelligence platform, an industrial-first precision agriculture solution, to Pakistan. It was piloted at 47 locations (spanning around 1,200 hectares of land), addressing growers’ pain points by bringing the benefits of precision agriculture to their doorsteps. This year, we have extended its reach by more than 10 times (nearly 130,000 hectares of land) in almost 600 locations across the country. The project team selected highly infested areas to set up traps, which then enabled the sales team to initiate evidence-based conversations with the grower community about preventive crop protection products that includes pesticides and insecticides. Mega farmer meeting field visits and demonstrations plots coupled with extensive marketing activities, were setup to include farmer community. With the help of App real-time pest monitoring (using heat maps and infestation prediction through predictive analytics) we have equipped our growers with on spot insights that will help them optimize pesticide applications. Heat maps allow growers to identify infestation hot spots to fine-tune pesticide delivery, while predictive analytics enable preventive application of pesticides before the situation escalates. Ultimately, they empower growers to keep their crops safe for a healthy harvest.

Keywords: precision pest management, precision agriculture, real time pest tracking, pest forecasting

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Authors: Talita Cavaignac

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Adorno's critique of totality, especially in a split society marked by reification, also rests on the impossibility of generalizing normative principles. Given the unfeasibility of normative universalizations, which conditions can justify the possibility of criticism and normativity in Adorno's thought? If reason itself is still entangled in alienation from the model of the domination of nature, how could be possible a critical theory? In political terms, if the notion of totality is challenged by the critique of identity, how can Adorno maintain the ideal of liberation and reconciliation between private interests and the possibility of some sort of ethics without giving up a materialist theory of society and without betting in a necessary link between redemption and history? Faced with this complex of questions, it is intended to reflect on the sense in which the notion of ‘suffering’ could throw help to the epistemological problem of the foundations of criticism in Adorno's work. The idea is that, in contrast to a universalizable model of justice, Adorno mobilizes in the notion of ‘suffering’ a gateway to the critical reflection of society. He would thus develop an approach to moral problems through the sensual-bodily perspective, fear, pain, and somatic factors. Nevertheless, due to the attention to the damaged experience and to the constitution of subjectivity -a sense in which the concept of mimesis continues to stand out- we understand suffering as an expression of an objective reification. Following the statement of other authors, the intention is to think how the resources linked to the idea of ‘suffering’ in Adorno's writings are engaged in the reflection of the problem of morality and of the contradictions between universal and particular (articulated in Hegel's tradition).

Keywords: ethics, morality, sensitive, Theodor Adorno

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Authors: Taerim Kim, Shin Ahn, Chang Hwan Sohn, Dong Woo Seo, Won Young Kim

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Object: Reversible cerebral vasospasm syndrome (RCVS) remains an underrated cause of thunderclap headache which shares similar history of the ‘worst-ever’ headache with subarachnoid hemorrhage (SAH) to the emergency physicians. This study evaluated the clinical manifestations, radiological features, and outcomes of patients with RCVS so that the physicians could raise the high index of suspicion to detect RCVS in more patients with thunderclap headache before having life-threatening complications. Methods: The electric medical records of 18 patients with diagnostic criteria of RCVS at the emergency department (ED) between January 2013 and December 2014 were retrospective reviewed. Results: The mean age was 50.7 years, and 80% were women. Patients with RCVS visit an average of 4.7 physicians before receiving an accurate diagnosis and mean duration of symptom until diagnosis is 9.3 days. All patients except one experienced severe headache, from 8 to 10 pain intensity on a numerical rating scale (NRS). 44% of patients had nausea as an associated symptom, 66% of patients experienced worsening of headache while gagging, leaning forward, defecating, urinating or having sex. The most frequently affected vessels are middle cerebral arteries demonstrating the characteristic diffuse “string of beads” appearance. Four patients had SAH as a complication. Conclusion: Patients with RCVS have a unique set of clinical and imaging features. Emergency physicians should raise the high index of suspicion to detect RCVS in more patients with thunderclap headache before life-threatening complications.

Keywords: headache, thunderclap, subarachnoid haemorrhage, stroke

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Authors: Mehrdad Taghipour, Mina Rostami, Mahdi Eskandarlou

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Partial-thickness skin graft is the cornerstone for scalp defect repair. Given the potential side effects following harvesting from these sites, this study aimed to compare the outcomes of graft harvesting from scalp and lower limb. This clinical trial was conducted among a sample number of 40 partial thickness graft candidates (20 case and 20 control group) with scalp defect presenting to Plastic Surgery Clinic at Besat Hospital, Hamadan, Iran during 2018-2019. Sampling was done by simple randomization using random digit table. The donor site in case group and control group was scalp and lower limb respectively. Overall, 28 patients (70%) were male and 12 (30%) were female. Basal cell carcinoma (BCC) and trauma were the most common etiology for the defects. There was a statistically meaningful relationship between two groups regarding the etiology of defect (P=0.02). The mean diameter of defect was 24.28±45.37 mm for all of the patients. The difference between diameters of defect in both groups were statistically meaningful while no such difference between graft diameters was seen. The graft “Take” was completely successful in both groups according to evaluations. The level of postoperative pain was lower in the case group compared to the control according to VAS scale and the satisfaction was higher in them per Likert scale. Scalp can safely be used as donor site for skin graft to be used for scalp defects associated with better results and lower complication rates compared to other donor sites.

Keywords: donor site, graft, scalp, partial thickness

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Authors: Yun-Tsuen Chen, Shih-Ting Huang, Pi-Fen Cheng, Yu-Ting Su, Joffrey Hsu, Hui-Zhu Chen

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Acute intestinal obstruction is one of the differentials of acute abdomen and requires timely alleviation of intestinal distention and abdominal pain to avoid perforation, intra-abdominal infection, and peritonitis. Investigation to identify the cause of obstruction will direct treatment planning and allow for more effective management. In this study, we present a 71-year-old female presenting with symptoms of acute intestinal obstruction for five days. After extensive history taking, physical exam, medical imaging, and pathology, the patient was diagnosed with colon cancer with lung metastasis and acute intestinal obstruction. The patient was placed on nil per os status with intravenous fluid support, intravenous antibiotics, and a decompression nasogastric tube was placed. The patient received decompression with colostomy creation surgery. After assessing the patient’s clinical condition and tumor staging, a multidisciplinary healthcare team created an individualized treatment plan, which included plans to prepare the patient for home self-care and maintain good mental health with regular monitoring in the clinic setting. This case demonstrates the importance of early diagnosis, effective treatment, and a multidisciplinary approach to the management of acute intestinal obstruction secondary to colon cancer.

Keywords: acute intestinal obstruction, colostomy surgery, metastatic colon cancer, multidisciplinary healthcare team

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