Search results for: surgical history

Authors: Shu-Hui Wen, Wei-Chuan Chang, Hsien-Chang Wu

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Background: Little is known about the benefits and risks of use of Chinese herbal medicine (CHM) in conditions related to hormone therapy (HT) use on the risk of ischemic stroke (IS). The aim of this study is to explore the risk of IS in menopausal women treated with HT and CHM. Materials and methods: A total of 32,441 menopausal women without surgical menopause aged 40- 65 years were selected from 2003 to 2010 using the 2-million random samples of the National Health Insurance Research Database in Taiwan. According to the medication usage of HT and CHM, we divided the current and recent users into two groups: an HT use-only group (n = 4,989) and an HT/CHM group (n = 9,265). Propensity-score matching samples (4,079 pairs) were further created to deal with confounding by indication. The adjusted hazard ratios (HR) of IS during HT or CHM treatment were estimated by the robust Cox proportional hazards model. Results: The incidence rate of IS in the HT/CHM group was significantly lower than in the HT group (4.5 vs. 12.8 per 1000 person-year, p < 0.001). Multivariate analysis results indicated that additional CHM use was significant with a lower risk of IS (HR = 0.3; 95% confidence interval, 0.21-0.43). Further subgroup analyses and sensitivity analyses had similar findings. Conclusion: We found that combined use of HT and CHM was associated with a lower risk for IS than HT use only. Further study is needed to examine possible mechanism underlying this association.

Keywords: Chinese herbal medicine, hormone therapy, ischemic stroke, menopause

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Authors: Michelangelo Liban, Debbie Liquete

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A case of a 93-year-old Filipina who experienced a sudden onset of left-sided hemichorea hemiballismus after falling from a standing height due to dizziness and then sought consult at the Emergency Room. She was not known to have diabetes mellitus nor experienced any symptoms of diabetes aside from its rare neurological manifestation of hemichorea-hemiballismus prior to this consult. On further workup, her baseline laboratory tests at the Emergency Room Department showed a CBG of 340mg/dL, an HbA1c of 15%, no ketones were detected in her urine but a hyperdensity with a Hounsfeld unit of 38 on CT, and hyperintensity on T1 weighted MRI on her right striatum with an incidental finding of a subdural hematoma measured as a 0.7cm hyperdensity on her right temporoparietal area with no midline shift. She was then treated with Clonazepam 2mg ¼ tab twice a day before bedtime and insulin 70/30 16 units in the morning and eight units in the evening, which provided good glycemic control maintained at 140-180 mg/dL, complete cessation of the left-sided hemichorea hemiballismus was also observed. The subdural hematoma was deemed non-surgical, and she refused admission into our institution; hence observation on an outpatient basis was done. This is a case of a rare neurological manifestation of diabetes mellitus but with good treatment response to anti-chorea medications combined with diabetes medications.

Keywords: hemichorea, hemiballismus, striatopathy, diabetes

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Authors: Mustafa Gülen, Eylem Güzel, Soner Guler

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The studies concentrated on the historical background of Van show the fact that Van has had a significant position as a settlement since ancient times and that it has hosted many civilizations during history. With the dominance of Ottoman Empire in 16th century, the region had been re-constructed by building new walls at the southern side of Van Castle. These construction activities had mostly been fulfilled by the usage of adobe which had been a fundamental material for thousands of years. As a result of natural disasters, battles and the move at the threshold of 20th century to the new settlement which is 9 kilometers away from the Ancient City Van is an open-air museum with the ruins of churches, mosques and baths. In this study, the usage of adobe in historical structures of Van city is evaluated in detail.

Keywords: historical structures, adobe, Van city, adobe

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Authors: Hala Barakat

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Architecture plays a crucial role in the colonization and organization of spaces, as well as the preservation of cultures and history. As a result of 70 years of occupation, Palestinian land, culture, and history are endangered today. The government of Israel has used architecture to strangulate Palestinians out and seize their land. The occupation has managed to fragment the West Bank and cause sensible scars on the landscape by creating obstacles, barriers, watchtowers, checkpoints, walls, apartheid roads, border devices, and illegal settlements to unjustly claim land from its indigenous population. The apartheid architecture has divided the Palestinian social and urban fabric into pieces, similarly to the Bantustans. The architectural techniques and methods used by the occupation are evidence of prejudice, and while the illegal settlements remain to be condemned by the United Nations, little is being done to officially end this apartheid. Illegal settlements range in scale from individual units to established cities and house more than 60,000 Israeli settlers that immigrated from all over Europe and the United States. Often architecture by Israel is being directed towards expressing ideologies and serving as evidence of its political agenda. More than 78% of what was granted to Palestine after the development of the Green Line in 1948 is under Israeli occupation today. This project aims to map the illegal architecture as a criticism of governmental agendas in the West Bank and Historic Palestinian land. The paper will also discuss the resistance to the newly developed plan for the last Arab village in Jerusalem, Lifta. The illegal architecture has isolated Palestinians from each other and installed obstacles to control their movement. The architecture of occupation has no ethical or humane logic but rather entirely political, administrative, and it should not be left for the silenced architecture to tell the story. Architecture is not being used as a connecting device but rather a way to implement political injustice and spatial oppression. By narrating stories of the architecture of occupation, we can highlight the spatial injustice of the complex apartheid infrastructure. The Israeli government has managed to intoxicate architecture to serve as a divider between cultural groups, allowing the unlawful and unethical architecture to define its culture and values. As architects and designers, the roles we play in the development of illegal settlements must align with the spatial ethics we practice. Most importantly, our profession is not performing architecturally when we design a house with a particular roof color to ensure it would not be mistaken with a Palestinian house and be attacked accidentally.

Keywords: apartheid, illegal architecture, occupation, politics

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Authors: Jason Michael Crozier

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The wrestling territories of the mid-twentieth century in the United States are widely considered the birthplace of modern professional wrestling, and by many professional wrestlers, to be a beacon of hope for the easing of racial tensions during the civil rights era and beyond. The performers writing on this period speak of racial equality but fail to acknowledge the exploitation of black athletes as a racialized capital commodity who suffered the challenges of systemic racism, codified by a false narrative of aspirational exceptionalism and equality measured by audience diversity. The promoters’ ability to equate racial and capital exploitation with equality leads to a broader discussion of the history of Muscular Christianity in the United States and the exploitation of black bodies. Narratives of racial erasure that dominate the historical discourse when examining athleticism and exceptionalism redefined how blackness existed and how physicality and race are conceived of in sport and entertainment spaces. When discussing the implications of race and professional wrestling, it is important to examine the role of promotions as ‘imagined communities’ where the social agency of wrestlers is defined and quantified based on their ‘desired elements’ as a performer. The intentionally vague nature of this language masks a deep history of racialization that has been perpetuated by promoters and never fully examined by scholars. Sympathetic racism and the omission of cultural identity are also key factors in the limitations and racial barriers placed upon black athletes in the squared circle. The use of sympathetic racism within professional wrestling during the twentieth century defined black athletes into two distinct categorizations, the ‘black savage’ or the ‘black minstrel’. Black wrestlers of the twentieth century were defined by their strength as a capital commodity and their physicality rather than their knowledge of the business and in-ring skill. These performers had little agency in their ability to shape their own character development inside and outside the ring. Promoters would often create personas that heavily racialized the performer by tying them to a regional past or memory, such as that of slavery in the deep south using dog collar matches and adoring black characters in chains. Promoters softened cultural memory by satirizing the historic legacy of slavery and the black identity.

Keywords: sympathetic racism, social agency, racial commodification, stereotyping

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Authors: Esther Ushike Akashie

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No matter who you are, where you are from and irrespective of age and gender, there is a universal need for power and energy. Every year, this need grows even more urgent the more scientific and technological inventions advance. Due to this fact, we find that majority of the research related to energy and power has been focused on finding new and innovative ways to produce power. Furthermore, we observe that because of the environmental state of our world today and the impact of climate change, one of the most explored routes of study has been the use of renewable energies. In this paper, we will be looking at one of the oldest forms of renewable energy, hydroelectric energy. First off, an overview of its history, sources, technical aspects, and applications will be evaluated. After which, we will then proceed to understand the main benefits and drawbacks of this form of renewable energy and offer insights on how it can be better utilized in our world today.

Keywords: hydropower, hydroelectric energy, advantages, disadvantages

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Authors: Salehah Tahkin, Norlaila Mustafa, Dayang Anita Abdul Aziz

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Knowledge of medical ethics is important to all practitioners so the best care can be delivered to all patients through safe practice. Surgeons are not exceptions to this. Knowledge, attitude, and practice (KAP) of medical ethics among paediatric surgeons and trainees in Malaysia has not been evaluated before. This study aims to determine the level of KAP regarding medical ethics among these groups. This was a cross-sectional study involving three groups of samples, i.e., paediatric surgeons (PS), paediatric surgical trainees (PST), and medical officers with a special interest in paediatric surgery (MO). A validated KAP questionnaire was used. Standard formulas were used to calculate objective indexes for measuring KAP, which were then compared for statistical significance across different sample groups; p less than 0.05 is taken as significant. The index is rated into 5 classes using a score of 0 to 10, i.e., poor (1-2.99), fair (3-4.99), good (5-6.99), very good (7-8.99), and excellent (9-10). There were 117 samples, i.e., PS n=45 (38.5%), PST n=25 (21.3%), and MO n=47 (40.2%). For knowledge, all three groups display a good index score (mean score of 5.44). For attitude, PS and MO also display an index score of good (mean score of 5.81), while the PST index score was fair (4.82). For practice, our study shows a highest score of 7.14 (very good) among PST. However, these differences were not statistically significant (p> 0.05). Conclusion: Training in paediatric surgery must continue to emphasize professionalism and medical ethics education to deliver the best health care services.

Keywords: KAP, medical ethics, paediatric, surgeons, trainees

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Authors: Anne Nicole Fuentes

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A 29 year old Gravida 1 Para 0 who presented at the hospital with a 5-week history of amenorrhea, abdominal pain and vaginal bleeding. Transvaginal ultrasound revealed 3 pathologic findings : Tuboovarian complex on the right adnexa, a complex mass indicative of an unruptured ectopic pregnancy and right ovarian new growth probably endometrioma. Pelvic laparotomy was done and histopathologic finding revealed tubal pregnancy, right and mature cystic teratoma of the right ovary. This case report demonstrates the importance of considering the coexistence of different gynecologic pathologies in the same patient and clinical importance of an accurate diagnostic evaluation.

Keywords: mature cystic teratoma, ectopic pregnancy, Tuboovarian abscess, bHCG

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Authors: Brindusa Grigoriu

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Inscribing itself in the field of the history of multilingual communities with a focus on the evolution of language didactics, our paper aims at providing a pragmatic-interactional approach on a corpus proposing to scholars of the international scientific community a relevant text of early modern European literature: the first romance in French, The Conte of Flore and Blanchefleur by Robert d’Orbigny (1150). The multicultural context described by the romance is one in which an Arab-speaking prince, Floire, and his Francophone protégée, Blanchefleur, learn Latin together at the court of Spain and become fluent enough to turn it into the language of their love. This learning process is made up of interactional patterns of affective relevance, in which the proficiency of the protagonists in the domain of emotive acts becomes a matter of linguistic and pragmatic emulation. From five to ten years old, the pupils are efficiently stimulated by their teacher of Latin, Gaidon – a Moorish scholar of the royal entourage – to cultivate their competencies of oral expression and reading comprehension (of Antiquity classics), while enjoying an ever greater freedom of written expression, including the composition of love poems in this second language of culture and emotional education. Another relevant parameter of the educational process at court is that Latin shares its prominent role as a language of culture with French, whose exemplary learner is the (Moorish) queen herself. Indeed, the adult 'First lady' strives to become a pupil benefitting from lifelong learning provided by a fortuitous slave-teacher with little training, her anonymous chambermaid and Blanchefleur’s mother, who, despite her status of a war trophy, enjoys her Majesty’s confidence as a cultural agent of change in linguistic and theological fields. Thus, the two foreign languages taught at Spains’s court, Latin and French – as opposed to Arabic -, suggest a spiritual authority allowing the mutual enrichment of intercultural pioneers of cross-linguistic communication, in the aftermath of religious wars. Durably, and significantly – if not everlastingly – the language of physical violence rooted in intra-cultural solipsism is replaced by two Romance languages which seem to embody, together and yet distinctly, the parlance of peace-making.

Keywords: multilingualism, history of European language learning, French and Latin learners, multicultural context of medieval romance

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Authors: Phil P. Wagner

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There is an overwhelming amount of athlete-centric information available for sport practitioners in this era of tech and big data, but protocols in athletic rehabilitation remain arbitrary. It is a common assumption that the rate at which tissue heals amongst individuals is the same; yielding protocols that are entirely time-based. Progressing athletes through rehab programs that lack individualization can potentially expose athletes to stimuli they are not prepared for or unnecessarily lengthen their recovery period. A 7-year aggregated and anonymous database was used to develop reliable and valid assessments to measure athletic resilience. Each assessment utilizes force plate technology with proprietary protocols and analysis to provide key thresholds for injury risk and recovery. Using a T score to analyze movement qualities, much like the Z score used for bone density from a Dexa scan, specific prescriptions are provided to mitigate the athlete’s inherent injury risk. In addition to obliging to surgical clearance, practitioners must put in place a clearance protocol guided by standardized assessments and achievement in strength thresholds. In order to truly hold individuals accountable (practitioners, athletic trainers, performance coaches, etc.), success in improving pre-defined key performance indicators must be frequently assessed and analyzed.

Keywords: analytics, athlete rehabilitation, athlete resilience, injury prediction, injury prevention

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Authors: Darya O. Prima, Elena V. Vorontsova, Yuri G. Slizhov, Andrey V. Zibarev

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A broad family of carbocycle-fluorinated aza-heterocycles including 1,3-benzodiazoles (benzimidazoles), 1,2,3-benzotriazoles, 2,1,3-benzothia/selenadiazoles and 1,4-benzodiazines (quinoxalines) was synthesized in the unified way and assessed for cytotoxicity towards the Hep2 (laryngeal epidermoid carcinoma, a kind of oral cancer) cells. The diazoles, triazoles and selenadiazoles revealed low medium inhibitory concentrations IC50 = 2.2-26.4 µМ and induced the cells’ apoptosis at low concentrations C = 1-25 µМ. For selenadiazoles, cell death dynamics was observed already in the first hours after the treatment. Replacement of one atom F by group Me2N in some cases enlarged apoptotic activity of the compounds towards the Hep2 cells. In contrast, the archetypal (i.e. non-fluorinated) 1,3-benzodiazole, 1,2,3-benzotriazole and 2,1,3-benzoselenadiazole were low toxic (IC50 > 100 µM) and induced apoptosis only at high concentrations. The chlorinated congeners of the heterocycles under discussion were highly toxic towards the Hep2 cells but revealed insignificant ability to induce their apoptosis. Overall, the findings above suggest that fluorinated 1,3-benzodiazole, 1,2,3-benzotriazole and 2,1,3-benzoselenadiazole derivatives can be considered as potential anticancer drugs. For the laryngeal epidermoid carcinoma (for which, according to available statistics, the five-year survival rate remained ~50% during the past 30 years), it is especially important since surgical treatment is seriously complicated here thus encouraging medicament one.

Keywords: Apoptosis, aza-heterocycles, cytotoxicity, fluorinated, Hep2 cells, synthesis

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Authors: Mehwish Shahzadi

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Sunflower is cultivated all over the world not only as an ornament plant but also for the purpose of getting oil. It is the third most cultivated plant in the history because its oil considered best for health. The present study deals with the preparation of sunflower oil from commercial seed sample which was obtained from local market. The physicochemical properties of the oil were determined which included saponification value, acid value and ester value. Results showed that saponification value of the oil was 191.675, acid value was 0.64 and ester value to be 191.035 for the sample under observation. GC-MS analysis of sunflower oil was carried out to check its composition. Oleic acid was determined with linoleic acid and isopropyl palmitate. It represents the presence of three major components of sunflower oil. Other compounds detected were, p-toluylic acid, butylated hydroxytoluene, 1,2-benzenedicarboxylic acid, benzoic acid, 2,4,6-trimethyl-, 2,4,6-trimethylphenyl ester and 2,4-decadienal, (E,E).

Keywords: GC-MS, oleic acid, saponification value, sunflower oil

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Authors: Samul Sahile Kebede

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Back ground: -Immune hemolytic anemia commonly affects human immune deficiency, infected individuals. Among anemic HIV patients in Africa, the burden of IHA due to autoantibody was ranged from 2.34 to 3.06 due to the drug was 43.4%. IHA due to autoimmune is potentially a fatal complication of HIV, which accompanies the greatest percent from acquired hemolytic anemia. Objective: -The main aim of this study was to determine the magnitude and associated factors of immune hemolytic anemia among human immuno deficiency virus infected adults at the university of Gondar comprehensive specialized hospital north west Ethiopia from March to April 2021. Methods: - An institution-based cross-sectional study was conducted on 358 human immunodeficiency virus-infected adults selected by systematic random sampling at the University of Gondar comprehensive specialized hospital from March to April 2021. Data for socio-demography, dietary and clinical data were collected by structured pretested questionnaire. Five ml of venous blood was drawn from each participant and analyzed by Unicel DHX 800 hematology analyzer, blood film examination, and antihuman globulin test were performed to the diagnosis of immune hemolytic anemia. Data was entered into Epidata version 4.6 and analyzed by STATA version 14. Descriptive statistics were computed and firth penalized logistic regression was used to identify predictors. P value less than 0.005 interpreted as significant. Result; - The overall prevalence of immune hemolytic anemia was 2.8 % (10 of 358 participants). Of these, 5 were males, and 7 were in the 31 to 50 year age group. Among individuals with immune hemolytic anemia, 40 % mild and 60 % moderate anemia. The factors that showed association were family history of anemia (AOR 8.30 at 95% CI 1.56, 44.12), not eating meat (AOR 7.39 at 95% CI 1.25, 45.0), and high viral load 6.94 at 95% CI (1.13, 42.6). Conclusion and recommendation; Immune hemolytic anemia is less frequent condition in human immunodeficiency virus infected adults, and moderate anemia was common in this population. The prevalence was increased with a high viral load, a family history of anemia, and not eating meat. In these patients, early detection and treatment of immune hemolytic anemia is necessary.

Keywords: anemia, hemolytic, immune, auto immune, HIV/AIDS

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Authors: Natalia Fontes De Oliveira

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Nature and women have a long age association that has persisted throughout history, cultures, literature, and arts. Women’s physiological functions of reproduction and childbearing are viewed as closer to nature as a binary opposition to men, who have metaphorically and historically been associated with culture. To liberate from strictures of phallogocentric rhetoric, a radical critique of the categories of nature and culture must be undertaken. This paper proposes that nature writing in Margaret Atwood’s The Testaments is used subversively as a form of rebellion to disrupt the metaphorical relationship between women and nature. In tune with ecofeminist concerns, the imagery rewrites patriarchal paradigms of binary oppositions as the protagonists narrate a complex and plural relationship between nature and women.

Keywords: ecofeminism, Margaret Atwood, nature writing, women's writing

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Authors: Shirin Jalili, Ramin Ghasemi Shayan

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Atrial fibrillation is the foremost common arrhythmia around the world, with expanding recurrence famous with age. Thromboembolic occasions and strokes are the number one cause of mortality and morbidity. For patients who don't react to restorative treatment for rate and beat control, the maze method offers an elective treatment mediation. pharmaco-medical treatment for atrial fibrillation is pointed at the control of rate or cadence, intrusive treatment for atrial fibrillation is pointed at cadence control. An obtrusive approach may comprise of percutaneous catheter treatment, surgery, or a crossover approach. Since the maze method is recognized as the foremost successful way to dispense with AF, combining the maze strategy amid major cardiac surgeries has been received in clinical hone. the maze strategy, moreover known as Cox¬maze iii or the ‘cut¬and¬sew’ method, involves making different incisions within the atria to make an arrangement of scars that dispose of each potential zone of re¬entry. The electrical drive is constrained through a maze of scars that coordinates the electrical drive from the sinus node to the av node. By settling the headstrong period between ranges of scar, re¬entry is disposed of. in this article, we evaluate the Maze surgery method that's the surgical method of choice for the treatment of restorative atrial fibrillation.

Keywords: atrial fibrillation, congenital heart disease, procedure, maze surgery, treatment

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Authors: Dorota Galeza

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This paper argues that networks, such as the ECN and the American network, are affected by certain small events which are inherent to path dependence and preclude the full evolution towards efficiency. It is advocated that the American network is superior to the ECN in many respects due to its greater flexibility and longer history. This stems in particular from the creation of the American network, which was based on a small number of cases. Such a structure encourages further changes and modifications which are not necessarily radical. The ECN, by contrast, was established by legislative action, which explains its rigid structure and resistance to change. This paper is an attempt to transpose the superiority of the American network on to the ECN. It looks at concepts such as judicial cooperation, harmonisation of procedure, peer review and regulatory impact assessments (RIAs), and dispute resolution procedures.

Keywords: antitrust, competition, networks, path dependence

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Authors: Benjamin J. Kuo, Silvia D. Vaca, Joao Ricardo Nickenig Vissoci, Catherine A. Staton, Linda Xu, Michael Muhumuza, Hussein Ssenyonjo, John Mukasa, Joel Kiryabwire, Lydia Nanjula, Christine Muhumuza, Henry E. Rice, Gerald A. Grant, Michael M. Haglund

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Background: Traumatic Brain Injury (TBI) is disproportionally concentrated in low- and middle-income countries (LMICs), with the odds of dying from TBI in Uganda more than 4 times higher than in high income countries (HICs). The disparities in the injury incidence and outcome between LMICs and resource-rich settings have led to increased health outcomes research for TBIs and their associated risk factors in LMICs. While there have been increasing TBI studies in LMICs over the last decade, there is still a need for more robust prospective registries. In Uganda, a trauma registry implemented in 2004 at the Mulago National Referral Hospital (MNRH) showed that RTI is the major contributor (60%) of overall mortality in the casualty department. While the prior registry provides information on injury incidence and burden, it’s limited in scope and doesn’t follow patients longitudinally throughout their hospital stay nor does it focus specifically on TBIs. And although these retrospective analyses are helpful for benchmarking TBI outcomes, they make it hard to identify specific quality improvement initiatives. The relationship among epidemiology, patient risk factors, clinical care, and TBI outcomes are still relatively unknown at MNRH. Objective: The objectives of this study are to describe the processes of care and determine risk factors predictive of poor outcomes for TBI patients presenting to a single tertiary hospital in Uganda. Methods: Prospective data were collected for 563 TBI patients presenting to a tertiary hospital in Kampala from 1 June – 30 November 2016. Research Electronic Data Capture (REDCap) was used to systematically collect variables spanning 8 categories. Univariate and multivariate analysis were conducted to determine significant predictors of mortality. Results: 563 TBI patients were enrolled from 1 June – 30 November 2016. 102 patients (18%) received surgery, 29 patients (5.1%) intended for surgery failed to receive it, and 251 patients (45%) received non-operative management. Overall mortality was 9.6%, which ranged from 4.7% for mild and moderate TBI to 55% for severe TBI patients with GCS 3-5. Within each TBI severity category, mortality differed by management pathway. Variables predictive of mortality were TBI severity, more than one intracranial bleed, failure to receive surgery, high dependency unit admission, ventilator support outside of surgery, and hospital arrival delayed by more than 4 hours. Conclusions: The overall mortality rate of 9.6% in Uganda for TBI is high, and likely underestimates the true TBI mortality. Furthermore, the wide-ranging mortality (3-82%), high ICU fatality, and negative impact of care delays suggest shortcomings with the current triaging practices. Lack of surgical intervention when needed was highly predictive of mortality in TBI patients. Further research into the determinants of surgical interventions, quality of step-up care, and prolonged care delays are needed to better understand the complex interplay of variables that affect patient outcome. These insights guide the development of future interventions and resource allocation to improve patient outcomes.

Keywords: care continuum, global neurosurgery, Kampala Uganda, LMIC, Mulago, prospective registry, traumatic brain injury

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Authors: Ezzati Givi M., Ezzatigivi N., Eimani H.

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Trigeminal Neuralgia (TN) consists of painful attacks often triggered with general activities, which cause impairment and disability. The first line of treatment consists of pharmacotherapy. However, the occurrence of many side-effects limits its application. Acute pain relief is crucial for titrating oral drugs and making time for neurosurgical intervention. This study aimed to examine the long-term anesthetic effect of QX-314 and capsaicin in trigeminal neuralgia using an animal model. TN was stimulated by surgical constriction of the infraorbital nerve in rats. After seven days, anesthesia infiltration was done, and the duration of mechanical allodynia was compared. Thirty-five male Wistar rats were randomly divided into seven groups as follows: control (normal saline); lidocaine (2%); QX314 (30 mM); lidocaine (2%)+QX314 (15 mM); lidocaine (2%)+QX314 (22 mM); lidocaine (2%)+QX314 (30 mM); and lidocaine (2%)+QX314 (30 mM) +capsaicin (1μg). QX314 in combination with lidocaine significantly increased the duration of anesthesia, which was dose-dependent. The combination of lidocaine+QX314+capsaicin could significantly increase the duration of anesthesia in trigeminal neuralgia. In the present study, we demonstrated that the combination of QX-314 with lidocaine and capsaicin produced a long-lasting, reversible local anesthesia and was superior to lidocaine alone in the fields of the duration of trigeminal neuropathic pain blockage.

Keywords: trigeminal neuralgia, capsaicin, lidocaine, long-lasting

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Authors: Milene Magalhães Pinto, Irlen Antônio Gonçalves

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This paper is within the area of History of Education in Brazil, having a descriptive and exploratory nature. It has been built on the belief that professional education is organized under political guidelines and solidifies through institutionalized discourses, allowing to know its mission concerning the society in which it operates by studying these speeches. Our purpose is to analyze how the Republican political culture yielded changes in public education through reforms to professional education in the First Republic, based on seven procedures of law that occurred in the Legislature of State of Minas Gerais. The Republican effort to reform the teaching was the result of a conception of society that aspired to advance the country by way of the national worker.

Keywords: professional education, republican political culture, education reforms, Brazil

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Authors: Cynthia Briggs, Kimberly Gerardi

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Over the past six years, the authors have been working together on World Language Collaborations in the Middle School French Program at St. Luke's School in New Canaan, Connecticut, USA. Author 2 brings design expertise to the projects, and both teachers have utilized the fabrication lab, emerging technologies, and collaboration with students. Each year, author 1 proposes a project scope, and her students are challenged to design and engineer a signature project. Both partners have improved the iterative process to ensure deeper learning and sustained student inquiry. The projects range from a 1:32 scale model of the Eiffel Tower that was CNC routed to a fully functional jukebox that plays francophone music, lights up, and can hold up to one thousand songs powered by Raspberry Pi. The most recent project is a Fragrance Marketplace, culminating with a pop-up store for the entire community to discover. Each student will learn the history of fragrance and the chemistry behind making essential oils. Students then create a unique brand, marketing strategy, and concept for their signature fragrance. They are further tasked to use the industrial design process (bottling, packaging, and creating a brand name) to finalize their product for the public Marketplace. Sometimes, these dynamic projects require maintenance and updates. For example, our wall-mounted, three-foot francophone clock is constantly changing. The most recent iteration uses Chat GPT to program the Arduino to reconcile the real-time clock shield and keep perfect time as each hour passes. The lights, motors, and sounds from the clock are authentic to each region, represented with laser-cut embellishments. Inspired by Michel Parmigiani, the history of Swiss watch-making, and the precision of time instruments, we aim for perfection with each passing minute. The authors aim to share exemplary work that is possible with students of all ages. We implemented the reverse engineering process to focus on student outcomes to refine our collaborative process. The products that our students create are prime examples of how the design engineering process is applicable across disciplines. The authors firmly believe that the past and present of World cultures inspire innovation.

Keywords: collaboration, design thinking, emerging technologies, world language

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Authors: Himali Gunasekara, Baddika Jayaratne

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Haematological abnormalities are known to cause Ischemic Stroke or Transient Ischemic Attack (TIA). The identification of haematological correlates plays an important role in a management and secondary prevention. The objective of this study was to describe haematological correlates of stroke and their association between stroke profile. The haematological correlates screened were Lupus Anticoagulant, Dysfibroginemia, Paroxysmal nocturnal haemoglobinurea (PNH), Sickle cell disease, Systemic Lupus Erythematosis (SLE) and Myeloploriferative Neoplasms (MPN). A cross sectional descriptive study was conducted in a sample of 152 stroke patients referred to haematology department of National Hospital of Sri Lanka for thrombophilia screening. Different tests were performed to assess each hematological correlate. Diluted Russels Viper Venom Test and Kaolin clotting time were done to assess Lupus anticoagulant. Full blood count (FBC), blood picture, Sickling test and High Performance Liquid Chromatography were the tests used for detection of Sickle cell disease. Paroxysmal nocturnal haemoglobinurea was assessed by FBC, blood picture, Ham test and Flowcytometry. FBC, blood picture, Janus Kinase 2 (V617F) mutation analysis, erythropoietin level and bone marrow examination were done to look for the Myeloproliferative neoplasms. Dysfibrinogenaemia was assessed by TT, fibrinogen antigen test, clot observation and clauss test. Anti nuclear antibody test was done to look for systemic lupus erythematosis. Among study sample, 134 patients had strokes and only 18 had TIA. The recurrence of stroke/TIA was observed in 13.2% of patients. The majority of patients (94.7%) have had radiological evidence of thrombotic event. One fourth of patients had past thrombotic events while 12.5% had family history of thrombosis. Out of haematological correlates screened, Lupus anticoagulant was the commonest haematological correlate (n=16 ) and dysfibrigonaemia(n=11 ) had the next high prevalence. One patient was diagnosed with Essential thrombocythaemia and one with SLE. None of the patients were positive for screening tests done for sickle cell disease and PNH. The Haematological correlates were identified in 19% of our study sample. Among stroke profile only presence of past thrombotic history was statistically significantly associated with haematological disorders (P= 0.04). Therefore, hematological disorders appear to be an important factor in etiological work-up of stroke patients particularly in patients with past thrombotic events.

Keywords: stroke, transient ischemic attack, hematological correlates, hematological disorders

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Authors: Shaojian Li

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The traditional Chinese patterns, as an integral part of Chinese culture, possess unique values in history, culture, and art. However, with the passage of time and societal changes, many of these traditional patterns are at risk of being lost, damaged, or forgotten. To undertake the digital preservation and protection of these traditional patterns, this paper will collect and organize images of traditional Chinese patterns. It will provide exhaustive and comprehensive semantic annotations, creating a resource library of traditional Chinese pattern images. This will support the digital preservation and application of traditional Chinese patterns.

Keywords: digitization of cultural heritage, traditional Chinese patterns, digital humanities, database construction

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Authors: Jayathilake Wijethunga B. G. Mudiyanselage, Jeewantha Ranawaka, Nirosha Lansakara

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Introduction: Women imprisonment is rising in the world. Imprisoned women have more psychological problems and more adverse childhood experiences than the general population. Female prisoners who had psychological problems had more adverse childhood experiences than the prisoners who did not have psychological problems. Most of the imprisoned women are mothers. Mothers are the principal carer for the children. The psychological status of imprisoned female is worth seeking along with its associates since this is a group of women who need others assistance to make their life adjusted. Any intervention that could uplift their psychological wellbeing would make their life better if they are to be released out of the prison. Since there are no studies done in Sri Lanka to study the imprisoned women psychological wellbeing and their childhood experiences, it is important to study on this to find the magnitude of the problem in Sri Lanka. Methodology: A descriptive cross-sectional study was done at the Welikada Prison, Colombo, among the imprisoned women. 273 imprisoned women were selected using simple random sampling technique. Using interviewer administered questionnaire 270 women were interviewed. Three women did not consent for the study. Frequencies of the selected socio demographic characteristics and selected childhood experiences calculated. GHQ 30 questionnaire was used to assess the psychological distress. Odds ratio was used to calculate the associations between the psychological distress and the selected socio demographic characteristics, selected childhood experiences. Results: Response rate was 98.9%. Mean age of the imprisoned women were 41.28years (SD ±11.86yrs) and Most of women were within the age group of 35-49 years (38.1%). Of them 68.5% were currently married and majority had at least one child. (86.3%). House hold member’s smoking (58.5%) and alcohol (40.4%) use was the commonest adverse childhood experience experienced by the imprisoned women. Nearly one fourth (22.6%) of the imprisoned women had attempted suicide during their life and more than half (55.7%) of them had attempted before the age of 18 years. Similarly of the 258 women who had been sexually active during their life, half (50.0%) of the women had exposed to sexual activities during first eighteen years of life and mean age at first sexual exposure was 19.2 (SD±4.86) years. Nearly three forth (73.7%) of imprisoned women were psychologically distressed in the study sample. Being a women of aged less than 25 years((OR=4.51, 95% CI=1.035-19.64)),previous history of suicidal attempts(OR=2.10,95%CI =1.00-4.41), not having enough foods to eat( OR=2.97, 1.009-8.75) and absence of someone to tell worries (OR=0.355, 95% CI =0.113-0.945) during childhood were significantly associate with psychological distress. Conclusion: Nearly three forth of the imprisoned women were psychologically distressed and younger age, history of suicidal attempts, the absence of someone to tell their worries and not having enough food to eat during childhood were risk factors for psychological distress. Recommendation: Need to strengthen the rehabilitation and mental health services to the imprisoned women.

Keywords: adverse childhood experiences, imprisoned women, psychological distress, prisoners

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Authors: Nuhi Arslani, Aleks Brumec

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Adhesive small bowel obstruction (ASBO) accounts for 20% of emergency surgical procedures and intraabdominal adhesions account for 65% of such cases. In a 10-year post-operative period of abdominal surgery patients, around 35% of them will be readmitted because of ASBO. The first step in approaching ASBOs is using the Bologna guidelines, which include a thorough initial evaluation to diagnose or rule out an ASBO and then proceed with either further imaging studies or emergency surgery, which can be either open or laparoscopic. The contraindications for a laparoscopic approach include hemodynamic instability of the patient and infections in the peritoneum or port sites. Studies have shown that a laparoscopic approach to adhesiolysis is linked with a significantly smaller risk of readmissions and reoperations as well as with faster recovery time and fewer postoperative infections, but has a higher risk of bowel injuries, so a careful selection of patients is required. Although studies favor a laparoscopic approach, many countries still prefer a laparotomy, often because a laparoscopic approach requires surgeons to be highly skilled in the procedure. In the US and UK, between 50 and 60% of surgeons would approach an ASBO with laparoscopy, while in Italy, this number is around 15% and it is most likely similar in Slovenia. We believe that in the right cases and in the right patients, a laparoscopic approach can be equally feasible for treating ASBOs and is associated with fewer intraoperative and postoperative complications.

Keywords: adhesive small bowel obstruction, laparoscopy, adhesions, adhesiolysis

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Authors: Mercedes Rodriguez Sanchez, Laura Luceño Casals

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With the rise of social media, creative people and brands everywhere are constantly generating content. The students with Bachelor's Degrees in Fashion Design use platforms such as Instagram or TikTok to look for inspiration and entertainment, as well as a way to develop their own ideas and share them with a wide audience. Information and Communications Technologies (ICT) have become a central aspect of higher education, virtually affecting every aspect of the student experience. Following the current trend, during the first semester of the second year, a collaborative project across two subjects –Design Management and History of Fashion Design– was implemented. After an introductory class focused on the relationship between fashion and cinema, as well as a brief history of 20th-century fashion, the students freely chose a work team and an iconic look from a movie costume. They researched the selected movie and its sociocultural context, analyzed the costume and the work of the designer, and studied the style, fashion magazines and most popular films of the time. Students then redesigned and recreated the costume, for which they were compelled to recycle the materials they had available at home as an unavoidable requirement of the activity. Once completed the garment, students delivered in-class, team-based presentations supported by the final design, a project summary poster and a making-of video, which served as a documentation tool of the costume design process. The methodologies used include Challenge-Based Learning (CBL), debates, Internet research, application of Information and Communications Technologies, and viewing clips of classic films, among others. After finishing the projects, students were asked to complete two electronic surveys to measure the acquisition of transversal and specific competencies of each subject. Results reveal that this activity helped the students' knowledge acquisition, a deeper understanding of both subjects and their skills development. The classroom dynamic changed. The multidisciplinary approach encouraged students to collaborate with their peers, while educators were better able to keep students' interest and promote an engaging learning process. As a result, the activity discussed in this paper confirmed the research hypothesis: it is positive to propose innovative teaching projects that combine academic research with playful learning environments.

Keywords: cinema, cooperative learning, fashion design, higher education, upcycling

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Authors: Ehsan A. Yahia, Ayman E. El-Sharkawey, Magda M. Bayoumi

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Background: Wound dressings perform a crucial role in cutaneous wound management due to their ability to protect wounds and promote dermal and epidermal tissue regeneration. Aim: To evaluate the effectiveness of using hydrogel/nano silver-based dressing vs. traditional dressing on diabetic foot wound healing. Methods: Sixty patients with type-2 diabetes hospitalized for diabetic foot wound treatment were recruited from selected Surgical departments. A prospective randomized control study was carried. Results: The results showed that the percentage of a reduction rate of the ulcer by the third week of the treatment in the hydrogel/nano silver-based dressing group was higher (15.11%) than in the traditional wound dressing group (33.44%). Moreover, the mean ulcer size "sq mm" in the hydrogel/nano silver-based dressing group recognized a faster healing rate (15.11±7.89) and considerably lesser in comparison to the traditional in the third week (21.65±8.4). Conclusion: The hydrogel/nanosilver-based dressing showed better results than traditional dressing in managing diabetic ulcer foot.

Keywords: diabetes, wound care, diabetic foot, wound dressing, hydrogel nanosilver

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Authors: Asif Zaheer Shaikh, Zhaoyong Zhang, Jaime Yong, Ume Laila Shah

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Islamic finance is growing with remarkable pace, especially Islamic banking, a major segment of Islamic finance, is expanding rapidly. This paper discusses the position of Islamic finance and Islamic banking, around the world in general and particularly in Pakistan. History of Islamic banking in Pakistan is protested, presently a significant growth is observed. However Islamic banking is confronting with number of challenges, which are refraining from sustainable growth of this industry in Pakistan. Growth level of Islamic banks should be steeper to contribute substantial share in country’s economy. It is important to formulate effective policies, at institutional and operational level to address these challenges through close collaboration of key stakeholders.

Keywords: Islamic finance, challenges, Islamic banking, Pakistan

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Authors: Agnes Simone

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A 52-year-old male with unknown psychiatric and medical history was brought to the Psychiatric Emergency Room by ambulance directly from jail. He had been detained for three weeks for possession of a firearm while intoxicated. On initial evaluation, the patient was unable to provide a reliable history. He presented with odd jerking movements of his extremities and catatonic features, including mutism and stupor. His vital signs were stable. Patient was transferred to the medical emergency department for work-up of altered mental status. Due to suspicion for opioid overdose, the patient was given naloxone (Narcan) with no improvement. Laboratory work-up included complete blood count, comprehensive metabolic panel, thyroid stimulating hormone, vitamin B12, folate, magnesium, rapid plasma reagin, HIV, blood alcohol level, aspirin, and Tylenol blood levels, urine drug screen, and urinalysis, which were all negative. CT head and chest X-Ray were also negative. With this negative work-up, the medical team concluded there was no organic etiology and requested inpatient psychiatric admission. Upon re-evaluation by psychiatry, it was evident that the patient continued to have an altered mental status. Of note, the medical team did not include substance withdrawal in the differential diagnosis due to stable vital signs and a negative urine drug screen. The psychiatry team decided to check California's prescription drug monitoring program (CURES) and discovered that the patient was prescribed benzodiazepine alprazolam (Xanax) 2mg BID, a sedative-hypnotic, and hydrocodone/acetaminophen 10mg/325mg (Norco) QID, an opioid. After a thorough chart review, his daughter's contact information was found, and she confirmed his benzodiazepine and opioid use, with recent escalation and misuse. It was determined that the patient was experiencing alprazolam withdrawal, given this collateral information, his current symptoms, negative urine drug screen, and recent abrupt discontinuation of medications while incarcerated. After admission to the medical unit and two doses of alprazolam 2mg, the patient's mental status, alertness, and orientation improved, but he had no memory of the events that led to his hospitalization. He was discharged with a limited supply of alprazolam and a close follow-up to arrange a taper. Accompanying this case report, a qualitative review of presentations with alprazolam withdrawal was completed. This case and the review highlights: (1) Alprazolam withdrawal can occur at low doses and within just one week of use. (2) Alprazolam withdrawal can present without any vital sign instability. (3) Alprazolam withdrawal does not respond to short-acting benzodiazepines but does respond to certain long-acting benzodiazepines due to its unique chemical structure. (4) Alprazolam withdrawal is distinct from and more severe than other benzodiazepine withdrawals. This case highlights (1) the importance of physician utilization of drug-monitoring programs. This case, in particular, relied on California's drug monitoring program. (2) The importance of obtaining collateral information, especially in cases in which the patient is unable to provide a reliable history. (3) The importance of including substance intoxication and withdrawal in the differential diagnosis even when there is a negative urine drug screen. Toxidrome of withdrawal can be delayed. (4) The importance of discussing addiction and withdrawal risks of medications with patients.

Keywords: addiction risk of benzodiazepines, alprazolam withdrawal, altered mental status, benzodiazepines, drug monitoring programs, sedative-hypnotics, substance use disorder

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Authors: Volkan Gulsen

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This paper attempts to indicate the main class dynamics of the Brexit process in a Gramscian theoretical framework. It further aims to point out the influence of the withdrawal of the United Kingdom on the European Union class structure. It defines the unification process of the European Union as a passive revolution. In that way, the Brexit process has been described as a moment of negation in the European Union history of class struggle. It will be argued that the withdrawal of the United Kingdom has already altered the European class structure from the embedded neoliberal structure to a more corporate-liberal one.

Keywords: brexit, gramsci, passive revolution, post-neoliberalism

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Authors: Zainab Elazab, Azhar Aziz

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Background: Spontaneous Splenic artery pseudoaneurysm rupture is a rare condition which is potentially life threatening, if not detected and managed early. We report a case of abdominal pain with intraperitoneal free fluid, which turned out to be spontaneous rupture of a splenic artery pseudoaneurysm, and was treated with arterial embolization. Case presentation: A 28-year old, previously healthy male presented to the ED with a history of sudden onset upper abdominal pain and fainting attack. The patient denied any history of trauma or prior similar attacks. On examination, the patient had tachycardia and a low-normal BP (HR 110, BP 106/66) but his other vital signs were normal (Temp. 37.2, RR 18 and SpO2 100%). His abdomen was initially soft with mild tenderness in the upper region. Blood tests showed leukocytosis of 12.3 X109/L, Hb of 12.6 g/dl and lactic acid of 5.9 mmol/L. Ultrasound showed trace of free fluid in the perihepatic and perisplenic areas, and a splenic hypoechoic lesion. The patient remained stable; however, his abdomen became increasingly tender with guarding. We made a provisional diagnosis of a perforated viscus and the patient was started on IV fluids and IV antibiotics. An erect abdominal x-ray did not show any free air under the diaphragm so a CT abdomen was requested. Meanwhile, bedside ultrasound was repeated which showed increased amount of free fluid, suggesting intra-abdominal bleeding as the most probable etiology for the condition. His CT abdomen revealed a splenic injury with multiple lacerations, a focal intrasplenic enhancing area on venous phase scan (suggesting a pseudoaneurysm with associated splenic intraparenchymal, sub capsular and perisplenic hematomas). Free fluid in the subhepatic and intraperitoneal regions along the small bowel was also detected. Angiogram was done which confirmed a diagnosis of pseudoaneurysm of intrasplenic arterial branch, and angio-embolization was done to control the bleeding. The patient was later discharged in good condition with a surgery follow-up. Conclusion: Splenic artery pseudoaneurysm rupture is a rare cause of abdominal pain which should be considered in any case of abdominal pain with intraperitoneal bleeding. Early management is crucial as it carries a high mortality. Bedside ultrasound is a useful tool to help for early diagnosis of such cases.

Keywords: abdominal pain, pseudo aneurysm, rupture, splenic artery

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