Search results for: burning mouth syndrome

Authors: Eun-Young Kwon, Myung-Sook Choi, Su-Jung Cho, Ji-Young Choi, So Young Kim, Youngji Han

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Overweight and obesity have been linked to a low-grade chronic inflammatory response and an increased risk of developing metabolic syndrome including insulin resistance, type 2 diabetes mellitus and certain types of cancers. Luteolin is a dietary flavonoid with anti-inflammatory, anti-oxidant, anti-cancer and anti-diabetic properties. However, little is known about the detailed mechanism associated with the effect of luteolin on inflammation-related obesity and its complications. The aim of the present study was to reveal the anti-diabetic effect of luteolin in diet-induced obesity mice using “transcriptomics” tool. Thirty-nine male C57BL/6J mice (4-week-old) were randomly divided into 3 groups and were fed normal diet, high-fat diet (HFD, 20% fat) and HFD+0.005% (w/w) luteolin for 16 weeks. Luteolin improved insulin resistance, as measured by HOMA-IR and glucose tolerance, along with preservation action of pancreatic β-cells, compared to the HFD group. Luteoiln was significantly decreased the levels of leptin and ghrelin that play a pivotal role in energy balance, and the macrophage low-grade inflammation marker sCD163 (soluble Cd antigen 163) in plasma. Activities of hepatic anti-oxidant enzymes (catalase and glutathione peroxidase) were increased, while the levels of plasma transaminase (GOT and GPT) and oxidative damage markers (hepatic mitochondria H2O2 and TBARS) were markedly decreased by luteolin supplementation. In addition, luteolin increased oxidative capacity and fatty acid utilization by presenting decrease in enzyme activities of citrate synthase, cytochrome C oxidase and β-hydroxyacyl CoA dehydrogenase and UCP3 gene expression compared to high-fat diet. Moreover, our microarray results of muscle also revealed down-regulated gene expressions associated with TCA cycle by HFD were reversed to normal level by luteolin treatment. Taken together, our results indicate that luteolin is one of bioactive components for improving insulin resistance by increasing oxidative capacity, modulating anti-oxidant metabolism and suppressing inflammatory signaling cascades in diet-induced obese mice. These results provide possible therapeutic targets for prevention and treatment of diet-induced obesity and its complications.

Keywords: anti-oxidant metabolism, diabetes, luteolin, oxidative capacity

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Authors: Mokgadi Julia Ngoepe-Ntsoane

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The article aims to make a case for a legislative framework for the fire sector in South Africa. Robust legislative framework is essential for empowering those with obligatory mandate within the sector. This article contributes to the body of knowledge in the field of policy reviews particularly with regards to the legal framework. It has been observed overtime that the scholarly contributions in this field are limited. Document analysis was the methodology selected for the investigation of the various legal frameworks existing in the country. It has been established that indeed the national legislation on the fire industry does not exist in South Africa. From the documents analysed, it was revealed that the sector is dominated by cartels who are exploiting the new entrants to the market particularly SMEs. It is evident that these cartels are monopolising the system as they have long been operating in the system turning it into self- owned entities. Commitment to addressing the challenges faced by fire services and creating a framework for the evolving role that fire brigade services are expected to execute in building safer and sustainable communities is vital. Legislation for the fire sector ought to be concluded with immediate effect. The outdated national fire legislation has necessitated the monopolisation and manipulation of the system by dominating organisations which cause a painful discrimination and exploitation of smaller service providers to enter the market for trading in that occupation. The barrier to entry bears long term negative effects on national priority areas such as employment creation, poverty, and others. This monopolisation and marginalisation practices by cartels in the sector calls for urgent attention by government because if left attended, it will leave a lot of people particularly women and youth being disadvantaged and frustrated. The downcast syndrome exercised within the fire sector has wreaked havoc and is devastating. This is caused by cartels that have been within the sector for some time, who know the strengths and weaknesses of processes, shortcuts, advantages and consequences of various actions. These people take advantage of new entrants to the sector who in turn find it difficult to manoeuvre, find the market dissonant and end up giving up their good ideas and intentions. There are many pieces of legislation which are industry specific such as housing, forestry, agriculture, health, security, environmental which are used to regulate systems within the institutions involved. Other regulations exist as bi-laws for guiding the management within the municipalities.

Keywords: sustainable job creation, growth and development, transformation, risk management

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Authors: Ana Carolina Kogawa, Selma Gutierrez Antonio, Hérida Regina Nunes Salgado

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Rifaximin is an oral antimicrobial, gut - selective and not systemic with adverse effects compared to placebo. It is used for the treatment of hepatic encephalopathy, travelers diarrhea, irritable bowel syndrome, Clostridium difficile, ulcerative colitis and acute diarrhea. The crystalline form present in the rifaximin with minimal systemic absorption is α, being the amorphous form significantly different. Regulators are increasingly attention to polymorphisms. Polymorphs can change the form by altering the drug characteristics compromising the effectiveness and safety of the finished product. International Conference on Harmonization issued the ICH Guidance Q6A, which aim to improve the control of polymorphism in new and existing pharmaceuticals. The objective of this study was to obtain polymorphic forms of rifaximin employing recrystallization processes and characterize them by thermal analysis (thermogravimetry - TG and differential scanning calorimetry - DSC), X-ray diffraction, scanning electron microscopy and solubility test. Six polymorphic forms of rifaximin, designated I to VI were obtained by the crystallization process by evaporation of the solvent. The profiles of the TG curves obtained from polymorphic forms of rifaximin are similar to rifaximin and each other, however, the DTG are different, indicating different thermal behaviors. Melting temperature values of all the polymorphic forms were greater to that shown by the rifaximin, indicating the higher thermal stability of the obtained forms. The comparison of the diffractograms of the polymorphic forms of rifaximin with rifaximin α, β and γ constant in patent indicate that forms III, V and VI are formed by mixing polymorph β and α and form III is formed by polymorph β. The polymorphic form I is formed by polymorph β, but with a significant amount of amorphous material. Already, the polymorphic form II consists of polymorph γ, amorphous. In scanning electron microscope is possible to observe the heterogeneity of morphological characteristics of crystals of polymorphic forms among themselves and with rifaximin. The solubility of forms I and II was greater than the solubility of rifaximin, already, forms III, IV and V presented lower solubility than of rifaximin. Similarly, the bioavailability of the amorphous form of rifaximin is considered significantly higher than the form α, the polymorphic forms obtained in this work can not guarantee the excellent tolerability of the reference medicine. Therefore, studies like these are extremely important and they point to the need for greater requirements by the regulatory agencies competent about polymorphs analysis of the raw materials used in the manufacture of medicines marketed globally. These analyzes are not required in the majority of official compendia. Partnerships between industries, research centers and universities would be a viable way to consolidate researches in this area and contribute to improving the quality of solid drugs.

Keywords: electronic microscopy, polymorphism, rifaximin, solubility, X-ray diffraction

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Authors: Amanda Aliende da Matta

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This communication presents an aspect of phenomenon selection in an applied hermeneutic phenomenology study on care and vulnerability: the need to consider it as a situated universal. For that, we will first present the study and its methodology. Secondly, we will expose the need to understand phenomena as situation-defined, incorporating feminist thought. In an informatics class for 14 year olds, we explained the exercise: students have to make a 5 slide presentation about a topic of their choice. A does it on streetwear, B on Cristiano Ronaldo, C on Marvel, but J did it on Down Syndrome. Introducing it to the class, J explains the physical and cognitive differences caused by trisomy; when asked to explain it further, he says: "they are angels, teacher," and shows us a poster on his cellphone that says: if you laugh at a different child he will laugh with you because his innocence outweighs your ignorance. The anecdote shows, better than any theoretical explanation, something that some vulnerable people have; something beautiful and special but difficult to define. Let's call this something caring. The research has the main objective of accounting for the experience of caregiving in vulnerability, and it will be carried out with Applied Hermeneutic Phenomenology (AHP). The method's objective is to investigate the lived human experience in its pre-reflexive dimension to know its meaning structures. Contrary to other research methods, AHP does not produce theory about a specific context but seeks the meaning of the lived experience, in its characteristic of human experience. However, it is necessary that we understand care as defined in a concrete situation. We cannot start the research with an a priori definitive concept of care, or we would fall into the mistake of closing ourselves to only what we already know, as explained by Levinas. We incorporate, then, the notion of situated universals. Loyal to phenomenology, the definition of the phenomenon should start with an investigation of the word's etymology: the word cura, in its etymological root, means care. And care comes from the Latin word cogitātus/cōgĭto, which means "to pursue something in mind" and "to consider thoroughly." The verb cōgĭto, meanwhile, is composed of co- (altogether) and agitare (to deal with or think committedly about something, to concern oneself with) / ăgĭto (to set in motion, to move). Care, therefore, has in its origin a meditation on something, a concern about something, a verb that has a sense of action and movement. To care is to act out of concern for something/someone. This etymology, though, is not the final definition of the phenomenon, but only its skeleton. It needs to be embodied in the concrete situation to become a possible lived experience. And that means that the lived experience descriptions (LEDs) should be selected by taking into consideration how and if care was engendered in that concrete experience. Defining the phenomenon has to take into consideration situated knowledge.

Keywords: applied hermeneutic phenomenology, care ethics, hermeneutics, phenomenology, situated universalism

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Authors: Lugean K. Alomari, Rahaf K. Sharif, Basil K. Alomari, Hind M. Aljabri, Faisal F. Aljahdali, Amal A. Alomari, Saeed A. Alghamdi

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Background: The thermal pulsation system is a therapy that uses heat and massage to treat dry eye disease; thus, some trials have been published to compare it with the conventional treatment. The aim of this study is to conduct a systematic review and meta-analysis comparing the efficacy of thermal pulsation systems with conventional treatment in patients undergoing cataract surgery. Methods: Medline, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched for eligible trials. We included three randomized controlled trials (RCTs) that compared the thermal pulsation system with the conventional treatment in patients undergoing cataract surgery. A table of characteristics was plotted, and the Quality of the studies was assessed using the Cochrane risk-of-bias tool for randomized trials (RoB 2). Forest plots were plotted using the Random-effect Inverse Variance method. χ2 test and the Higgins-I-squared (I2) model were used to assess heterogeneity. A total of 201 cataract surgery patients were included, with 105 undergoing preoperative pulsation therapy and 96 receiving conventional treatment. Demographic analysis revealed comparable distributions across groups. Results: All the studies in our analysis are of good quality with a low risk of bias. A total of 201 patients were included in the analysis, out of which 105 underwent pulsation therapy, and 95 were in the control group. Tear Break-up Time (TBUT) analysis revealed no significant baseline differences, except pulsation therapy being better at 1 month. (SMD 0.42 [95%CI 0.14 - 0.70] p=0.004). This positive trend continued at three months (SMD 0.52 [95% CI (0.20 – 0.84)] p=0.002). Corneal fluorescein staining scores and Meibomian gland-yielding secretion scores showed no significant differences at baseline. However, at one month, pulsation therapy significantly improved Meibomian gland function (SMD -0.86 [95% CI (-1.20 - -0.53)] p<0.00001), indicating a reduced risk of dry eye syndrome. Conclusion: Preoperative pulsation therapy appears to enhance post-cataract surgery outcomes, particularly in terms of tear film stability and Meibomian gland secretory function. The sustained positive effects observed at one and three months post-surgery suggest the potential for long-term benefits.

Keywords: lipiflow, cataract, thermal pulsation, dry eye

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Authors: Rajish Shil, Mohammad Ali Houri, Mohammad Milad Ismail, Fatimah Al Kaabi

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The clinical presentation of Primary hyperparathyroidism can vary from simple asymptomatic hypercalcemia to severe life-threatening hypercalcemic crisis with multi-organ dysfunction, which can be due to parathyroid adenoma or sometimes with malignant cancer. This cascade of clinical presentation can lead to a diagnostic and therapeutic challenge for treating the disease. We are presenting a case of severe hypercalcemic crisis due to parathyroid adenoma with an emphasis on early management, diagnosis, and interventions to prevent any lifelong complications and any permanent organ dysfunction. A 30 years old female with a history of primary Infertility, admitted to Al Ain Hospital critical care unit with Acute Severe Necrotizing Pancreatitis. She initially had a 1-month history of abdominal pain on and off, for which she was treated conservatively with no much improvement, and later on, she developed life-threatening severe pancreatitis, which required her to be admitted to the critical care unit. She was transferred from a private healthcare facility, where she was found to have a very high level of calcium up to 15mmol/L. She received systemic Zoledronic Acid, which lowered her calcium level transiently and later was increased again. She went on to develop multiple end-organ damages along with multiple electrolytes disturbances. She was found to have high levels of Parathyroid hormone, which was correlated with a parathyroid mass on the neck via radiological imaging. After a long course of medical treatment to lower the calcium to a near-normal level, parathyroidectomy was done, which showed parathyroid adenoma on histology. She developed hungry bone syndrome after the surgery and pancreatic pseudocyst after resolving of pancreatitis. She required aggressive treatment with Intravenous calcium for her hypocalcemia as she received zoledronic acid at the beginning of the disease. Later on, she was discharged on long term calcium and other electrolytes supplements. In patients presenting with hypercalcemia, it is prudent to investigate and start treatment early to prevent complications and end-organ damage from hypercalcemia and also to treat the primary cause of the hypercalcemia, with conscious follow up to prevent hypocalcemic complications after treatment. It is important to follow up patients with parathyroid adenomas for a long period in order to detect any recurrence of the tumor or to make sure if the primary tumor is either benign or malignant.

Keywords: hypercalcemia, pancreatitis, hypocalcemia, hyperparathyroidism

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Authors: Anietie J. Atangwho, Udeme E. Asibong, Item J. Atangwho, Ndifreke E. Udonwa

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Diabesity, a syndrome where diabetes and obesity occur simultaneously in a single patient, has emerged as a recent challenge to the medical world and is already at epidemic proportion in some countries. Therefore, this study aimed to determine the prevalence of diabesity among adult patients attending the General Outpatient clinic of three healthcare facilities in Calabar in a bid to improve healthcare delivery to patients at risk. A cross-sectional descriptive study design was employed using a mixed method approach that comprised quantitative and qualitative components i.e., Focused Group Discussion (FGD) and Key Informant Interview (KII). One hundred and ninety (190) participants aged 18 to 72 years and body mass index (BMI) ≥ 30kg/m2 were recruited as the study population for the quantitative study using systematic random sampling technique and analysed using SPSS version 25. The qualitative component performed 4 FGDs and 3 KIIs. Results of sociodemographic variables showed respondents aged 35 – 44 as highest in number (37.3%). Of this number, 83.7% were females, 76.8% married, and 3.7% earned USD1,110.00 monthly. Whereas majority of the participants (65.8 %) were within class 1 obesity, only 38% considered themselves obese. Diabesity occurrence was found to be 12.6% (i.e. BMI ≥ 30 to 45.2kg/m2 vs FBS ≥ 7.0 – 14.8mmo/l), with 38% of them being previously undiagnosed. About 48.4 % of the respondents ate two meals only per day; with 90.5% eating between meals. Snacking was predominant, mostly pastries (67.9%), with 58.9% taking cola drinks alongside. Sixty-one percent participated in one form of exercise or the other, with walking/trekking as the most common; 34.4 % had no regular exercise schedule. Only about 39.5% of the participants spent less than an hour on devices like phone, television, and laptops. Additionally, previously known and newly diagnosed hypertensive patients were 27.9% and 7.2%, respectively. Qualitative assessment with KII and FGDs showed eating unhealthy diets and lack of exercise as major factors responsible for diabesity. The bivariate analysis revealed significant association between diabesity with marital status and hypertension (p = 0.007 and p = 0.005, respectively). Also, positive association with diabesity were eating snacking (p = 0.017) and number of times a respondent snacks per day (p = 0.035). Overall, the study has revealed the occurrence of diabesity in Calabar at 12.6 % of the study population, with 38 % of them previously undiagnosed; it identified unhealthy diets and lack of exercise as causative factors as well as hypertension as snacking associatory indicators of diabesity.

Keywords: diabesity, obesity, diabetes, unhealthy diet

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Authors: Shivani Dhande, Sanjiv Choudhary, Adarshlata Singh

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Introduction: Chemical peeling is a popular, relatively inexpensive day procedure and generally safe method for treatment of pigmentary skin disorders and for skin rejuvenation. Chemical peels are classified by the depth of action into superficial, medium, and deep peels.Various facial pigmentary conditions have significant impact on quality of life causing psychological stress, necessitating its safe and effective treatment.Aim & Objectives:To compare the efficacy of Salicylic acid, Trichloroaceticacid & Glycolic Acid in facial melanosis(melasma,photomelanosis& post acne pigmentation).To study the side effects of above mentioned peeling agents. Method and Materials:It was a randomized parallel control single blind study consisting of total of 36 cases, 12 cases each of melasma, photo melanosis and post acne pigmentation within age group 20-50 years having fitzpatrick’s skin type4. Woods lamp examination was done to confirm the type of melasma.Patients with keloidal tendency, active herpes infection or past history of hypersensitivity to salicylic acid, trichloroaceticand glycolic acid as well aspatients on systemic isotretinoin were excluded.Clinical photographs at the beginning of therapy and then serially, were taken to assess the clinical response. Prior to application a written informed consent was obtained. A post auricular test peel was performed. Patients were divided into 3 groups, containing 12 patients each of melasma, photomelanosis and post acnepigmentation.All the three peels SA peel 20% (done once in 2 weeks), GA peel 50% (done once in 3 weeks) and TCA 15% (done once in 3 weeks) were used with total six settings for each patient. Before application of peel patients were counseled to wash the face with soap and water. Then face was dried and cleaned with spirit and acetone to remove all cutaneous oils. GA, TCA, SA were applied with cotton buds/gauze withmild strokes. After a contact period off 5-10mins neutralization was done with cold water. Post peel topical sunscreen application was mandatory. MASI was used pre and post treatment to assess melasma. Investigator’s global improvement scale- overall hyperpigmentation (4-significant, 3-moderate, 2-mild, 1-minimal, 0-no change ) and Patient’s satisfaction grading scale (>70%- excellent response, 50-70%- good response, <50%- average response) was used to assess improvement in all the three facial melanosis.Results:In our study of 12 patients of melasma, 4 (33.33%)patients showed excellent results;3 (25%) with GAand 1(8.33%) of TCA.Good response was seen in 4 (33.33%) patients;1(8.33%) each for GA & SA and 2(16.66%) for TCA.Poor response was seen in 4(33.33%) patients;1(8.33%) for TCA and 3 (25%) for SA.Of 12 patients of photomelanosis, excellent resultswas seen in 3(25%)patients of TCA. Good response was seen in 4 (33.33%) patients, 1(8.33%) each of TCA &SA and 2(16.66%) of GA.Poor responsewas seen in 5(41.66%) patients;3 (25%) for SA and 2(16.66%) of GA.Of 12 patients of post acne pigmentation, excellent responsein 3 (25%) patients;2(16.66%) of SA and 1(8.33%) of TCA.Good responsewas seen in 5(41.66%) patients;2(16.66%) of SA and GA and1(8.33%) of TCA.Poor response was seen in 4 (33.33%) patients; 2 (16.66%) for SA and TCA both. No major side effects in the form of scarring or persistant pigmentation was seen. Transient blackening of skin with burning sensation was seen in cases treated with TCA and SA. Post procedural itching and redness was noted with GA peel. Conclusion- In our study GA(50%),TCA(15%) & SA(20%) peels showed excellent response in melasma, photomelanosis and post-acne pigmentation respectively.All the 3 peeling agents were well tolerated without any significant side-effects in the above specified concentrations.

Keywords: facial melanosis, gycolic acid, salicylic acid, trichloroacetic acid

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Authors: Achiron Anat, Mathilda Mandel, Mayust Sue, Achiron Reuven, Gurevich Michael

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Introduction: As coronavirus disease 2019 (COVID-19) vaccination is currently spreading around the world, it is of importance to assess the ability of multiple sclerosis (MS) patients to mount an appropriate immune response to the vaccine in the context of disease-modifying treatments (DMT’s). Objectives: Evaluate immunity generated following COVID-19 vaccination in MS patients, and assess factors contributing to protective humoral and cellular immune responses in MS patients vaccinated against severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) virus infection. Methods: Review our recent data related to (1) the safety of PfizerBNT162b2 COVID-19 mRNA vaccine in adult MS patients; (2) the humoral post-vaccination SARS-CoV2 IgG response in MS vaccinees using anti-spike protein-based serology; and (3) the cellular immune response of memory B-cells specific for SARS-CoV-2 receptor-binding domain (RBD) and memory T-cells secreting IFN-g and/or IL-2 in response to SARS-CoV2 peptides using ELISpot/Fluorospot assays in MS patients either untreated or under treatment with fingolimod, cladribine, or ocrelizumab; (4) covariate parameters related to mounting protective immune responses. Results: COVID-19 vaccine proved safe in MS patients, and the adverse event profile was mainly characterised by pain at the injection site, fatigue, and headache. Not any increased risk of relapse activity was noted and the rate of patients with acute relapse was comparable to the relapse rate in non-vaccinated patients during the corresponding follow-up period. A mild increase in the rate of adverse events was noted in younger MS patients, among patients with lower disability, and in patients treated with DMTs. Following COVID-19 vaccination protective humoral immune response was significantly decreased in fingolimod- and ocrelizumab- treated MS patients. SARS-CoV2 specific B-cell and T-cell cellular responses were respectively decreased. Untreated MS patients and patients treated with cladribine demonstrated protective humoral and cellular immune responses, similar to healthy vaccinated subjects. Conclusions: COVID-19 BNT162b2 vaccine proved as safe for MS patients. No increased risk of relapse activity was noted post-vaccination. Although COVID-19 vaccination is new, accumulated data demonstrate differences in immune responses under various DMT’s. This knowledge can help to construct appropriate COVID-19 vaccine guidelines to ensure proper immune responses for MS patients.

Keywords: covid-19, vaccination, multiple sclerosis, IgG

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Authors: Carlos M. Goncalves, Luisa Duarte, Teresa Cartaxo

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The aim of this work was to understand the reasons behind the underutilization of electroconvulsive therapy (ECT) in the younger population and raise possible solutions. We conducted a non-systematic review of literature throughout a search on PubMed, using the terms ‘children’, ‘adolescents’ and ‘electroconvulsive’, ‘therapy’. Candidate articles written in languages other than English were excluded. Articles were selected according to title and/or abstract’s content relevance, resulting in a total of 5 articles. ECT is a recognized effective treatment in adults for several psychiatric conditions. As in adults, ECT in children and adolescents is proven most beneficial in the treatment of severe mood disorders, catatonia, and, to a lesser extent, schizophrenia. ECT in adults has also been used to treat autism’s self-injurious behaviours, Tourette’s syndrome and resistant first-episode schizophrenia disorder. Despite growing evidence on its safety and effectiveness in children and adolescents, like those found in adults, ECT remains a controversial and underused treatment in patients this age, even when it is clearly indicated. There are various possible reasons to this; limited awareness among professionals (lack of knowledge and experience among child psychiatrists), stigmatic public opinion (despite positive feedback from patients and families, there is an unfavourable and inaccurate representation in the media, contributing to a negative public opinion), legal restrictions and ethical controversies (restrictive regulations such as a minimum age for administration), lack of randomized trials (the currently available studies are retrospective, with small size samples, and most of the publications are either case reports or case series). This shows the need to raise awareness and knowledge, not only for mental health professionals, but also to the general population, through the media, regarding indications, methods and safety of ECT in order to provide reliable information to the patient and families. Large-scale longitudinal studies are also useful to further demonstrate the efficacy and safety of ECT and can aid in the formulation of algorithms and guidelines as without these changes, the availability of ECT to the younger population will remain restricted by regulations and social stigma. In conclusion, these results highlight that lack of adequate knowledge and accurate information are the most important factors behind the underutilization of ECT in younger population. Mental healthcare professionals occupy a cornerstone position; if data is given by a well-informed healthcare professional instead of the media, general population (including patients and their families) will probably regard the procedure in a more favourable way. So, the starting point should be to improve health care professional’s knowledge and experience on this choice of treatment.

Keywords: adolescents, children, electroconvulsive, therapy

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Authors: Jessica A. Hellings, Piyushkumar Jani

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Background: Systemic autoimmune disorders are increasingly implicated in neuropsychiatric illness, especially in the setting of treatment resistance in individuals of all ages. Gluten allergy in fullest extent results in celiac disease, affecting multiple organs including central nervous system (CNS). Clinicians often lack awareness of the association between neuropsychiatric illness and gluten allergy, partly since many such research studies are published in immunology and gastroenterology journals. Methods: Following a Pubmed literature search and online searches on celiac disease websites, 40 articles are critically reviewed in detail. This work reviews celiac disease, gluten intolerance and current evidence of their relationship to neuropsychiatric and systemic illnesses. The review also covers current work-up and diagnosis, as well as dietary interventions, gluten restriction outcomes, and future research directions. Results: Gluten allergy in susceptible individuals damages the small intestine, producing a leaky gut and malabsorption state, as well as allowing antibodies into the bloodstream, which attack major organs. Lack of amino acid precursors for neurotransmitter synthesis together with antibody-associated brain changes and hypoperfusion may result in neuropsychiatric illness. This is well documented; however, studies in neuropsychiatry are often small. In the large CATIE trial, subjects with schizophrenia had significantly increased antibodies to tissue transglutaminase (TTG), and antigliadin antibodies, both significantly greater gluten antibodies than in control subjects. On later follow up, TTG-6 antibodies were identified in these subjects’ brains but not in their intestines. Significant evidence mostly from small studies also exists for gluten allergy and celiac-related depression, anxiety disorders, attention-deficit/hyperactivity disorder, autism spectrum disorders, ataxia, and epilepsy. Dietary restriction of gluten resulted in remission in several published cases, including for treatment-resistant schizophrenia. Conclusions: Ongoing and larger studies are needed of the diagnosis and treatment efficacy of the gluten-free diet in neuropsychiatric illness. Clinicians should ask about the patient history of anemia, hypothyroidism, irritable bowel syndrome and family history of benefit from the gluten-free diet, not limited to but especially in cases of treatment resistance. Obtaining gluten antibodies by a simple blood test, and referral for gastrointestinal work-up in positive cases should be considered.

Keywords: celiac, gluten, neuropsychiatric, translational

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Authors: Ardiansyah I. Ryan, Ashsholih K. R., Fathurrohman G. R., Kurniadi M. R., Huda P. A

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The burden of brain-related disease is very high. There are a lot of brain-related diseases with limited treatment result and thus raise the burden more. The Parkinson Disease (PD), Mental Health Problem, or Paralysis of extremities treatments had risen concern, as the patients for those diseases usually had a low quality of life and low chance to recover fully. There are also many other brain or related neural diseases with the similar condition, mainly the treatments for those conditions are still limited as our understanding of the brain function is insufficient. Brain Implant Technology had given hope to help in treating this condition. In this paper, we examine the current update of the brain implant technology. Neurotechnology is growing very rapidly worldwide. The United States Food and Drug Administration (FDA) has approved the use of Deep Brain Stimulation (DBS) as a brain implant in humans. As for neural implant both the cochlear implant and retinal implant are approved by FDA too. All of them had shown a promising result. DBS worked by stimulating a specific region in the brain with electricity. This device is planted surgically into a very specific region of the brain. This device consists of 3 main parts: Lead (thin wire inserted into the brain), neurostimulator (pacemaker-like device, planted surgically in the chest) and an external controller (to turn on/off the device by patient/programmer). FDA had approved DBS for the treatment of PD, Pain Management, Epilepsy and Obsessive Compulsive Disorder (OCD). The target treatment of DBS in PD is to reduce the tremor and dystonia symptoms. DBS has been showing the promising result in animal and limited human trial for other conditions such as Alzheimer, Mental Health Problem (Major Depression, Tourette Syndrome), etc. Every surgery has risks of complications, although in DBS the chance is very low. DBS itself had a very satisfying result as long as the subject criteria to be implanted this device based on indication and strictly selection. Other than DBS, there are several brain implant devices that still under development. It was included (not limited to) implant to treat paralysis (In Spinal Cord Injury/Amyotrophic Lateral Sclerosis), enhance brain memory, reduce obesity, treat mental health problem and treat epilepsy. The potential of neurotechnology is unlimited. When brain function and brain implant were fully developed, it may be one of the major breakthroughs in human history like when human find ‘fire’ for the first time. Support from every sector for further research is very needed to develop and unveil the true potential of this technology.

Keywords: brain implant, deep brain stimulation (DBS), deep brain stimulation, Parkinson

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Authors: Lakmini Wijesooriya, Vicki Chalker, Jessica Day, Priyantha Perera, N. P. Sunil-Chandra

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M. pneumoniae has been identified as an etiology for exacerbation of asthma (EQA), although viruses play a major role in EOA. M. pneumoniae infection is treated empirically with macrolides, and its antibiotic sensitivity is not detected routinely. Characterization of the organism by genotyping and determination of macrolide resistance is important epidemiologically as it guides the empiric antibiotic treatment. To date, there is no such characterization of M. pneumoniae performed in Sri Lanka. The present study describes the characterization of M. pneumoniae detected from a child with EOA following a screening of 100 children with EOA. Of the hundred children with EOA, M. pneumoniae was identified only in one child by Real-Time polymerase chain reaction (PCR) test for identifying the community-acquired respiratory distress syndrome (CARDS) toxin nucleotide sequences. The M. pneumoniae identified from this patient underwent detection of macrolide resistance via conventional PCR, amplifying and sequencing the region of the 23S rDNA gene that contains single nucleotide polymorphisms that confer resistance. Genotyping of the isolate was performed via nested Multilocus Sequence Typing (MLST) in which eight (8) housekeeping genes (ppa, pgm, gyrB, gmk, glyA, atpA, arcC, and adk) were amplified via nested PCR followed by gene sequencing and analysis. As per MLST analysis, the M. pneumoniae was identified as sequence type 14 (ST14), and no mutations that confer resistance were detected. Resistance to macrolides in M. pneumoniae is an increasing problem globally. Establishing surveillance systems is the key to informing local prescriptions. In the absence of local surveillance data, antibiotics are started empirically. If the relevant microbiological samples are not obtained before antibiotic therapy, as in most occasions in children, the course of antibiotic is completed without a microbiological diagnosis. This happens more frequently in therapy for M. pneumoniae which is treated with a macrolide in most patients. Hence, it is important to understand the macrolide sensitivity of M. pneumoniae in the setting. The M. pneumoniae detected in the present study was macrolide sensitive. Further studies are needed to examine a larger dataset in Sri Lanka to determine macrolide resistance levels to inform the use of macrolides in children with EOA. The MLST type varies in different geographical settings, and it also provides a clue to the existence of macrolide resistance. The present study enhances the database of the global distribution of different genotypes of M. pneumoniae as this is the first such characterization performed with the increased number of samples to determine macrolide resistance level in Sri Lanka. M. pneumoniae detected from a child with exacerbation of asthma in Sri Lanka was characterized as ST14 by MLST and no mutations that confer resistance were detected.

Keywords: mycoplasma pneumoniae, Sri Lanka, characterization, macrolide resistance

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Authors: Steven G. Sclan

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Background: Since December 2019, the world has been afflicted by the spread of the Severe Acute Respiratory Syndrome-Corona Virus-2 (SARS-CoV-2), which is responsible for the condition referred to as Covid-19. The illness has had a cataclysmic impact on the political, social, economic, and overall well-being of the population of the entire globe. While Covid-19 has had a substantial universal fatality impact, it may have an even greater effect on the socioeconomic, medical well-being, and healthcare planning for remaining societies. Significance: As these numbers illustrate, many more persons survive the infection than die from it, and many of those patients have noted ongoing, persistent symptoms after successfully enduring the acute phase of the illness. Recognition and understanding of these symptoms are crucial for developing and arranging efficacious models of care for all patients (whether or not having been hospitalized) surviving acute covid illness and plagued by post-acute symptoms. Furthermore, regarding Covid infection in children (< 18 y/o), although it may be that Covid “+” children are not major vectors of infective transmission, it now appears that many more children than initially thought are carrying the virus without accompanying obvious symptomatic expression. It seems reasonable to wonder whether viral effects occur in children – those children who are Covid “+” and now asymptomatic – and if, over time, they might also experience similar symptoms. An even more significant question is whether Covid “+” asymptomatic children might manifest increased multiple health problems as they grow – i.e., developmental complications (e.g., physical/medical, metabolic, neurobehavioral, etc.) – in comparison to children who had been consistently Covid “ - ” during the pandemic. Topics Addressed and Theoretical Importance: This review is important because of the description of both quantitative and qualitative methods for clinical and biomedical research. Topics reviewed will consider the importance of well-designed, comprehensive (i.e., quantitative and qualitative methods) longitudinal studies of Post Covid-19 symptoms in both adults and children. Also reviewed will be general characteristics of longitudinal studies and a presentation of a model for a proposed study. Also discussed will be the benefit of longitudinal studies for the development of efficacious interventions and for the establishment of cogent, practical, and efficacious community healthcare service planning for post-acute covid patients. Conclusion: Results of multi-dimensional, longitudinal studies will have important theoretical implications. These studies will help to improve our understanding of the pathophysiology of long COVID and will aid in the identification of potential targets for treatment. Such studies can also provide valuable insights into the long-term impact of COVID-19 on public health and socioeconomics.

Keywords: COVID-19, post-COVID-19, long COVID, longitudinal research, quantitative research, qualitative research

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Authors: Alexander K. Edwards

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Introduction: The moral dimension of teacher education globally has assumed a new paradigm of thinking based on the public gain (return-on-investments), value-creation (quality), professionalism (practice), and business strategies (innovations). Abundant literature reveals an interesting revolutionary trend in complimenting the raising of teachers and academic performances. Because of the global competition in the knowledge-creation and service areas, the C21st teacher at all levels is expected to be resourceful, strategic thinker, socially intelligent, relationship aptitude, and entrepreneur astute. This study is a significant contribution to practice and innovations to raise exemplary or primal teachers. In this study, the qualities needed were considered as ‘Quadrant Intelligence (Q-i)’ model for a primal teacher leadership beyond the classroom. The researcher started by examining the issue of the majority of teachers in Ghana Education Services (GES) in need of this Q-i to be effective and efficient. The conceptual framing became determinants of such Q-i. This is significant for global employability and versatility in teacher education to create premium and primal teacher leadership, which are again gaining high attention in scholarship due to failing schools. The moral aspect of teachers failing learners is a highly important discussion. In GES, some schools score zero percent at the basic education certificate examination (BECE). The question is what will make any professional teacher highly productive, marketable, and an entrepreneur? What will give teachers the moral consciousness of doing the best to succeed? Method: This study set out to develop a model for primal teachers in GES as an innovative way to highlight a premium development for the C21st business-education acumen through desk reviews. The study is conceptually framed by examining certain skill sets such as strategic thinking, social intelligence, relational and emotional intelligence and entrepreneurship to answer three main burning questions and other hypotheses. Then the study applied the causal comparative methodology with a purposive sampling technique (N=500) from CoE, GES, NTVI, and other teachers associations. Participants responded to a 30-items, researcher-developed questionnaire. Data is analyzed on the quadrant constructs and reported as ex post facto analyses of multi-variances and regressions. Multiple associations were established for statistical significance (p=0.05). Causes and effects are postulated for scientific discussions. Findings: It was found out that these quadrants are very significant in teacher development. There were significant variations in the demographic groups. However, most teachers lack considerable skills in entrepreneurship, leadership in teaching and learning, and business thinking strategies. These have significant effect on practices and outcomes. Conclusion and Recommendations: It is quite conclusive therefore that in GES teachers may need further instructions in innovations and creativity to transform knowledge-creation into business venture. In service training (INSET) has to be comprehensive. Teacher education curricula at Colleges may have to be re-visited. Teachers have the potential to raise their social capital, to be entrepreneur, and to exhibit professionalism beyond their community services. Their primal leadership focus will benefit many clienteles including students and social circles. Recommendations examined the policy implications for curriculum design, practice, innovations and educational leadership.

Keywords: emotional intelligence, entrepreneurship, leadership, quadrant intelligence (q-i), primal teacher leadership, strategic thinking, social intelligence

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Authors: Nadia Arikat, Katharine Blain

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During the worst of the COVID pandemic, only essential treatment was provided for patients needing urgent care. With the prolonged extent of the pandemic, there has been a return to more routine referrals for paediatric dentistry advice and treatment for specialist conditions. However, some of these patients and/or their carers may have significant medical issues meaning that attending in-person appointments carries additional risks. This poses an ethical dilemma for clinicians. This project looks at how a secure video conferencing platform (“Near Me”) has been used to assess the need and urgency for in-person new patient visits, particularly for patients and families with additional risks. “Near Me” is a secure online video consulting service used by NHS Scotland. In deciding whether to bring a new patient to the hospital for an appointment, the clinical condition of the teeth together with the urgency for treatment need to be assessed. This is not always apparent from the referral letter. In addition, it is important to judge the risks to the patients and carers of such visits, particularly if they have medical issues. The use and effectiveness of “Near Me” consultations to help decide whether vulnerable paediatric patients should have in-person appointments will be illustrated and discussed using two families: one where the child is medically compromised (Alagille syndrome with previous liver transplant), and the other where there is a medically compromised parent (undergoing chemotherapy and a bone marrow transplant). In both cases, it was necessary to take into consideration the risks and moral implications of requesting that they attend the dental hospital during a pandemic. The option of remote consultation allowed further clinical information to be evaluated and the families take part in the decision-making process about whether and when such visits should be scheduled. These cases will demonstrate how medically compromised patients (or patients with vulnerable carers), could have their dental needs assessed in a socially distanced manner by video consultation. Together, the clinician and the patient’s family can weigh up the risks, with regards to COVID-19, of attending for in-person appointments against the benefit of having treatment. This is particularly important for new paediatric patients who have not yet had a formal assessment. The limitations of this technology will also be discussed. It is limited by internet availability, the strength of the connection, the video quality and families owning a device which allows video calls. For those from a lower socio-economic background or living in some rural areas, this may not be possible or limit its usefulness. For the two patients discussed in this project, where the urgency of their dental condition was unclear, video consultation proved beneficial in deciding an appropriate outcome and preventing unnecessary exposure of vulnerable people to a hospital environment during a pandemic, demonstrating the usefulness of such technology when it is used appropriately.

Keywords: COVID-19, paediatrics, triage, video consultations

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Authors: Mohit Kumar, Beklashwar Salona, Shiv Murti, Mukesh Singh

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We report here a case of five-months old male baby, born as second child of non-consanguineous parents with no considerable history of genetic abnormality which was referred to our cytogenetic laboratory for chromosomal analysis. Physical dysmorphic facial features including mongoloid face, cleft palate, simian crease, and developmental delay were observed. We present this case with unique balanced autosomal translocation of t(3;10)(p21;p13). The risk of phenotypic abnormalities based on de novo balanced translocation was estimated to be 7%. The association of balanced chromosomal rearrangement with Down syndrome features such as multiple congenital anomalies, facial dysmorphism and congenital heart anomalies are very rare in a 5-months old male child. Trisomy-21 is not uncommon in chromosomal abnormality with the birth defect and balanced translocations are frequently observed in patients with secondary infertility or recurrent spontaneous abortion (RSA). Two ml heparinized peripheral blood cells cultured in RPMI-1640 for 72 hours supplemented with 20% fetal bovine serum, phytohemagglutinin (PHA), and antibiotics were used for chromosomal analysis. A total 30 metaphases images were captured using Olympus-BX51 microscope and analyzed using Bio-view karyotyping software through GTG-banding (G bands by trypsin and Giemsa) according to International System for Human Cytogenetic Nomenclature 2016. The results showed balanced translocation between short arm of chromosome # 3 and short arm of chromosome # 10. The karyotype of the child was found to be 46,XY,t(3;10)(p21; p13). Chromosomal abnormalities are one of the major causes of birth defect in new born babies. Also, balanced translocations are frequently observed in patients with secondary infertility or recurrent spontaneous abortion. The index case presented with dysmorphic facial features and had a balanced translocation 46,XY,t(3;10)(p21;p13). This translocation with break points at (p21; p13) has not been reported in the literature in a child with facial dysmorphism. To the best of our knowledge, this is the first report of novel balanced translocation t(3;10) with break points in a child with dysmorphic features. We found balanced chromosomal translocation instead of any trisomy or unbalanced aberrations along with some phenotypic abnormalities. Therefore, we suggest that such novel balanced translocation with abnormal phenotype should be reported in order to enable the pathologist, pediatrician, and gynecologist to have a better insight into the intricacies of chromosomal abnormalities and their associated phenotypic features. We hypothesized that dysmorphic features as seen in this case may be the result of change in the pattern of genes located at the breakpoint area in balanced translocations or may be due to deletion or mutation of genes located on the p-arm of chromosome # 3 and p-arm of chromosome # 10.

Keywords: balanced translocation, karyotyping, phenotypic abnormalities, facial dimorphisms

Procedia PDF Downloads 198

Authors: Dr. Jenit Gandhi, Dr. Manojith SS, Dr. Nakul GV, Dr. Sharath Honnani, Dr. Shaurav Ghosh, Dr. Neel Shetty, Dr. Nagabhushan JS, Dr. Manish Joshi

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Introduction: Acute pancreatitis is an inflammatory condition of the pancreas which begins in pancreatic acinar cells and triggers local inflammation that may progress to systemic inflammatory response (SIRS) and causing distant organ involvement and its function and ending up with multiple organ dysfunction syndromes (MODS). Aim: A comparative study in acute pancreatitis to find out the effectiveness of early addition of Ulinastatin to current standard care in Indian subjects . Methodology: A current prospective observational study is done during study period of 1year (Dec 2018 –Dec 2019) duration to evaluate the effect of early addition of Ulinastatin to the current standard treatment and its efficacy to reduce the early complication, analgesic requirement and duration of hospital stay in patients with Acute Pancreatitis. Results: In the control group 25 were males and 05 were females. In the test group 18 were males and 12 females. Majority was in the age group between 30 - 70 yrs of age with >50% in the 30-50yrs age group in both test and control groups. The VAS was median grade 3 in control group as compared to median grade 2 in test group , the pain was more in the initial 2 days in test group compared to 4 days in test group , the analgesic requirement was used for more in control group (median 6) to test group( median 3 days ). On follow up after 5 days for a period of 2 weeks none of the patients in the test group developed any complication. Where as in the control group 8 patients developed pleural effusion, 04-Pseudopancreatic cyst, 02 – patient developed portal vein and splenic vein thrombosis, 02 patients – ventilator with ARDS which were treated symptomatically whereas in test group 02 patient developed pleural effusions and 01 pseudo pancreatic cyst with splenic artery aneurysm, 01 – patient with AKI and MODS symptomatically treated. The duration of hospital stay for a median period of 4 days (2 – 7 days) in test group and 7 days (4 -10 days) in control group. All patients were able to return to normal work on an average of 5days compared 8days in control group, the difference was significant. Conclusion:The study concluded that early addition of Ulinastatin to current standard treatment of acute Pancreatitis is effective in reducing pain, early complication and duration of hospital stay in Indian subject

Keywords: Ulinastatin, VAS – visual analogue score , AKI – acute kidney injury , ARDS – acute respiratory distress syndrome

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Authors: Kakali Roy, Sahana P. Raju, Subhra Dhar, Sandipan Dhar

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Introduction: Xeroderma pigmentosa (XP) is a rare inherited (autosomal recessive) disease resulting from impairment in DNA repair that involves recognition and repair of ultraviolet radiation (UVR) induced DNA damage in the nucleotide excision repair pathway. Which results in increased photosensitivity, UVR induced damage to skin and eye, increased susceptibility of skin and ocular cancer, and progressive neurodegeneration in some patients. XP is present worldwide, with higher incidence in areas having frequent consanguinity. Being extremely rare, there is limited literature on XP and associated complications. Here, the clinico-pathological experience (spectrum of clinical presentation, histopathological findings of malignant skin lesions, and progression) of managing 8 cases of XP is presented. Methodology: A retrospective study was conducted in a pediatric tertiary care hospital in eastern India during a ten-year period from 2013 to 2022. A clinical diagnosis was made based on severe sun burn or premature photo-aging and/or onset of cutaneous malignancies at early age (1st decade) in background of consanguinity and autosomal recessive inheritance pattern in family. Results: The mean age of presentation was 1.2 years (range of 7month-3years), while three children presented during their infancy. Male to female ratio was 5:3, and all were born of consanguineous marriage. They presented with dermatological manifestations (100%) followed by ophthalmic (75%) and/or neurological symptoms (25%). Patients had normal skin at birth but soon developed extreme sensitivity to UVR in the form of exaggerated sun tanning, burning, and blistering on minimal sun exposure, followed by abnormal skin pigmentation like freckles and lentiginosis. Subsequently, over time there was progressive xerosis, atrophy, wrinkling, and poikiloderma. Six patients had varied degree of ocular involvement, while three of them had severe manifestation, including madarosis, tylosis, ectropion, Lagopthalmos, Pthysis bulbi, clouding and scarring of the cornea with complete or partial loss of vision, and ophthalmic malignancies. 50% (n=4) cases had skin and ocular pre-malignant (actinic keratosis) and malignant lesions, including melanoma and non melanoma skin cancer (NMSC) like squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) in their early childhood. One patient had simultaneous occurrence of multiple malignancies together (SCC, BCC, and melanoma). Subnormal intelligence was noticed as neurological feature, and none had sensory neural hearing loss, microcephaly, neuroregression, or neurdeficit. All the patients had been being managed by a multidisciplinary team of pediatricians, dermatologists, ophthalmologists, neurologists and psychiatrists. Conclusion: Although till date there is no complete cure for XP and the disease is ultimately fatal. But increased awareness, early diagnosis followed by persistent vigorous protection from UVR, and regular screening for early detection of malignancies along with psychological support can drastically improve patients’ quality of life and life expectancy. Further research is required on formulating optimal management of XP, specifically the role and possibilities of gene therapy in XP.

Keywords: childhood malignancies, dermato-pathological findings, eastern India, Xeroderma pigmentosa

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Authors: Majdah Alnefaie

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The ‘netnographic study’ and data mining have been used to monitor the public interaction on Social Media Sites (SMSs) to understand what the motivational factors influence the Saudi intentions regarding allowing women driving in Saudi Arabia in 2018. The netnographic study monitored the publics’ textual and visual communications in Twitter, Snapchat, and YouTube. SMSs users’ communications method is also known as electronic word of mouth (eWOM). Netnography methodology is still in its initial stages as it depends on manual extraction, reading and classification of SMSs users text. On the other hand, data mining is come from the computer and physical sciences background, therefore it is much harder to extract meaning from unstructured qualitative data. In addition, the new development in data mining software does not support the Arabic text, especially local slang in Saudi Arabia. Therefore, collaborations between social and computer scientists such as ‘netnographic study’ and data mining will enhance the efficiency of this study methodology leading to comprehensive research outcome. The eWOM communications between individuals on SMSs can promote a sense that sharing their preferences and experiences regarding politics and social government regulations is a part of their daily life, highlighting the importance of using SMSs as assistance in promoting participation in political and social. Therefore, public interactions on SMSs are important tools to comprehend people’s intentions regarding the new government regulations in the country. This study aims to answer this question, "What factors influence the Saudi Arabians' intentions of Saudi female's car-driving in 2018". The study utilized qualitative method known as netnographic study. The study used R studio to collect and analyses 27000 Saudi users’ comments from 25th May until 25th June 2018. The study has developed data collection model that support importing and analysing the Arabic text in the local slang. The data collection model in this study has been clustered based on different type of social networks, gender and the study main factors. The social network analysis was employed to collect comments from SMSs owned by governments’ originations, celebrities, vloggers, social activist and news SMSs accounts. The comments were collected from both males and females SMSs users. The sentiment analysis shows that the total number of positive comments Saudi females car driving was higher than negative comments. The data have provided the most important factors influenced the Saudi Arabians’ intention of Saudi females car driving including, culture and environment, freedom of choice, equal opportunities, security and safety. The most interesting finding indicted that women driving would play a role in increasing the individual freedom of choice. Saudi female will be able to drive cars to fulfill her daily life and family needs without being stressed due to the lack of transportation. The study outcome will help Saudi government to improve woman quality of life by increasing the ability to find more jobs and studies, increasing income through decreasing the spending on transport means such as taxi and having more freedom of choice in woman daily life needs. The study enhances the importance of using use marketing research to measure the public opinions on the new government regulations in the country. The study has explained the limitations and suggestions for future research.

Keywords: netnographic study, data mining, social media, Saudi Arabia, female driving

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Authors: Kriti Jain, Sucha Singh Gill

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Subsidies have been a major part of agricultural policies around the world, and more extensively since the green revolution in developing countries, for the sake of attaining higher agricultural productivity and achieving food security. But entrenched subsidies lead to distorted incentives and promote inefficiencies in the agricultural sector, threatening the viability of these very subsidies and sustainability of the agricultural production systems, posing a threat to the livelihood of farmers and laborers dependent on it. This paper analyzes the economic and ecological sustainability implications of prolonged input and output subsidies in agriculture by studying the case of Indian Punjab, an agriculturally developed state responsible for ensuring food security in the country when it was facing a major food crisis. The paper focuses specifically on the environmentally unsustainable cropping pattern changes as a result of Minimum Support Price (MSP) and assured procurement and on the resource use efficiency and cost implications of power subsidy for irrigation in Punjab. The study is based on an analysis of both secondary and primary data sources. Using secondary data, a time series analysis was done to capture the changes in Punjab’s cropping pattern, water table depth, fertilizer consumption, and electrification of agriculture. This has been done to examine the role of price and output support adopted to encourage the adoption of green revolution technology in changing the cropping structure of the state, resulting in increased input use intensities (especially groundwater and fertilizers), which harms the ecological balance and decreases factor productivity. Evaluation of electrification of Punjab agriculture helped evaluate the trend in electricity productivity of agriculture and how free power imposed further pressure on the extant agricultural ecosystem. Using data collected from a primary survey of 320 farmers in Punjab, the extent of wasteful application of groundwater irrigation, water productivity of output, electricity usage, and cost of irrigation driven electricity subsidy to the exchequer were estimated for the dominant cropping pattern amongst farmers. The main findings of the study revealed how because of a subsidy has driven agricultural framework, Punjab has lost area under agro climatically suitable and staple crops and moved towards a paddy-wheat cropping system, that is gnawing away the state’s natural resources like water table has been declining at a significant rate of 25 cms per year since 1975-76, and excessive and imbalanced fertilizer usage has led to declining soil fertility in the state. With electricity-driven tubewells as the major source of irrigation within a regime of free electricity and water-intensive crop cultivation, there is both wasteful application of irrigation water and electricity in the cultivation of paddy crops, burning an unproductive hole in the exchequer’s pocket. There is limited access to both agricultural extension services and water-conserving technology, along with policy imbalance, keeping farmers in an intensive and unsustainable production system. Punjab agriculture is witnessing diminishing returns to factor, which under the business-as-usual scenario, will soon enter the phase of negative returns to factor.

Keywords: cropping pattern, electrification, subsidy, sustainability

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Authors: Damith Tennakoon, Mojgan Jadidi, Seyedreza Razavialavi

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With recent advancements of automation in robotics, from self-driving cars to autonomous 4-legged quadrupeds, one industry that has been stagnant is the construction industry. The methodologies used in a modern-day construction site consist of arduous physical labor and the use of heavy machinery, which has not changed over the past few decades. The dangers of a modern-day construction site affect the health and safety of the workers due to performing tasks such as lifting and moving heavy objects and having to maintain unhealthy posture to complete repetitive tasks such as painting, installing drywall, and laying bricks. Further, training for heavy machinery is costly and requires a lot of time due to their complex control inputs. The main focus of this research is using immersive wearable technology and robotic arms to perform the complex and intricate skills of modern-day construction workers while alleviating the physical labor requirements to perform their day-to-day tasks. The methodology consists of mounting a stereo vision camera, the ZED Mini by Stereolabs, onto the end effector of an industrial grade robotic arm, streaming the video feed into the Virtual Reality (VR) Meta Quest 2 (Quest 2) head-mounted display (HMD). Due to the nature of stereo vision, and the similar field-of-views between the stereo camera and the Quest 2, human-vision can be replicated on the HMD. The main advantage this type of camera provides over a traditional monocular camera is it gives the user wearing the HMD a sense of the depth of the camera scene, specifically, a first-person view of the robotic arm’s end effector. Utilizing the built-in cameras of the Quest 2 HMD, open-source hand-tracking libraries from OpenXR can be implemented to track the user’s hands in real-time. A mixed-reality (XR) Unity application can be developed to localize the operator's physical hand motions with the end-effector of the robotic arm. Implementing gesture controls will enable the user to move the robotic arm and control its end-effector by moving the operator’s arm and providing gesture inputs from a distant location. Given that the end effector of the robotic arm is a gripper tool, gripping and opening the operator’s hand will translate to the gripper of the robot arm grabbing or releasing an object. This human-robot interaction approach provides many benefits within the construction industry. First, the operator’s safety will be increased substantially as they can be away from the site-location while still being able perform complex tasks such as moving heavy objects from place to place or performing repetitive tasks such as painting walls and laying bricks. The immersive interface enables precision robotic arm control and requires minimal training and knowledge of robotic arm manipulation, which lowers the cost for operator training. This human-robot interface can be extended to many applications, such as handling nuclear accident/waste cleanup, underwater repairs, deep space missions, and manufacturing and fabrication within factories. Further, the robotic arm can be mounted onto existing mobile robots to provide access to hazardous environments, including power plants, burning buildings, and high-altitude repair sites.

Keywords: construction automation, human-robot interaction, hand-tracking, mixed reality

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Authors: Babarina Maria, Andropova Margarita

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Introduction: Hypoparathyroidism (HypoPT) is a rare endocrine disorder with an estimated prevalence of 0.25 per 1000 individuals. The most common cause of HypoPT is the loss of active parathyroid tissue following thyroid or parathyroid surgery. Sometimes permanent postoperative HypoPT occures, manifested by hypocalcemia in combination with low levels of PTH during 6 months or more after surgery. Cognitive impairments in patients with hypocalcemia due to chronic HypoPT are observed, and this can lead to problems and challenges in everyday living: memory loss and impaired concentration, that may be the cause of poor compliance. Clinical case: Patient K., 66 years old, underwent thyroidectomy in 2013 (at the age of 55) because of papillary thyroid cancer T1NxMx, histopathology findings confirmed the diagnosis. 5 years after the surgery, she was followed up on an outpatient basis, TSH levelsonly were monitored, and the dose of levothyroxine was adjusted. In 2018 due to, increasing complaints include tingling and cramps in the arms and legs, memory loss, sleep disorder, fatigue, anxiety, hair loss, muscle pain, tachycardia, positive Chvostek, and Trousseau signs were diagnosed during examination, also in blood analyses: total Ca 1.86 mmol/l (2.15-2.55), Ca++ 0.96 mmol/l (1.12-1.3), P 1.55 mmol/l (0.74-1.52), Mg 0.79 mmol/l (0.66-1.07) - chronic postoperative HypoPT was diagnosed. Therapy was initiated: alfacalcidol 0.5 mcg per day, calcium carbonate 2000 mg per day, cholecalciferol 1000 IU per day, magnesium orotate 3000 mg per day. During the case follow-up, hypocalcemia, hyperphosphatemia persisted, hypercalciuria15.7 mmol/day (2.5-6.5) was diagnosed. Dietary recommendations were given because of the high content of phosphorus rich foods, and therapy was adjusted: the dose of alfacalcidol was increased to 2.5 mcg per day, and the dose of calcium carbonate was reduced to 1500 mg per day. As part of the screening for complications of hypoPT, data for cataracts, Fahr syndrome, nephrocalcinosis, and kidney stone disease were not obtained. However, HypoPT compensation was not achieved, and therefore hydrochlorothiazide 25 mg was initiated, the dose of alfacalcidol was increased to 3 mcg per day, calcium carbonate to 3000 mg per day, magnesium orotate and cholecalciferol were continued at the same doses. Therapeutic goals were achieved: calcium phosphate product <4.4 mmol2/l2, there were no episodes of hypercalcemia, twenty-four-hour urinary calcium excretion was significantly reduced. Conclusion: Timely prescription, careful explanation of drugs usage rules, and monitoring and maintaining blood and urine parameters within the target contribute to the prevention of HypoPT complications development and life-threatening events.

Keywords: hypoparathyroidism, hypocalcemia, hyperphosphatemia, hypercalciuria

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Authors: Eeva Wallenius-Nareneva, Tuula Toivanen-Labiad

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Background: Oral health promotion event was organised for forty Afghanistan, Iraqi and Bangladeshi underage asylum seekers in Finland. The invitation to arrange this coaching occasion was accepted in the Degree Programme in Oral Hygiene in Metropolia. The personnel in the reception center found the need to improve oral health among the youngsters. The purpose was to strengthen the health literacy of the boys in their oral self-care and to reduce dental fears. The Finnish studies, especially the terminology of oral health was integrated to coaching with the help of interpreters. Cooperative learning was applied. Methods: Oral health was interactively discussed in four study group sessions: 1. The importance of healthy eating habits; - Good and bad diets, - Regular meals, - Acid attack o Xylitol. 2. Oral diseases − connection to general health; - Aetiology of gingivitis, periodontitis and caries, - Harmfulness of smoking 3. Tools and techniques for oral self-care; - Brushing and inter dental cleaning. 4. Sharing earlier dental care experiences; - Cultural differences, - Dental fear, - Regular check-ups. Results: During coaching deficiencies appeared in brushing and inter dental cleaning techniques. Some boys were used to wash their mouth with salt justifying it by salt’s antiseptic properties. Many brushed their teeth by vertical movements. The boys took feedback positively when a demonstration with model jaws revealed the inefficiency of the technique. The advantages of fluoride tooth paste were advised. Dental care procedures were new and frightening for many boys. Finnish dental care system was clarified. The safety and indolence of the treatments and informed consent were highlighted. Video presentations and the dialog lowered substantially the threshold to visit dental clinic. The occasion gave the students means for meeting patients from different cultural and language backgrounds. The information hidden behind the oral health problems of the asylum seekers was valuable. Conclusions: Learning dental care practices used in different cultures is essential for dental professionals. The project was a good start towards multicultural oral health care. More experiences are needed before graduation. Health education themes should be held simple regardless of the target group. The heterogeneity of the group does not pose a problem. Open discussion with questions leading to the theme works well in clarifying the target group’s knowledge level. Sharing own experiences strengthens the sense of equality among the participants and encourages them to express own opinions. Motivational interview method turned out to be successful. In the future coaching occasions must confirm active participation of everyone. This could be realized by dividing the participants to even smaller groups. The different languages impose challenges but they can be solved by using more interpreters. Their presence ensures that everyone understands the issues properly although the use of plain and sign languages are helpful. In further development, it would be crucial to arrange a rehearsal occasion to the same participants in two/three months’ time. This would strengthen the adaption of self-care practices and give the youngsters opportunity to pose more open questions. The students would gain valuable feedback regarding the effectiveness of their work.

Keywords: cooperative learning, interactive methods, motivational interviewing, oral health promotion, underage asylum seekers

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Authors: Adriana De Serio, Adrian Korek

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Aims: This experiential research work presents a Group-MusicTherapy-Theatre-Plan (MusThePlan) the authors have carried out to support the actors. The MusicTherapy gives rise to individual psychophysical feedback and influences the emotional centres of the brain and the subconsciousness. Therefore, the authors underline the effectiveness of the preventive, educational, and training goals of the MusThePlan to lead theatre students and actors to deal with anxiety and to overcome psychophysical weaknesses, shyness, emotional stress in stage performances, to increase flexibility, awareness of one's identity and resources for a positive self-development and psychophysical health, to develop and strengthen social bonds, increasing a network of subjects working for social inclusion and reduction of stigma. Materials-Methods: Thirty students from the University Theatre Faculty participated in weekly music therapy sessions for two months; each session lasted 120 minutes. MusThePlan: Each session began with a free group rhythmic-sonorous-musical-production by body-percussion, voice-canto, instruments, to stimulate communication. Then, a synchronized-structured bodily-rhythmic-sonorous-musical production also involved acting, dances, movements of hands and arms, hearing, and more sensorial perceptions and speech to balance motor skills and the muscular tone. Each student could be the director-leader of the group indicating a story to inspire the group's musical production. The third step involved the students in rhythmic speech and singing drills and in vocal exercises focusing on the musical pitch to improve the intonation and on the diction to improve the articulation and lead up it to an increased intelligibility. At the end of each musictherapy session and of the two months, the Musictherapy Assessment Document was drawn up by analysis of observation protocols and two Indices by the authors: Patient-Environment-Music-Index (time to - tn) to estimate the behavior evolution, Somatic Pattern Index to monitor subject’s eye and mouth and limb motility, perspiration, before, during and after musictherapy sessions. Results: After the first month, the students (non musicians) learned to play percussion instruments and formed a musical band that played classical/modern music on the percussion instruments with the musictherapist/pianist/conductor in a public concert. At the end of the second month, the students performed a public musical theatre show, acting, dancing, singing, and playing percussion instruments. The students highlighted the importance of the playful aspects of the group musical production in order to achieve emotional contact and harmony within the group. The students said they had improved kinetic and vocal and all the skills useful for acting activity and the nourishment of the bodily and emotional balance. Conclusions: The MusThePlan makes use of some specific MusicTherapy methodological models, techniques, and strategies useful for the actors. The MusThePlan can destroy the individual "mask" and can be useful when the verbal language is unable to undermine the defense mechanisms of the subject. The MusThePlan improves actor’s psychophysical activation, motivation, gratification, knowledge of one's own possibilities, and the quality of life. Therefore, the MusThePlan could be useful to carry out targeted interventions for the actors with characteristics of repeatability, objectivity, and predictability of results. Furthermore, it would be useful to plan a University course/master in “MusicTherapy for the Theatre”.

Keywords: musictherapy, sonorous-musical energy, quality of life, theatre

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Authors: Neha Batra Bali, Monika Tomar, Vinay Gupta

Abstract:

A reagentless biosensor for detection of urea based on ZnO-CuO composite thin film is presented in following work. Biosensors have immense potential for varied applications ranging from environmental to clinical testing, health care, and cell analysis. Immense growth in the field of biosensors is due to the huge requirement in today’s world to develop techniques which are both cost effective and accurate for prevention of disease manifestation. The human body comprises of numerous biomolecules which in their optimum levels are essential for functioning. However mismanaged levels of these biomolecules result in major health issues. Urea is one of the key biomolecules of interest. Its estimation is of paramount significance not only for healthcare sector but also from environmental perspectives. If level of urea in human blood/serum is abnormal, i.e., above or below physiological range (15-40mg/dl)), it may lead to diseases like renal failure, hepatic failure, nephritic syndrome, cachexia, urinary tract obstruction, dehydration, shock, burns and gastrointestinal, etc. Various metal nanoparticles, conducting polymer, metal oxide thin films, etc. have been exploited to act as matrix to immobilize urease to fabricate urea biosensor. Amongst them, Zinc Oxide (ZnO), a semiconductor metal oxide with a wide band gap is of immense interest as an efficient matrix in biosensors by virtue of its natural abundance, biocompatibility, good electron communication feature and high isoelectric point (9.5). In spite of being such an attractive candidate, ZnO does not possess a redox couple of its own which necessitates the use of electroactive mediators for electron transfer between the enzyme and the electrode, thereby causing hindrance in realization of integrated and implantable biosensor. In the present work, an effort has been made to fabricate a matrix based on ZnO-CuO composite prepared by pulsed laser deposition (PLD) technique in order to incorporate redox properties in ZnO matrix and to utilize the same for reagentless biosensing applications. The prepared bioelectrode Urs/(ZnO-CuO)/ITO/glass exhibits high sensitivity (70µAmM⁻¹cm⁻²) for detection of urea (5-200 mg/dl) with high stability (shelf life ˃ 10 weeks) and good selectivity (interference ˂ 4%). The enhanced sensing response obtained for composite matrix is attributed to the efficient electron exchange between ZnO-CuO matrix and immobilized enzymes, and subsequently fast transfer of generated electrons to the electrode via matrix. The response is encouraging for fabricating reagentless urea biosensor based on ZnO-CuO matrix.

Keywords: biosensor, reagentless, urea, ZnO-CuO composite

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Authors: I. M. Salama, R. N. Miftahof

Abstract:

A functional element of the myenteric nervous plexus is a morphologically distinct ganglion. Composed of sensory, inter- and motor neurons and arranged via synapses in neuronal circuits, their task is to decipher and integrate spike coded information within the plexus into regulatory output signals. The stability of signal processing in response to a wide range of internal/external perturbations depends on the plasticity of individual neurons. Any aberrations in this inherent property may lead to instability with the development of a dynamics chaos and can be manifested as pathological conditions, such as intestinal dysrhythmia, irritable bowel syndrome. The aim of this study is to investigate patterns of signal transduction within a two-neuronal chain - a ganglion - under normal physiological and structurally altered states. The ganglion contains the primary sensory (AH-type) and motor (S-type) neurons linked through a cholinergic dendro somatic synapse. The neurons have distinguished electrophysiological characteristics including levels of the resting and threshold membrane potentials and spiking activity. These are results of ionic channel dynamics namely: Na+, K+, Ca++- activated K+, Ca++ and Cl-. Mechanical stretches of various intensities and frequencies are applied at the receptive field of the AH-neuron generate a cascade of electrochemical events along the chain. At low frequencies, ν < 0.3 Hz, neurons demonstrate strong connectivity and coherent firing. The AH-neuron shows phasic bursting with spike frequency adaptation while the S-neuron responds with tonic bursts. At high frequency, ν > 0.5 Hz, the pattern of electrical activity changes to rebound and mixed mode bursting, respectively, indicating ganglionic loss of plasticity and adaptability. A simultaneous increase in neuronal conductivity for Na+, K+ and Ca++ ions results in tonic mixed spiking of the sensory neuron and class 2 excitability of the motor neuron. Although the signal transduction along the chain remains stable the synchrony in firing pattern is not maintained and the number of discharges of the S-type neuron is significantly reduced. A concomitant increase in Ca++- activated K+ and a decrease in K+ in conductivities re-establishes weak connectivity between the two neurons and converts their firing pattern to a bistable mode. It is thus demonstrated that neuronal plasticity and adaptability have a stabilizing effect on the dynamics of signal processing in the ganglion. Functional modulations of neuronal ion channel permeability, achieved in vivo and in vitro pharmacologically, can improve connectivity between neurons. These findings are consistent with experimental electrophysiological recordings from myenteric ganglia in intestinal dysrhythmia and suggest possible pathophysiological mechanisms.

Keywords: neuronal chain, signal transduction, plasticity, stability

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Authors: Jannis Kountouras, Nikolaos Kapetanakis, Stergios A. Polyzos, Apostolis Papaeftymiou, Panagiotis Katsinelos, Ioannis Venizelos, Christina Nikolaidou, Christos Zavos, Iordanis Romiopoulos, Elena Tsiaousi, Evangelos Kazakos, Michael Doulberis

Abstract:

Background & Aims: Helicobacter pylori infection (Hp-I) has been recognized as a substantial risk agent involved in gastrointestinal (GI) tract oncogenesis by stimulating cancer stem cells (CSCs), oncogenes, immune surveillance processes, and triggering GI microbiota dysbiosis. We aimed to investigate the possible involvement of active Hp-I in the sequence: chronic inflammation–adenoma–colorectal cancer (CRC) development. Methods: Four pillars were investigated: (i) endoscopic and conventional histological examinations of patients with CRC, colorectal adenomas (CRA) versus controls to detect the presence of active Hp-I; (ii) immunohistochemical determination of the presence of Hp; expression of CD44, an indicator of CSCs and/or bone marrow-derived stem cells (BMDSCs); expressions of oncogene Ki67 and anti-apoptotic Bcl-2 protein; (iii) expression of CD45, indicator of immune surveillance locally (assessing mainly T and B lymphocytes locally); and (iv) correlation of the studied parameters with the presence or absence of Hp-I. Results: Among 50 patients with CRC, 25 with CRA, and 10 controls, a significantly higher presence of Hp-I in the CRA (68%) and CRC group (84%) were found compared with controls (30%). The presence of Hp-I with accompanying immunohistochemical expression of CD44 in biopsy specimens was revealed in a high proportion of patients with CRA associated with moderate/severe dysplasia (88%) and CRC patients with moderate/severe degree of malignancy (91%). Comparable results were also obtained for Ki67, Bcl-2, and CD45 immunohistochemical expressions. Concluding Remarks: Hp-I seems to be involved in the sequence: CRA – dysplasia – CRC, similarly to the upper GI tract oncogenesis, by several pathways such as the following: Beyond Hp-I associated insulin resistance, the major underlying mechanism responsible for the metabolic syndrome (MetS) that increase the risk of colorectal neoplasms, as implied by other Hp-I related MetS pathologies, such as non-alcoholic fatty liver disease and upper GI cancer, the disturbance of the normal GI microbiota (i.e., dysbiosis) and the formation of an irritative biofilm could contribute to a perpetual inflammatory upper GIT and colon mucosal damage, stimulating CSCs or recruiting BMDSCs and affecting oncogenes and immune surveillance processes. Further large-scale relative studies with a pathophysiological perspective are necessary to demonstrate in-depth this relationship.

Keywords: Helicobacter pylori, colorectal cancer, colorectal adenomas, gastrointestinal oncogenesis

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Authors: B. T. Naveen Kumar, Anuj Tyagi, Niraj Kumar Singh, Visanu Boonyawiwat, A. H. Shanthanagouda, Orawan Boodde, K. M. Shankar, Prakash Patil, Shubhkaramjeet Kaur

Abstract:

Early mortality syndrome (EMS)/Acute Hepatopancreatic Necrosis Disease (AHPND) has emerged as a major obstacle for the shrimp farming around the world. It is caused by a strain of Vibrio parahaemolyticus. The possible preventive and control measure is, early and rapid detection of the pathogen in the broodstock, post-larvae and monitoring the shrimp during the culture period. Polymerase chain reaction (PCR) based early detection methods are good, but they are costly, time taking and requires a sophisticated laboratory. The present study was conducted to develop a simple, sensitive and rapid diagnostic farmer level kit for the reliable detection of AHPND in shrimp. A panel of monoclonal antibodies (MAbs) were raised against the recombinant Pir B protein (rPirB). First, an immunodot was developed by using MAbs G3B8 and Mab G3H2 which showed specific reactivity to purified r-PirB protein with no cross-reactivity to other shrimp bacterial pathogens (AHPND free Vibrio parahaemolyticus (Indian strains), V. anguillarum, WSSV, Aeromonas hydrophila, and Aphanomyces invadans). Immunodot developed using Mab G3B8 is more sensitive than that with the Mab G3H2. However, immunodot takes almost 2.5 hours to complete with several hands-on steps. Therefore, the flow-through assay (FTA) was developed by using a plastic cassette containing the nitrocellulose membrane with absorbing pads below. The sample was dotted in the test zone on the nitrocellulose membrane followed by continuos addition of five solutions in the order of i) blocking buffer (BSA) ii) primary antibody (MAb) iii) washing Solution iv) secondary antibody and v) chromogen substrate (TMB) clear purple dots against a white background were considered as positive reactions. The FTA developed using MAbG3B8 is more sensitive than that with MAb G3H2. In FTA the two MAbs showed specific reactivity to purified r-PirB protein and not to other shrimp bacterial pathogens. The FTA is simple to farmer/field level, sensitive and rapid requiring only 8-10 min for completion. Tests can be developed to kits, which will be ideal for use in biosecurity, for the first line of screening (at the port or pond site) and during monitoring and surveillance programmes overall for the good management practices to reduce the risk of the disease.

Keywords: acute hepatopancreatic necrosis disease, AHPND, flow-through assay, FTA, farmer level, immunodot, pond site, shrimp

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Authors: Nursyafiq Ali Shibramulisi, Nor Farah Fauzi, Nur Azniza Zawin Anuar, Nurul Atikah Azmi, Janice Hew Pei Fang

Abstract:

Background: Work related musculoskeletal disorders (WRMD) among dental personnel have been underestimated and under-reported worldwide and specifically in Malaysia. The problem will arise and progress slowly over time, as it results from accumulated injury throughout the period of work. Several risk factors, such as repetitive movement, static posture, vibration, and adapting poor working postures, have been identified to be contributing to WRMSD in dental practices. Dental personnel is at higher risk of getting this problem as it is their working nature and core business. This would cause pain and dysfunction syndrome among them and result in absence from work and substandard services to their patients. Methodology: A cross-sectional study involving 19 government dental clinics in Perak was done over the period of 3 months. Those who met the criteria were selected to participate in this study. Malay version of the Self-Reported Nordic Musculoskeletal Discomfort Form was used to identify the prevalence of WRMSD, while the intensity of pain in the respective regions was evaluated using a 10-point scale according to ‘Pain as The 5ᵗʰ Vital Sign’ by MOH Malaysia and later on were analyzed using SPSS version 25. Descriptive statistics, including mean and SD and median and IQR, were used for numerical data. Categorical data were described by percentage. Pearson’s Chi-Square Test and Spearman’s Correlation were used to find the association between the prevalence of WRMSD and other socio-demographic data. Results: 159 dentists, 73 dental therapists, 26 dental lab technicians, 81 dental surgery assistants, and 23 dental attendants participated in this study. The mean age for the participants was 34.9±7.4 and their mean years of service was 9.97±7.5. Most of them were female (78.5%), Malay (71.3%), married (69.6%) and right-handed (90.1%). The highest prevalence of WRMSD was neck (58.0%), followed by shoulder (48.1%), upper back (42.0%), lower back (40.6%), hand/wrist (31.5%), feet (21.3%), knee (12.2%), thigh 7.7%) and lastly elbow (6.9%). Most of those who reported having neck pain scaled their pain experiences at 2 out of 10 (19.5%), while for those who suffered upper back discomfort, most of them scaled their pain experience at 6 out of 10 (17.8%). It was found that there was a significant relationship between age and pain at neck (p=0.007), elbow (p=0.027), lower back (p=0.032), thigh (p=0.039), knee (p=0.001) and feet (p=0.000) regions. Job position also had been found to be having a significant relationship with pain experienced at the lower back (p=0.018), thigh (p=0.011), knee, and feet (p=0.000). Conclusion: The prevalence of WRMSD among dental personnel in Perak was found to be high. Age and job position were found to be having a significant relationship with pain experienced in several regions. Intervention programs should be planned and conducted to prevent and reduce the occurrence of WRMSD, as all harmful or unergonomic practices should be avoided at all costs.

Keywords: WRMSD, ergonomic, dentistry, dental

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