Search results for: axial pain

Authors: Athicha Cherdpunt, Patompong Satapornpong

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The medical cannabis is made up of components also known as cannabinoids, which consists of two ingredients which are Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD). Interestingly, the Cannabinoid can be used for many treatments such as chemotherapy, including nausea and vomiting, cachexia, anorexia nervosa, spinal cord injury and disease, epilepsy, pain, and many others. However, the adverse drug reactions (ADRs) of THC can cause sedation, anxiety, dizziness, appetite stimulation and impairments in driving and cognitive function. Furthermore, genetic polymorphisms of CYP2C9, CYP2C19 and CYP3A4 influenced the THC metabolism and might be a cause of ADRs. Particularly, CYP2C19*17 allele increases gene transcription and therefore results in ultra-rapid metabolizer phenotype (UM). The aim of this study, is to investigate the frequency of CYP2C19*17 alleles in Thai patients who have been treated with medical cannabis. We prospectively enrolled 60 Thai patients who were treated with medical cannabis and clinical data from College of Pharmacy, Rangsit University. DNA of each patient was isolated from EDTA blood, using the Genomic DNA Mini Kit. CYP2C19*17 genotyping was conducted using the real time-PCR ViiA7 (ABI, Foster City, CA, USA). 30 patients with medical cannabis-induced ADRs group, 20 (67%) were female, and 10 (33%) were male, with an age range of 30-69 years. On the other hand, 30 patients without medical cannabis-induced ADRs (control group) consist of 17 (57%) female and 13 (43%) male. The most ADRs for medical cannabis treatment in the case group were dry mouth and dry throat (77%), tachycardia (70%), nausea (30%) and arrhythmia(10%). Accordingly, the case group carried CYP2C19*1/*1 (normal metabolizer) approximately 93%, while 7% patients carrying CYP2C19*1/*17 (ultra rapid metabolizers) exhibited in this group. Meanwhile, we found 90% of CYP2C19*1/*1 and 10% of CYP2C19*1/*17 in control group. In this study, we identified the frequency of CYP2C19*17 allele in Thai population which will support the pharmacogenetics biomarkers for screening and avoid ADRs of medical cannabis treatment.

Keywords: CYP2C19, allele frequency, ultra rapid metabolizer, medical cannabis

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Authors: Eric Lai, Sarah Lorger, David Eisinger, Richard Waugh

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Introduction: Percutaneous embolization of varicoceles has shown similar outcomes to surgery. However, there are advantages of radiological intervention as patients are not exposed to general anaesthesia, experience a quicker recovery and face a lower risk of major complications. Radiological interventions are also preferable after a failed surgical approach. We evaluate clinical outcomes of percutaneous embolization at a tertiary hospital in Sydney, Australia. Methods: Retrospective case series without a control group from a single site (Royal Prince Alfred Hospital, Sydney, Australia). A data search was performed on the interventional radiology database with the word “varicocele” between February 2017 and March 2022. 62 patients were identified. Each patient file was reviewed and included in the study if they met the inclusion criteria. Results: A total of 56 patients were included. 6 patients were excluded as they did not receive intervention after the initial diagnostic venography. Technical success was 100%. Complications were seen in 3 patients (5.3%). The complications included post-procedural pain and fever, venous perforation with no clinical adverse outcome, and a mild allergic reaction to contrast. Recurrence occurred in 3 patients (5.6%), all of whom received a successful second procedure. DISCUSSION: This study demonstrates comparable rates of technical success, complication rate and recurrence to other studies in the literature. When compared to surgical outcomes, the results were also similar. The main limitation is multiple patients lack long-term follow-up beyond 1 year, resulting in potential underestimation of the recurrence rate. Conclusion: Percutaneous embolization of varicocele is a safe alternative to surgical intervention.

Keywords: varicocele, interventional radiology, urology, radiology

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Authors: Anukriti Verma, Bhawna Rathi, Shivani Sharda

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Reactive Arthritis (ReA) is a disorder that causes inflammation in joints due to certain infections at distant sites in the body. ReA begins with stiffness, pain, and inflammation in these areas especially the ankles, knees, and hips. It gradually causes several complications such as conjunctivitis in the eyes, skin lesions in hand, feet and nails and ulcers in the mouth. Nowadays the diagnosis of ReA is based upon a differential diagnosis pattern. The parameters for differentiating ReA from other similar disorders include physical examination, history of the patient and a high index of suspicion. There are no standard lab tests or markers available for ReA hence the early diagnosis of ReA becomes difficult and the chronicity of disease increases with time. It is reported that enteric disorders such as Inflammatory Bowel Disease (IBD) that is inflammation in gastrointestinal tract namely Crohn’s Disease (CD) and Ulcerative Colitis (UC) are reported to be linked with ReA. Several microorganisms are found such as Campylobacter, Salmonella, Shigella and Yersinia causing IBD leading to ReA. The aim of our study was to perform the in-silico analysis in order to find interactions between microorganisms and human host causing IBD leading to ReA. A systems biology approach for metabolic network reconstruction and simulation was used to find the essential genes of the reported microorganisms. Interactomics study was used to find the interactions between the pathogen genes and human host. Genes such as nhaA (pathogen), dpyD (human), nagK (human) and kynU (human) were obtained that were analysed further using the functional, pathway and network analysis. These genes can be used as putative drug targets and biomarkers in future for early diagnosis, prevention, and treatment of IBD leading to ReA.

Keywords: drug targets, inflammatory bowel disease, reactive arthritis, systems biology

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Authors: Anicet Dansou

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Textile reinforced concrete (TRC)is increasingly used nowadays in various fields, in particular civil engineering, where it is mainly used for the reinforcement of damaged reinforced concrete structures. TRC is a composite material composed of multi- or uni-axial textile reinforcements coupled with a fine-grained cementitious matrix. The TRC composite is an alternative solution to the traditional Fiber Reinforcement Polymer (FRP) composite. It has good mechanical performance and better temperature stability but also, it makes it possible to meet the criteria of sustainable development better.TRCs are highly anisotropic composite materials with nonlinear hardening behavior; their macroscopic behavior depends on multi-scale mechanisms. The characterization of these materials through numerical simulation has been the subject of many studies. Since TRCs are multiscale material by definition, numerical multi-scale approaches have emerged as one of the most suitable methods for the simulation of TRCs. They aim to incorporate information pertaining to microscale constitute behavior, mesoscale behavior, and macro-scale structure response within a unified model that enables rapid simulation of structures. The computational costs are hence significantly reduced compared to standard simulation at a fine scale. The fine scale information can be implicitly introduced in the macro scale model: approaches of this type are called non-classical. A representative volume element is defined, and the fine scale information are homogenized over it. Analytical and computational homogenization and nested mesh methods belong to these approaches. On the other hand, in classical approaches, the fine scale information are explicitly introduced in the macro scale model. Such approaches pertain to adaptive mesh refinement strategies, sub-modelling, domain decomposition, and multigrid methods This research presents the main principles of numerical multiscale approaches. Advantages and limitations are identified according to several criteria: the assumptions made (fidelity), the number of input parameters required, the calculation costs (efficiency), etc. A bibliographic study of recent results and advances and of the scientific obstacles to be overcome in order to achieve an effective simulation of textile reinforced concrete in civil engineering is presented. A comparative study is further carried out between several methods for the simulation of TRCs used for the structural reinforcement of reinforced concrete structures.

Keywords: composites structures, multiscale methods, numerical modeling, textile reinforced concrete

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Authors: Ajay Kumar, Satwinderjeet Kaur

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Onosma bracteata Wall. (Boraginaceae), is known to be a medicinal plant, useful in the treatment of body swellings, abdominal pain and urinary calculi, etc. The present study focused on the radical scavenging and cancer growth inhibitory properties of isolates from O. bracteata. Obea fraction demonstrated noticeable free radical scavenging ability along with antiproliferative activity in human osteosarcoma MG-63, human neuroblastoma IMR-32, and human lung cancer A549 cell lines using MTT assay with GI50 values of 88.56, 101.61 and 112.7 μg/ml, respectively. The scanning electron and confocal microscopy studies showed morphological alterations including nuclear condensation and formation of apoptotic bodies in osteosarcoma MG-63 cells. Obea fraction in osteosarcoma MG-63 cells augmented the reactive oxygen species (ROS) level and decreased the mitochondrial membrane potential. Flow cytometry analysis revealed the Obea treated cells to be arrested in the G0/G1 phase in a dose dependent manner supported by the observed increase in the early apoptotic cell population. Western blotting analysis showed that the expression of p-NF-kB, COX-2, p-Akt, and Bcl-xL decreased whereas, the expression of GSK-3β, p53, caspase-3 and caspase-9 proteins increased. The downregulation of Bcl-2, Cyclin E, CDK2 and mortalin gene expression and upregulation of p53 genes was unfolded in RT-qPCR studies. The presence of catechin, kaempferol, Onosmin A and epicatechin, as revealed in high-performance liquid chromatography (HPLC) studies, contributes towards the chemopreventive potential of O. bracteata which can be tapped for chemotherapeutic use.

Keywords: apoptosis, confocal microscopy, HPLC, mitochondria membrane potential, reactive oxygen species

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Authors: Naim Izet Kajtazi

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Context: Although rare, glomus tumor (i.e., nonchromaffin chemodectomas and paragan¬gliomas) is the most common middle ear tumor, with female predominance. Pre-operative embolization is often required to devascularize the hypervascular tumor for better surgical outcomes. Process: A 35-year-old female presented with episodes of frequent dizziness, ear fullness, and right ear tinnitus for 12 months. Head imaging revealed a right glomus tympanicum tumor. She underwent pre-operative endovascular embolization of the glomus tympanicum tumor with surgical, cyanoacrylate-based glue. Immediately after the procedure, she developed drowsiness and severe pain in the right temporal region. Further investigations revealed a right cerebellar stroke in the posterior inferior cerebellar artery territory. She was treated with intravenous heparin, followed by one year of oral anticoagulation. With rehabilitation, she significantly recovered from her post embolization stroke. However, the tumor was resected at another institution. Ten years later, follow-up imaging indicated a gradual increase in the size of the glomus jugulare tumor, compressing the nearby critical vascular structures. She subsequently received radiation therapy to treat the residual tumor. Outcome: Currently, she has no neurological deficit, but her mild dizziness, right ear tinnitus, and hearing impairment persist. Relevance: This case highlights the complex nature of these tumors, which often bring challenges to the patients as well as treatment teams. The multi-disciplinary team approach is necessary to tailor the management plan for individual tumors. Although embolization is a safe procedure, careful attention and thoughtful anatomic knowledge regarding dangerous anastomosis are essential to avoid devastating complications. Complications occur due to encountered vessel anomalies and new anastomoses formed during the gluing and changes in hemodynamics.

Keywords: stroke, embolization, MRI brain, cerebral angiogram

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Authors: Domenica Tambasco, Riina Bray, Sophia Jaworski, Gillian Grant, Celeste Corkery

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Fibromyalgia is a chronic condition characterized by widespread musculoskeletal pain, fatigue, and reduced function. Management of symptoms include medications, physical treatments and mindfulness therapies. Myofascial Release is a modality that has been successfully applied in var-ious musculoskeletal conditions. However, to the author’s best knowledge, it is not yet recog-nized as a self-management therapy option in Fibromyalgia. In this study, we investigated whether Self-applied Myofascial Release (SMR) is associated with overall improved function and symptoms in Fibromyalgia. Methods: Eligible adult patients with a confirmed diagnosis of Fibromyalgia at Women’s College Hospital were recruited to SMR. Sessions ran for 1 hour once a week for 7 weeks, led by the same two Physiotherapists knowledgeable in this physical treat-ment modality. The main outcome measure was an overall impact score for function and symp-toms based on the validated assessment tool for Fibromyalgia, the Revised Fibromyalgia Impact Questionnaire (FIQR), measured pre and post-intervention. Both descriptive and analytical methods were applied and reported. Results: We analyzed results using a paired t-test to deter-mine if there was a statistically significant difference in mean FIQR scores between initial (pre-intervention) and final (post-intervention) scores. A clinically significant difference in FIQR was defined as a reduction in score by 10 or more points. Conclusions: Our pilot study showed that SMR appeared to be a safe and effective intervention for our Fibromyalgia participants and the overall impact on function and symptoms occurred in only 7 weeks. Further studies with larger sample sizes comparing SMR to other physical treatment modalities (such as stretching) in an RCT are recommended.

Keywords: fibromyalgia, myofascial release, physical therapy, FIQR

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Authors: Angelis P. Barlampas, Ghita Bianca-Andreea

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A case of a prostatic midline cyst is presented, which was found during a routine general ultrasound examination in an otherwise healthy young man. The incidence of prostatic cysts discovered in suprapubic ultrasound examination has constantly been rising over the previous decades. Despite the fact that the majority of them are benign, a significant amount is related to symptoms, such as pain, dysuria, infertility, and even cancer. The wide use of ultrasound examination and the increasing availability of high-resolution ultrasound systems have rendered new diagnostic challenges. Once upon a time a suprapubic ultrasound was only useful for measuring only the size and the dimensions of the prostatic gland. It did not have the ability to analyze and resolve structures such as cystic or solid nodules. The current machine equipment has managed to depict the imaging characteristics of lesions with high acuity that compares of an intrarectal ultrasound. But the last one is a specialized examination, which demands expertise and good knowledge. Maybe the time has come for the general radiologist and, especially the one who uses suprapubic ultrasound, to pay more attention to the examination of the prostate gland and to take advantage of the superb abilities and the high resolution of the new ultrasound systems. That is exactly, what this case is emphasizing. The incidental discovery of prostatic cysts, and the relatively little available literature about managing them turns them into an interesting theme for exploring and studying. The prostatic cysts are further divided into midline and paramidline cysts, with the first being usually utricle cysts. A more precise categorization is as follows: A midline cystic lesion usually regards a Mullerian duct cyst, a prostatic utricle cyst, an ejaculatory duct cyst, a prostatic cystadenoma, a ductus deferens cyst, and a TURP. On the other hand, a lateral cystic lesion usually refers to a cystic degeneration of benign prostatic hyperplasia, a prostatic retention cyst, a seminal vesicle cyst, diverticular prostatitis, a prostatic abscess, cavitatory prostatitis from chronic prostatitis, a parasitic prostatic cyst, a cystic prostatic carcinoma, e.t.c.

Keywords: prostatic cyst, radiology, benign prostatic lesions, prostatic cancer, suprapubic prostatic ultrasound

Procedia PDF Downloads 58

Authors: Valery Gulyayev, Sergey Glazunov, Elena Andrusenko, Nataliya Shlyun

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Enhancement of technology and techniques for drilling deep directed oil and gas bore-wells are of essential industrial significance because these wells make it possible to increase their productivity and output. Generally, they are used for drilling in hard and shale formations, that is why their drivage processes are followed by the emergency and failure effects. As is corroborated by practice, the principal drilling drawback occurring in drivage of long curvilinear bore-wells is conditioned by the need to obviate essential force hindrances caused by simultaneous action of the gravity, contact and friction forces. Primarily, these forces depend on the type of the technological regime, drill string stiffness, bore-hole tortuosity and its length. They can lead to the Eulerian buckling of the drill string and its sticking. To predict and exclude these states, special mathematic models and methods of computer simulation should play a dominant role. At the same time, one might note that these mechanical phenomena are very complex and only simplified approaches (‘soft string drag and torque models’) are used for their analysis. Taking into consideration that now the cost of directed wells increases essentially with complication of their geometry and enlargement of their lengths, it can be concluded that the price of mistakes of the drill string behavior simulation through the use of simplified approaches can be very high and so the problem of correct software elaboration is very urgent. This paper deals with the problem of simulating the regimes of drilling deep curvilinear bore-wells with prescribed imperfect geometrical trajectories of their axial lines. On the basis of the theory of curvilinear flexible elastic rods, methods of differential geometry, and numerical analysis methods, the 3D ‘stiff-string drag and torque model’ of the drill string bending and the appropriate software are elaborated for the simulation of the tripping in and out regimes and drilling operations. It is shown by the computer calculations that the contact and friction forces can be calculated and regulated, providing predesigned trouble-free modes of operation. The elaborated mathematic models and software can be used for the emergency situations prognostication and their exclusion at the stages of the drilling process design and realization.

Keywords: curvilinear drilling, drill string tripping in and out, contact forces, resistance forces

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Authors: Naso Isaiah Thanavisuth

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Introduction: Medical cannabis can be used for treatment, including anorexia, pain, inflammation, multiple sclerosis, Parkinson's disease, epilepsy, cancer, and metabolic syndrome-related disorders. However, medical cannabis leads to adverse effects (AEs), which is delta-9-tetrahydrocannabinol (THC). In previous studies, the major of THC metabolism enzymes are CYP2C9. Especially, the variation of CYP2C9 gene consist of CYP2C9*2 on exon 3 (C430T) (Arg144Cys) and CYP2C9*3 on exon 7 (A1075C) (Ile359Leu) to decrease enzyme activity. Notwithstanding, there is no data describing whether the variant of CYP2C9 genes are a pharmacogenetics marker for prediction of THC-induced AEs in Thai patients. Objective: We want to investigate the association between CYP2C9 gene and THC-induced AEs in Thai patients. Method: We enrolled 39 Thai patients with medical cannabis treatment consisting of men and women who were classified by clinical data. The quality of DNA extraction was assessed by using NanoDrop ND-1000. The CYP2C9*2 and *3 genotyping were conducted using the TaqMan real time PCR assay (ABI, Foster City, CA, USA). Results: All Thai patients who received the medical cannabis consist of twenty four (61.54%) patients who were female and fifteen (38.46%) were male, with age range 27- 87 years. Moreover, the most AEs in Thai patients who were treated with medical cannabis between cases and controls were tachycardia, arrhythmia, dry mouth, and nausea. Particularly, thirteen (72.22%) medical cannabis-induced AEs were female and age range 33 – 69 years. In this study, none of the medical cannabis groups carried CYP2C9*2 variants in Thai patients. The CYP2C9*3 variants (*1/*3, intermediate metabolizer, IM) and (*3/*3, poor metabolizer, PM) were found, three of thirty nine (7.69%) and one of thirty nine (2.56%) , respectively. Conclusion: This is the first study to confirm the genetic polymorphism of CYP2C9 and medical cannabis-induced AEs in the Thai population. Although, our results indicates that there is no found the CYP2C9*2. However, the variation of CYP2C9 allele might serve as a pharmacogenetics marker for screening before initiating the therapy with medical cannabis for prevention of medical cannabis-induced AEs.

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

Procedia PDF Downloads 106

Authors: R. R. Billones, N. Lukkahatai, L. N. Saligan

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Mindfulness based interventions (MBIs) have been used in medically unexplained symptoms (MUS). This systematic review describes the literature investigating the general effect of MBIs on MUS and identifies the effects of specific MBIs on specific MUS conditions. The preferred reporting items for systematic reviews and meta-analysis guidelines (PRISMA) and the modified Oxford quality scoring system (JADAD) were applied to the review, yielding an initial 1,556 articles. The search engines included PubMed, ScienceDirect, Web of Science, Scopus, EMBASE, and PsychINFO using the search terms: mindfulness, or mediations, or mindful or MBCT or MBSR and medically unexplained symptoms or MUS or fibromyalgia or FMS. A total of 24 articles were included in the final systematic review. MBIs showed large effects on socialization skills for chronic fatigue syndrome (d=0.65), anger in fibromyalgia (d=0.61), improvement of somatic symptoms (d=1.6) and sleep (d=1.12) for painful conditions, physical health for chronic back pain (d=0.51), and disease intensity for irritable bowel disease/syndrome (d=1.13). A manualized MBI that applies the four fundamental elements present in all types of interventions were critical to efficacy. These elements were psycho-education sessions specific to better understand the medical symptoms, the practice of awareness, the non-judgmental observance of the experience at the moment, and the compassion to ones’ self. The effectiveness of different mindfulness interventions necessitates giving attention to improve the gaps that were identified related to home-based practice monitoring, competency training of mindfulness teachers, and sound psychometric properties to measure the mindfulness practice.

Keywords: mindfulness-based interventions, medically unexplained symptoms, mindfulness-based cognitive therapy, mindfulness-based stress reduction, fibromyalgia, irritable bowel syndrome

Procedia PDF Downloads 142

Authors: Jibran Abbasy, Rizwan Sultan, Ammar Humayun, Tabish Chawla

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Background: Hydatid disease caused by Echinococcus Granulosus affects liver in 70-90% of cases. Dogs are the definitive host while humans are the accidental host. Modalities used for its treatment are especially important for our population as the disease is endemic in many Asian countries. The aim of the study was to perform an audit of the various modalities used for treatment of hydatid disease of liver and the response to each modality in tertiary care center of Pakistan. Materials and Methods: Retrospective audit of patients diagnosed and treated for Hydatid disease of the liver at Aga Khan University Hospital from 1st January 2007 to 31st December 2014 was completed. All patients aged 16 and above were included. Patients who had extra hepatic disease and missing records were excluded. Outcome measures were morbidity, mortality and recurrence of the disease. Results: During the study period 56 patients were treated for isolated hepatic hydatid disease and were included. Mean age was 39 years with 48% being females and 52% males. Most common presenting complaint was abdominal pain seen in 53% of patients(n=41). Duration of symptoms was less than 6 months in 74% (n=38). Mostly right lobe was involved in 69% (n=38).Most common treatment modality used was surgery in 34 patients followed by PAIR in 14 patients while 8 patients were treated medically. At a median follow up of 34 months recurrence was seen in 2 patients treated with PAIR while no patient treated with surgery had recurrence with the median follow up of 20 months. While no morbidity and mortality were observed in PAIR, but in surgery 5 patients had morbidity while 1 patient had mortality. Conclusion: Our data is comparative to other studies in terms of morbidity, mortality, and recurrence. We had adequate follow up. In our study PAIR and surgery both are effective and have less complications and recurrence rate. Surgery is still the gold standard in terms of recurrence.

Keywords: echinococcous granulosus, puncture aspiration irrigation reaspiration (PAIR), surgery, hydatid disease

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Authors: Mohd Zubairy Bin Shamsudin

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Work-related Musculoskeletal Disorder (WMSDs) is one of the occupational health problems encountered by workers over the world. In Malaysia, there is increasing in trend over the years, particularly in the manufacturing sectors. Current method to observe workplace WMSDs is self-report questionnaire, observation and direct measurement. Observational method is most frequently used by the researcher and practitioner because of the simplified, quick and versatile when it applies to the worksite. However, there are some limitations identified e.g. some approach does not cover a wide spectrum of biomechanics activity and not sufficiently sensitive to assess the actual risks. This paper elucidates the development of Work Movement Task Analysis (WMTA), which is an observational tool for industrial practitioners’ especially untrained personnel to assess WMSDs risk factors and provide a basis for suitable intervention. First stage of the development protocol involved literature reviews, practitioner survey, tool validation and reliability. A total of six themes/comments were received in face validity stage. New revision of WMTA consisted of four sections of postural (neck, back, shoulder, arms, and legs) and associated risk factors; movement, load, coupling and basic environmental factors (lighting, noise, odorless, heat and slippery floor). For inter-rater reliability study shows substantial agreement among rater with K = 0.70. Meanwhile, WMTA validation shows significant association between WMTA score and self-reported pain or discomfort for the back, shoulder&arms and knee&legs with p<0.05. This tool is expected to provide new workplace ergonomic observational tool to assess WMSDs for the next stage of the case study.

Keywords: assessment, biomechanics, musculoskeletal disorders, observational tools

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Authors: E. Xavier, B. Nandita

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Rohingyas are an ethnic and religious minority that resides in the Rakhine State of Myanmar. Post the military coup in 1962, Rohingyas have not been recognized as one of the ethnic tribes of Burma under the legislation. They have lost citizenship, education, health care rights, and instantly became illegal immigrants. While the historicization of this conflict is crucial, this paper wants to humanize the Rohingya population’s embodiment of violence on three different levels – individual, social, and political. In addition, the study focuses on their liminal existence in refugee camps in Bangladesh and in other parts of the world, such as Malaysia and the United States of America. A multi-medium study, it includes first-hand interviews with the Rohingya community in Wisconsin and Chicago, second-hand interviews from documentaries and past ethnographies from scholars to draw meaningful conclusions about their experience as a community. In the end, it focuses on the group of Rohingyas who have managed to resettle in another country and their transitioning experience. Rohingyas embody violence on their individual, social, and political bodies in different ways. Along with rape, murder, and physical harm, the community also encounters sexually transmitted infections, post-traumatic stress disorder symptoms, and poor mental health. On a social level, they encounter heightened gender discrimination, work industry shifting, and immense, shared emotional pain. As for their political body, the news media and journalism industry uses their bodies for purposes that benefit both parties and flirts with a tone of sensationalism in their reporting. In addition, the Rohingya community fluctuates with the concept of nationality, patriotism, citizenship, and refugee when they think about the future. This study provides a framework that future aid or health programs can use to determine the type of community need and its significance in the Rohingya community.

Keywords: embodiment, liminal, refugee, Rohingya

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Authors: Sara Javanmardi, Sepehr Aziziz, Baharak Divband, Masoumeh Firouzamandi

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Post-operative adhesions are the most common cause of intestinal obstruction, female infertility and chronic abdominal pain. We developed a novel approach for preventing post-operative peritoneal adhesions using a biodegradable and thermosensitive curcumin hydrogel in rats. Thirteen male Sprague-Dawley rats were assigned randomly into five groups of six animals each: In SHAM group, the cecum was exteriorized, gently manipulated and sent back into the abdomen. In CONTROL group, the surgical abrasion was performed with no further treatment. In Hydrogel group, surgical abrasion was performed with local application of blank hydrogel (1 mL). In Curcumin group, surgical abrasion was performed with local application of curcumin (1 mL). In CUR/HGEL group, surgical abrasion was performed with local application of curcumin hydrogel (1 mL). On day 10, adhesions were assessed using a standardized scale (Evans model), and samples were collected for the Real-time PCR. Real-time PCR was performed to determine mRNA levels of VCAM-1, ICAM-1 and GAPDH. The macroscopic adhesion intensity showed statistically significant differences between the CUR/HGEL and other groups (P=0.0005). The findings of the present study revealed there were statistically significant differences between the groups regarding adhesion band length and numbers (P<0.0001). The protein and mRNA expression of VCAM-1 and ICAM-1 in secal tissues were significantly down regulated due to curcumin-hydrogel application in CUR/HGEL compared to other groups (p<0.05). The thermosensitive hydrogel could reduce the severity and even prevent formation of intra-abdominal adhesion. Curcumin hydrogel could serve as a potential barrier agent to prevent post-operative peritoneal adhesion in rats.

Keywords: peritoneal adhesion, hydrogel, curcumijn, ICAM-1, VCAM-1

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Authors: Naqoosh Haidry

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Objective & Goal: Enucleation of the maxillomandibular cysts will lead to the creation of post-surgical bone defects which may take more than a year for complete bone healing. The use of bone grafts is common to aid bone regeneration in large defects. The study aimed to evaluate the healing and bone formation capabilities of polymer of injectable platelet fibrin (i-PRF) and hydroxyapatite (HA) as bone graft substitute in maxilla-mandibular postsurgical defects compared to hydroxyapatite alone. The primary objective was to find out the clinical and radiological assessment of healing postoperatively and compare the outcome of both groups. Material and Methods: After surgical enucleation of 19 maxillomandibular cysts/tumors, either HA or HA+ i-PRF graft was adapted to the defect. Clinical outcome variables such as pain (VAS score), edema, and mucosal color were evaluated on postoperative days 01, 03, and 07 while radiological outcome variables such as volume of defect (cc), density of new bone (HU) on computed tomography were evaluated at 2nd and 4th month. The results obtained were tabulated and compared with the inferential analysis. Results: Clinical parameters seem to be better in the HA + i-PRF group, but the result was non-significant. Radiologically, the mean healing ratios were significantly greater in the HA + i-PRF group (63.5 ± 2.34 at 2nd month, 90.3 ± 7.32 at 4th month) compared to the HA group (57.2 ± 5.21at 2nd month, 80.8 ± 5.33 at 4th month). When comparing the mean density of new bone, there was a statistically significant difference with a mean difference of 95.2 HU more in the HA + i-PRF (623 HU ± 42.9) compared to the HA group (528 HU ± 96.5) in 2nd month. Conclusion: The polymer of i-PRF and HA prepared as the sticky bone yields faster and better bone healing in post-enucleation maxillomandibular bony defects as compared to hydroxyapatite alone based on radiological findings till four months.

Keywords: bone defect, density of new bone, hydroxyapatite, injectable platelet rich fibrin, maxillomandibular cysts, surgical defect

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Authors: Aysegul Alyamac, Sukru Gulec

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Ankaferd Blood Stopper (ABS) is a plant extract used to stop bleeding caused by injuries and surgical interventions. ABS also involved in wound healing of intestinal mucosal damage due to oxidative stress and inflammation. Inflammatory Bowel Disease (IBD) is a common chronic disorder of the gastrointestinal tract that causes abdominal pain, diarrhea, and gastrointestinal bleeding, and increases the risk of colon cancer. Inflammation is an essential factor in the development of IBD. The various studies have been performed about the physiological effects of ABS; however, ABS dependent mechanism on colonic inflammation has not been elucidated. Thus, the protective effect of ABS on colonic inflammation was investigated in this study. The Caco-2 and RAW 264.7 murine macrophage cells were used as a model of in vitro colonic inflammation. RAW 264.7 cells were treated with lipopolysaccharide (LPS) for 12 hours to induce the inflammation, and a conditional medium was obtained. Caco-2 cells were treated with 15 µl/ml ABS for 4 hours, then incubated with conditional medium and the cells also were incubated with 15 µl/ml ABS and conditional medium together for 4 hours. Tumor necrosis factor alpha (TNF-α) protein levels were targeted in testing inflammatory condition and its level was significantly increased (25 fold, p<0.001) compared to the control group by using Enzyme-Linked Immunosorbent Assay (ELISA) method. The COX-2 mRNA level was used as a marker gene to show the possible anti-inflammatory effect of ABS in Caco-2 cells. RAW cells-derived conditional medium significantly (3.3 fold, p<0.001) induced cyclooxygenase-2 (COX-2) mRNA levels in Caco-2 cells. The pretreatment of Caco-2 cells caused a significant decrease (3.3 fold, p<0.001) in COX-2 mRNA levels relative to conditional medium given group. Furthermore, COX-2 mRNA level was significantly reduced (4,7 fold, p<0.001) in ABS and conditional medium treated group. These results suggest that ABS might have an anti-inflammatory effect in vitro.

Keywords: Ankaferd blood stopper, CaCo-2, colonic inflammation, RAW 264.7

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Authors: M. G. Nasuruddin, S. Ishak

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In anthropological medicine (traditional therapeutic healing) symbolic interface are used to connect with the cognitive and metacognitive mechanisms to activate conscious and unconscious response of patients or other recipients. At the same time they are used to communicate with the inhabitants of the nether world to whom are ascribed almost all cases of psychosomatic illness. The symbols, which are cultural specific, are divided into verbal and non-verbal forms of communication. The verbal forms are chanting of mantra and doa and the invocation to invoke the spirits while the non-verbal ones are the physical materials such as the offerings, props and decorative elements, music, movements, olfactory sensation and the performance space. The process of communication through these symbols is affected by the Shaman who is a link or intermediary between the healer (Shaman) and the patients and between the healer and the spirits of the nether world. The paper also examines the scientific perspective of the traditional healing through the use of these symbols. The response to these symbols as external stimuli is embedded in the genes that are linked to the hereditary factor in the person’s DNA. When the patients are tuned in to external stimuli such as music, chanting and singing (sonic orders), it can triggers a response from the brain, which may activate its inner pharmacy by releasing drugs such as dopamine and/or opiodsto ameliorate pain and counter depression, anxiety and create a feel good feeling. These symbols act like placebo, evoking the power of the mind over the body and triggering the innate self-healing energy. At the same time they could also be used as nocebo, for example black magic, which has the opposite effect of placebo. In whatever capacity they operate these symbols, which are either visual or auditory, is an integral part of anthropological medicine. For they communicate and conjure emotional responses that are conducive to healing by activating the internal brain pharmacy.

Keywords: communication, healing, placebo, nacebo, symbol

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Authors: Sonto Maputle

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Background: Support during labour increase women's chances of having positive childbirth experiences as well as childbirth outcomes. The purpose of this study was to determine the support provided by midwives to women during labour at the public hospital in Limpopo Province. The study was conducted at the Tertiary hospital in Limpopo Province. Methods: A qualitative, participant observation approach was used. Population consisted of all women that were admitted to deliver their babies and the midwives who provided midwifery care in the obstetric unit of one tertiary public hospital in Limpopo Province. Non-probability, purposive and convenience sampling were used to sample 24 women and 12 midwives. Data were collected through participant observations which included unstructured conversations with the use of observational guide, field notes of events and conversations that occurred when women interact with midwives were recorded verbatim and a Visual Analog Scale to complement the observations. Data was analysed qualitatively but were presented in the tables and bar graphs. Results: Five themes emerged as support provided by midwives during labour, namely; communication between women and midwives, informational support, emotional support activities, interpretation of the experienced labour pain and supportive care activities during labour. Conclusion: The communication was occurring when the midwife was rendering midwifery care and very limited for empowering. The information sharing focused on the assistive actions rather than on the activities that would promote mothers’ participation. The emotional support activities indicated lack of respect and disregard cultural preferences and this contributed to inability to exercise choices in decision-making. The study recommended the implementation of Batho Pele principles in order to provide woman-centred care during labour.

Keywords: communication between women and midwives, labour pains, informational and emotional support, physical comforting measures

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Authors: Beatriz Lafuente Alcázar, Yash Wani, Amit J. Nimunkar

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Cardiovascular Diseases (CVDs) are the leading cause of death globally, and around 80% of sudden cardiac deaths are due to arrhythmias or irregular heartbeats. The majority of these pathologies are revealed by either short-term or long-term alterations in the electrocardiogram (ECG) morphology. The ECG is the main diagnostic tool in cardiology. It is a non-invasive, pain free procedure that measures the heart’s electrical activity and that allows the detecting of abnormal rhythms and underlying conditions. A cardiologist can diagnose a wide range of pathologies based on ECG’s form alterations, but the human interpretation is subjective and it is contingent to error. Moreover, ECG records can be quite prolonged in time, which can further complicate visual diagnosis, and deeply retard disease detection. In this context, deep learning methods have risen as a promising strategy to extract relevant features and eliminate individual subjectivity in ECG analysis. They facilitate the computation of large sets of data and can provide early and precise diagnoses. Therefore, the cardiology field is one of the areas that can most benefit from the implementation of deep learning algorithms. In the present study, a deep learning algorithm is trained following a novel approach, using a combination of different databases as the training set. The goal of the algorithm is to achieve the detection of R-peaks in ECG signals. Its performance is further evaluated in ECG signals with different origins and features to test the model’s ability to generalize its outcomes. Performance of the model for detection of R-peaks for clean and noisy ECGs is presented. The model is able to detect R-peaks in the presence of various types of noise, and when presented with data, it has not been trained. It is expected that this approach will increase the effectiveness and capacity of cardiologists to detect divergences in the normal cardiac activity of their patients.

Keywords: arrhythmia, deep learning, electrocardiogram, machine learning, R-peaks

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Authors: Mohammed Ghazwani, Shyma Ali Alshahrani, Zahra Abdu Yousef, Taif Torki Asiri, Ghofran Abdur Rahman, Asma Ali Alshahrani, Umme Hani

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Background and introduction: Piroxicam is a nonsteroidal anti-inflammatory drug characterized by low solubility-high permeability used to reduce pain, swelling, and joint stiffness from arthritis. Hydrotropes are a class of compounds that normally increase the aqueous solubility of insoluble solutes. Aim: The objective of the present research study was to formulate and optimize Piroxicam hydrotropic starch gel using sodium salicylate, sodium benzoate as hydrotropic salts, and potato starch for topical application. Materials and methods: The prepared Piroxicam hydrotropic starch gel was characterized for various physicochemical parameters like drug content estimation, pH, tube extrudability, and spreadability; all the prepared formulations were subjected to in-vitro diffusion studies for six hours in 100 ml phosphate buffer (pH 7.4) and determined gel strength. Results: All formulations were found to be white opaque in appearance and have good homogeneity. The pH of formulations was found to be between 6.9-7.9. Drug content ranged from 96.8%-99.4.5%. Spreadability plays an important role in patient compliance and helps in the uniform application of gel to the skin as gels should spread easily; F4 showed a spreadability of 2.4cm highest among all other formulations. In in vitro diffusion studies, extrudability and gel strength were good with F4 in comparison with other formulations; hence F4 was selected as the optimized formulation. Conclusion: Isolated potato starch was successfully employed to prepare the gel. Hydrotropic salt sodium salicylate increased the solubility of Piroxicam and resulted in a stable gel, whereas the gel prepared using sodium benzoate changed its color after one week of preparation from white to light yellowish. Hydrotropic potato starch gel proposed a suitable vehicle for the topical delivery of Piroxicam.

Keywords: Piroxicam, potato starch, hydrotropic salts, hydrotropic starch gel

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Authors: Surender Singh, Yogendra Kumar Gupta

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Boerhaavia diffusa (BD) Linn. belonging to family Nyctaginaceae is a herbaceous plant and known as ‘punarnava’ in Hindi, used as herbal medicine for pain relief and various ailments. It is widely used as a green leafy vegetable in many Asian and African countries. The objective of present study was to investigate potential adverse effects, if any, of standardized root extract of Boerhaavia diffusa in rats following subchronic administration. In acute toxicity study, no mortality was found at a dose of 2000mg/kg which indicates that oral LD50 of Boerhaavia diffusa root extract is more than 2000mg/kg. The chronic administration of Boerhaavia diffusa for 28 days at a dose of 1000mg/kg body weight did not produce any significant changes in hematological (RBC, WBC, platelets, hemoglobin, bleeding time, clotting time) and biochemical (triglycerides, blood glucose, high density lipoprotein, serum creatinine, serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase) parameters of male and female rats as compared to normal control group. All the animals survived until the scheduled necropsy, and their physical and behavioral examinations did not reveal any treatment-related adverse effects. No pathological changes were observed in histological section of heart, kidney, liver, testis, ovaries and brain of Boerhaavia diffusa treated male and female rats as compared to normal control animals.These observations from oral acute toxicitystudy suggest that the extract is practically non-toxic. Thus, it can be inferred that the Boerhaavia diffusa root extract at levels up to 1000 mg/kg/day was found to be safe and does not cause adverse effects in rats. So, the no-observed effect level (NOAEL) of the extract was found to be 1000mg/kg/day.

Keywords: Boerhaavia diffusa, histology, toxicity, sub-acute

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Authors: Navpreet Kaur, Randhir Singh

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Diabetic neuropathy is one of the most common microvascular complications of diabetes mellitus which affects more than 50% of diabetic patients. The present study targeted oxidative stress mediated nerve damage in diabetic rats using a hydro-alcohol extract of Cucurbita pepo L. (Family: Cucurbitaceae) and its potential in treatment of diabetic neuropathy. Diabetes neuropathy was induced in Wistar rats by injection of streptozotocin (65 mg/kg, i.p.) 15 min after Nicotinamide (230 mg/kg, i.p.) administration. Hydro-alcohol extract of C. pepo seeds was assessed by oral administration at 100, 200 and 400 mg/kg in STZ-nicotinamide induced diabetic rats. Thermal hyperalgesia (Eddy's hot plate and tail immersion), mechanical hyperalgesia (Randall-Selitto) and tactile allodynia (Von Frey hair tests) were evaluated in all groups of streptozotocin diabetic rats to assess the extent of neuropathy. Tissue (sciatic nerve) antioxidant enzymes (SOD, CAT, GSH and LPO) levels were measured along with the formation of AGEs in serum to assess the effect of hydro-alcohol extract of C. pepo in ameliorating oxidative stress. Diabetic rats exhibited significantly decreased tail-flick latency in the tail-immersion test and decreased paw withdrawal threshold in both Randall-Selitto and von-Frey hair test. A decrease in the nociceptive threshold was accompanied by significantly increased oxidative stress in sciatic nerve of diabetic rats. Treatment with the C. pepo hydro-alcohol extract significantly attenuated all the behavioral and biochemical alterations in a dose-dependent manner. C. pepo attenuated the diabetic condition and also reversed neuropathic pain through modulation of oxidative stress and thus it may find application as a possible therapeutic agent against diabetic neuropathy.

Keywords: advanced glycation end products, antioxidant enzymes, cucurbita pepo, hyperglycemia

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Authors: Maryam Firouzmandi, Moosa Miri

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Smile is considered to be one of the most effective methods of influencing people. Increasing numbers of patients are requesting cosmetic dental procedures to achieve the perfect smile. Based on the patient’s age, oral and facial characteristics, and the dentist’s expertise, different concepts of treatment would be available. Orthodontics is the most conservative and the ideal treatment alternative for crowded anterior teeth; however, it may be rejected by patients due to occupational limitations of time, physical discomfort including pain and functional limitations, psychological discomfort, and appearance during treatment. In addition, orthodontic treatment will not resolve deficits of contour and color of the anterior teeth. In consequence, patients may demand restorative techniques to resolve their anterior mal-alignment instead, often called "instant orthodontics". Following its introduction, however, adhesive dentistry has suffered at times from overuse. Creating short-term attractive smiles at the expense of long-term dental health and optimal tooth biomechanics by using cosmetic techniques should not be considered an ethical approach. The objective of this narrative review was to investigate the literature for guidelines with regard to decision making and treatment planning for anterior tooth mal-alignment. In this regard, indications of orthodontic, restorative, combination of both treatments, and adjunctive periodontal surgery were discussed in clinical cases to achieve a proportional smile. Restorative modalities would include disking, cosmetic contouring, veneers, and crowns and were compared with limited or comprehensive orthodontic options. A rapid review was also presented on pros and cons of snap on smile to mask malalignments. Diagnostic tools such as mock up, wax up, and digital smile design were also considered to achieve more conservative and functional treatments with respect to biologic factors.

Keywords: crowding, misalignment, veneer, crown, orthodontics

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Authors: Parastoo Parhizkar, Jaber Yaghini, Omid Fakheran

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Background: Third molar surgery is often associated with postoperative problems which cause serious impediments on daily activities and quality of life. Steroidal anti-inflammatory drugs may decrease these common post-operative complications. The purpose of this review is evaluating the available evidence regarding the efficacy of corticosteroids used as adjunctive therapy for patients undergoing third molar surgery. Methods: PubMed, Google scholar, Scopus, web of science, clinicaltrials.gov, scirus.com, Cochrane central register for controlled trials, LILACS, OpenGrey, centerwatch, isrctn, who.int and ebsco were searched without restrictions regarding the year of publication. Randomized clinical trials assessing patient-reported outcomes in patients undergoing surgical therapy, were eligible for inclusion. Study quality was assessed using the CONSORT-checklist. No meta-analysis was performed. Results: A total of twelve Randomized Clinical Trials were included in this study. Methylprednisolone and Dexamethasone may decrease postoperative side effects such as pain, trismus and edema. Based on the results both of them could improve patients’ satisfaction, and there is no significant difference between these two types of corticosteroids regarding the patient centered outcomes (p > 0.05). Intralesional and intravenous injection of Dexamethasone showed an equivalent result, with statistically significant better results (P < 0.05) in comparison with the oral treatment. Conclusion: various types of corticosteroids can enhance the patient’s satisfaction following third molar surgery. However, there is no significant difference between Dexamethasone, Prednisolone and Methylprednisolone groups in this regard. Comparing the various administration routs, local injection of Dexamethasone is quite simple, painless and cost-effective adjunctive therapy with better drug efficacy.

Keywords: third molar surgery, corticosteroids, patient-reported outcomes, health related quality of life

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Authors: Mualla McManus, Jenna Luche Thaye

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World Health Organisation International Classification of Disease codes were created to define disease including infections in order to guide and educate diagnosticians. Most infectious diseases such as syphilis are clearly defined by their ICD 10 codes and aid/help to educate the clinicians in syphilis diagnosis and treatment globally. However, current ICD 10 codes for relapsing fever Borreliosis and Lyme disease are less clearly defined and can impede appropriate diagnosis especially if the clinician is not familiar with the symptoms of these infectious diseases. This is despite substantial number of scientific articles published in peer-reviewed journals about relapsing fever and Lyme disease. In the USA there are estimated 380,000 people annually contacting Lyme disease, more cases than breast cancer and 6x HIV/AIDS cases. This represents estimated 0.09% of the USA population. If extrapolated to the global population (7billion), 0.09% equates to 63 million people contracting relapsing fever or Lyme disease. In many regions, the rate of contracting some form of infection from tick bite may be even higher. Without accurate and appropriate diagnostic codes, physicians are impeded in their ability to properly care for their patients, leaving those patients invisible and marginalized within the medical system and to those guiding public policy. This results in great personal hardship, pain, disability, and expense. This unnecessarily burdens health care systems, governments, families, and society as a whole. With accurate diagnostic codes in place, robust data can guide medical and public health research, health policy, track mortality and save health care dollars. Better defined ICD codes are the way forward in educating the diagnosticians about relapsing fever and Lyme diseases.

Keywords: WHO ICD codes, relapsing fever, Lyme diseases, World Health Organisation

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Authors: Abhishek Pandey

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Ibuprofen and Acetaminophen is widely used as prescription & non-prescription medicine. Ibuprofen mainly used in the treatment of mild to moderate pain related to headache, migraine, postoperative condition and in the management of spondylitis, osteoarthritis and rheumatoid arthritis. Acetaminophen is used as an analgesic and antipyretic drug. Ibuprofen having high tendency of sticking to punches of tablet punching machine while Acetaminophen is not ordinarily compressible to tablet formulation because Acetaminophen crystals are very hard and brittle in nature and fracture very easily when compressed producing capping and laminating tablet defects therefore wet granulation method is used to make them compressible. The aim of study was to prepare Ibuprofen and Acetaminophen tablets by direct compression and top spray granulation technique. In this Investigation tablets were prepared by using directly compressible grade excipients. Dibasic calcium phosphate, lactose anhydrous (DCL21), microcrystalline cellulose (Avicel PH 101). In order to obtain best or optimized formulation, nine different formulations were generated among them batch F7, F8, F9 shows good results and within the acceptable limit. Formulation (F7) selected as optimize product on the basis of dissolution study. Furtherly, directly compressible granules of both drugs were prepared by using top spray granulation technique in fluidized bed processor equipment and compressed .In order to obtain best product process optimization was carried out by performing four trials in which various parameters like inlet air temperature, spray rate, peristaltic pump rpm, % LOD, properties of granules, blending time and hardness were optimized. Batch T3 coined as optimized batch on the basis physical & chemical evaluation. Finally formulations prepared by both techniques were compared.

Keywords: direct compression, top spray granulation, process optimization, blending time

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Authors: H. Shahid

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Due to Ozone layer depletion on earth, the incoming ultraviolet (UV) radiation is recorded at its high index levels such as 25 in South Peru (13.5° S, 3360 m a.s.l.) Also, the planning of human inhabitation on Mars is under discussion where UV radiations are quite high. The exposure to UV is health hazardous and is avoided by UV filters. On the other hand, artificial UV sources are in use for water thermolysis to generate Hydrogen and Oxygen, which are later used as fuels. This paper presents the utility of employing UVA (315-400nm) and UVB (280-315nm) electromagnetic radiation from the solar spectrum to design and implement an optically active, Hydrogen and Oxygen generation system via thermolysis of desalinated seawater. The proposed system finds its utility on earth and can be deployed in the future on Mars (UVB). In this system, by using Fresnel lens arrays as an optical filter and via active tracking, the ultraviolet light from the sun is concentrated and then allowed to fall on two sub-systems of the proposed system. The first sub-system generates electrical energy by using UV based tandem photovoltaic cells such as GaAs/GaInP/GaInAs/GaInAsP and the second elevates temperature of water to lower the electric potential required to electrolyze the water. An empirical analysis is performed at 30 atm and an electrical potential is observed to be the main controlling factor for the rate of production of Hydrogen and Oxygen and hence the operating point (Q-Point) of the proposed system. The hydrogen production rate in the case of the commercial system in static mode (650ᵒC, 0.6V) is taken as a reference. The silicon oxide electrolyzer cell (SOEC) is used in the proposed (UV) system for the Hydrogen and Oxygen production. To achieve the same amount of Hydrogen as in the case of the reference system, with minimum chamber operating temperature of 850ᵒC in static mode, the corresponding required electrical potential is calculated as 0.3V. However, practically, the Hydrogen production rate is observed to be low in comparison to the reference system at 850ᵒC at 0.3V. However, it has been shown empirically that the Hydrogen production can be enhanced and by raising the electrical potential to 0.45V. It increases the production rate to the same level as is of the reference system. Therefore, 850ᵒC and 0.45V are assigned as the Q-point of the proposed system which is actively stabilized via proportional integral derivative controllers which adjust the axial position of the lens arrays for both subsystems. The functionality of the controllers is based on maintaining the chamber fixed at 850ᵒC (minimum operating temperature) and 0.45V; Q-Point to realize the same Hydrogen production rate as-is for the reference system.

Keywords: hydrogen, oxygen, thermolysis, ultraviolet

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Authors: Hushyar Azari

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Aim and background: Deep brain stimulation (DBS) is regarded as an important therapeutic choice for Parkinson's disease (PD). The two most common targets for DBS are the subthalamic nucleus (STN) and globus pallidus (GPi). This review was conducted to compare the clinical effectiveness of these two targets. Methods: A systematic literature search in electronic databases: Embase, Cochrane Library and PubMed were restricted to English language publications 2010 to 2021. Specified MeSH terms were searched in all databases. Studies which evaluated the Unified Parkinson's Disease Rating Scale (UPDRS) III were selected by meeting the following criteria: (1) compared both GPi and STN DBS; (2) had at least three months follow-up period; (3)at least five participants in each group; (4)conducted after 2010. Study quality assessment was performed using the Modified Jadad Scale. Results: 3577 potentially relevant articles were identified, of these, 3569 were excluded based on title and abstract, duplicate and unsuitable article removal. Eight articles satisfied the inclusion criteria and were scrutinized (458 PD patients). According to Modified Jadad Scale, the majority of included studies had low evidence quality which was a limitation of this review. 5 studies reported no statistically significant between-group difference for improvements in UPDRS ш scores. At the same time, there were some results in terms of pain, action tremor, rigidity, and urinary symptoms, which indicated that STN DBS might be a better choice. Regarding the adverse effects, GPi was superior. Conclusion: It is clear that other larger randomized clinical trials with longer follow-up periods and control groups are needed to decide which target is more efficient for deep brain stimulation in Parkinson’s disease and imposes fewer adverse effects on the patients. Meanwhile, STN seems more reasonable according to the results of this systematic review.

Keywords: brain stimulation, globus pallidus, Parkinson's disease, subthalamic nucleus

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Authors: Alakija Temitope Olufunmilayo, Akinyemi, Yagba Joy

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Hepatitis is the inflammation of the liver tissue that can cause whiteness of the eyes (Jaundice), lack of appetite, vomiting, tiredness, abdominal pain, diarrhea. Hepatitis is acute if it resolves within 6 months and chronic if it last longer than 6 months. Acute hepatitis can resolve on its own, lead to chronic hepatitis or rarely result in acute liver failure. Chronic hepatitis may lead to scarring of the liver (Cirrhosis), liver failure and liver cancer. Modelling Hepatitis B may become necessary in order to reduce its spread. So, dynamic SIR model can be used. This model consists of a system of three coupled non-linear ordinary differential equation which does not have an explicit formula solution. It is an epidemiological model used to predict the dynamics of infectious disease by categorizing the population into three possible compartments. In this study, a five-compartment dynamic model of Hepatitis B disease was proposed and developed by adding control measure of sensitizing the public called awareness. All the mathematical and statistical formulation of the model, especially the general equilibrium of the model, was derived, including the nonlinear least square estimators. The initial parameters of the model were derived using nonlinear least square embedded in R code. The result study shows that the proportion of Hepatitis B patient in the study population is 1.4 per 1,000,000 populations. The estimated Hepatitis B induced death rate is 0.0108, meaning that 1.08% of the infected individuals die of the disease. The reproduction number of Hepatitis B diseases in Nigeria is 6.0, meaning that one individual can infect more than 6.0 people. The effect of sensitizing the public on the basic reproduction number is significant as the reproduction number is reduced. The study therefore recommends that programme should be designed by government and non-governmental organization to sensitize the entire Nigeria population in order to reduce cases of Hepatitis B disease among the citizens.

Keywords: hepatitis B, modelling, non-linear ordinary differential equation, sihar model, sensitization

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