Search results for: chronic pain

Authors: Manish Subedi, Bijay Bartaula, Ashok R. Pant, Purbesh Adhikari, Sanjib K. Sharma

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Background: The pattern of glomerular disease varies worldwide. In absence of kidney disease/Kidney biopsy registry in Nepal, the exact etiology of different forms of glomerular disease is primarily unknown in our country. Method: We retrospectively analyzed 175 cases of renal biopsies performed from dated September 2014 to August 2016 at B. P. Koirala Institute of Health Sciences, Dharan, Nepal. Results: The commonest indication for renal biopsy was nephrotic syndrome (34.9%), followed by Systemic lupus erythematosus with suspected renal involvement (22.3%). Majority of patients were in the 30-60 year bracket (57.2%), with the mean age of the patients being 35.37 years. The average number of glomeruli per core was 13, with inadequate sampling in 5.1%. IgA nephropathy (17%) was found to be the most common primary glomerular disease, followed by membranous nephropathy (14.6%) and FSGS (14.6%). The commonest secondary glomerular disease was lupus nephritis. Complications associated with renal biopsy were pain at biopsy site in 18% of cases, hematuria in 6% and perinephric hematoma in 4% cases. Conclusion: The commonest primary and secondary glomerular disease was IgA nephropathy and lupus nephritis respectively. The high prevalence of Systemic lupus erythematosus with lupus nephritis among Nepalese in comparison with other developing countries warrants further evaluation. As an initial attempt towards documentation of glomerular diseases in the national context, this study should serve as a stepping stone towards the eventual establishment of a full-fledged national registry of glomerular diseases in Nepal.

Keywords: glomerular, Nepal, renal biopsy, systemic lupus erythematoses

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Authors: Obinna K. Ihesiulor, Krishna Shankar, Paul Smith, Alan Fien

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Excessive fretting wear at the taper-trunnion junction (trunnionosis) apparently contributes to the high failure rates of hip implants. Implant wear and corrosion lead to the release of metal particulate debris and subsequent release of metal ions at the taper-trunnion surface. This results in a type of metal poisoning referred to as metallosis. The consequences of metal poisoning include; osteolysis (bone loss), osteoarthritis (pain), aseptic loosening of the prosthesis and revision surgery. Follow up after revision surgery, metal debris particles are commonly found in numerous locations. Background: A stable connection between the femoral ball head (taper) and stem (trunnion) is necessary to prevent relative motions and corrosion at the taper junction. Hence, the importance of component assembly cannot be over-emphasized. Therefore, the aim of this study is to determine the influence of head-stem junction assembly by press fitting and the subsequent disengagement/disassembly on the connection strength between the taper ball head and stem. Methods: CoCr femoral heads were assembled with High stainless hydrogen steel stem (trunnion) by Push-in i.e. press fit; and disengaged by Pull-out test. The strength and stability of the two connections were evaluated by measuring the head pull-out forces according to ISO 7206-10 standards. Findings: The head-stem junction strength linearly increases with assembly forces.

Keywords: wear, modular hip prosthesis, taper head-stem, force assembly and disassembly

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Authors: Ilma Robo, Saimir Heta, Greta Plaka, Vera Ostreni

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Purpose: Drug gingival hyperplasia is an uncommon pathology encountered during routine work in dental units. The purpose of this paper is to present the clinical appearance of gingival hyperplasia caused by medications. There are already three classes of medications that cause hyperplasia and based on data from the literature, the clinical cases encountered and included in this study have been compared. Materials and Methods: The study was conducted in a total of 311 patients, out of which 182 patients were included in our study, meeting the inclusion criteria. After each patient's history was recorded and it was found that patients were in their knowledge of chronic illness, undergoing treatment of gingivitis hypertrophic drugs was performed with a clinical examination of oral cavity and assessment by vertical and horizontal evaluation according to the periodontal indexes. Results: Of the data collected during the study, it was observed that 97% of patients with gingival hyperplasia are treated with nifedipine. 84% of patients treated with selected medicines and gingival hyperplasia in the oral cavity has been exposed at time period for more than 1 year and 1 month. According to the GOI, in the first rank of this index are about 21% of patients, in the second rank are 52%, in the third rank are 24% and in the fourth grade are 3%. According to the horizontal growth index of gingival hyperplasia, grade 1 included about 61% of patients and grade 2 included about 39% of patients with gingival hyperplasia. Bacterial index divides patients by degrees: grading 0 - 8.2%, grading 1 - 32.4%, grading 2 - 14% and grading 3 - 45.1%. Conclusions: The highest percentage of gingival hyperplasia caused by drugs is due to dosing of nifedipine for a duration of dosing and application for systemic healing for more than 1 year.

Keywords: drug gingival hyperplasia, horizontal growth index, vertical growth index

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Authors: Kamran Yazdanbakhsh, Somayeh Mahmoudi

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Multiple sclerosis is the most common chronic disease of the central nervous system associated with demyelination of neurons and several demyelinated parts of the disease encompasses throughout the white matter and affects the sensory and motor function. This study compared the effectiveness of two methods of cognitive therapy and supportive-expressive therapy on the efficacy and quality of life in MS patients. This is an experimental project which has used developed group pretest - posttest and follow-up with 3 groups. The study included all patients with multiple sclerosis in 2013 that were members of the MS Society of Iran in Tehran. The sample included 45 patients with MS that were selected volunteerily of members of the MS society of Iran and randomly divided into three groups and pretest, posttest, and follow-up (three months) for the three groups had been done.The dimensions of quality of life in patients with multiple sclerosis scale, and general self-efficiency scale of Schwarzer and Jerusalem was used for collecting data. The results showed that there was a significant difference between the mean of quality of life scores at pretest, posttest, and follow-up of the experimental groups. There was no significant difference between the mean of quality of life of the experimental groups which means that both groups were effective and had the same effect. There was no significant difference between the mean of self-efficiency scores in control and experimental group in pretest, posttest and follow-up. Thus, by using cognitive and supportive-expressive group therapy we can improve quality of life in MS patients and make great strides in their mental health.

Keywords: cognitive group therapy, life style, MS, self-efficiency, supportive-expressive group therapy

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Authors: Diego Carrasco, Catarina Freitas, Hugo Rio Tinto, Ricardo Rio Tinto, Nuno Couto, Joaquim Gago, Carlos Carvalho

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Introduction: Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CD) to drain the gallbladder can be a palliative care procedure for non-surgical oncologic patients with cholelithiasis and cholangitis process. Case description: A 59-years old Caucasian male diagnosed with extrahepatic cholangiocarcinoma with multiple liver, lung and peritoneum metastasis, unresponsive to treatment with gemcitabine/cisplatin, presented in the institution with fever, hypotension, and severe upper right abdominal pain secondary to cholelithiasis and cholangitis process. The patient was admitted and started on large spectrum antibiotics plus fluid-challenge. Afterward, a percutaneous transhepatic biliary drainage (PTBD) was performed to drain the gallbladder. This procedure temporarily stabilized the patient. However, the definitive solution required gallbladder removal. Since the patient exhibited an advanced oncologic disease and poor response to the chemotherapy, he was not a candidate for surgical intervention. Diagnostic Pathways: A self-expanding metal stent was placed from the duodenum into the bile duct by endoscopic ultrasound-guided. The stent allowed efficient drainage of the contrast from the gallbladder at the end of the endoscopic procedure. Conclusion and Discussion: The stent allowed efficient drainage of the contrast from the gallbladder at the end of the endoscopic procedure and successfully reversed the cholangitis process. EUS-CD is an effective and safe technique and can be used as a palliative care procedure for non-surgical oncologic patients.

Keywords: palliative care, cholangiocarcinoma, choledochoduodenostomy, endoscopic ultrasound-guided

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Authors: Hilal Ahmad Punoo

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Conjugated linoleic acid (CLA) is a mixture of positional and geometric isomers of octadecadienoic acid with two conjugated double bonds. Of more than a dozen isomers of CLA found naturally in dairy and meat products from ruminants, c-9, t-11 and t-10, c-12 are the two isomers with known physiological importance, including anticarcinogenic, antidiabetic, antilipogenic, and antiatherosclerotic effects. Conjugated linoleic acids (CLA) may influence the onset and severity of several chronic diseases, including various cancers, atherosclerosis, obesity, bone density loss, and diabetes. These findings are of special interest to the agriculture community, because dietary sources of CLA are almost exclusively beef and dairy products. Thus, a better understanding of the specific isomers and mechanisms responsible for these positive effects of CLA on human health would be both prudent and economically beneficial. To date, research related to the advantages of CLA consumption on human health has been conducted using experimental laboratory animals and cell culture systems. These data consistently show that relatively low levels of CLA can influence risk of cancer. Further, very recent investigations suggest that the predominate CLA isoform (cis-9, trans-11 CLA or rumenic acid) found in beef and milk fat possesses anticarcinogenic effects but does not alter body composition; the trans-10, cis-12 CLA has been shown to inhibit lipogenesis. Clearly, further work, especially using human subjects, will be required to characterize the potential benefits of CLA consumption on human health. Moreover, we suggest that foods naturally containing high amounts of CLA (e.g., beef and dairy products) be considered as meeting the definition of functional foods.

Keywords: conjugated linoleic acid, potential health benefits, fats, animals, humans

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Authors: Ibrahim Ahmed, Richard Amoateng, Akhil Jain, Mohamed Ahmed

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Alcoholic cardiomyopathy (ACM) is a type of acquired cardiomyopathy caused by chronic alcohol consumption. Frequently ACM is associated with arrhythmias such as atrial flutter. Our aim was to characterize the patient demographics and investigate the effect of atrial flutter (AF) on ACM. This was a retrospective cohort study using the Nationwide Inpatient Sample database to identify admissions in adults with principal and secondary diagnoses of alcoholic cardiomyopathy and atrial flutter from 2019. Multivariate linear and logistic regression models were adjusted for age, gender, race, household income, insurance status, Elixhauser comorbidity score, hospital location, bed size, and teaching status. The primary outcome was all-cause mortality, and secondary outcomes were the length of stay (LOS) and total charge in USD. There was a total of 21,855 admissions with alcoholic cardiomyopathy, of which 1,635 had atrial flutter (AF-ACM). Compared to Non-AF-ACM cohort, AF-ACM cohort had fewer females (4.89% vs 14.54%, p<0.001), were older (58.66 vs 56.13 years, p<0.001), fewer Native Americans (0.61% vs2.67%, p<0.01), had fewer smaller (19.27% vs 22.45%, p<0.01) & medium-sized hospitals (23.24% vs28.98%, p<0.01), but more large-sized hospitals (57.49% vs 48.57%, p<0.01), more Medicare (40.37% vs 34.08%, p<0.05) and fewer Medicaid insured (23.55% vs 33.70%, p=<0.001), fewer hypertension (10.7% vs 15.01%, p<0.05), and more obesity (24.77% vs 16.35%, p<0.001). Compared to Non-AF-ACM cohort, there was no difference in AF-ACM cohort mortality rate (6.13% vs 4.20%, p=0.0998), unadjusted mortality OR 1.49 (95% CI 0.92-2.40, p=0.102), adjusted mortality OR 1.36 (95% CI 0.83-2.24, p=0.221), but there was a difference in LOS 1.23 days (95% CI 0.34-2.13, p<0.01), total charge $28,860.30 (95% CI 11,883.96-45,836.60, p<0.01). In patients admitted with ACM, the presence of AF was not associated with a higher all-cause mortality rate or odds of all-cause mortality; however, it was associated with 1.23 days increase in LOS and a $28,860.30 increase in total hospitalization charge. Native Americans, older age and obesity were risk factors for the presence of AF in ACM.

Keywords: alcoholic cardiomyopathy, atrial flutter, cardiomyopathy, arrhythmia

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Authors: Christopher Leung, Assad Zahid

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Mesenteric vasculitis can often mimic abdominal sepsis in a postoperative setting leading to a predicament where steroids could improve mesenteric vasculitis whilst worsening abdominal sepsis. Here this study presents a unique and rare case of perforated sigmoid diverticulitis secondary to systemic vasculitis. A 68-year-old gentleman presented with perforated sigmoid diverticulitis requiring an emergency Hartmann’s procedure. Early in his postoperative course, he had painful and asymmetrical neuropathy that, after a careful history and examination, revealed a patient with mono neuritis multiplex on a background history of longstanding rheumatoid arthritis. On day seven of his postoperative course, he had rising inflammatory markers and a CT abdomen and pelvis showing fluid around the mesentery. Whilst contamination from sigmoid perforation was somewhat congruent with these signs, a diagnosis of polyarteritis nodosa, a common cause of mononeuritis multiplex, is also possible, although involvement of the large bowel in polyarteritis nodosa is extremely rare. The histopathology from the initial Hartmann’s procedure was re-examined, showing medium vessel disease vasculitis. Given his lack of fevers, absence of abdominal pain, and worsening neurology, he was given a provisional diagnosis of polyarteritis nodosa and was treated successfully, not on IV antibiotics but on steroids. Large bowel involvement of polyarteritis nodosa is extremely rare and this is the first case of polyarteritis nodosa causing perforated diverticulitis. The learning point here is to obtain a good clinical picture of a patient to identify mesenteric vasculitis as compared to abdominal sepsis as the treatment of one worsens the other.

Keywords: abdominal sepsis, diverticulitis, mesenteric vasculitis, polyarteritis nodosa

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Authors: Shantanu Prakash, Suruchi Shukla, Amita Jain

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Introduction: The hepatitis C virus (HCV) is a major public health problem and a leading cause of chronic liver disease. Injection drug use and individuals receiving blood and blood products are the primary modes of HCV transmission. Our study aims to establish the prevalent genotypes/ subtypes of HCV circulating in Uttar Pradesh, North India, as reported from a tertiary care hospital. Methods: It is a retrospective observational analysis of consecutive 404 HCV RNA positive cases referred to our hospital during September 2014 to April 2017. The study was approved by an institutional ethics committee. Written informed consent was taken from each participant. Clinical and demographic details of these patients were recorded using predesigned questionnaires. All the laboratory testing was carried on stored serum sample of enrolled cases. Genotyping of all 404 strains was done by Sanger’s sequencing of the core region. The phylogenetic analysis of 179 HCV strains with high -quality sequencing data was performed. Results: The distribution of prevalent genotypes/ subtypes as noted in the present study was; Genotype (GT)1a [n-101(25%)], GT1b [n-12(2.9%)], GT1c [1(0.25%)], GT3a [275(68.07%)], GT3b [9(2.2%)], GT3g [2(0.49%)], GT3i [3(0.74%)], and GT4a [1(0.24%)]. HCV genotypes GT2, GT5 and GT6 were not detected from our region. Sequence analysis showed high genotypic variability in HCV GT3. Phylogenetic analysis showed that HCV GT3 and GT1 circulating in our region were related to Indian strains reported earlier. Conclusions: HCV genotypes 3a and 1a are commonest circulating genotypes in Uttar Pradesh (UP), India.

Keywords: Hepatitis C virus, genetic variation, bioinformatics, genotype, HCV

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Authors: Yulmaida Amir, Fahrul Rozi, Insany C. Kamil, Fanny Aryani

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ODAPUS (Orang dengan Lupus) is an Indonesian term for people with Lupus, a chronic autoimmune disease in which immune system of the body becomes hyperactive and attacks normal tissue. The number of ODAPUS indicate an increase in Indonesia, thereby helping to improve their quality of life to be important to help their recovery. This study aims to examine the effect of resilience, self-esteem, and social support on the quality of life of women who had been diagnosed as having Lupus. Data were collected from 64 ODAPUS in Indonesia, using the World Health Organization Quality of Life (WHOQOL), Resilience Scale from Wagnil and Young (1993), self-esteem scale (developed from Coopersmith’s theory), and Social Support Questioner from Northouse (1988). Regression data analysis showed that resilience, social support, and self-esteem predict the quality of life of the ODAPUS simultaneously. If the variable was analysed individually, self-esteem did not significantly contribute to the quality of life. Resilience contributed most significantly to the quality of life, followed by social support. Of five sources of social supports included in the research, support from family members (parents and brother/sisters) has the most significant contribution to the quality of life, followed by support from spouse, and from friends. Interestingly, social support from medical personnel (medical doctors and nurses) had not a significant contribution to the quality of life of ODAPUS. As a conclusion, this research showed that the ability of ODAPUS to cope with difficulty in life, and support from family members, spouse, and friends were the significant predictors for their quality of life.

Keywords: quality of life, resilience, self-esteem, social supports

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Authors: Priyanka Dixit

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Reproductive health problem is an important public health issue in most of the developing countries like India. It is a common problem in India for women in the reproductive age group to suffer from reproductive illnesses and not seek care. Existing literatures tell us very little about the several dimensions of reproductive morbidity. In addition the general perception says, metros have better medical infrastructure, so its residents should lead a healthier life. However some of the studies reveal a very different picture. Therefore, the present study is conducted with the specific objectives to find out the prevalence of reproductive health problem and treatment seeking behavior of currently married women in four metro cities in India namely; Mumbai, Delhi, Chennai and Kolkata. In addition, this paper also examines the effect of socio-economic and demographic factors on self-reported reproductive health problems. Bi-variate and multivariate regression have been applied to achieve the proposed objectives. Study is based on National Family Health Survey 2015-16 data. The analysis shows that the prevalence of any reproductive health problem among women is the highest in Mumbai followed by Delhi, Chennai, and Kolkata. A bulk of women in all four metro cities has reported abdominal pain, itching and burning sensation as the major problems while urinating. However, in spite of the high prevalence of reproductive health problems, a huge proportion of such women in all these cities do not seek any advice or treatment for these problems. This study also investigates determinants that affect the prevalence of reproductive health problem to policy makers plan for proper interventions for improving women’s reproductive health.

Keywords: reproductive health, India, national family health survey-4, city

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Authors: Nanyombi Lubimbi, Josette Niyokindi

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Background: As in many other developing countries in Africa, Rwanda suffers from a chronic shortage of skilled Health Care professionals including Clinical Instructors. This shortage negatively affects the clinical instruction quality therefore impacting student-learning outcomes. Due to poor clinical supervision, it is often noted that students have no structure or consistent guidance in their learning process. The Clinical Educators and the Rwandan counterparts identified the need to create a favorable environment for learning. Description: During orientation the expectations of the student learning process, collaboration of the clinical instructors with the nurses and Clinical Educators is outlined. The ward managers facilitate structured learning by helping the students identify a maximum of two patients using the school’s objectives to guide the appropriate selection of patients. Throughout the day, Clinical Educators with collaboration of Clinical Instructors when present conduct an ongoing assessment of learning and provide feedback to the students. Post-conference is provided once or twice a week to practice critical thinking skills of patient cases that they have been taking care of during the day. Lessons Learned: The students are found to be more confident with knowledge and skills gained during rotations. Clinical facility evaluations completed by students at the end of their rotations highlight the student’s satisfaction and recommendation for continuation of structured learning. Conclusion: Based on the satisfaction of both students and Clinical Instructors, we have identified need for structured learning during clinical rotations. We acknowledge that more evidence-based practice is necessary to effectively address the needs of nursing and midwifery students throughout the country.

Keywords: Rwanda, clinical rotation, structured learning, critical thinking skills, post-conference

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Authors: Valentina Narvaez Gaitan, Paula K. Rodriguez Ramirez, Derian D. Espinosa

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Corrective orthosis has great importance in orthopedic treatments providing assistance in improving mobility and stability in order to improve the quality of life for a different patient. The corrective orthosis studied in this article can correct deformities, reduce pain, and improve the ability to perform daily activities. This work describes the design and evaluation of a corrective orthosis for knee hyperextension. This orthosis is capable of generating a progressive and variable alignment of the joint, limiting the range of motion according to medical criteria. The main objective was to design a corrective knee orthosis capable of correcting knee hyperextension progressively to return to its natural angle with greater economic affordability and adjustable size. The limiting mechanism is based on a goniometer to determine the desired angles. The orthosis was made of acrylic to reduce costs and maintenance; neoprene is also used to make comfortable contact; additionally, Velcro was used in order to adjust the orthosis for various sizes. Simulations of static and fatigue analysis of the mechanism were performed to verify its resistance and durability under normal conditions. A biomechanical gait study of gait was carried out on 10 healthy subjects without the orthosis and limiting their knee extension capacity in a normal gait cycle with the orthosis to observe the efficiency of the proposed system. In the results obtained, the knee angle curves show that the maximum extension angle was the established angle by the orthosis. Showing the efficiency of the proposed design for different leg sizes.

Keywords: biomechanical study, corrective orthosis, efficiency, goniometer, knee hyperextension.

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Authors: Hamad Alhamad

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Introduction: The number of retirees in Kuwait is rising quickly, and this is causing more people to become concerned about their well-being. Despite the fact that loneliness and quality of life are significant indices of retiree wellbeing, little research has been done on the topic among retirees in Kuwait. The aim of this study is to explore the level of loneliness and quality of life among retirees in Kuwait. Methods: This is a a cross-sectional descriptive research targeting retirees who live in Kuwait. The UCLA loneliness scale (version 3) and the 36-Item Short Form Survey (36- SF) were utilized. Data was analyzed using SPSS. The ethical approval was obtained from Kuwait University and the Ministry of Health (286). Results: Total respondents in this research were 202 (N=202). The results indicate 77.7% (N=157) experience moderate level of loneliness, 19.8% (N=40) experience high level of loneliness, and only 205% (N=5) experience low level of loneliness. The results of the SF-36 health related questionnaire, participants scores in the eight domains: Physical functioning, general health, role limitations due to physical and emotional health, energy, social functioning, pain, and emotional wellbeing , scored low means. The average of the means was calculated and was (49.8), which indicated that all participants have moderately low Quality of life. Significant relationship with p value equal to ( p= 0.004), was found between a sociodemographic characteristic and level of loneliness in which retirees who were married indicated higher levels of loneliness compared to the single, divorced, and widowed retirees. Conclusion: The study revealed retirees in Kuwait feel moderate loneliness and have a low Quality of Time. The study indicates that retirees should be more considered emotionally and improved and help explore the negative effects on their quality of time In addition to exploring the leading factors to the feeling of loneliness.

Keywords: older adults, social isolation, work, retirement

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Authors: Abeer Rababa'h, Ragad Bsoul, Mohammad Alkhatatbeh, Karem Alzoubi

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Introduction: Tobacco use is one of the main risk factors to cardiovascular diseases (CVD) and atherosclerosis in particular. WPS contains several toxic materials such as: nicotine, carcinogens, tar, carbon monoxide and heavy metals. Thus, WPS is considered to be as one of the toxic environmental factors that should be investigated intensively. Therefore, the aim of this study is to investigate the effect of WPS on several cardiovascular biological markers that may cause atherosclerosis in mice. The study also conducted to study the temporal effects of WPS on the atherosclerotic biomarkers upon short (2 weeks) and long-term (8 weeks) exposures. Methods: mice were exposed to WPS and heart homogenates were analyzed to elucidate the effects of WPS on matrix metalloproteinase (MMPs), endothelin-1 (ET-1) and, myeloperoxidase (MPO). Following protein estimation, enzyme-linked immunosorbent assays were done to measure the levels of MMPs (isoforms 1, 3, and 9), MPO, and ET-1 protein expressions. Results: our data showed that acute exposure to WPS significantly enhances the levels of MMP-3, MMP- 9, and MPO expressions (p < 0.05) compared to their corresponding control. However, the body was capable to normalize the level of expressions for such parameters following continuous exposure for 8 weeks (p > 0.05). Additionally, we showed that the level of ET-1 expression was significantly higher upon chronic exposure to WPS compared to both control and acute exposure groups (p < 0.05). Conclusion: Waterpipe exposure has a significant negative effect on atherosclerosis and the enhancement of the atherosclerotic biomarkers expression (MMP-3 and 9, MPO, and ET-1) might represent an early scavenger of compensatory efforts to maintain cardiac function after WP exposure.

Keywords: atherosclerotic biomarkers, cardiovascular disease, matrix metalloproteinase, waterpipe

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Authors: Azza H. El-Medany, Hanan H. Hagar, Jamila H. El-Medany

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Ulcerative colitis (UC) is one of chronic inflammatory diseases primarily affecting colon with unknown etiology. Some researches papers mentioned the possibility of the use of drugs that affect the angiotensin II in reducing the complication of ulcerative colitis. The aim of the present study is to evaluate the potential protective and therapeutic effects of captopril and valsartan on ulcerative colitis induced experimentally in rats using acetic acid. The results were assessed by histological assessment of colonic tissues and measurement of malondialdehyde (MDA), tumor necrosis factor (TNF-α), transforming growth factor (TGF-1B), angiotensin converting enzyme (ACE), reduced glutathione (GSH) and platelet activating factor (PAF) levels in colonic tissues. Oral pre-treatment with captopril or valsartan in a dose of 30 mgkg-1 body weight for 2 weeks before induction of colitis (prophylactic groups) and continuously for 2 weeks after induction (therapeutic groups) significantly reduce MDA, TNF-α, PAF, TGF-1B and ACE levels in colonic tissues as compared to acetic acid control group. Also, a significant increase in GSH level was observed in colonic tissues. Captopril and valsartan attenuated the macroscopic and microscopic colonic damage induced by acetic acid. These results suggest that either captopril or valsartan may be effective as prophylactic or treatment of UC through inhibition of ACE and scavenging effect on oxygen-derived free radicals.

Keywords: captopril, valsartan, angiotensin converting enzyme, reduced glutathione, tumor necrosis factor

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Authors: Emily Adams, Eddie Donaghy, David Henderson, Lauren Ng, Caroline Sanders, Rowena Stewart, Maria Wolters, Stewart Mercer

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Ongoing review abstract: Older People Experiencing Homelessness (OPEH) can have mental and physical indicators of aging 10–20 years earlier than the general population and experience premature mortality due to age-related chronic conditions. Emerging literature suggests digital interventions could positively impact PEH’s well-being. However, the increased reliance on digital delivery may also perpetuate digital inequalities for socially excluded groups, including PEH. The potential triple disadvantage of being older, homeless, and digitally excluded creates a uniquely problematic situation that warrants further research. This scoping review aims to investigate and synthesise the range and type of digital interventions available to OPEH and the organisations that support OPEH. The following databases were searched on 28th July 2023: Medline, Scopus, International Bibliography of the Social Sciences (IBSS)‎, Applied Social Sciences Index & Abstracts (ASSIA)‎, Association for Computing Machinery Digital Library (ACMDL) and Policy commons. A search strategy was developed in collaboration with an academic librarian. The presentation will include: An introduction to OPEH and digital exclusion Overview of the results of this review: OPEH usage of digital platforms Current digital interventions available The role of support organisations Current gaps in the evidence, future research and recommendations for policy and practice

Keywords: homeless, digital exclusion, aging, technology

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Authors: Bilge Meral Koc, Elvan Yilmaz Akyuz, Tugce Ozlu

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This study aimed to discover the effects of coconut oil intake and diet therapy on anthropometric measurements, biochemical findings and irisin levels in overweight individuals. Materials and Methods: Overweight individuals (n=44, 19-30 years) without any chronic disease were included. In this randomized controlled crossover study, the participants were divided into two groups (Group 1: 23 people, Group 2: 21 people). In the first phase, Group 1 received diet therapy to lose 0.5-1 kg of weight per week and 20 mL of coconut oil/day, while Group 2 only received diet therapy. In the second phase, Group 1 received diet therapy while Group 2 received diet therapy and 20 mL of coconut oil/day. Anthropometric measurements were taken four times. Irisin was measured four times by enzyme-linked immunosorbent (ELISA) method and other biochemical findings were measured twice. Statistical analysis was made on SPSS 20. Results: The irisin level decreased significantly when the participants only took coconut oil (p≤0.05). There was a significant decrease in the participants' body weight, body mass index (BMI) level and body fat percentage (p≤0.01). Insulin, total cholesterol, low density lipoproteins (LDL) cholesterol, and triglyceride (TG) levels of all participants decreased significantly (p≤0.05). There was no significant difference in irisin level due to body weight loss (p≤0.05); coconut oil provided a significant decrease in irisin level (p≤0.05). Conclusion: Diet therapy and weight loss did not have an effect on irisin level, but coconut oil alone was found to reduce irisin level. Coconut oil had no impact on anthropometric and biochemical findings.

Keywords: coconut oil, diet therapy, irisin, overweight

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Authors: Hsiu-Chuan Hsueh, Kuei-Feng Shen Jr., Chia-Ling Chao, Hui-Chuan Pan

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This article described a 75 years old woman who has suffered from intestinal perforation and accepted surgery with temporary enterostomy, the operation makes her depressed, refused relatives and friend's care, facing low willingness to participate in various activities due to fear of changing body appearance caused by surgery and leave enterostomy. The author collected information through observation talks, physical evaluation, and medical records during the period of care from November 14 to November 30, 2016, we used the four aspects of physiology, psychology, society and spirituality as a whole sexual assessment to establish the nursing problems of patient, included of acute pain, disturbance of body image,coping ineffective individual. For patient care issues, to encouraged case to express their inner feelings and take part in self-care programs through providing good therapeutic interpersonal relationships with their families. However, it provided clear information about the disease and follow-up treatment plan, give compliments in a timely manner, enhanced self-confidence of individual cases and their motivation to participate in self-care of stoma, further face the disease in a positive manner. At the same time, cross-section team care model and individual care measures were developed to enhance the care skills after returning home and at the same time assist the individual in facing the psychological impact caused by stoma. Hope to provide this experience, as a reference for the future care of the disease.

Keywords: enterostomy, intestinal perforation, nursing experience, ostomy

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Authors: Anthoni Jeorge

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Throughout the history of the world, servant leadership has been researched, and favourable results such as individual, team, and organizational have been linked to the construct. This research paper designates St. Camillus de Lellis, a practitioner of servant leadership and founder of the Ministers of the Sick as a servant leader in his approach to care for the sick. Service is the visible face of his servant leadership. First of all, despite many challenges, St. Camillus de Lellis practiced leadership by the example of compassionate service to the sick. Second, he made service to the sick the highest priority of his life. Third, Camillus displayed servant leadership such that his manner of leadership gave birth to a New School of Service to the Sick. The paper identifies the distinctive dimensions and essential elements which characterized his service-centered leadership. Furthermore, discuss the six major characteristics of a servant leader as set forth by St. Camillus’s life example. The research illustrates the transformational power of servant leadership infield healthcare in general and, in doing so, provides servant leadership seekers ways servant leadership can transform elder care in one’s own field (St. Camillus Health Systems). Thus, it ascertains that servant leadership is best-fit for humanized elder care. Supported by the review of literature, the paper ascertains that Camillus, by identifying himself with the sick, gained deeper insights concerning the pain and suffering of the population. Uniquely drawn from his true grit, Camillus’ service-centered leadership is value-based, people-oriented, and compassion-filled. His way of service to the sick is the prolongation of gestures of mercy and compassion. It is hoped that the results of this study will help health care workers and servant leadership practitioners to humanize elder care and cultivate servant leadership attitude in their health care services to the sick. By incorporating such service-oriented elements into their leadership orientation, health care workers will be true servant leaders of the sick.

Keywords: leadership, service, healthcare, compassion

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Authors: Brajevic-gizdic Igna, Vuletic Gorka

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Introduction: Research in opiate addiction is increasingly indicating the importance of substitution therapy in opiate addicts. Opiate addiction is a chronic relapsing disease that includes craving as a criterion. Craving has been considered a predictor of a relapse, which is defined as a strong desire with an excessive need to take a substance. The study aimed to measure the intensity of craving using the VAS (visual analog scale) in opioid addicts taking the Opioid Substitution Therapy (OST). Method: The total sample compromised of 30 participants in outpatient treatment. Two groups of opiate addicts were considered: Methadone-maintenance and buprenorphine-maintenance addicts. The participants completed the survey questionnaire during the outpatient treatment. Results: The results indicated high levels of cravings in patients during the treatment on OST, which is considered an important destabilization factor in abstinence. Thus, the use of methadone/buprenorphine dose should be considered. Conclusion: These findings provided an objective measurement of methadone /buprenorphine dosage and therapy options. The underdoes of OST can put patients at high risk of relapse, resulting in high levels of craving. Thus, when determining the therapeutic dose of OST, it is crucial to consider patients´ craving. This would achieve stabilization more quickly and avoid relapse in abstinence. Subjective physician assessment and patient’s statement are the main criteria to determine OST dosage. Future studies should use larger sample sizes and focus on the importance of intensity craving measurement on OST to objectify methadone /buprenorphine dosage.

Keywords: abstinence, addicts, methadone, OST, quality of life

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Authors: Supannika Klangphukhiew, Roongnapa Srichana, Rina Patramanon

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Cortisol has been used as a well-known commercial stress biomarker. A homeostasis response to psychological stress is indicated by an increased level of cortisol produced in hypothalamus-pituitary-adrenal (HPA) axis. Chronic psychological stress contributing to the high level of cortisol relates to several health problems. In this study, the cortisol biosensor was fabricated that mimicked the natural receptors. The artificial antibodies were prepared using molecular imprinted polymer technique that can imitate the performance of natural anti-cortisol antibody with high stability. Cortisol-molecular imprinted polymer (cortisol-MIP) was obtained using the multi-step swelling and polymerization protocol with cortisol as a target molecule combining methacrylic acid:acrylamide (2:1) with bisacryloyl-1,2-dihydroxy-1,2-ethylenediamine and ethylenedioxy-N-methylamphetamine as cross-linkers. Cortisol-MIP was integrated to the sensor. It was coated on the disposable screen-printed carbon electrode (SPCE) for portable electrochemical analysis. The physical properties of Cortisol-MIP were characterized by means of electron microscope techniques. The binding characteristics were evaluated via covalent patterns changing in FTIR spectra which were related to voltammetry response. The performance of cortisol-MIP modified SPCE was investigated in terms of detection range, high selectivity with a detection limit of 1.28 ng/ml. The disposable cortisol biosensor represented an application of MIP technique to recognize steroids according to their structures with feasibility and cost-effectiveness that can be developed to use in point-of-care.

Keywords: stress biomarker, cortisol, molecular imprinted polymer, screen-printed carbon electrode

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Authors: Ahmed A. Abd El Rahim, Mohamed M. M. Essa, Magdy M. A. Shabana, Said A. Mohamed, Mohamed Ibrahim Mabrouk

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Background: Sacroiliac joint (SIJ) dysfunction is considered the main cause of pregnancy-related back pain, which may continue to persist postnatally. Myofascial release technique (MFR) is an application of low-intensity, prolonged stretch to myofascial structures to improve function by increasing the sliding properties of restricted myofascial tissues. Purpose: This study was designed to investigate the effect of MFR on postnatal SIJ hypo-mobility. Materials and Methods: Fifty postnatal women complaining of SIJ hypo-mobility participated in this study. Their ages ranged from 26 to 35 yrs., and their body mass index (BMI) didn`t exceed 30 kg/m2. They were randomly assigned to two equal groups, group A (Gr. A) and group B (Gr. B). Both groups received three sessions per week for eight successive weeks. Gr. A received a traditional physical therapy program, while Gr. B received a traditional physical therapy program in addition to MFR. Doppler imaging of vibration was utilized to measure SIJ mobility pre- and post-intervention, and an electronic digital goniometer was used to measure back flexion and extension Range of motion. Results: Findings revealed a statistical improvement in post-intervention values of SIJ mobility in addition to trunk flexion and extension ROM in Gr. B compared to Gr. A (P<0.001). Conclusion: Adding MFR to traditional physical therapy programs is highly recommended in the treatment of SIJ hypo-mobility in postnatal women.

Keywords: sacroiliac hypo-mobility, sacroiliac dysfunction, myofascial release technique, traditional physical therapy, postnatal

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Authors: Gauri Shankar Shah

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Objectives: The Type I diabetes mellitus in children is frequently a missed diagnosis and children presents in emergency with diabetic ketoacidosis having significant morbidity and mortality. The present study was done to find out the clinical presentation and outcome at a tertiary-care centre. Methods: This was retrospective analysis of data of Type I diabetes mellitus reporting to our centre during last one year (2012-2013). Results: There were 12 patients (8 males) and the age group was 4-14 years (mean ± 3.7). The presenting symptoms were fever, vomiting, altered sensorium and fast breathing in 8 (66.6%), 6 (50%), 4 (33.3%), and 4 (33.3%) cases, respectively. The classical triad of polyuria, polydypsia, and polyphagia were present only in two patients (33.2%). Seizures and epigastric pain were found in two cases each (33.2%). The four cases (33.3%) presented with diabetic ketoacidosis due to discontinuation of insulin doses, while 2 had hyperglycemia alone. The hemogram revealed mean hemoglobin of 12.1± 1.6 g/dL and total leukocyte count was 22,883.3 ± 10,345.9 per mm3, with polymorphs percentage of 73.1 ± 9.0%. The mean blood sugar at presentation was 740 ± 277 mg/ dl (544–1240). HbA1c ranged between 7.1-8.8 with mean of 8.1±0.6 %. The mean sodium, potassium, blood ph, pCO2, pO2 and bicarbonate were 140.8 ± 6.9 mEq/L, 4.4 ± 1.8mEq/L, 7.0 ± 0.2, 20.2 ± 10.8 mmHg, 112.6 ± 46.5 mmHg and 9.2 ± 8.8 mEq/L, respectively. All the patients were managed in pediatric intensive care unit as per our protocol, recovered and discharged on intermediate insulin given twice daily. Conclusions: Thus, it shows that these patients have uncontrolled hyperglycemia and often presents in emergency with ketoacidosis and deranged biochemical profile. The regular administration of insulin, frequent monitoring of blood sugar and health education are required to have better metabolic control and good quality of life.

Keywords: type I diabetes mellitus, hyperglycemia, outcome, glycemic control

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Authors: Jeanne Grace, Jacqueline Naiker

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Background: Longevity is increasing, accompanied by a rise in disability and chronic diseases with physical activity (PA) delaying disability, ensuring successful aging (SA) and independent living in older adults. Aim: This study aimed to determine objectively measured PA levels, health-related quality of life (HRQoL), life-space mobility, and successful aging (SA) of older adults in KwaZulu-Natal province, South Africa, as well as their mutual associations. Methods: A total of 210 older adults aged 65–92 years were purposively sampled and completed the Medical Outcomes Study 36-Item Short-Form Health Survey, the Life-Space Mobility, and Successful Aging questionnaires. PA levels were measured using an Omron Pedometer, which the participants wore for seven consecutive days. Results: The average number of steps taken per day for the seven days was 2025, with 98.6% of the entire study population classified as sedentary. The Vitality domain (one of 8 categorized) reflected the best health status (M = 59.9, SD ± 18.8), with a significant 93% of the participants indicating that they had not visited places outside their immediate neighborhood (P < 0.0005). A significant, negative association between the average number of steps taken in 7 days and all three SA variables – namely, the physical (r = –0.152, P = 0.027), sociological (r = –0.148, P = 0.032) and psychological (r = –0.176, P = 0.010), and a significant, positive association with life-space mobility (r = 0.224, P = 0.001) was noted. Conclusion: The majority of the elderly were sedentary, affecting their HRQoL, life-space mobility, and SA negatively.

Keywords: active life expectancy, geriatrics, nursing homes, well-being

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Authors: Suruchi Shukla, Shantanu Prakash, Amita Jain

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Introduction: Arboviral diseases are one of the most common causes of viral hemorrhagic fever (VHF). Of which, Dengue and Chikungunya pose a significant health problem in India. Arbovirus has a tendency to cross the territories and emerge in the new region. Considering the above issues, in the current study active surveillance was conducted among viral hemorrhagic fever (VHF) cases reported from Uttar Pradesh (UP), India. We studied the arboviral etiology of VHF; mainly Dengue, Chikungunya, and ZIKA. Methods: Clinical samples of 465 suspected VHF cases referred to tertiary care referral center of UP, India were enrolled in the study during a period from 15th May 2016 to 9th March 2018. Serum specimens were collected and analyzed for the presence of Dengue, Chikungunya, and ZIKA either by serology and/or by molecular assays. Results: Of all tested, 165 (35.4%) cases were positive for either Dengue or Chikungunya. Dengue (21.2%) was found to be the most prevalent, followed by Chikungunya, (6.6%). None of the cases tested positive for ZIKA virus. Serum samples of 35 (7.5%) cases were positive for both Dengue and Chikungunya. DEN-2 serotype was the most predominant serotype. Phylogenetic and sequence analysis of DEN-2 strains showed 100% clustering with the Cosmopolitan genotype strain. Bleeding from several sites, jaundice, abdominal pain, arthralgia, haemoconcentration, and thrombocytopenia were significantly higher in dengue hemorrhagic cases. However, the rash was significantly more common in Chikungunya patients. Most of the Dengue and Chikungunya positive cases (Age group 6-40 years) were seen in post monsoon season (September to November). Conclusion: Only one-third of total VHF cases are positive for either Dengue/Chikungunya or both. This necessitates the screening of other etiologies capable of causing hemorrhagic manifestations.

Keywords: viral hemorrhagic fever, dengue, chikungunya, zika, India

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Authors: Samira K. Al-Nasser, Siamak Noroozi, Roya Haratian, Adrian Harvey

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A total knee replacement (TKR) is a surgical procedure necessary when there is severe pain and/or loss of function in the knee. Surgeons balance the load in the knee and the surrounding soft tissue by feeling the tension at different ranges of motion. This method can be unreliable and lead to early failure of the joint. The ideal kinematics and load distribution have been debated significantly based on previous biomechanical studies surrounding both TKRs and normal knees. Intraoperative sensors like VERASENSE and eLibra have provided a method for the quantification of the load indicating a balanced knee. A review of the literature written about intraoperative sensors and tension/stability of the knee was done. Studies currently debate the quantification of the load in medial and lateral compartments specifically. However, most research reported that following a TKR the medial compartment was loaded more heavily than the lateral compartment. In several cases, these results were shown to increase the success of the surgery because they mimic the normal kinematics of the knee. In conclusion, most research agrees that an intercompartmental load differential of between 10 and 20 pounds, where the medial load was higher than the lateral, and an absolute load of less than 70 pounds was ideal. However, further intraoperative sensor development could help improve the accuracy and understanding of the load distribution on the surgical outcomes in a TKR. A reduction in early revision surgeries for TKRs would provide an improved quality of life for patients and reduce the economic burden placed on both the National Health Service (NHS) and the patient.

Keywords: intraoperative sensors, joint load forces, kinematics, load balancing, and total knee replacement

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Authors: M. Sangeetha, D. Chamundeeswari, C. Saravanababu, C. Rose, V. Gopal

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Rheumatoid arthritis (RA) is a chronic, progressive, systemic inflammatory disorder affecting the synovial joints and typically producing symmetrical arthritis that leads to joint destruction, which is responsible for the deformity and disability. Despite improvements in the treatment of RA over the past decade, there still is a need for new therapeutic agents that are efficacious, less expensive, and free of severe adverse reactions. The present study aimed to investigate role of inflammatory markers in arthritic rats treated with ethanolic bark extract of Albizia procera. The protective effect of ethanolic bark extract of Albizia procera against complete Freund’s adjuvant (CFA) induced arthritis in rats. Arthritis was induced by an intradermal injection of 0.1 ml FCA in the foot pad of left hind limb of rats. ETBE (100 and 200 mg/kg b.wt./p.o) and the reference drug diclofenac (25 mg/kg b.wt./p.o) were administered to arthritic rats. Paw volume was measured for all the animals before inducing arthritis and thereafter once in seven days by using plethysmometer for 42 days. Gene expression of inflammatory markers such as IL-1β and IL-10 were investigated in paw tissues. Up regulation of IL-1β and Down regulation IL-10 were observed in CFA injected rats when compared to normal rats. ETBE attenuated these alterations dose dependently when compared to the vehicle treated rats. These results provide insights into the mechanism of anti-arthritic activity, and unravel potential therapeutic use of Albizia procera in arthritis.

Keywords: CFA-Complete Freund’s adjuvant, ETBE – ethanolic bark extract, IL- interleukins, RA-rheumatoid arthritis

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Authors: Peter Jin

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Ever since the recent resurgence of interest in political theorist Carl Schmitt’s work, much of the current analysis on Schmitt has fo-cused on evaluating Schmitt’s legacy by exposing contradictions in his rationale. Rather than condemn such contradictions, this paper instead seeks to analyze these contradictions in an effort to better understand the radical shift in Schmitt’s intellectual trajectory from an astute critic of liberal democracy to a fascist apologist towards the end of the Weimar period. An essential part of this change is his interest in what Schmitt called ‘the emergence of aesthetics.’ Schmitt diagnosed the underlying issue with the aesthetic in the political sphere to be its irrationalism, indifference, and indeci-siveness. For Schmitt, the latter two of these were especially prob-lematic for two of his key concepts: the ‘political’ and ‘the shared historical reality.’ Schmitt’s radical depiction of ‘the political’ as an existential opposition of allegiances that necessitated a state of emergency and a decisionist sovereign political struggle required an equally radical justification, or Schmitt’s call for ‘a shared his-torical reality’ not based in historical fact yet able to mobilize the masses. In this way, Schmitt clearly condemns the indifferent, indecisive aesthetic that runs against his decisionist, action-oriented political theory. Yet despite his firm stance against aestheticism, Schmitt himself used the evocative and irrational power of aesthet-icism as a tool to present his own ‘political myth’ that compelled believers to join in decisive unity against a common enemy. In short, Schmitt’s contradictions on aestheticism and his creation of a ‘political myth’ suggest that Schmitt’s underlying conflict with aestheticism was not as much of an issue of irrationality as it was a chronic preoccupation with coercing concrete action at the expense of rational deliberation.

Keywords: aesthetics of the political, Carl Schmitt, political myth, Weimar democracy

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Authors: Ghadeer M Alkusayer, Adelicia Yu, Pamela Orr

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Study objective: To report a case of postpartum pulmonary cryptococcal infection (CCI) in an otherwise healthy 35-year-old woman. Additionally, the cases of pulmonary cryptococcal infections either in the antepartum or the postpartum period with pregnancy outcomes, were systematically reviwed. Methods: A systematic search of Cochrane Library, MEDLINE, and EMBASE was conducted for peer-reviewed studies without date restrictions, published in English and relating to CCI during pregnancy or postpartum period. Conference press, editorials, opinion pieces and letters were excluded. Two authors independently screened citations and full-text articles, extracted data and assessed study quality. Given the heterogeneity of study designs, a narrative synthesis was conducted. Results: The search identified 128 references, of which 22 case reports and series met the inclusion criteria. This is a total of 29 women (including the current case) . The mean age of the women was 28.3 ± 12.3 years. Nine (31.03%) presented and were diagnosed in the postpartum period. Two (6.90%) of the patients were reported as immunocompromised with HIV. Four maternal deaths (13.79%) were found in this case series with one (4.3%) patient with severe neurological deficits. Four (17.4%) infant deaths were reported. Women primary presentation varied with chest pain 13 (44.82%), headache 10 (35.70%), dyspnea 19 (65.51%), or fever 12 (41.38%). Three studies reported placental pathology positive for C. neoformans. Conclusion: This case of pulmonary cryptococcal infection in the postpartum period is an important addition to the literature of this rare infection in pregnancy. The patient is not immunocompromised. The patient was successfully treated with 4 months of Fluconazole 400 mg and continued to breastfeed the healthy baby.

Keywords: pulmonary cryptococcus, pregnancy, cryptococci , postpartum

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